Transcript Chapter 14

Chapter 14
Clinical and Counseling
Assessment
Clinical and Counseling Assessment
• Clinical psychology: the branch of
psychology that has its primary focus the
prevention, diagnosis, and treatment of
abnormal behavior with a focus on the more
severe forms of psychopathology
– Clinical psychologists receive training in
psychological assessment and psychotherapy
– These professionals are employed in hospitals,
mental health centers, independent practice, and
academia
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Clinical and Counseling Assessment
• Counseling psychology: a branch of
psychology that shares similar concerns
with clinical psychology, but instead
focuses on the more “everyday” concerns of
human life (e.g., marriage, family,
academics, and career)
• The tools employed by both branches of
psychology overlap considerably
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An Overview
• Various questions addressed through the use of
assessment tools in clinical or counseling
psychology include:
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Does this patient have a mental disorder?
What is the diagnosis?
What is this person’s current level of functioning?
How does their current level of functioning
compare with others in their cohort?
– What type of treatment can benefit this individual?
– How can this person’s personality best be
described?
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An Overview
Does this person have a mental disorder?
• Clinical assessment may be undertaken for
various reasons and to answer a variety of
questions
• For clinical psychologists, assessment tools
may be used to clarify the problem, make a
diagnosis, or design a treatment plan
• Data derived may confirm or refute a
clinician’s preliminary hypotheses based on
the clinical interview
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An Overview
What is this person’s current level of functioning?
• Premorbid functioning: the level of
psychological and physical performance prior to
the development of a disorder, illness, or
disability
• Periodic testing with various instruments can also
provide information about the kinds of activities
the patient should pursue and avoid
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An Overview
What type of treatment can benefit this
individual?
• Not all individuals that seek psychotherapy are
suffering from a mental disorder.
• Many people seek psychotherapy for purposes
of personal growth or support in coping with a
difficult life circumstance.
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The Diagnosis of Mental
Disorders
• Frequently, assessment tools are used to make
diagnoses
• The American Psychiatric Association’s
Diagnostic Statistic Manual (DSM) is the
primary reference source for diagnosis.
• The DSM-IV-TR names and describes all
known mental disorders and includes a
category called Conditions not attributable to
a mental disorder that are a focus of attention
or treatment.
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The Diagnosis of Mental
Disorders
• Much controversy surrounds the utility of the
DSM
– It is firmly rooted in the medical model and thus
discounts patterns of thinking and behavior,
concepts arguably central to mental health.
– Different clinicians interviewing the same patient
may produce different diagnoses based on their
interpretation and use of the DSM.
– The DSM may be culturally insensitive and thus
offers limited use in diverse populations.
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The Diagnosis of Mental
Disorders
• Proponents of the DSM believe it offers a
wealth of information.
– Perfect inter-diagnostician reliability cannot be
achieved due to the nature of the subject matter.
– Supporters maintain that the diagnostic system is
useful as a guide, whether or not any particular
diagnostic category is actually classifiable as a
disease.
• DSM diagnoses are descriptive and
atheoretical.
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The Diagnosis of Mental
Disorders
Diagnoses are coded according to five axes:
– Axis I: Disorder of infancy, childhood, and adolescence;
dementias; substance use disorders; mood and anxiety
disorders; and schizophrenia. Also included are conditions
that may be the focus of treatment but are not cause for
diagnosis.
– Axis II: Mental retardation and personality disorders.
– Axis III: Physical conditions that may affect mental
functioning.
– Axis IV: Different problems or sources of stress, such as
financial, legal, marital, occupational, or other problems.
– Axis V: A global rating of overall functioning.
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The Diagnosis of Mental
Disorders
• Evolutionary model of mental disorder
(Wakefield, 1992): a conceptualization of a
mental disorder as harmful failure of internal
mechanisms to perform their naturally-selected
functions
– Assumes a scientific judgment that such
evolutionary failure exists
– Involves a value judgment that this failure is
indeed harmful
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The Diagnosis of Mental
Disorders
• Schjelderup-Ebbe (1921) coined the term
“pecking order” when observing the behaviors of
defeated hens in dominance contests.
– His observation is directly relevant to
evolutionary views of psychopathology.
– He observed that hens, when defeated, became
severely withdrawn; their behaviors were
similar to those displayed in depressed human
beings.
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The Diagnosis of Mental
Disorders
• Social rank theory of depression (Price, 1969,
1972): postulates the triggering of a yielding
mechanism that prompts the individual to
disengage from competitive endeavors, indicating
that he is no longer a competitor for resources and
status
– This behavioral course has been termed an
“involuntary defeat strategy” (Sloman &
Gilbert, 2000), which proves adaptive in the
short-term but is counterproductive when
engaged for long durations.
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The Diagnosis of Mental
Disorders
• In development of the DSM-V, a DSM-V
Research Planning Conference convened in 1999.
– Planning work groups were created to examine
developmental issues, gaps in the current diagnostic
system, and cultural issues, among other topics.
• Between 2004 and 2008, 13 conferences were held
to address various questions and set the research
agenda.
• From 2007 onward, the work groups met regularly
to discuss strengths and weakness of the DSM-IV
and review the literature.
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Proposed Changes in the DSM-V
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Clinical interview
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The Interview in Clinical Assessment
• A clinical interview may be conducted for
several reasons:
– To arrive at a diagnosis
– To pinpoint areas that must be addressed in
psychotherapy
– To determine whether an individual will harm
himself or others
– To guide decisions about what else needs to be
done to assess an individual
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The Interview in Clinical Assessment
• Types of interviews
– Interviews may be typed in respect to different
variables
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Content
Structure
Tone (e.g., stress interview)
State of consciousness (e.g., hypnotic interview)
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The Interview in Clinical Assessment
• General interview questions
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Demographic data
Reason for referral
Medical history and present medical conditions
Familial medical history
Psychological history and present psychological
conditions
– History with medical or psychological
professionals
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The Interview in Clinical Assessment
• Mental status examination
– An examination intended to screen for intellectual,
emotional, and neurological deficits
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Appearance
Behavior
Orientation
Psychomotor activity
State of consciousness
Thought content
Thought processes
Judgment
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Sensorium
Affect
Mood
Personality
Memory
Intellectual resources
Insight
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Case History Data and Psychological
Tests
• Biographical and related data can be acquired from
interviewing the assessee and significant others in his
or her life.
– Additional sources of case history data include hospital,
school, military, and employment records as well as other
related documents.
• Some psychological tests are employed for diagnostic
purposes, while others are used to assess traits, states,
interests, and attitudes.
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Culturally-Informed Psychological
Assessment
• An approach to evaluation that is keenly perceptive of
and responsive to issues of acculturation, values,
identity, worldview, language, and other culturerelated variables as they possibly impact the
evaluation process or interpretation of resulting data.
• ADRESSING: Age, Disability, Religion, Ethnicity,
Social status, Sexual orientation, Indigenous heritage,
National origin, Gender
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Special Applications of Clinical
Measures
• Forensic psychological assessment: the theory
and application of psychological evaluation and
measurement in a legal context
– Dangerousness to oneself or others
• Tarasoff v. the Regents of the University of California
– Competency to stand trial
• Dusky v. United States
– Criminal responsibility
• Durham v. United States
– Readiness for parole or probation
– Diagnosis and evaluation of emotional injury
– Profiling
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Special Applications of Clinical
Measures
• Custody evaluation: a psychological
assessment of parents or guardians and their
parental capacity and/or of children and their
parental needs and preferences
– Evaluation of the parent
– Evaluation of the child
• Child abuse and neglect
– Physical signs of abuse and neglect
– Emotional and behavioral signs of abuse and
neglect
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The Psychological Report
• Psychological reports vary depending on their purpose
• Barnum effect: the finding that people tend to accept
vague personality descriptions as accurate descriptions of
themselves
• Clinical prediction: the application of a clinician’s own
training and clinical experience as a determining factor in
clinical judgment and actions
• Mechanical prediction: the application of empirically
demonstrated statistical rules and probabilities to the
computer generation of findings and recommendations
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