Clinical Assessment, Diagnosis, And Treatment

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Idiographic understanding

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An understanding of the behavior of a particular individual

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Assessment

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The process of collecting and interpreting relevant information about a client or research participant; used to determine how and why a person is behaving abnormally and how that person may be helped;used to evaluate treatment progress

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Standardization

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The process in which a test is administered to a large group of people whose performance then serves as a standard or norm against which any individuals score can be measured; must standardize admin, scoring and interpretation

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Reliability

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A measure of the consistency of test or research results; same results in same situation

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Validity

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The accuracy of a tests or study's results; that is, the extent to which the test or study actually measures or shows what it claims

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Mental status exam

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A set of interview questions and observations designed to reveal the degree and nature of a client's abnormal functioning

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Test

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A device for gathering information about a few aspects of a person's psychological functioning from which broader information about the person can be inferred

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Projective test

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A test consisting of vague and ambiguous material that people interpret or respond to; mainly used by psychodynamic practitioners

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Personality inventory

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A test designed to measure broad personality characteristics, consisting of statements about behaviors, beliefs, and feelings that people evaluate as either characteristic or uncharacteristic of them; easier, cheaper, faster, to administer that projective tests; objectively scored and standardized

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Response inventories

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Tests designed to measure a persons responses in one specific area of functioning, such as affect, social skills, or cognitive processes

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Psychophysiological test

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A test that measures physical responses ( such as heart rate and muscle tension) as possible indicators of psychological problems; most popular -polygraph

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Neurological tests

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A test that directly measures brain structure or activity

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Neuroimaging techniques / brain scan

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Neurological test that provide images of brain structure or activity, such as CT scans, PET scans, and MRIs

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Neuropsychological test

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A test that detects brain impairment by measuring a persons cognitive, perceptual, and motor performances; most widely used- Bender Visual-Motor Gesalt Test

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Intelligence test

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A test designed to measure a persons intellectual ability; typically compromised of a series of tests assessing both verbal and nonverbal skills

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Intelligence quotient IQ

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An overall score derived from intelligence tests; represents the ratio of a person's mental age to his or her chronological age

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Diagnosis

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A determination that a persons problems reflect a particular disorder

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Syndrome

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A cluster of symptoms that usually occur together

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Classification system

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A list of disorders, along with descriptions of symptoms and guidelines for making appropriate diagnoses

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Empirically supported treatment / evidence – based treatment

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A movement in the clinical field that seeks to identify which therapies have received clear research support for each disorder, to develop corresponding treatment guidelines, and to spread such information to clinicians

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Rapprochement movement

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An effort to identify a set of common strategies that run through the work of all effective therapists

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Psychopharmacologist

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A psychiatrist who primarily prescribes medications

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Clinical assessment tools fall into three catagories

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clinical interviews

tests

observations

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To be useful, assessment tools must be ________ and have clear reliability and validity.

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standardized

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test retest reliability

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yields the same results every time it is given to the same people

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interrater reliability

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different judges independently agree on how to score and interpret a particular tool

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face validity

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a tool appears to measure what it is supposed to measure; does not necessarily indicate true validity

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predictive validity

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a tool accurately predicts future characteristics or behavior

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concurrent validity

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a tools results agree with independent measures assessing similar characteristics or behavior

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clinical interview

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face to face encounter; often first contact between client and clinician/assessor; used to collect detailed info, personal history about client; allow the interviewer to focus on whatever topics they consider most important

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Unstructured interview

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clinicians ask open ended ?s

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Structured interview

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clinicians ask prepared ?s, often from a published interview schedule

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Limitation to clinical interviews

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-may lack validity or accuracy (ind may be intentionally misleading)

-interviewers may be biased or may make mistakes in judgement

-interviews,particularly unstructured ones, may lack reliability

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Rorschach Test

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projective test created by Hermann Rorschach; ink blot

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Thematic Apperception Test TAT

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pictorial projective test where 30 black and white pictures of ind in vague situations are shown to a person and they are asked to make up a dramatic story about each card

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Sentence Completion Test

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asks people to complete a series of unfinished sentences; considered a good springboard for discussion and a quick and easy way to pinpoint topics to explore

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Drawings test

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clinicians ask clients to draw a human figure and talk about them; evaluations of these drawings are based on the details and shape of the drawing, solidity of the pencil line, location of the drawing on the paper, the size of the figure, features of the figures, use of background, and comments made by the respondent during the drawing task

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Draw a Person test DAP

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the most popular of the drawing tests, ind are first told to draw "a person" and then are instructed to draw another person of the opposite sex

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Strengths and Weaknesses of Projective Tests

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helpful for providing "supplementary info", have rarely demonstrated much reliability or validity, may be biased against minority ethnic groups

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MMPI: Minnesota Multiphasic Personality Inventory

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-500 + self statemtents that can be answered true, false, and cannot say

-statements describe physical concerns, mood, morale, attitudes toward religion, sex, and social activities, and psychological symptoms

-assesses careless respoding and lying

-compromised of ten clincal scales

-Scores range from 0-120

-Above 70=deviant

-graphed to create a profile

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affective inventories

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measure the severity of such emotions as anxiety, depression, and anger; most widely used -Beck Depression Inventory

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social skills inventories

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used particularly by behavioral and family-social clinicians, ask respondents to indicate how they would react in a variety of social situation

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cognitive inventories

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reveal a persons typical thoughts and assumptions and can uncover counterproductive patterns of thinking

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Strengths and weaknesses of response inventories

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have a strong face validity

not all have been subjected to careful standardizaion, reliability, and / or validity procedures

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Strengths and weaknesses of psychophysiological tests

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require expensive equipment that must be tuned and maintained

can be inaccurate and unreliable

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Strengths and weaknesses of neurological and neuropsychological tests

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can be very accurate

as best, though, these tests are general screening devices

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strengths of intelligence tests

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are among the most carefully produced of all clinical tests

highly standardized on large groups of subjects

have very high reliability and validity

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Weaknesses of intelligence tests

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performance can be influenced by nonintelligence factors (motivation, anxiety)

tests may contain cultural biases in language or tasks

members of minority groups may have less experience and be less comfortable with these types of tests, influencing their results

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naturalistic observation

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occur in everyday environments-homes, schools, institutions, community settings

most focus on parent-child, sibling-child, or teacher-child interactions

observations generally made by "participant observers" and reported to a clinician

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If naturalistic observation of impractical, ______ observations are used and conducted in artificial settings.

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analog

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Strengths and weaknesses of naturalistic and analog observations

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Validity and reliability are a concern

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self monitoring

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people observe themselves and carefully record the frequency of certain behaviors, feelings, or cognitions as they occur over time

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Self Monitoring strengths and weaknesses

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useful in assessing infrequent behaviors

useful in observing overly frequent behaviors

provides a means of measuring private thoughts or perception

validity is often a problem- clients may not record accurately, clients change behavior

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differential diagnosis

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method of determining the correct psychiatric diagnosis in the initial stages of the assessment. In this stage, several possible diagnosis might exist, and the clinician may not know which the the true disorder without further exploration. This method is a process of elimination and when all other possible diagnoses are ruled out the last remaining "valid" diagnosis is considered the appropriate one.