Clinical Assessment in Psychology
Content
1
A AAb bbn nno oor rrm mma aal llP PPs ssy yyc cch hho ool llo oog ggy yy D DDo oou uug ggl lla aas ss A AA. .. H HHÖ ÖÖc cck kke eer rr A AAd ddj jju uun nnc cct ttP PPr rro oof ffe ees sss sso oor rro oof ffS SSo
ooc cci iia aal lla aan nnd ddB BBe eeh hha aav vvi iio oor rra aal llS SSc cci iie een nnc cce ees ss 2
C CCh hha aap ppt tte eer rr3 33 3
C CCl lli iin nni iic cca aal llA AAs sss sse ees sss ssm mme
een nnt tt: ::H HHo oow wwa aan nnd ddW WWh hhy yyD DDo ooe ees sst tth hhe eeC CCl lli iie een nnt ttB BBe eeh hha aav vve eeA AAb bbn nno oor rrm mma aal lll lly yy? ?? The specific tools used in an assessment depend on the clinician s theoretical orientation Hundreds of
clinical assessment tools have been developed and fall into three categories: Clinical interviews Tests Observations 4
C CCl lli iin nni iic cca aal llI IIn nnt tte eer rrv vvi iie eew wws ss Face-to-face encounters Often the first contact between a client and a clinician/assessor Used to collect detailed
information, especially personal history, about a client Allow the interviewer to focus on whatever topics they consider most important 5
C CCl lli iin nni iic cca aal llI IIn nnt tte eer rrv vvi iie eew wws ss Conducting the interview Focus depends on theoretical orientation Can be either unstructured or structured
In unstructured interviews, clinicians ask open-ended questions In structured interviews, clinicians ask prepared questions, often from a published interview schedule May include a mental status exam 6
C CCl lli iin nni iic cca aal llT TTe ees sst tts ss Devices for gathering information about a few aspects of a person s psychological
functioning, from which broader information can be inferred More than 500 different tests are in use They fall into six categories 7
C CCl lli iin nni iic cca aal llT TTe ees sst tts ss 1. Projective tests Require that subjects interpret vague and ambiguous stimuli or follow open-ended instruction Mainly used
by psychodynamic practitioners Most popular: Rorschach Test Thematic Apperception Test Sentence Completion Test
Drawings 8 9 10 11 12 13 14 15
C CCl lli iin nni iic cca aal llT TTe ees sst tt: ::R RRo oor rrs ssc cch hha aac cch hhI IIn nnk kkb bbl llo oot ttC CCl lli iin nni
iic cca aal llT TTe ees sst tt: :: T TTh hhe eem mma aat tti iic ccA AAp ppp ppe eer rrc cce eep ppt tti iio oon nnT TTe ees sst tt C CCl lli iin nni iic cca aal llT TTe ees sst tt: :: S SSe een nnt tte een nnc cce ee-C CCo
oom mmp ppl lle eet tti iio oon nnT TTe ees sst tt I wish ___________________________ My father ________________________ C CCl lli iin nni iic cca aal llT TTe ees sst tt: ::D DDr rra aaw wwi iin nng ggs ss Draw-a-Person (DAP) test: Draw a person Draw another person of the opposite
sex C CCl lli iin nni iic cca aal llT TTe ees sst tts ss 1. Projective tests Strengths and weaknesses: Helpful for providing supplementary information Have rarely demonstrated much reliability or validity May be biased against minority ethnic groups C CCl lli iin nni iic cca aal llT TTe ees sst tts ss
2. Personality inventories Designed to measure broad personality characteristics Focus on behaviors, beliefs, and feelings Usually based on self-reported responses Most widely used: Minnesota Multiphasic Personality Inventory For Adults: MMPI (original) or MMPI-2 (1989 revision) For Adolescents: MMPI-A C CCl lli iin nni iic cca aal llT TTe ees sst tt: ::M MMM MMP
PPI II M MMi iin nnn nne ees sso oot tta aaM MMu uul llt tti iip pph hha aas ssi iic ccP PPe eer rrs sso oon nna aal lli iit tty yyI IIn nnv vve een nnt tto oor rry yy Consists of more than 500 self-statements that can be answered true, false, or cannot
say Statements describe physical concerns; mood; morale; attitudes toward religion, sex, and social activities; and psychological symptoms Assesses careless responding & lying C CCl lli iin nni iic cca aal llT TTe ees sst tt: ::M MMM MMP PPI II M MMi iin nnn nne ees sso oot tta aaM MMu uul llt tti iip pph hha
aas ssi iic ccP PPe eer rrs sso oon nna aal lli iit tty yyI IIn nnv vve een nnt tto oor rry yy Comprised of ten clinical scales: Hypochondriasis (HS) Depression (D)
Conversion hysteria (Hy) Psychopathic deviate (PD) Masculinity-femininity (Mf) Scores range from 0 120 Above 70 = deviant Graphed to create a profile Paranoia (P) Psychasthenia (Pt) Schizophrenia (Sc) Hypomania (Ma) Social introversion (Si) 16 17 18 19 20 21
C CCl lli iin nni iic cca aal llT TTe ees sst tts ss 2. Personality inventories Strengths and weaknesses: Easier, cheaper, and faster to administer than projective tests Objectively scored and standardized Appear to have greater validity than projective tests Measured traits often cannot be directly examined how can we
really know the assessment is correct? Tests fail to allow for cultural differences in responses C CCl lli iin nni iic cca aal llT TTe ees sst tts ss 3. Response inventories Usually based on self-reported responses Focus on one specific area of functioning Affective inventories (example: Beck Depression Inventory) Social skills inventories
Cognitive inventories C CCl lli iin nni iic cca aal llT TTe ees sst tts ss 3. Response inventories Strengths and weaknesses: Increasing in use and number Not all have been subjected to careful standardization, reliability, and/or validity procedures (BDI and a few others are exceptions) C CCl lli iin nni iic cca aal llT TTe
ees sst tts ss 4. Psychophysiological tests Measure physiological response as an indication of psychological problems Includes heart rate, blood pressure, body temperature, galvanic skin response, and muscle contraction Most popular is the polygraph (lie detector) C CCl lli iin nni iic cca aal llT TTe ees sst tts ss 4. Psychophysiological tests Strengths
and weaknesses: Require expensive equipment that must be tuned and maintained Can be inaccurate and unreliable C CCl lli iin nni iic cca aal llT TTe ees sst tts ss 5. Neurological and neuropsychological tests
23 24 25 26 27 28 29
Neurological tests directly assess brain function by assessing brain structure and activity Examples: EEG, PET scans, CAT scans, MRI Neuropsychological tests indirectly assess brain function by assessing cognitive, perceptual, and motor functioning Most
widely used is the Bender Visual-Motor Gestalt Test C CCl lli iin nni iic cca aal llT TTe ees sst tt: :: B BBe een nnd dde eer rrV VVi iis ssu uua aal ll-M MMo oot tto oor rrG GGe ees sst tta aal llt ttT TTe ees sst tt C CCl lli iin nni iic cca
aal llT TTe ees sst tts ss 5. Neurological and neuropsychological tests Strengths and weaknesses: Can be very accurate At best, though, these tests are general screening devices Best when used in a battery of tests, each targeting a specific skill area C CCl lli iin nni iic cca aal llT TTe ees sst tts
ss 6. Intelligence tests Designed to measure intellectual ability Composed of a series of tests assessing both verbal and nonverbal skills Generate an intelligence quotient (IQ) C CCl lli iin nni iic cca aal llT TTe ees sst tts ss 6. Intelligence tests Strengths and weaknesses: Are among the most carefully produced of
all clinical tests Highly standardized on large groups of subjects Have very high reliability and validity Because intelligence is an inferred quality, it can only be measured indirectly C CCl lli iin nni iic cca aal llT TTe ees sst tts ss 6. Intelligence tests Strengths and weaknesses: Performance can be influenced by nonintelligence
factors (e.g., motivation, anxiety, test-taking experience) Tests may contain cultural biases in language or tasks C CCl lli iin nni iic cca aal llO OOb bbs sse eer rrv vva aat tti iio oon nns ss Systematic observation of behavior Several kinds: Naturalistic Analog Self-monitoring C CCl lli iin nni iic cca aal
llO OOb bbs sse eer rrv vva aat tti iio oon nns ss Naturalistic and analog observations Naturalistic observations occur in everyday environments Can occur in homes, schools, institutions (hospitals and prisons), and community settings Tend to focus on parent child, sibling child, or teacher child interactions Observations are generally made by participant observers and reported to
a clinician
31 32 33 34 35
If naturalistic observation is impractical, analog observations are used in artificial settings C CCl lli iin nni iic cca aal llO OOb bbs sse eer rrv vva aat tti iio oon nns ss Naturalistic and analog observations Strengths and
weaknesses: Reliability is a concern Different observers may focus on different aspects of behavior Validity is a concern Risk of overload, observer drift, and observer bias Client reactivity may also limit validity Observations may lack cross-situational validity C CCl lli iin nni iic cca aal llO OOb bbs sse eer rrv vva aat tti
iio oon nns ss Self-monitoring People observe themselves and carefully record certain behaviors, feelings, or cognitions as they occur over time C CCl lli iin nni iic cca aal llO OOb bbs sse eer rrv vva aat tti iio oon nns ss Self-monitoring Strengths and weaknesses: Useful in assessing infrequent behaviors Useful
for observing overly frequent behaviors Provides a means of measuring private thoughts or perceptions Validity is often a problem Clients may not receive proper training and instruction Clients may not record information accurately When people monitor themselves, they often change their behavior D DDi iia aag ggn nno oos ssi iis ss: ::D DDo ooe
ees sst tth hhe eeC CCl lli iie een nnt tt s ssS SSy yyn nnd ddr rro oom mme eeM MMa aat ttc cch hha aaK KKn nno oow wwn nnD DDi iis sso oor rrd dde eer rr? ?? Using all available information, clinicians attempt to paint a clinical picture Influenced by their theoretical orientation
Using assessment data and the clinical picture, clinicians attempt to make a diagnosis A determination that a person s problems reflect a particular disorder or syndrome Based on an existing classification system C CCl lla aas sss ssi iif ffi iic cca aat tti iio oon nnS SSy yys sst tte eem mms ss Lists of
categories, disorders, and symptom descriptions, with guidelines for assignment Focus on clusters of symptoms (syndromes) In current use in the US: DSM-IV-TR Diagnostic and Statistical Manual of Mental Disorders (4th edition), Text Revision D DDS SSM MM-I IIV VV-T TTR RR Published in 1994, revised in 2000 (TR) Lists approximately 400 disorders
Listed in the inside back flap of your text Describes criteria for diagnoses, key clinical features, and related features which are often but not always present T TTh hhe eeD DDS SSM MM-I IIV VV-T TTR RR
37 38 39 40 41 42 43
Most widely used classification system in the US Multiaxial Uses 5 axes (branches of information) to develop a full clinical picture People usually receive a diagnosis on either Axis I or Axis II, but they
may receive diagnoses on both L LLi iif ffe eet tti iim mme eeP PPr rre eev vva aal lle een nnc cce eeo oof ffD DDS SSM MM-I IIV VV-T TTR RRD DDi iia aag ggn nno oos sse ees ss T TTh hhe eeD DDS SSM MM-I IIV VV-T TTR RR
Axis I Most frequently diagnosed disorders, except personality disorders and mental retardation M MMa aaj jjo oor rrA AAx xxi iis ssI IID DDi iia aag ggn nno oos sst tti iic ccC CCa aat tte eeg ggo oor rri iie ees ssT TTh hhe eeD DDS SSM MM-I IIV VV-T TTR RR Axis II
Personality disorders and mental retardation Long-standing problems Axis III Relevant general medical conditions Axis IV Psychosocial and environmental problems T TTh hhe eeD DDS SSM MM-I IIV VV-T TTR RR Axis V Global assessment of psychological, social, and occupational functioning (GAF) Current functioning and highest functioning in past
year 0 100 scale I IIs ssD DDS SSM MM-I IIV VV-T TTR RRa aan nnE EEf fff ffe eec cct tti iiv vve eeC CCl lla aas sss ssi iif ffi iic cca aat tti iio oon nnS SSy yys sst tte eem mm? ?? Classification systems are judged by their reliability and validity
Here reliability = different diagnosticians agreeing on a diagnosis using the same classification system DSM-IV-TR has greater reliability than any previous editions Used field trials to increase reliability Reliability is still a concern I IIs ssD DDS SSM MM-I IIV VV-T TTR RRa aan nnE EEf fff ffe eec cct tti iiv vve eeC CCl
lla aas sss ssi iif ffi iic cca aat tti iio oon nnS SSy yys sst tte eem mm? ?? The validity of a classification system is the accuracy of information that the diagnostic categories provide Predictive validity is of the most use clinically DSM-IV-TR has greater validity than any previous editions Conducted extensive literature
reviews and ran field studies Validity is still a concern
45 46 47 48 49 50
I IIs ssD DDS SSM MM-I IIV VV-T TTR RRa aan nnE EEf fff ffe eec cct tti iiv vve eeC CCl lla aas sss ssi iif ffi iic cca aat tti iio oon nnS SSy yys sst tte eem
mm? ?? Beyond concerns about reliability and validity, a growing number of theorists believe that two fundamental problems weaken the DSM-IV-TR: Basic assumption that disorders are qualitatively different from normal behavior Reliance on discrete diagnostic categories C CCa aan nnD DDi iia aag ggn nno oos ssi iis ssa aan nnd ddL LLa aab bbe eel
lli iin nng ggC CCa aau uus sse eeH HHa aar rrm mm? ?? Misdiagnosis always a concern Major issue is reliance on clinical judgment Also present is the issue of labeling and stigma Diagnosis may be a self-fulfilling prophecy Because of these problems, some clinicians would like to cease the practice of diagnosis
T TTh hhe eeE EEf fff ffe eec cct tti iiv vve een nne ees sss sso oof ffT TTr rre eea aat ttm mme een nnt tt More than 400 forms of therapy in practice, but is therapy effective? Difficult question to answer: How do you define success? How do you measure improvement?
How do you compare treatments treatments differ in range and complexity; therapists differ in skill and knowledge; clients differ in severity and motivation T TTh hhe eeE EEf fff ffe eec cct tti iiv vve een nne ees sss sso oof ffT TTr rre eea aat ttm mme een nnt tt Controlled clinical research and therapy outcome
studies typically assess one of the following questions: Is therapy in general effective? Are particular therapies generally effective? Are particular therapies effective for particular problems? T TTh hhe eeE EEf fff ffe eec cct tti iiv vve een nne ees sss sso oof ffT TTr rre eea aat ttm mme een nnt tt Is therapy
generally effective? Research suggests that therapy is generally more effective than no treatment or placebo In one major study using meta-analysis, the average person who received treatment was better off than 75% of the untreated subjects T TTh hhe eeE EEf fff ffe eec cct tti iiv vve een nne ees sss sso oof ffT TTr rre eea
aat ttm mme een nnt tt Is therapy generally effective? Some clinicians are concerned with a related question: Can therapy can be harmful? Has this potential Studies report ~5% get worse with treatment T TTh hhe eeE EEf fff ffe eec cct tti iiv vve een nne ees sss sso oof ffT TTr rre eea
aat ttm mme een nnt tt Are particular therapies generally effective?
Generally, therapy-outcome studies lump all therapies together to consider their general effectiveness One critic has called this the uniformity myth It is argued that scientists must look at the effectiveness of particular therapies There is a movement ( rapprochement ) to look at commonalities among therapies T TTh hhe eeE EEf fff ffe eec cct tti iiv
vve een nne ees sss sso oof ffT TTr rre eea aat ttm mme een nnt tt Are particular therapies effective for particular problems? Studies now being conducted to examine effectiveness of specific treatments for specific disorders: What specific treatment, by whom, is the most effective for this individual with that specific problem, and under which
set of circumstances? Recent studies focus on the effectiveness of combined approaches drug therapy combined with certain forms of psychotherapy to treat certain disorders
A AAb bbn nno oor rrm mma aal llP PPs ssy yyc cch hho ool llo oog ggy yy D DDo oou uug ggl lla aas ss A AA. .. H HHÖ ÖÖc cck kke eer rr A AAd ddj jju uun nnc cct ttP PPr rro oof ffe ees sss sso oor rro oof ffS SSo
ooc cci iia aal lla aan nnd ddB BBe eeh hha aav vvi iio oor rra aal llS SSc cci iie een nnc cce ees ss 2
C CCh hha aap ppt tte eer rr3 33 3
C CCl lli iin nni iic cca aal llA AAs sss sse ees sss ssm mme
een nnt tt: ::H HHo oow wwa aan nnd ddW WWh hhy yyD DDo ooe ees sst tth hhe eeC CCl lli iie een nnt ttB BBe eeh hha aav vve eeA AAb bbn nno oor rrm mma aal lll lly yy? ?? The specific tools used in an assessment depend on the clinician s theoretical orientation Hundreds of
clinical assessment tools have been developed and fall into three categories: Clinical interviews Tests Observations 4
C CCl lli iin nni iic cca aal llI IIn nnt tte eer rrv vvi iie eew wws ss Face-to-face encounters Often the first contact between a client and a clinician/assessor Used to collect detailed
information, especially personal history, about a client Allow the interviewer to focus on whatever topics they consider most important 5
C CCl lli iin nni iic cca aal llI IIn nnt tte eer rrv vvi iie eew wws ss Conducting the interview Focus depends on theoretical orientation Can be either unstructured or structured
In unstructured interviews, clinicians ask open-ended questions In structured interviews, clinicians ask prepared questions, often from a published interview schedule May include a mental status exam 6
C CCl lli iin nni iic cca aal llT TTe ees sst tts ss Devices for gathering information about a few aspects of a person s psychological
functioning, from which broader information can be inferred More than 500 different tests are in use They fall into six categories 7
C CCl lli iin nni iic cca aal llT TTe ees sst tts ss 1. Projective tests Require that subjects interpret vague and ambiguous stimuli or follow open-ended instruction Mainly used
by psychodynamic practitioners Most popular: Rorschach Test Thematic Apperception Test Sentence Completion Test
Drawings 8 9 10 11 12 13 14 15
C CCl lli iin nni iic cca aal llT TTe ees sst tt: ::R RRo oor rrs ssc cch hha aac cch hhI IIn nnk kkb bbl llo oot ttC CCl lli iin nni
iic cca aal llT TTe ees sst tt: :: T TTh hhe eem mma aat tti iic ccA AAp ppp ppe eer rrc cce eep ppt tti iio oon nnT TTe ees sst tt C CCl lli iin nni iic cca aal llT TTe ees sst tt: :: S SSe een nnt tte een nnc cce ee-C CCo
oom mmp ppl lle eet tti iio oon nnT TTe ees sst tt I wish ___________________________ My father ________________________ C CCl lli iin nni iic cca aal llT TTe ees sst tt: ::D DDr rra aaw wwi iin nng ggs ss Draw-a-Person (DAP) test: Draw a person Draw another person of the opposite
sex C CCl lli iin nni iic cca aal llT TTe ees sst tts ss 1. Projective tests Strengths and weaknesses: Helpful for providing supplementary information Have rarely demonstrated much reliability or validity May be biased against minority ethnic groups C CCl lli iin nni iic cca aal llT TTe ees sst tts ss
2. Personality inventories Designed to measure broad personality characteristics Focus on behaviors, beliefs, and feelings Usually based on self-reported responses Most widely used: Minnesota Multiphasic Personality Inventory For Adults: MMPI (original) or MMPI-2 (1989 revision) For Adolescents: MMPI-A C CCl lli iin nni iic cca aal llT TTe ees sst tt: ::M MMM MMP
PPI II M MMi iin nnn nne ees sso oot tta aaM MMu uul llt tti iip pph hha aas ssi iic ccP PPe eer rrs sso oon nna aal lli iit tty yyI IIn nnv vve een nnt tto oor rry yy Consists of more than 500 self-statements that can be answered true, false, or cannot
say Statements describe physical concerns; mood; morale; attitudes toward religion, sex, and social activities; and psychological symptoms Assesses careless responding & lying C CCl lli iin nni iic cca aal llT TTe ees sst tt: ::M MMM MMP PPI II M MMi iin nnn nne ees sso oot tta aaM MMu uul llt tti iip pph hha
aas ssi iic ccP PPe eer rrs sso oon nna aal lli iit tty yyI IIn nnv vve een nnt tto oor rry yy Comprised of ten clinical scales: Hypochondriasis (HS) Depression (D)
Conversion hysteria (Hy) Psychopathic deviate (PD) Masculinity-femininity (Mf) Scores range from 0 120 Above 70 = deviant Graphed to create a profile Paranoia (P) Psychasthenia (Pt) Schizophrenia (Sc) Hypomania (Ma) Social introversion (Si) 16 17 18 19 20 21
C CCl lli iin nni iic cca aal llT TTe ees sst tts ss 2. Personality inventories Strengths and weaknesses: Easier, cheaper, and faster to administer than projective tests Objectively scored and standardized Appear to have greater validity than projective tests Measured traits often cannot be directly examined how can we
really know the assessment is correct? Tests fail to allow for cultural differences in responses C CCl lli iin nni iic cca aal llT TTe ees sst tts ss 3. Response inventories Usually based on self-reported responses Focus on one specific area of functioning Affective inventories (example: Beck Depression Inventory) Social skills inventories
Cognitive inventories C CCl lli iin nni iic cca aal llT TTe ees sst tts ss 3. Response inventories Strengths and weaknesses: Increasing in use and number Not all have been subjected to careful standardization, reliability, and/or validity procedures (BDI and a few others are exceptions) C CCl lli iin nni iic cca aal llT TTe
ees sst tts ss 4. Psychophysiological tests Measure physiological response as an indication of psychological problems Includes heart rate, blood pressure, body temperature, galvanic skin response, and muscle contraction Most popular is the polygraph (lie detector) C CCl lli iin nni iic cca aal llT TTe ees sst tts ss 4. Psychophysiological tests Strengths
and weaknesses: Require expensive equipment that must be tuned and maintained Can be inaccurate and unreliable C CCl lli iin nni iic cca aal llT TTe ees sst tts ss 5. Neurological and neuropsychological tests
23 24 25 26 27 28 29
Neurological tests directly assess brain function by assessing brain structure and activity Examples: EEG, PET scans, CAT scans, MRI Neuropsychological tests indirectly assess brain function by assessing cognitive, perceptual, and motor functioning Most
widely used is the Bender Visual-Motor Gestalt Test C CCl lli iin nni iic cca aal llT TTe ees sst tt: :: B BBe een nnd dde eer rrV VVi iis ssu uua aal ll-M MMo oot tto oor rrG GGe ees sst tta aal llt ttT TTe ees sst tt C CCl lli iin nni iic cca
aal llT TTe ees sst tts ss 5. Neurological and neuropsychological tests Strengths and weaknesses: Can be very accurate At best, though, these tests are general screening devices Best when used in a battery of tests, each targeting a specific skill area C CCl lli iin nni iic cca aal llT TTe ees sst tts
ss 6. Intelligence tests Designed to measure intellectual ability Composed of a series of tests assessing both verbal and nonverbal skills Generate an intelligence quotient (IQ) C CCl lli iin nni iic cca aal llT TTe ees sst tts ss 6. Intelligence tests Strengths and weaknesses: Are among the most carefully produced of
all clinical tests Highly standardized on large groups of subjects Have very high reliability and validity Because intelligence is an inferred quality, it can only be measured indirectly C CCl lli iin nni iic cca aal llT TTe ees sst tts ss 6. Intelligence tests Strengths and weaknesses: Performance can be influenced by nonintelligence
factors (e.g., motivation, anxiety, test-taking experience) Tests may contain cultural biases in language or tasks C CCl lli iin nni iic cca aal llO OOb bbs sse eer rrv vva aat tti iio oon nns ss Systematic observation of behavior Several kinds: Naturalistic Analog Self-monitoring C CCl lli iin nni iic cca aal
llO OOb bbs sse eer rrv vva aat tti iio oon nns ss Naturalistic and analog observations Naturalistic observations occur in everyday environments Can occur in homes, schools, institutions (hospitals and prisons), and community settings Tend to focus on parent child, sibling child, or teacher child interactions Observations are generally made by participant observers and reported to
a clinician
31 32 33 34 35
If naturalistic observation is impractical, analog observations are used in artificial settings C CCl lli iin nni iic cca aal llO OOb bbs sse eer rrv vva aat tti iio oon nns ss Naturalistic and analog observations Strengths and
weaknesses: Reliability is a concern Different observers may focus on different aspects of behavior Validity is a concern Risk of overload, observer drift, and observer bias Client reactivity may also limit validity Observations may lack cross-situational validity C CCl lli iin nni iic cca aal llO OOb bbs sse eer rrv vva aat tti
iio oon nns ss Self-monitoring People observe themselves and carefully record certain behaviors, feelings, or cognitions as they occur over time C CCl lli iin nni iic cca aal llO OOb bbs sse eer rrv vva aat tti iio oon nns ss Self-monitoring Strengths and weaknesses: Useful in assessing infrequent behaviors Useful
for observing overly frequent behaviors Provides a means of measuring private thoughts or perceptions Validity is often a problem Clients may not receive proper training and instruction Clients may not record information accurately When people monitor themselves, they often change their behavior D DDi iia aag ggn nno oos ssi iis ss: ::D DDo ooe
ees sst tth hhe eeC CCl lli iie een nnt tt s ssS SSy yyn nnd ddr rro oom mme eeM MMa aat ttc cch hha aaK KKn nno oow wwn nnD DDi iis sso oor rrd dde eer rr? ?? Using all available information, clinicians attempt to paint a clinical picture Influenced by their theoretical orientation
Using assessment data and the clinical picture, clinicians attempt to make a diagnosis A determination that a person s problems reflect a particular disorder or syndrome Based on an existing classification system C CCl lla aas sss ssi iif ffi iic cca aat tti iio oon nnS SSy yys sst tte eem mms ss Lists of
categories, disorders, and symptom descriptions, with guidelines for assignment Focus on clusters of symptoms (syndromes) In current use in the US: DSM-IV-TR Diagnostic and Statistical Manual of Mental Disorders (4th edition), Text Revision D DDS SSM MM-I IIV VV-T TTR RR Published in 1994, revised in 2000 (TR) Lists approximately 400 disorders
Listed in the inside back flap of your text Describes criteria for diagnoses, key clinical features, and related features which are often but not always present T TTh hhe eeD DDS SSM MM-I IIV VV-T TTR RR
37 38 39 40 41 42 43
Most widely used classification system in the US Multiaxial Uses 5 axes (branches of information) to develop a full clinical picture People usually receive a diagnosis on either Axis I or Axis II, but they
may receive diagnoses on both L LLi iif ffe eet tti iim mme eeP PPr rre eev vva aal lle een nnc cce eeo oof ffD DDS SSM MM-I IIV VV-T TTR RRD DDi iia aag ggn nno oos sse ees ss T TTh hhe eeD DDS SSM MM-I IIV VV-T TTR RR
Axis I Most frequently diagnosed disorders, except personality disorders and mental retardation M MMa aaj jjo oor rrA AAx xxi iis ssI IID DDi iia aag ggn nno oos sst tti iic ccC CCa aat tte eeg ggo oor rri iie ees ssT TTh hhe eeD DDS SSM MM-I IIV VV-T TTR RR Axis II
Personality disorders and mental retardation Long-standing problems Axis III Relevant general medical conditions Axis IV Psychosocial and environmental problems T TTh hhe eeD DDS SSM MM-I IIV VV-T TTR RR Axis V Global assessment of psychological, social, and occupational functioning (GAF) Current functioning and highest functioning in past
year 0 100 scale I IIs ssD DDS SSM MM-I IIV VV-T TTR RRa aan nnE EEf fff ffe eec cct tti iiv vve eeC CCl lla aas sss ssi iif ffi iic cca aat tti iio oon nnS SSy yys sst tte eem mm? ?? Classification systems are judged by their reliability and validity
Here reliability = different diagnosticians agreeing on a diagnosis using the same classification system DSM-IV-TR has greater reliability than any previous editions Used field trials to increase reliability Reliability is still a concern I IIs ssD DDS SSM MM-I IIV VV-T TTR RRa aan nnE EEf fff ffe eec cct tti iiv vve eeC CCl
lla aas sss ssi iif ffi iic cca aat tti iio oon nnS SSy yys sst tte eem mm? ?? The validity of a classification system is the accuracy of information that the diagnostic categories provide Predictive validity is of the most use clinically DSM-IV-TR has greater validity than any previous editions Conducted extensive literature
reviews and ran field studies Validity is still a concern
45 46 47 48 49 50
I IIs ssD DDS SSM MM-I IIV VV-T TTR RRa aan nnE EEf fff ffe eec cct tti iiv vve eeC CCl lla aas sss ssi iif ffi iic cca aat tti iio oon nnS SSy yys sst tte eem
mm? ?? Beyond concerns about reliability and validity, a growing number of theorists believe that two fundamental problems weaken the DSM-IV-TR: Basic assumption that disorders are qualitatively different from normal behavior Reliance on discrete diagnostic categories C CCa aan nnD DDi iia aag ggn nno oos ssi iis ssa aan nnd ddL LLa aab bbe eel
lli iin nng ggC CCa aau uus sse eeH HHa aar rrm mm? ?? Misdiagnosis always a concern Major issue is reliance on clinical judgment Also present is the issue of labeling and stigma Diagnosis may be a self-fulfilling prophecy Because of these problems, some clinicians would like to cease the practice of diagnosis
T TTh hhe eeE EEf fff ffe eec cct tti iiv vve een nne ees sss sso oof ffT TTr rre eea aat ttm mme een nnt tt More than 400 forms of therapy in practice, but is therapy effective? Difficult question to answer: How do you define success? How do you measure improvement?
How do you compare treatments treatments differ in range and complexity; therapists differ in skill and knowledge; clients differ in severity and motivation T TTh hhe eeE EEf fff ffe eec cct tti iiv vve een nne ees sss sso oof ffT TTr rre eea aat ttm mme een nnt tt Controlled clinical research and therapy outcome
studies typically assess one of the following questions: Is therapy in general effective? Are particular therapies generally effective? Are particular therapies effective for particular problems? T TTh hhe eeE EEf fff ffe eec cct tti iiv vve een nne ees sss sso oof ffT TTr rre eea aat ttm mme een nnt tt Is therapy
generally effective? Research suggests that therapy is generally more effective than no treatment or placebo In one major study using meta-analysis, the average person who received treatment was better off than 75% of the untreated subjects T TTh hhe eeE EEf fff ffe eec cct tti iiv vve een nne ees sss sso oof ffT TTr rre eea
aat ttm mme een nnt tt Is therapy generally effective? Some clinicians are concerned with a related question: Can therapy can be harmful? Has this potential Studies report ~5% get worse with treatment T TTh hhe eeE EEf fff ffe eec cct tti iiv vve een nne ees sss sso oof ffT TTr rre eea
aat ttm mme een nnt tt Are particular therapies generally effective?
Generally, therapy-outcome studies lump all therapies together to consider their general effectiveness One critic has called this the uniformity myth It is argued that scientists must look at the effectiveness of particular therapies There is a movement ( rapprochement ) to look at commonalities among therapies T TTh hhe eeE EEf fff ffe eec cct tti iiv
vve een nne ees sss sso oof ffT TTr rre eea aat ttm mme een nnt tt Are particular therapies effective for particular problems? Studies now being conducted to examine effectiveness of specific treatments for specific disorders: What specific treatment, by whom, is the most effective for this individual with that specific problem, and under which
set of circumstances? Recent studies focus on the effectiveness of combined approaches drug therapy combined with certain forms of psychotherapy to treat certain disorders
