Clinical Assessment in Psychology
Clinical Assessment in Psychology
Clinical Assessment in Psychology
Abnormal Psychology
Douglas A. Hcker Adjunct Professor of Social and Behavioral Sciences
Chapter 3
Clinical Assessment: How and Why Does the Client Behave Abnormally?
The specific tools used in an assessment depend on the clinicians theoretical orientation Hundreds of clinical assessment tools have been developed and fall into three categories:
Clinical interviews Tests Observations
Clinical Interviews
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
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Clinical Interviews
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
Clinical Tests
Devices for gathering information about a few aspects of a persons psychological functioning, from which broader information can be inferred More than 500 different tests are in use
They fall into six categories
Clinical Tests
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
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Clinical Test: Rorschach Inkblot Clinical Test: Thematic Apperception Test Clinical Test: Sentence-Completion Test SentenceI wish ___________________________ My father ________________________
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Clinical Tests
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
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Clinical Tests
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
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Above 70 = deviant Graphed to create a profile Paranoia (P) Psychasthenia (Pt) Schizophrenia (Sc) Hypomania (Ma) Social introversion (Si)
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Clinical Tests
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?
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Clinical Tests
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
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Clinical Tests
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)
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Clinical Tests
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
Clinical Tests
4.
Psychophysiological tests
Strengths and weaknesses:
Require expensive equipment that must be tuned and maintained Can be inaccurate and unreliable
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Clinical Tests
5.
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
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Clinical Tests
5.
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Clinical Tests
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)
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Clinical Tests
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
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Clinical Tests
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
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Clinical Observations
Systematic observation of behavior Several kinds:
Naturalistic Analog Self-monitoring
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Clinical Observations
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 parentchild, siblingchild, or teacherchild interactions Observations are generally made by participant observers and reported to a clinician
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Clinical Observations
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
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Clinical Observations
Self-monitoring
People observe themselves and carefully record certain behaviors, feelings, or cognitions as they occur over time
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Clinical Observations
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
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Using assessment data and the clinical picture, clinicians attempt to make a diagnosis
A determination that a persons problems reflect a particular disorder or syndrome Based on an existing classification system
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Classification Systems
Lists of categories, disorders, and symptom descriptions, with guidelines for assignment
Focus on clusters of symptoms (syndromes)
DSM-IV-TR
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
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The DSM-IV-TR
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Axis III
Relevant general medical conditions
Axis IV
Psychosocial and environmental problems
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The DSM-IV-TR
Axis V
Global assessment of psychological, social, and occupational functioning (GAF)
Current functioning and highest functioning in past year 0100 scale
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Because of these problems, some clinicians would like to cease the practice of diagnosis
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Generally, therapy-outcome studies lump all therapies together to consider their general effectiveness
One critic has called this the uniformity myth
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Recent studies focus on the effectiveness of combined approaches drug therapy combined with certain forms of psychotherapy to treat certain disorders