Allyn & Bacon copyright Clinical Assessment

Assessment: Basic Elements Clinical Assessment- procedure in which a clinician uses psychological tests, observation, and interviews to develop a summary of the client’s symptoms and problems in order to understand their nature and extent. Assessment paves the way for diagnosis Relationship between Assessment & Diagnosis Dynamic process that precedes and continues throughout treatment. (see Dynamic Formulation; text book) Why is Diagnosis Necessary? Insurance Claims Help in planning and managing treatment. Guide staffing and facility patterns

Assessment: Basic Elements Four General Areas in Assessment I. Assess the Presenting Problem II. Social History III. Personality Factors IV. Social Context Factors Influencing Assessment The influence of professional orientation Trust and rapport between the clinician- client

Assessment: Physical Organism The General Physical Examination Check systems of the body to rule out behavioral symptoms that closely mimic those of mental disorders (e.g. breathing, hormones). The Neurological Examination EEG- graphic record of the brains electrical activity (assesses brain waves: look for dysrhythmia) Anatomical Brain Scans CAT Scan (relies on the use of x-ray) MRI (better due to ability to differentiate tissues) PET Scans- provides a metabolic portrait Functional MRI- measures changes in local oxygenation

Assessment: Physical Organism The Neuropsychological Examination Testing devices are used to measure a persons performance on cognitive, perceptual, and motor tasks as a clue to the extent and location of brain damage. Standardized Tests or Test Battery Example (Halstead-Reitan Battery -6 hours) Funding is problematic Time consuming.

Psychosocial Assessment Assessment Interviews Structured (most reliable) and Unstructured Interviews Computerized Interviewing Clinical observation of behavior Self-Monitoring Rating scales Kinds of Clinical Observations Natural Setting Role Playing Create a Transaction in Vivo

Psychosocial Assessment Intelligence Tests Vocabulary (verbal) Digit span (performance) Projective Personality Tests The Rorschach The Thematic Apperception Test (TAT) Sentence Completion Test All Projective Tests are Somewhat Subjective and Time Consuming

Projective Test

Thematic Apperception Test

Psychosocial Assessment Objective personality tests The MMPI The clinical scales of the MMPI Criticisms of the MMPI The MMPI-2

Assessment: Data Integration Ethical issues in assessment Potential cultural bias of instrument or clinician Theoretical orientation of the clinician Under-emphasis on the external situation Insufficient validation Inaccurate data or premature evaluation

UNRESOLVED ISSUES Incorporating psychological test data into therapy – an unfulfilled relationship

Assessment Data and Therapy Most clinicians do not routinely use assessment techniques Research supports use of assessment techniques in proper diagnosis and treatment When test results are shared appropriately with a client positive outcomes in treatment are noted Test feedback alone can produce therapeutic results that were comparable to or better than therapy without test feedback