Copyright © 2010 Allyn & Bacon This multimedia product and its contents are protected under copyright law. The following are prohibited by law: any public performance or display, including transmission over any network; preparation of any derivative work, including the extraction, in whole or part, of any images; any rental, lease, or lending of the program. ISBN: PowerPoint for Abnormal Psychology Fourteenth Edition James N. Butcher Susan Mineka Jill M. Hooley Prepared by Andy Pomerantz Southern Illinois University Edwardsville
Copyright © 2010 Allyn & Bacon Chapter 4 Clinical Assessment and Diagnosis
Copyright © 2010 Allyn & Bacon 3 The Basic Elements in Assessment First, the presenting problem must be identified Situational or pervasive? Duration? Prior attempts to help or treat? Self-defeating or resourceful? How does problem impact social roles? Does problem match any DSM-IV disorder criteria? First, the presenting problem must be identified Situational or pervasive? Duration? Prior attempts to help or treat? Self-defeating or resourceful? How does problem impact social roles? Does problem match any DSM-IV disorder criteria?
Copyright © 2010 Allyn & Bacon 4 The Relationship Between Assessment and Diagnosis Classifying the presenting problem is important for numerous reasons Planning treatment Knowledge of range of diagnostic problems in client population, which dictate needs for facilities Insurance payment Classifying the presenting problem is important for numerous reasons Planning treatment Knowledge of range of diagnostic problems in client population, which dictate needs for facilities Insurance payment
Copyright © 2010 Allyn & Bacon 5 Taking a Social or Behavioral History A good assessment should include a social history noting: Personality factors The social context A good assessment should include a social history noting: Personality factors The social context
Copyright © 2010 Allyn & Bacon 6 Ensuring Culturally Sensitive Assessment Procedures U.S. population has grown increasingly diverse in recent years It is critical for practitioners to conduct culturally competent assessment APA ethical code addresses need for cultural competence Cultural variables can include ethnicity, language, SES, gender, and others U.S. population has grown increasingly diverse in recent years It is critical for practitioners to conduct culturally competent assessment APA ethical code addresses need for cultural competence Cultural variables can include ethnicity, language, SES, gender, and others
Copyright © 2010 Allyn & Bacon 7 The Influence of Professional Orientation How clinicians go about the assessment process often depends on their basic treatment orientations
Copyright © 2010 Allyn & Bacon For psychological assessment to proceed effectively, the client must feel comfortable with the clinician 8 Trust and Rapport Between the Clinician and the Client
Copyright © 2010 Allyn & Bacon 9 Assessment of the Physical Organism Assessment of the physical organism incorporates The general physical examination The neurological examination The neuropsychological examination Assessment of the physical organism incorporates The general physical examination The neurological examination The neuropsychological examination
Copyright © 2010 Allyn & Bacon Many psychological problems have physical components either as Causal factors Symptom patterns Therefore, it is often important to include a medical examination in the psychological assessment Many psychological problems have physical components either as Causal factors Symptom patterns Therefore, it is often important to include a medical examination in the psychological assessment 10 The General Physical Examination
Copyright © 2010 Allyn & Bacon The Neurological Examination If organic brain damage is suspected, neurological tests can aid in determining the site and extent of organic brain disorder The neurological examination may include: An EEG A CAT scan A PET scan A functional MRI If organic brain damage is suspected, neurological tests can aid in determining the site and extent of organic brain disorder The neurological examination may include: An EEG A CAT scan A PET scan A functional MRI 11
Copyright © 2010 Allyn & Bacon 12 The Neuropsychological Examination The neuropsychological examination involves the use of an expanding array of testing devices to measure a person’s cognitive, perceptual, and motor performance as clues to the extent and location of brain damage
Copyright © 2010 Allyn & Bacon 13 The Neuropsychological Examination One popular neuropsychological examination, the Halstead-Reitan battery, includes the following tests: Halstead Category Test Tactual Performance Test Rhythm Test Speech Sounds Perception Test Finger Oscillation Task One popular neuropsychological examination, the Halstead-Reitan battery, includes the following tests: Halstead Category Test Tactual Performance Test Rhythm Test Speech Sounds Perception Test Finger Oscillation Task
Copyright © 2010 Allyn & Bacon 14 Psychosocial Assessment Psychosocial assessment attempts to provide a realistic picture of an individual in interaction with his or her social environment Three procedures commonly used in psychosocial assessments include: Assessment interviews (which may be structured or unstructured) Clinical observation of behavior Psychological tests Psychosocial assessment attempts to provide a realistic picture of an individual in interaction with his or her social environment Three procedures commonly used in psychosocial assessments include: Assessment interviews (which may be structured or unstructured) Clinical observation of behavior Psychological tests
Copyright © 2010 Allyn & Bacon 15 Assessment Interviews A face-to-face interaction in which the clinician obtains information about the client’s situation, personality, and behavior Structured interviews restrict freedom to explore but increase reliability Unstructured interviews allow for more exploration but decrease reliability A face-to-face interaction in which the clinician obtains information about the client’s situation, personality, and behavior Structured interviews restrict freedom to explore but increase reliability Unstructured interviews allow for more exploration but decrease reliability
Copyright © 2010 Allyn & Bacon 16 The Clinical Observation of Behavior Ideally, clinical observation takes place in a natural environment, such as a child’s behavior in a classroom or at home However, it often takes place at the clinic or hospital where the client seeks help Rating scales can augment clinical observations of behavior and can increase reliability and validity Ideally, clinical observation takes place in a natural environment, such as a child’s behavior in a classroom or at home However, it often takes place at the clinic or hospital where the client seeks help Rating scales can augment clinical observations of behavior and can increase reliability and validity
Copyright © 2010 Allyn & Bacon 17 Psychological Tests Two general categories of psychological tests for use in clinical practice are Intelligence tests such as the WISC-IV and WAIS-III Personality tests Projective personality tests Objective personality tests Two general categories of psychological tests for use in clinical practice are Intelligence tests such as the WISC-IV and WAIS-III Personality tests Projective personality tests Objective personality tests
Copyright © 2010 Allyn & Bacon 18 Psychological Tests The most commonly used intelligence tests include: The WISC-IV and the Stanford-Binet (for children) The WAIS-III (for adults) These tests are individually administered and typically take 2-3 hours to administer, score, and interpret The most commonly used intelligence tests include: The WISC-IV and the Stanford-Binet (for children) The WAIS-III (for adults) These tests are individually administered and typically take 2-3 hours to administer, score, and interpret
Copyright © 2010 Allyn & Bacon 19 Psychological Tests In projective personality tests Unstructured stimuli are presented to a subject The subject projects meaning or structure onto the stimuli These projections reveal hidden motives In projective personality tests Unstructured stimuli are presented to a subject The subject projects meaning or structure onto the stimuli These projections reveal hidden motives
Copyright © 2010 Allyn & Bacon 20 Psychological Tests Projective personality tests include: The Rorschach Inkblot Test The Thematic Apperception Test The Sentence Completion Test Projective personality tests include: The Rorschach Inkblot Test The Thematic Apperception Test The Sentence Completion Test
Copyright © 2010 Allyn & Bacon 21 Psychological Tests In objective personality tests A subject is required to read and respond to itemized statements or questions Objective personality tests include: The MMPI-2 The MMPI includes ten clinical scales measuring psychopathology and a few validity scales measuring straightforwardness In objective personality tests A subject is required to read and respond to itemized statements or questions Objective personality tests include: The MMPI-2 The MMPI includes ten clinical scales measuring psychopathology and a few validity scales measuring straightforwardness
Copyright © 2010 Allyn & Bacon 22 Advantages and Limitations of Objective Personality Tests Objective personality tests have the benefits of being cost-effective and highly reliable They have been criticized for being too mechanistic and requiring too much reading ability and cooperation Actuarial procedures are used for MMPI and other scientifically constructed objective tests Objective personality tests have the benefits of being cost-effective and highly reliable They have been criticized for being too mechanistic and requiring too much reading ability and cooperation Actuarial procedures are used for MMPI and other scientifically constructed objective tests
Copyright © 2010 Allyn & Bacon 23 Advantages and Limitations of Objective Personality Tests Computers are increasingly used in psychological testing To gather information and to interpret or evaluate data collected via other means Some clinicians are more reluctant than others to employ computers into their practices Computers are increasingly used in psychological testing To gather information and to interpret or evaluate data collected via other means Some clinicians are more reluctant than others to employ computers into their practices
Copyright © 2010 Allyn & Bacon 24 Developments in Practice 4.4: Esteban’s MMPI-2 Profile and Report
Copyright © 2010 Allyn & Bacon The Integration of Assessment Data Assessment data from various sources must be integrated into a coherent working model Integration can be done by one mental health professional or a team Sometimes, a definitive picture emerges Sometimes, there are discrepancies that necessitate further assessment Assessment data from various sources must be integrated into a coherent working model Integration can be done by one mental health professional or a team Sometimes, a definitive picture emerges Sometimes, there are discrepancies that necessitate further assessment 25
Copyright © 2010 Allyn & Bacon 26 Ethical Issues in Assessment Ethical issues in assessment include: Potential cultural bias Theoretical orientation of the clinician Underemphasis on the external situation Insufficient validation Inaccurate data or premature evaluation Ethical issues in assessment include: Potential cultural bias Theoretical orientation of the clinician Underemphasis on the external situation Insufficient validation Inaccurate data or premature evaluation
Copyright © 2010 Allyn & Bacon 27 Classifying Abnormal Behavior Classification involves the attempt to delineate meaningful subvarieties of maladaptive behavior The benefits of classification include: The introduction of order The enabling of communication The enabling of statistical research Insurance issues Classification involves the attempt to delineate meaningful subvarieties of maladaptive behavior The benefits of classification include: The introduction of order The enabling of communication The enabling of statistical research Insurance issues
Copyright © 2010 Allyn & Bacon 28 Reliability and Validity A classification system’s usefulness depends largely on its reliability and validity
Copyright © 2010 Allyn & Bacon 29 Differing Models of Classification Three basic approaches include: The categorical approach– a patient is healthy or disordered, but there is no overlap The dimensional approach– the patient may fall along a range from superior functioning to absolutely impaired functioning The prototypal approach– a conceptual entity depicts an idealized combination of characteristics, some of which the patient may not have Three basic approaches include: The categorical approach– a patient is healthy or disordered, but there is no overlap The dimensional approach– the patient may fall along a range from superior functioning to absolutely impaired functioning The prototypal approach– a conceptual entity depicts an idealized combination of characteristics, some of which the patient may not have
Copyright © 2010 Allyn & Bacon 30 Formal Diagnostic Classification of Mental Disorders The Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Disease (ICD) are the two major classification systems in use ICD is more commonly used in Europe DSM is more commonly used in the U.S. DSM purports to be a categorical system, but it is in fact prototypal The Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Disease (ICD) are the two major classification systems in use ICD is more commonly used in Europe DSM is more commonly used in the U.S. DSM purports to be a categorical system, but it is in fact prototypal
Copyright © 2010 Allyn & Bacon 31 Formal Diagnostic Classification of Mental Disorders DSM has five axes Axis I: The particular clinical syndromes or other conditions that may be the focus of clinical attention Axis II: Personality disorders, mental retardation Axis III: General medical conditions Axis IV: Psychosocial and environmental problems Axis V: Global assessment of functioning DSM has five axes Axis I: The particular clinical syndromes or other conditions that may be the focus of clinical attention Axis II: Personality disorders, mental retardation Axis III: General medical conditions Axis IV: Psychosocial and environmental problems Axis V: Global assessment of functioning
Copyright © 2010 Allyn & Bacon 32 Formal Diagnostic Classification of Mental Disorders Mental health professionals should be aware of the downsides of labeling It may close off further inquiry Patients may play out the expectations of their “role” Others may stigmatize the labeled person Nevertheless, arriving at such a diagnosis is usually required before the commencement of clinical services Mental health professionals should be aware of the downsides of labeling It may close off further inquiry Patients may play out the expectations of their “role” Others may stigmatize the labeled person Nevertheless, arriving at such a diagnosis is usually required before the commencement of clinical services
Copyright © 2010 Allyn & Bacon 33 Unresolved Issues DSM is periodically revised Revision efforts are currently underway Personality disorders may be revised to reflect a more dimensional perspective PTSD criteria may be revised to allow for “indirect” traumatization (e.g., 9/11 attacks) DSM is periodically revised Revision efforts are currently underway Personality disorders may be revised to reflect a more dimensional perspective PTSD criteria may be revised to allow for “indirect” traumatization (e.g., 9/11 attacks)
Copyright © 2010 Allyn & Bacon End of Chapter 4