Module 2 - The Clinical Assessment PDF

University of the Cordilleras College of Arts and Sciences Department of Psychology and Behavioral Science P117 – Clinical Psychology Module 2...

University of the Cordilleras College of Arts and Sciences Department of Psychology and Behavioral Science P117 – Clinical Psychology Module 2 THE CLINICAL ASSESSMENT I. WHO DEFINES ABNORMALITY? o Diagnostic and Statistical Manual of Mental Disorders (DSM) - the prevailing diagnostic guide for mental health professionals - every day as they perform assessments, conduct therapy, and design and execute research studies. o In DSM-5, mental disorder is defined as a “clinically significant disturbance” in “cognition, emotion regulation, or behavior” that indicates a “dysfunction” in “mental functioning” that is “usually associated with significant distress or disability” in work, relationships, or other areas of functioning (American Psychiatric Association, 2013, p. 20) Earlier editions of the DSM 1. DSM 1 (1952) & DSM 2 (1968) ▪ Published by the American Psychiatric Association ▪ Contained only three broad categories of disorders: - psychoses (which would contain today’s schizophrenia) - neuroses (which would contain today’s major depression, bipolar disorder, and anxiety disorders) - character disorders (which would contain today’s personality disorders 2. DSM III (1980) ▪ Introduced the multiaxial assessment system that remained in DSM through the next several editions but was dropped in DSM-5. ▪ When multiaxial assessment was in place, the psychiatric problems were described on each of five distinct axes. - Axis I - included disorders thought to be more episodic (likely to have beginning and ending points) - Axis II - included disorders thought to be more stable or long-lasting - Axes III and IV - offered clinicians a place to list medical conditions and psychosocial/environmental problems, respectively, relevant to the mental health issues at hand - Axis V - known as the Global Assessment of Functioning (GAF) scale, provided clinicians an opportunity to place the client on a 100-point continuum describing the overall level of functioning ▪ An immediately noticeable feature of DSM-III was its size: It was a significantly longer, more expansive diagnostic manual than its predecessors. DSM-III offered extended descriptions and added lists of specific criteria. In addition, it included many new disorders—265 disorders in total, as compared with 182 in DSM-II and 106 in DSM-I Page 1 of 5  3. DSM IV ▪ Retained the major quantitative and qualitative changes instituted by DSM-III in 1980 4. DSM 5 ▪ Published in 2013 and it was the first substantial revision of the manual in about 20 years. II. WHAT IS CLINICAL ASSESSMENT? The first major concern in clinical psychology is to arrive at an assessment of the client experiencing difficulty. Clinical assessment involves an evaluation of an individual’s strengths and weaknesses, and a conceptualization of the problem, all of which lead to a better understanding of the client. Assessment is also considered a “one-stop-shop” process. It is a rigorous process, and it is something that cannot be done at once. In some cases, it is a continuing or ongoing process. In addition, clinical assessment is preferred over psychodiagnosis which is better reserved for the process of specifying a psychiatric diagnostic label, such as psychological evaluation which may be very broad which does not necessarily include the client in difficulties. The Referral Question This is often the starting line of the assessment process. It begins with a question and this could come from anyone – the client, a friend, parents, a teacher, etc. Sometimes, referral questions are vague and clinicians need to do extra work in uncovering precisely the question. Once it's clear, the clinician, now, knows what needs to be done, the clinical assessment may begin. Clinical assessment can be: o Formal – involves a systematic study of the person through the use of specifically designed interviews, tests, and observations in differentiated stages of the clinical process. o Informal – it is a part of the psychotherapeutic process in which the clinician in less intentional ways is sensitive to, takes note, and judges the qualities of the client. Types of Clinical Assessment Techniques 1. Ask someone who knows the person (informant) o Obtaining information from other people who knows the person can help you build the “picture of your client”. Relatives, friends, colleagues, and employers may know a great deal about the person and can be a rich source of information. However, be mindful of the issues when consulting with others. There are two objections to consulting others: i. Many problems are highly personal – significant others may be informed about the outward effects of the difficulties, but they don’t know the underlying causes. ii. Confidentiality in the clinical relationship prevents the consultation of others unless the client agrees to it. Page 2 of 5 2. Observe the person as he behaves naturally o Using the naturalistic method of observations. 3. Observe the person in standardized test situations o Psychological testing can help clinicians understand the client better. Aside from the test results themselves, observing the client under controlled conditions can still provide insight and additional information. o An element common to all kinds of psychological assessment is feedback. In other words, clinical psychologists provide their clients with the results of tests or interviews that have been conducted (American Psychological Association, 2002). This feedback can come in the form of a face-to-face meeting, a written report, or other forms. Purpose of Psychological Test ▪ Used to help clinicians gain a better understanding of the client. ▪ Used to help the clinicians decide if the client’s needs are within the range of his or her service. ▪ Used for information-giving purposes to assist the individual gain better self- understanding. 4. Ask the person himself o The interview is the backbone of the clinical assessment. It involves putting questions to the client to which, if he can and will, provide direct replies. It can also provide an opportunity for observing non-verbal behavior. Any assessment technique used by clinicians should possess the qualities of: a. Validity - the extent that it measures what it claims to measure (Hood, 2015). b. Reliability - the extent that it yields consistent, repeatable results (Hogan, 2015). If its results depend on when, where, or how the technique was administered, its reliability might be questionable. c. Clinical utility – assuming the technique is used in a clinical setting, it should be beneficial to the clinician III. CLINICAL INTERVIEW A. The Interviewer General Skills of the Interviewer (Sommers-Flanagan, 2009) ▪ Quieting yourself - does not simply mean that the interviewer shouldn’t talk much during the interview, what should be quieted is the interviewer’s internal, self- directed thinking pattern. ▪ Being self-aware - the interviewer’s ability to know how he or she tends to affect others interpersonally and how others tend to relate to him or her ▪ Developing positive working relationships - there is no formula for developing positive working relationships during an interview; however, attentive listening, appropriate empathy, genuine respect, and cultural sensitivity play significant roles. Page 3 of 5 Specific Skills ▪ Listening ▪ Eye contact - when the client notices the interviewer’s continuous, appropriate eye contact, the client feels heard. ▪ Body Language - includes facing the client, appearing attentive, minimizing restlessness, and displaying appropriate facial expressions ▪ Vocal Qualities - use pitch, tone, volume, and fluctuation in their own voices to let clients know that their words and feelings are deeply appreciated ▪ Verbal Tracking - repeat keywords and phrases back to their clients to assure the clients that they have been accurately heard ▪ Referring to the Client by the Proper Name ▪ Observing the client’s behavior B. Components of the Interview 1. Rapport - refers to a positive, comfortable relationship between the interviewer and the client; how an interviewer is with clients - interviewers should make an effort to put the client at ease, especially early in the interview session - interviewers can acknowledge the unique, unusual situation of the clinical interview - interviewers can enhance rapport by noticing how the client uses language and then following the client’s lead 2. Technique - what an interviewer does with - Open vs close-ended question - Clarification - make sure the interviewer has an accurate understanding of the client’s comments - Confrontation - focus on apparently contradictory information provided by clients - Paraphrasing - to assure clients that they are being accurately heard; echoes the client’s words - Reflection of feelings - intended to make clients feel that their emotions are recognized; echoes the client’s feelings - Summarizing - involves tying together various topics that may have been discussed, connecting statements that may have been made at different points, and identifying themes that have recurred during the interview C. Considerations to take before the interview a. Note-taking - written notes are certainly more reliable than the interviewer’s memory. b. Audio and Video Recordings - unlike note-taking, recording a client’s interview requires that the interviewer obtain written permission from the client. c. The interview room - as a general rule, “when choosing a room [for interviews], it is useful to strike a balance between professional formality and casual comfort” d. Confidentiality D. Types of Interviews a. Intake interviews - determines whether the client needs treatment; if so, what form of treatment is needed (inpatient, outpatient, specialized provider, etc.); and whether the current facility can provide that treatment or the client should be referred to a more suitable facility Page 4 of 5  b. Diagnostic interviews - the interviewer can confidently and accurately assign accurate diagnoses to the client’s problems c. Structured vs Unstructured interviews - Structured - predetermined, planned sequence of questions that an interviewer asks a client - Unstructured - no predetermined or planned questions. In unstructured interviews, interviewers improvise. Clinicians determine their questions on the spot, seeking information that they decide is relevant during the interview - Semistructured - include unstructured segments, typically at the beginning of the interview, which allow clients to describe in their own words - the current problem and any relevant history. Then structured segment will follow where the clinician may ask a succession of targeted questions to address specific diagnostic criteria. d. Crisis interviews - designed not only to assess a problem demanding urgent attention (most often, clients actively considering suicide or another act of harm toward self or others) but also to provide immediate and effective intervention for that problem Mental Status Exam (MSE) ▪ Its primary purpose is to quickly assess how the client is functioning at the time of the evaluation. Page 5 of 5