Unit 2: Psychological Assessment PDF

Unit 2. Complete. Unit 2 The process of Psychological Assessment Psychological Assessment Manuel Galán Psychology 1 INDEX CONTENTS 1. Basic aspects. An introdu...

Unit 2. Complete. Unit 2 The process of Psychological Assessment Psychological Assessment Manuel Galán Psychology 1 INDEX CONTENTS 1. Basic aspects. An introduction to the process. 2. The process of Clinical Assessment. 2.1. Assessment before the treatment 2.2. Assessment during the treatment 2.3. Assessment after the treatment 2 2  Unit 2. Complete. 1. Basic aspects An introduction to the process. 3 3 1. Basic aspects “Clinical Assessment in Psychology is a multi-step process. Although different goals are set at each step, as a whole, the general goal is to gather information on the patient and case, and this is done by applying a variety of techniques characterized by quality criteria. The information gathered is then seized up into a hypothesis formulation, that will undergo validation, in order to carry on to a diagnosis an/or a treatment plan. This process requires constant decision-making right from the start by a qualified trained therapist who will display stage-dependent therapeutic skills” (Marín et al., 2017) 4 4  Unit 2. Complete. 1. Basic aspects 1.1. Objectives of the process. o Diagnosis: evaluation in order to assign a subject to a category of the psychiatric classification system. It usually involves a prognosis and facilitates communication between specialists. o Orientation or counselling: assessment of a person or persons in order to help make decisions or establish future action plans. o Selection: assessment in order to choose the most suitable person(s) to perform a certain pre-specified activity. o Treatment or behavioural change: assessment to intervene in order to produce positive changes in the subject’s behaviour. 5 5 1. Basic aspects 1.2. Psychological Assessment Models. Several authors have reviewed the phases of the process: Attending to different models. Phases will also vary depending on the goal of the evaluation. Guidelines for the assessment process (GAP) o European Association for Psychological Assessment. o In 2001 the Committee published a scheduled guideline to help psychologists carry out a complete and appropriate assessment. 6 6  Unit 2. Complete. 1. Basic aspects 1.2. Psychological Assessment Models. Several authors have reviewed the phases of the process: Ballesteros’ main contribution was to describe and define Assessment as a process. Her model describes the process as a lineal frame albeit she highlighted the fact that most of the tasks are carried out all along different stages. She discriminates between different stages with different goals in each. Ballesteros (2011) organizes these stages into two blocks highlighting the fact that assessment is undertaken before, during and after the treatment. *Easy to follow Appraisal- Evaluative Approach Interventional-Assessment Approach Phase 1: First information collection Phase 5: Development of an Intervention plan Phase 2: Hypothesis formulation Phase 6: Application of the treatment and Phase 3: Hypothesis validation assessment. Continuum assessment Phase 4: Results communication. Writing Phase 7: Assessment after treatment. Final and oral feedback of the results report 7 7 1. Basic aspects 1.2. Psychological Assessment Models. Several authors have reviewed the phases of the process: Another model highly studied and applied is Muñoz’s model (2003) based on a model by Nezu, Haynes and Persons. Muñoz’s model is timeless. The process is divided considering three simultaneous axes: o Descriptive Analyses: Includes the first stages in which the main goal is to gather information. o Functional and Formulation Analyses: Holds the hypothesis formulation and Case formulation. o Diagnosis: A diagnosis based on the DSM or CIE criteria, can be made. 8 8  Unit 2. Complete. 1. Basic aspects 1.2. Psychological Assessment Models. Muñoz’s model (2003) Remember… (unit 1) 9 9 2. The process of Clinical Assessment Based on Muñoz’s and Ballesteros’ models (and following the GAP) 10 10  Unit 2. Complete. 2. The process of Clinical Assessment 2.1. Assessment before the treatment. 2.1.1. Approaching the clinical demand. The clinical assessment process starts with a Clinical demand (Clinical problem). Usually, the first approach is not face-to-face with the client, but on the phone, by email or through another person who is in charge of gathering the initial information. Main goal To agree on some general conditions of the sessions (localization, hours, fees…) this first contact is very important for the client and will provide the therapist with some information of the problem. Albeit it is difficult to make decisions with this If the problem is related to a child and you information, sometimes you will already are not an expert in childhood cases, you know whether to accept the case or refer it. have the information to make a decision. 11 11 2. The process of Clinical Assessment 2.1. Assessment before the treatment. 2.1.1. Approaching the clinical demand. Assessment It is an open chat, not an interview. Techniques Therapeutic Keep in mind that the patient has given great thought to this first contact Skills o Being able to know if the clinical demand is urgent: client/patient will provide information on the symptomatology, and behaviours from which you will have to assess the urgency (e.g., people with suicide attempts). o Be able to give out information clearly: The person who contacts us is under an emotional storm which can interfere with listening and learning. Protip: The way we are in our everyday life is how we are going to be in our consult. It is not that when we go inside our consult we are going to dress in the psychologist costume and be a different person. If we tend to interrupt our Friends when they are speaking, we are going to interrupt the patient, if we do not think about others’ feelings, we are not going to be empathetic… These are going to be skills that you can start practising in your everyday life. 12 12  Unit 2. Complete. 2. The process of Clinical Assessment 2.1. Assessment before the treatment. 2.1.1. Approaching the clinical demand. Therapeutic Keep in mind that the patient has given great thought to this first contact Skills o Handling emotional reactions: When people talk about a problem, emotions show up in an uncontrolled way. Psychologists need to handle this reaction and without being rude and unpleasant, let people know that there will be time to talk about everything in detail but now is not the time or place. o Being kind, warm and polite: Rapport starts at this moment. o Be assertive when considering if you have enough information to accept or refer the case and also when talking about time and money. Role-play to practice all these first therapeutic skills 13 13 2. The process of Clinical Assessment 2.1. Assessment before the treatment. 2.1.2. Initial exploration. Hypothesis formulation based on impressions. The first face-to-face contact with the patient. Main goal o Obtain general information about the demand, the reason for consultation. Decide whether to carry on with the o Formulate the first hypothesis case and the assessment: based on impressions. Reasons to deny: - Demand outside our expertise area - Group of people we do not have training (infants, The therapist is not the only one people with neurological problems…) - Controvert cases (legal issues, morality issues…) making decisions; the patient also evaluates us thinking if he/she has “Role-play” the been feeling comfortable during the therapist decides not session… Rapport to take the case 14 14  Unit 2. Complete. 2. The process of Clinical Assessment 2.1. Assessment before the treatment. 2.1.2. Initial exploration. Hypothesis formulation based on impressions. Main goal Why is the assessment requested? Who? What do you want to achieve? What are the behaviours that will initially be analyzed? 15 15 2. The process of Clinical Assessment 2.1. Assessment before the treatment. 2.1.2. Initial exploration. Hypothesis formulation based on impressions. Main goal Some more information to collect: (apart from the demand)  Information about actual  Information about past environmental or environmental and personal personal conditions. conditions. Interview the client or relatives, reports from the o Family, social and economic conditions. o Current life events. past... This will be o Occupation. o Birth and growth. discussed in more o Leisure and free time. o Family and social circumstances. detail in the next o Physical health status. o Educational conditions. unit (“The o Lifestyles. o Biological conditions. Interview”). o Values. o Historical life events. o Other conditions relevant to the case....... 16 16  Unit 2. Complete. 2. The process of Clinical Assessment 2.1. Assessment before the treatment. 2.1.2. Initial exploration. Hypothesis formulation based on impressions. Main goal The therapist agreement Contains important information about the professional services and business policies of the therapist. Apart from issues that are always included (such as the fee or confidentiality principles) for each specific case, it may be necessary to modify or stress certain issues. Imagine a patient that is coming to therapy because of an alcohol abuse problem it is important to give this issue extra The agreement contract weight in the contract: “Alcohol intake is not allowed on the day the appointment is held. If this is not followed, I will (2.1.3 slides) assume you are in no state to attend the meeting and so, it 17 will be immediately cancelled but expected to be paid for” 17 2. The process of Clinical Assessment 2.1. Assessment before the treatment. 2.1.2. Initial exploration. Hypothesis formulation based on impressions. Main goal Patient’s expectations At the end of this first encounter we ask about the patient’s expectations, which sometimes can be too high or confusing or too many. However, it will be in the next session where treatment goals will be discussed Think what the “… I expect to be happier/feel better…” patient means from “… I would like for you to teach me to fly…” these expectations: “… I don´t know what to do with my life…” 18 18  Unit 2. Complete. 2. The process of Clinical Assessment 2.1. Assessment before the treatment. 2.1.2. Initial exploration. Hypothesis formulation based on impressions. Remember: Main goal It is a scientific process The hypothesis formulation We have now collected some information about the problem/s and the person. Questions whose answer may involve a hypothesis: o What evidence is there that these behaviours are related to other behaviours? o What personal/environmental variables, and biological conditions may be influencing that behaviour? o... 19 19 2. The process of Clinical Assessment 2.1. Assessment before the treatment. 2.1.2. Initial exploration. Hypothesis formulation based on impressions. Remember: Main goal It is a scientific process The hypothesis formulation o Predictive association: Some aptitudes or Types of hypothesis that we behaviours are associated with others; we can can prove right or wrong establish predictions based on this. e.g., The personality traits of this person will help o Quantification: Frequency, intensity, them to overcome this situation. duration… of a behaviour. e.g., How many times does he cry?/He cries 10 o Functional association: explanatory times each day. relationships (cause-effect) between variables. o Similarity: Is the behaviour similar to one e.g., The child does not perform because his teacher reinforces his disruptive performance behaviors. previously described? e.g., She acts in the same way as those diagnosed with PTSD 20 20  Unit 2. Complete. 2. The process of Clinical Assessment 2.1. Assessment before the treatment. 2.1.2. Initial exploration. Hypothesis formulation based on impressions. Assessment General screening techniques: Techniques Intake interview / Admission interview Therapeutic Skills …For the interview Balance with taking notes. Do not lose information but keep eye contact (rapport). Warm atmosphere. This initial exploration step is Summarize the information. carried out in one or two sessions depending on the case. Do not be too directive. 21 21 2. The process of Clinical Assessment 2.1. Assessment before the treatment. 2.1.2. Initial exploration. Hypothesis formulation based on impressions. Case: Laura. Let’s see the first 10’. Please, write down your first impressions. 22 Video, case Laura: https://www.youtube.com/watch?v=AayGEqKaiXk&list=PLQpRpg9inFfSrufoU-mtJerC49GGz6ctd&index=10&t=15s 22  Unit 2. Complete. 2. The process of Clinical Assessment 2.1. Assessment before the treatment. 2.1.3 Descriptive step. In this step, we are going to keep gathering information related to the problem/s. Descriptive hypothesis and functional hypothesis start being formulated. The problems we will work on, have to be measurable, and sometimes need to be reformulated So descriptive hypothesis will be all the hypotheses that we formulate when we treat to describe what happens when the problem/s show up and showed up, we gather information in order to identify all the variables related to the problem. Also, we call descriptive hypotheses to those which emit a diagnosis, titled as diagnosis hypothesis. We also start formulating the functional The origin hypothesis, hypothesis: We try to explain the function The maintenance hypothesis… between the variables and the problem/s. 23 23 2. The process of Clinical Assessment 2.1. Assessment before the treatment. 2.1.3 Descriptive step. Descriptive and diagnosis hypothesis formulation and elaboration of the list of problem/s We have decided to see the patient again because we will carry out the assessment and in some cases the treatment. (After this first or these two first sessions) First thing we have to do: summarize the information gathered from the previous session. (About 5-10 minutes). Next: We must sign with the client the agreement contract (it can also be given in the previous session). Which information The agreement contract should be on the contract? 24 24  Unit 2. Complete. The agreement contract 25 25 The agreement contract 26 26  Unit 2. Complete. The agreement contract 27 27 2. The process of Clinical Assessment 2.1. Assessment before the treatment. 2.1.3 Descriptive step. Descriptive and diagnosis hypothesis formulation and elaboration of the list of problem/s Main goal Know the patient’s different problems and the variables related to them (The first time it appeared, when it shows up, outcomes…) List of problems: Clarified, defined and operatively measured. Later, we will analyse each problem on the basis of a model. Assessment o Interviews: Open interviews, interviews focused on the problem/s, biographical… Techniques o Observation techniques: Self Monitoring. o Questionnaires: General screening questionnaires. o Other screening techniques: Mental state exam and other general techniques. 28 28  Unit 2. Complete. 2. The process of Clinical Assessment 2.1. Assessment before the treatment. 2.1.3 Descriptive step. Descriptive and diagnosis hypothesis formulation and elaboration of the list of problem/s Assessment Techniques Ask questions that If the patient says that they are having these problems: would help you to Eating problems: “when I start, I can’t stop” analyse the problem: Sleeping problems “It is hard for me to fall asleep, I spend two or three hours trying it” 29 29 2. The process of Clinical Assessment 2.1. Assessment before the treatment. 2.1.3 Descriptive step. Descriptive and diagnosis hypothesis formulation and elaboration of the list of problem/s Every turning gets more complicated with more information Therapeutic accumulating step by step, from which the therapist must Skills identify, integrate and associate the most important. o The therapist needs to distinguish between a problem and a symptom. Define the problems and identify all the variables which can be affecting them. o Formulate the descriptive hypothesis depending on the information gathered and chose the right strategies to validate them. o Understand and depth knowledge of the techniques chosen. And decide the best screening techniques. o Conduct the different interviews depending on the stage of assessment and the goal. 30 30  Unit 2. Complete. 2. The process of Clinical Assessment 2.1. Assessment before the treatment. 2.1.3 Descriptive step. Descriptive and diagnosis hypothesis formulation and elaboration of the list of problem/s Examples: » Hypothesis 2: Mrs Smith presents a high level of impulsivity, excessive » Hypothesis 1: Mr Sanz exhibits a emotional responses, and markedly sullen appearance and limited facial disturbing relationships, in the last expression. He spoke slowly five years she had two suicide throughout the interview. He seems attempts. Furthermore, Mrs Smith to have a depressive effect. He had has informed of possible abuses suffered from previous depressive suffered in her childhood. All this episodes. He informs of poor information leads us to hypothesise appetite, sleep disturbances and low that… Mrs Smith might suffer from energy. He might have depression. borderline personality disorder. 31 31 2. The process of Clinical Assessment 2.1. Assessment before the treatment. 2.1.3 Descriptive step. Descriptive and diagnosis hypothesis validation This part is usually carried out at the same time as the formulation of the descriptive hypothesis, validation and the list of problems. Validate the information related to problems, symptoms, behaviours, Main goal and sequential analysis (descriptive hypothesis) as well as validate the diagnosis hypothesis. Assessment We use experimental and quasi-experimental designs as well as we can use Techniques specific screening techniques or specific questionnaires. However, in order to validate the diagnosis hypothesis we have to carry out the triangulation of each hypothesis, which means, we have to assess each one using more than one type of technique. 32 32  Unit 2. Complete. 2. The process of Clinical Assessment 2.1. Assessment before the treatment. 2.1.3 Descriptive step. Descriptive and diagnosis hypothesis validation Assessment We use experimental and quasi-experimental designs as well as we can use Techniques specific screening techniques or specific questionnaires. However, in order to validate the diagnosis hypothesis we have to carry out the triangulation of each hypothesis, which means, we have to assess each one using more than one type of technique. 33 33 2. The process of Clinical Assessment 2.1. Assessment before the treatment. 2.1.3 Descriptive step. Descriptive and diagnosis hypothesis validation Assessment Techniques » Hypothesis 1: Mr. Sanz exhibits o Specific Screening questionnaires sullen appearance and limited facial o Specific self-questionnaires expression. He spoke slowly o Specific part of diagnosis interviews throughout the interview. He seems o Screen symptomatology of DSM V or to have a depressive affect. He had ICD11 and elaboration of an interview o Observation techniques … suffered from previous depressive episodes. He informs of poor How would you appetite, sleep disturbances and low validate this energy. He might have depression. hypothesis? 34 34  Unit 2. Complete. 2. The process of Clinical Assessment 2.1. Assessment before the treatment. 2.1.3 Descriptive step. Descriptive and diagnosis hypothesis validation The hypotheses due to their generality, are difficult to verify. Establishment of verifiable statements that can be contrasted. Selection of variables to be analyzed: variables included in the hypothesis. Selection of techniques and the procedure verify the hypothesis. Verifiable statement = A score above 20 points in the BDI will Example: imply moderate depression in Mr Sanz. "Ana suffers tachycardia every time she rides an elevator if she rides alone but not if she is accompanied she might suffer from claustrophobia“ Hypothesis. Ana’s score in “X” technique (that measures heart rate) will be >100 BPM at rest when riding an 35 elevator alone, and