Lecture III Flashcards
Assessment
Clinicians do tests, observations, interviews to summarize client’s symptoms
Diagnosis
Process through which the clinician gets a “summary classification” of the patient’s symptoms using a diagnostic manual such as DSM-5
Referral question
The first step in diagnosis where the problem is identified and summarized. Considerations: situational/pervasive, duration, prior attempts at treatment, effects, DSM
Comprehensive Assessment
Second step in diagnosis: can include general physical exam, neurological exam, neuropsychological exam
Neuropsychological exam
Assesses cognitive, perceptual, motor performance to assess if there is brain damage and to characterize level of cognitive functioning
Psychodiagnostic assessment
Assesses individual’s psychological presentation. Three common procedures: assessment interviews (structured/unstructured), clinical obs of behavior, psychological tests
Assessment interviews
Face-to-face where clinician obtains info on client’s situation, personality, behavior. Structured - less freedom but more reliability. Unstructured - more freedom to explore
Clinical observation of behavior
Ideally takes place in natural setting, but often in clinic or hospital. Rating scales can help increase validity
Two kinds of psychological tests
(1) Intelligence tests (WISC-IV, Stanford-Binet, WAIS-IV)
2) Personality tests (projective tests with unstructured stimuli, objective tests
Projective personality tests
Unstructured stimuli presented; patient must come up with meaning; believed to indicate unconscious. Includes Rorschach Inkblot Test, Thematic Apperception test, Sentence Completion test. Criticisms: inefficient, subjective, hard to score
Objective personality tets
Structured questionnaires; self-reports. Include MMPI. Advantages - cost effective, objective. Disadvantages: mechanistic, reduces complexity, self-report biases
Integrating assessment data
Data from various sources must be used to create a working model of the client’s condition
Assessment report components
Referral question, background information, behavioral observations, tests administered, test results, summaries, diagnostic impressions, recommendations
Ethical issues in assessment
Possible problems from cultural bias, theoretical orientation, underemphasis on external factors, insufficient validation, inaccurate data, premature evaluation
Classification pros and cons
Benefits: order, ability to communicate, statistical research, insurance.
Three models of classification
(1) Categorical - patient is healthy or disordered; no overlap
(2) Dimensional approach - there is a spectrum from superior functioning to absolutely impaired
(3) Prototypal - concept of an idealized combo of characteristics, some which patient may not have
2 major classification systems for mental disorder
Diagnostic and statistical manual of mental disorders (DSM) and International classification of disease (ICD)
DSM-IV Diagnosis - Axes
5 axes: (1) Syndromes or conditions
(2) Personality disorders, retardation
(3) General medical conditions
(4) Psychosocial and environmental
(5) Global assessment of functioning
DSM-V Diagnosis - non-axial
Non-axial documentation of diagnosis with separate notations for important psychosocial and contextual factors, disability
Why seek psychotherapy?
Believed that those who have psychological problems can learn more adaptive ways of perceiving, evaluating, and behaving
Therapeutic relationships
Must be a working alliance, with collaborative relationship, agreement on goals, affective bond, clear communication, motivation
Outcome assessment
Good ways to determine: therapist impression, client report, family/friend report, pre- vs post- treatment scores, measures of change in behavior. Though some conditions naturally resolve, therapy usually more effective. Sometimes can result in deterioration (boundary violations)
