M4. Lesson 3: Clinical Assessment

Question 1

What must a mental health professional do to effectively help treat a client?

Answer 1

For a mental health professional to be able to effectively help treat a client and know that the treatment selected worked (or is working), he/she first must engage in the clinical assessment of the client

Question 2

What is a clinical assessment?

Answer 2

It is the collecting information and drawing conclusions through the use of observation, psychological tests, neurological tests, and interviews to determine the person’s problem and the presenting symptoms.

Question 3

What else does the collection of information in clinical assessment involve?

Answer 3

This collection of information involves learning about the client’s skills, abilities, personality characteristics, cognitive and emotional functioning, the social context in terms of environmental stressors that are faced, and cultural factors particular to them such as their language or ethnicity.

Question 4

Clinical assessment is conducted throughout the process of seeking help. True or False.

Answer 4

True. Clinical assessment is not just conducted at the beginning of the process of seeking help but throughout the process.

Question 5

Why is clinical assessment conducted throughout the process of seeking help?

Answer 5

1. First, we need to determine if a treatment is even needed.
2. Assuming a treatment is needed, our second reason to engage in clinical assessment will be to determine what treatment will work best.
3. Finally, we need to know if the treatment we employed worked.

Question 6

How do we determine if treatment is needed in clinical assessment?

Answer 6

By having a clear accounting of the person’s symptoms and how they affect daily functioning, we can decide to what extent the individual is adversely affected.

Question 7

Why do we need to determine what treatment works best in clinical assessment?

Answer 7

There are numerous approaches to treatment. These include Behavior Therapy, Cognitive and Cognitive-Behavioral Therapy (CBT), Humanistic-Experiential Therapies, Psychodynamic Therapies, Couples and Family Therapy, and biological treatments (psychopharmacology). Of course, for any mental disorder, some of the aforementioned therapies will have greater efficacy than others. Even if several can work well, it does not mean a particular therapy will work well for that specific client. Assessment can help figure this out.

Question 8

What is involved in measuring if a treatment is working/has worked and why is it needed in clinical assessment?

Answer 8

This will involve measuring before any treatment is used and then measuring the behavior while the treatment is in place. We will even want to measure after the treatment ends to make sure symptoms of the disorder do not return. Knowing what the person’s baselines are for different aspects of psychological functioning will help us to see when improvement occurs.

Question 9

What happens in the beginning, middle, and the end of clinical assessment?

Answer 9

Obtaining the baselines happens in the beginning, implementing the treatment plan that is agreed upon happens more so in the middle, and then making sure the treatment produces the desired outcome occurs at the end.

Question 10

What should be made clear about the process of clinical assessment?

Answer 10

It should be clear from this discussion that clinical assessment is an ongoing process.

Question 11

What critical concepts does the assessment process involve?

Answer 11

The assessment process involves three critical concepts—reliability, validity, and standardization. Actually, these three are important to science in general.

Question 12

Why is reliability important?

Answer 12

Outside of clinical assessment, when our car has an issue and we take it to the mechanic, we want to make sure that what one mechanic says is wrong with our car is the same as what another says, or even two others. If not, the measurement tools they use to assess cars are flawed.

The same is true of a patient who is suffering from a mental disorder. If one mental health professional says the person suffers from major depressive disorder and another says the issue is borderline personality disorder, then there is an issue with the assessment tool being used (in this case, the DSM and more on that in a bit).

Question 13

What is interrater reliability?

Answer 13

Ensuring that two different raters are consistent in their assessment of patients is called interrater reliability.

Question 14

What is test-retest reliability?

Answer 14

Another type of reliability occurs when a person takes a test one day, and then the same test on another day. We would expect the person’s answers to be consistent, which is called test-retest reliability.

Question 15

What is an example of test-retest reliability?

Answer 15

For example, let’s say the person takes the MMPI on Tuesday and then the same test on Friday. Unless something miraculous or tragic happened over the two days in between tests, the scores on the MMPI should be nearly identical to one another.

Question 16

What does “identical” mean (in terms of identical scores in test-restest reliability)?

Answer 16

The score at test and the score at retest are correlated with one another. If the test is reliable, the correlation should be very high (remember, a correlation goes from -1.00 to +1.00, and positive means as one score goes up, so does the other, so the correlation for the two tests should be high on the positive side).

Question 17

What is validity?

Answer 17

In addition to reliability, we want to make sure the test measures what it says it measures. This is called validity.

Question 18

What is an example of validity?

Answer 18

Let’s say a new test is developed to measure symptoms of depression. It is compared against an existing and proven test, such as the Beck Depression Inventory (BDI). If the new test measures depression, then the scores on it should be highly comparable to the ones obtained by the BDI.

Question 19

Let’s say a new test is developed to measure symptoms of depression. It is compared against an existing and proven test, such as the Beck Depression Inventory (BDI). If the new test measures depression, then the scores on it should be highly comparable to the ones obtained by the BDI. What kind of validity is used here?

Answer 19

This is called concurrent or descriptive validity.

Question 20

What is face validity?

Answer 20

We might even ask if an assessment tool looks valid. If we answer yes, then it has face validity

Question 21

What should be noted about face validity?

Answer 21

It should be noted that this is not based on any statistical or evidence-based method of assessing validity.

Question 22

What is an example of face validity?

Answer 22

An example would be a personality test that asks about how people behave in certain situations. Therefore, it seems to measure personality, or we have an overall feeling that it measures what we expect it to measure.

Question 23

What is predictive validity?

Answer 23

Predictive validity is when a tool accurately predicts what will happen in the future.

Question 24

What is an example of predictive validity?

Answer 24

Let’s say we want to tell if a high school student will do well in college. We might create a national exam to test needed skills and call it something like the Scholastic Aptitude Test (SAT). We would have high school students take it by their senior year and then wait until they are in college for a few years and see how they are doing. If they did well on the SAT, we would expect that at that point, they should be doing well in college. If so, then the SAT accurately predicts college success. The same would be true of a test such as the Graduate Record Exam (GRE) and its ability to predict graduate school performance.

Question 25

What is standardization?

Answer 25

Finally, we want to make sure that the experience one patient has when taking a test or being assessed is the same as another patient taking the test the same day or on a different day, and with either the same tester or another tester. This is accomplished with the use of clearly laid out rules, norms, and/or procedures, and is called standardization.

Question 26

What happens when mental health professionals do not interpret the results of tests in the same way?

Answer 26

Equally important is that mental health professionals interpret the results of the testing in the same way, or otherwise, it will be unclear what the meaning of a specific score is.

Question 27

What are the different methods of assessment?

Answer 27

1. Observation
2. Clinical Interview
3. Psychological Tests and Inventories
4. Personality inventories
5. Neurological Tests
6. Physical Examination
7. Behavioral Assessment
8. Intelligence Tests

Question 28

What are two different types of observation?

Answer 28

1. naturalistic
2. laboratory

Question 29

What is the naturalistic type of observation?

Answer 29

observing the person or animal in their environment

Question 30

What is the laboratory type of observation?

Answer 30

observing the organism in a more controlled or artificial setting where the experimenter can use sophisticated equipment and videotape the session to examine it at a later time; one-way mirrors can also be used

Question 31

What are limitations of observation?

Answer 31

1. A limitation of this (observation) method is that the process of recording a behavior causes the behavior to change, called reactivity.
2. Another issue is that the behavior made in one situation may not be made in other situations, such as your significant other only acting out at the football game and not at home. This form of validity is called cross-sectional validity.

Question 32

What is reactivity?

Answer 32

when behavior changes due to observation

Question 33

What is cross-sectional validity?

Answer 33

when behaviors on one situation are not made in another situation

Question 34

How can we avoid low validity due to cross-sectional validity?

Answer 34

We also need our raters to observe and record behavior in the same way or to have high interrater reliability.

Question 35

What is a clinical interview?

Answer 35

A clinical interview is a face-to-face encounter between a mental health professional and a patient in which the former observes the latter and gathers data about the person’s behavior, attitudes, current situation, personality, and life history.

Question 36

What are the different types of clinical interview?

Answer 36

1. unstructured
2. structured
3. semi-structured

Question 37

What is an unstructured clinical interview?

Answer 37

An interview in which open-ended questions are asked

Question 38

What is a structured clinical interview?

Answer 38

An interview in which a specific set of questions according to an interview schedule are asked

Question 39

What is a semi-structured clinical interview?

Answer 39

An interview in which there is a pre-set list of questions, but clinicians can follow up on specific issues that catch their attention

Question 40

What is a mental status examination?

Answer 40

A mental status examination is used to organize the information collected during the interview and systematically evaluates the patient through a series of questions assessing appearance and behavior.

Question 41

What does the assessing of appearance include in a mental status examination?

Answer 41

The assessing of appearance includes grooming and body posture, thought processes and content to include disorganized speech or thought and false beliefs, mood and affect such that whether the person feels hopeless or elated, intellectual functioning to include speech and memory, and awareness of surroundings to include where the person is and what the day and time are.

Question 42

What does the mental health examination allow the professional to do?

Answer 42

The exam covers areas not normally part of the interview and allows the mental health professional to determine which areas need to be examined further.

Question 43

What is the limitation of clinical interviews?

Answer 43

The limitation of the interview is that it lacks reliability, especially in the case of the unstructured interview.

Question 44

What are psychological tests and interviews?

Answer 44

Psychological tests assess the client’s personality, social skills, cognitive abilities, emotions, behavioral responses, or interests.

Question 45

How can psychological tests and interviews be administered?

Answer 45

They can be administered either individually or to groups in paper or oral fashion.

Question 46

What are projective tests?

Answer 46

Projective tests consist of simple ambiguous stimuli that can elicit an unlimited number of responses.

Question 47

What are examples of projective tests?

Answer 47

They include the Rorschach or inkblot test and the Thematic Apperception Test, and sentence completion test.

Question 48

What is the Thematic Apperception Test?

Answer 48

Thematic Apperception Test asks the individual to write a complete story about each of 20 cards shown to them and give details about what led up to the scene depicted, what the characters are thinking, what they are doing, and what the outcome will be. From the response, the clinician gains perspective on the patient’s worries, needs, emotions, conflicts, and the individual always connects with one of the people on the card.

Question 49

What is the sentence completion test?

Answer 49

The sentence completion test asks individuals to finish an incomplete sentence. Examples include ‘My mother…’ or ‘I hope…’

Question 50

What are personality inventories?

Answer 50

Personality inventories ask clients to state whether each item in a long list of statements applies to them, and could ask about feelings, behaviors, or beliefs.

Question 51

What are examples of personality inventories?

Answer 51

Examples include the MMPI or Minnesota Multiphasic Personality Inventory and the NEO-PI-R, which is a concise measure of the five major domains of personality – Neuroticism, Extroversion, Openness, Agreeableness, and Conscientiousness.