Module 9: Clinical Psychology, Assessment and Applications Flashcards
Clinical versus Counselling Assessment
Clinical assessment: focuses on the prevention, assessment, diagnosis, and treatment of psychological disorders varying from mild to severe. Disorders.
Counselling assessment: focuses on issues related to work, relationships and lifestyles and personal development as well as impacts of trauma (abuse assault, domestic violence) and substance use, gambling etc.
What types of problems?
Clinical Assessment DSM-5 diagnosis-related
- Depression and bipolar
- Anxiety- phobias, OCD
- PTSD and trauma
- Substance-related
- Eating disorders
- Psychosis
- Personality disorders
What types of problems?
Counselling Assessment Lifestyle/personal
- Relationships – work, family and couples
- Grief and loss
- Managing life transitions
- Communication and assertiveness
- Stress
- Abuse and assault
- Low self-esteem
- Maintaining healthy lifestyles
What Clinical Assessment Achieves
Attempts to answer questions such as:
- Does the person have a mental disorder?
- If so, what is the diagnosis?
- What is their current level of functioning – both compared to previously (pre-morbid) and to others.
- What treatment should the person receive?
- What is the person’s personality features?
Research questions that inform clinical treatment:
- Which treatment approach is most effective?
- What kind of client tends to benefit most from a particular treatment?
What Clinical Assessment Achieves
Establishes a diagnosis and rules out alternatives – differential diagnosis.
Gathers baseline data on the severity and frequency of symptoms and associated problems
Evaluates progress in treatment
Evaluates treatment outcomes
Detects relapse in those who have completed treatment.
Methods of Assessment
- Case history data – case notes
- Referral letter
- Structured and semi-structured interviews
- Clinician rating scales
- Intellectual and cognitive tests
- Self-report measures of symptoms (behaviour, emotions, thoughts) or personality etc.
- Behavioural observation
- Self-monitoring
- Psychophysiological measures (sleep disorders, sexual disorders)
- Projective tests
Selected assessment techniques should be:
- Most reliable and valid available for problem areas
- Psychometrically sound for the client population
- Brief and practical
Choice of assessment strategies depends upon:
- Nature of setting
- Time available for assessment
- Capacity of client to participate in assessment e.g., due to features of psychological disorder, brain injury or developmental delay, education or literacy levels, cultural background.
Diagnosis based on Weiss Roberts and Louie (2015)
Clinicians need to observe patterns in clients with respect to nature, timing, and sequence of client experiences, behaviours etc.
In seeking to understand these, the clinician makes an interpretation – diagnosis – by applying systematic reasoning to the clinical evaluation process.
Hypothesis based on fit between client’s problems and those syndromes or clusters of features established through science of psychopathology.
Clinicians use data obtained from initial clinical interviews to construct of list of plausible diagnoses – differential diagnosis – to focus additional data gathering to narrow and refine diagnostic possibilities.
Diagnostic and statistical manual of mental disorders – 5th edition
- Developed by American Psychiatric Association
- Disorders, their criteria, and features determined by panels of experts based on current scientific knowledge
- Specific disorder criteria describe the nature, number, duration and other features required to meet the diagnosis
- World Health Organisation’s International Classification of Diseases – 11 provides similar disorders and criteria
Considering Cultural Factors in the DSM
Previously DSM listed culture-bound syndromes (e.g., koro, amok)
Concept expanded in the DSM-5 to include 3 elements:
- Cultural syndromes: group of relatively invariant symptoms occurring in specific cultural group, community or context
- Cultural idiom of distress: how group describes suffering and concepts of pathology and ways of expressing, communicating or naming distress
- Cultural explanation or perceived cause – cultural explanatory model of aetiology of symptoms or distress
Within each DSM-5 Category
Diagnostic criteria for specific disorder
- Subtypes and specifiers
- Coding and recording procedures
Explanatory text
- Diagnostic features
- Associated features
- Prevalence
- Diagnostic markers (sometimes)
- Development and course
- Risk and prognostic factors
- Culture-related diagnostic issues
- Gender-related diagnostic issues
- Suicide risk (sometimes)
- Functional consequences
- Differential diagnosis
- Comorbidity
Such a classification system provides:
- Common shorthand way to communicate among clinicians and researchers
- Organises scientific information regarding psychopathology
- Describes the relationships between disorders
- Provide explanation for what person has been experiencing
- But does it reduce person’s experience to label and stigmatise them?
Categorical versus Dimensional
The DSM has largely been categorical in nature- disorders describes in terms of specific criteria that differentiate them form other disorders – disorders were discrete ‘boxes’.
Two issues arise
- Are the boxes ‘real’ – meaningful?
- Can clinicians reliably diagnose – agree on which box?
o Example: Schizophrenia
In the DSM-IV-TR and earlier versions, schizophrenia has specific subtypes with distinct features – paranoid, disorganised, catatonic, undifferentiated, residual.
In the DSM-5 – subtypes eliminated – evaluated on core features of psychosis – delusion, hallucination, disorganised speech, abnormal psychomotor behaviour, and negative symptoms.
