Chapter 4 Handouts

1. Chapter 4 Handouts Clinical Assessment, Diagnosis, and Treatment

2. Handout 2 Clinical Assessment: How and Why Does the Client Behave Abnormally? What is assessment? _______________________________________ ______________ assessment is used to determine how and why a person is behaving abnormally and how that person may be helped Focus is _____________ – on an individual person Also may be used to evaluate treatment progress

3. Handout 3 Clinical Assessment: How and Why Does the Client Behave Abnormally? The specific tools used in an assessment depend on the clinician’s theoretical orientation Hundreds of clinical assessment tools have been developed and fall into three categories: Clinical interviews Tests Observations

4. Handout 4 Characteristics of Assessment Tools To be useful, assessment tools must be _________ and have clear _________ and _________ Standardization is the process in which a test is administered to a large group whose performance serves as a common standard (norm) against which individual scores are judged The “standardization sample” must be representative One must standardize _____________ , ___________ , and _______________

5. Handout 5 Characteristics of Assessment Tools Reliability is the _______________ of a test Two main types: __________________ reliability A good test will yield the same results in the same situation To test for this type of reliability, a subject is tested on two different occasions and the scores are correlated – the higher the correlation, the greater the test’s reliability __________________ reliability Independent judges agree on how to score and interpret a particular test

6. Handout 6 Characteristics of Assessment Tools Validity is the __________ of a test’s results A good test must accurately measure what it is supposed to be measuring Three specific types: ________________ – a test appears to measure what it is supposed to measure; does not necessarily indicate true validity ________________ – a test accurately predicts future characteristics or behavior ________________ – a test’s results agree with independent measures assessing similar characteristics or behavior

7. Handout 7 Clinical Interviews Face-to-face encounters Often the first contact between a client and a therapist/assessor Used to collect detailed information, especially personal history, about a client Allow the interviewer to focus on whatever topics they consider most important

8. Handout 8 Clinical Interviews Conducting the interview Focus depends on theoretical orientation Can be either ___________ or ___________ In unstructured interviews, clinicians ask open-ended questions In structured interviews, clinicians ask prepared questions, often from a published interview schedule May include a mental status exam

9. Handout 9 Clinical Interviews Limitations: May lack _________________ or accuracy Interviewers may be biased or may make mistakes in judgment Interviews, particularly _______________ ones, may lack reliability

10. Handout 10 Clinical Tests Devices for gathering information about specific topics from which broader information can be inferred More than 500 different tests are in use They fall into six categories …

11. Handout 11 Clinical Tests _________________ tests Require that subjects interpret vague and ambiguous stimuli or follow open-ended instruction Mainly used by ______________ practitioners Most popular: Rorschach inkblots Thematic Apperception Test Sentence completion Drawings

12. Handout 12 Clinical Test: Rorschach Inkblot

13. Handout 13 Clinical Test: Thematic Apperception Test

14. Handout 14 Clinical Test: Sentence-Completion Test “I wish ___________________________” “My father ________________________”

15. Handout 15 Clinical Test: Drawings Draw-a-Person (DAP) test: “Draw a person” “Draw another person of the opposite sex”

16. Handout 16 Clinical Tests Projective tests Strengths and weaknesses: Helpful for providing “supplementary” information Have rarely demonstrated much ________________ May be biased against __________________

17. Handout 17 Clinical Tests ________________ inventories Designed to measure broad personality characteristics Focus on behaviors, beliefs, and feelings Usually based on self-reported responses Most widely used: Minnesota Multiphasic Personality Inventory (MMPI)

18. Handout 18 Clinical Test: MMPIMinnesota Multiphasic Personality Inventory Consists of 550 self-statements that can be answered “true,” “false,” or “cannot say” Statements describe physical concerns; mood; morale; attitudes toward religion, sex, and social activities; and psychological symptoms Assesses careless responding & lying

19. Handout 19 Clinical Test: MMPIMinnesota Multiphasic Personality Inventory Comprised of ten clinical scales: Hypochondriasis (HS) Depression (D) Conversion hysteria (Hy) Psychopathic deviate (PD) Masculinity-femininity (Mf) Scores range from 0 – 120 Above 70 = deviant Graphed to create a “profile” Paranoia (P) Psychasthenia (Pt) Schizophrenia (Sc) Hypomania (Ma) Social introversion (Si)

21. Handout 21 Clinical Tests Personality inventories Strengths and weaknesses: Easier, cheaper, and faster to administer than projective tests ________________ scored and standardized Appear to have greater validity than projective tests Measured traits often cannot be directly examined – how can we really know the assessment is correct? Tests fail to allow for __________________ in responses

22. Handout 22 Clinical Tests Response inventories Usually based on self-reported responses Focus on one specific area of functioning Affective inventories (example: Beck Depression Inventory) Social skills inventories Cognitive inventories

24. Handout 24 Clinical Tests Response inventories Strengths and weaknesses: Have strong ____________________ Rarely include questions to assess careless or inaccurate responding Few (BDI is one exception) have been subjected to careful standardization, reliability, and/or validity procedures

25. Handout 25 Clinical Tests ____________________ tests Measure physiological response as an indication of psychological problems Includes heart rate, blood pressure, body temperature, galvanic skin response, and muscle contraction Most popular is the __________ (lie detector)

26. Handout 26 Clinical Tests Psychophysiological tests Strengths and weaknesses: Require expensive equipment that must be tuned and maintained Can be inaccurate and unreliable (see Box 4-2)

27. Handout 27 Clinical Tests ____________________________ tests Neurological tests __________ assess brain function by assessing brain structure and activity Examples: EEG, PET scans, CAT scans, MRI Neuropsychological tests __________ assess brain function by assessing cognitive, perceptual, and motor functioning Most widely used is the Bender Visual-Motor Gestalt Test

28. Handout 28 Clinical Test: Bender Visual-Motor Gestalt Test

29. Handout 29 Clinical Tests Neurological and neuropsychological tests Strengths and weaknesses: Can be very accurate Bender-Gestalt can detect general organic impairment in ~75% of cases At best, though, these tests are rough and general screening devices Best when used in a battery of tests, each targeting a specific skill area

30. Handout 30 Clinical Tests _______________________ tests Designed to measure intellectual ability Comprised of a series of tests assessing both verbal and non-verbal skills Generate an ______________________ (IQ) Most popular: Wechsler (WAIS, WISC)

31. Handout 31 Clinical Tests Intelligence tests Strengths and weaknesses: Are among the most carefully produced of all clinical tests Highly standardized on large groups of subjects Have very high reliability and validity Because intelligence is an inferred quality, it can only be measured indirectly

32. Handout 32 Clinical Tests Intelligence tests Strengths and weaknesses: Performance can be influenced by non-intelligence factors (e.g., ____________ , ____________ , ______________________) Tests may contain _________ in language or tasks Members of minority groups may have less experience and be less comfortable with these types of tests, influencing their results

33. Handout 33 Clinical Observations Systematic observation of behavior Several kinds: Naturalistic Analog Self-monitoring

34. Handout 34 Clinical Observations Naturalistic and analog observations Naturalistic observations occur in ____________ environments Can occur in homes, schools, institutions (hospitals and prisons), and community settings Tend to focus on parent–child, sibling–child, or teacher–child interactions Observations are generally made by “________________” and reported to a clinician If naturalistic observation is impractical, analog observations are used and occur in __________________

35. Handout 35 Clinical Observations Naturalistic and analog observations Strengths and weaknesses: Reliability is a concern Different observers may focus on different aspects of behavior Validity is a concern Risk of “overload,” “observer drift,” and observer bias ______________________ may also limit validity Observations may lack _____________________ validity

36. Handout 36 Clinical Observations Self-monitoring People observe themselves and carefully record the frequency of certain behaviors, feelings, or cognitions as they occur over time

37. Handout 37 Clinical Observations Self-monitoring Strengths and weaknesses: Useful in assessing infrequent behaviors Useful for observing overly frequent behaviors Provides a means of measuring private thoughts or perceptions Validity is often a problem Clients may not receive proper training and instruction Clients may not record information accurately When people are observed, they often change their behavior

38. Handout 38 Diagnosis: Does the Client’s Syndrome Match a Known Disorder? Using all available information, clinicians attempt to paint a “_______________” Influenced by their _________________ Using assessment data and the clinical picture, clinicians attempt to make a ________________ A determination that a person’s problems reflect a particular disorder or syndrome Based on an existing _________________

39. Handout 39 Classification Systems Lists of categories, disorders, and symptom descriptions, with guidelines for assignment Focus on clusters of symptoms (syndromes) In current use in the US: DSM-IV Diagnostic and Statistical Manual of Mental Disorders (4th edition)

40. Handout 40 DSM-IV Published in 1994, revised slightly in 2000 Lists approximately 400 disorders Listed in the inside back flap of your text Describes criteria for diagnoses, key clinical features, and related features which are often but not always present People can be diagnosed with multiple disorders…

41. Handout 41 Lifetime Prevalence of DSM Diagnoses

42. Handout 42 The DSM-IV ______________________________ Uses 5 axes (____________________) to develop a full clinical picture People usually receive a diagnosis on either Axis I or Axis II, but they may receive diagnoses on both

43. Handout 43 The DSM-IV Axis I Most frequently diagnosed disorders except personality disorders and mental retardation

44. Handout 44 Major Axis I Diagnostic Categories

45. Handout 45 The DSM-IV Axis II Personality disorders and mental retardation Long-standing problems Axis III Relevant general medical conditions Axis IV Psychosocial and environmental problems

46. Handout 46 The DSM-IV Axis V Global assessment of psychological, social, and occupational functioning Current functioning and highest functioning in past year 0–100 scale

47. Handout 47 Are Classifications Reliable and Valid? In this case reliability = different diagnosticians agreeing on a diagnosis using the same classification system DSM-IV has greater reliability than any previous editions Used field trials to increase reliability Reliability is still a concern

48. Handout 48 Are Classifications Reliable and Valid? In this case validity = accuracy of information that the diagnostic categories provide ____________ validity is of the most use clinically DSM-IV has greater validity than any previous editions Conducted extensive literature reviews and ran field studies Validity is still a concern

49. Handout 49 Can Diagnosis and Labeling Cause Harm? Misdiagnosis always a concern Major issue is reliance on __________________ Also present is the issue of _______________ Diagnosis may be a self-fulfilling prophecy

50. Handout 50 Treatment: How Might the Client Be Helped? Treatment decisions Begin with assessment information and diagnostic decisions to determine a treatment plan Use a combination of ___________________________ Other factors: ___________________________________________ ___________________________________________ General state of clinical knowledge – currently focusing on ___________________________________________

51. Handout 51 The Effectiveness of Treatment Over 400 forms of therapy in practice, but is therapy effective? Difficult question to answer: How do you define success? How do you measure improvement? How do you compare treatments – treatments differ in range and complexity; therapists differ in skill and knowledge; clients differ in severity and motivation…

52. Handout 52 The Effectiveness of Treatment Controlled clinical research and therapy outcome studies typically assess one of the following questions: Is therapy in general effective? Are particular therapies generally effective? Are particular therapies effective for particular problems?

53. Handout 53 The Effectiveness of Treatment Is therapy generally effective? Research suggests that therapy is generally more effective than ____________ or than In one major study using ____________ , the average person who received treatment was better off than 75% of the untreated subjects

54. Handout 54

55. Handout 55 The Effectiveness of Treatment Is therapy generally effective? A study conducted by Consumer Reports magazine found that “consumers” of therapy found it to be helpful or at least satisfying Also a question, though, is whether therapy can be harmful? Has this potential Studies report ~5% get worse with treatment

56. Handout 56 The Effectiveness of Treatment Are particular therapies generally effective? Generally, therapy outcome studies lump all therapies together to consider their general effectiveness One critic has called this the “__________________” It is argued that scientists must look at the effectiveness of ______________ therapies There is a movement (“______________”) to look at __________________ among therapies

57. Handout 57 The Effectiveness of Treatment Are particular therapies effective for particular problems? Studies now being conducted to examine effectiveness of specific treatments for specific disorders: “ ______ specific treatment, by ______, is the most effective for ______ individual with ______ specific problem, and under ______ set of circumstances?” Recent studies focus on the effectiveness of combined approaches – ________________ combined with certain forms of _______________ – to treat certain disorders