Comer, 2011 Chapter 3: Clinical Assessment, Diagnosis and Treatment I. II. III. IV. V. I. Overview Clinical Assessment A.

Methods Diagnosis Classification of Abnormal Behavior: DSM-IV-TR Treatment Overview

When a person presents with psychological problems, the first step is clinical assessment. Assessment involves collecting and evaluating information about a person in order to understand her psychological problems or symptoms. The information obtained through assessment allows the clinician to determine what factors are influencing the clients symptoms. The assessment information is used to make a diagnosis: i.e., to determine if the clients symptoms constitute a psychological disorder. A diagnosis is made by using the Diagnostic and Statistical Manual (DSM) by the American Psychiatric Association. DSM is a classification system of psychological (mental) disorders. If a client is diagnosed with a psychological disorder, then a treatment must be found to treat the disorder. Chapter 3 concerns these three steps: assessment, diagnosis, and treatment. II. Clinical Assessment What is presented here is a brief summary of the assessment tools available to clinicians. In exam 2 on this section of your textbook, I expect you to understand the categories of tests and what they are used for; however, I do not expect you to know all the individual tests presented. What I do expect you to know is the specific information on clinical interviews and personality inventories in your textbook and lecture. Methods 1. Clinical Interview Clinical interviews are conducted face-to-face between the clinician and client. They are used to collect information about the clients current problems, mental and emotional state and personal history. Typically there are a series of prepared questions that the clinician will ask the client. These questions vary with the clinicians theoretical perspective. Thus, a behaviorist clinician will ask different questions than a cognitive clinician. A.

2. textbook.

Tests There are six categories of assessments tests discussed in your

a. Projective Tests: These tests present the client with a vague, ambiguous stimulus such as a inkblot or picture or given a vague task to perform. The client is asked to provide his own meaning to the stimulus or task. Typically it is psychodynamic clinicians that would use these tests since the client is expected to project their unconscious issues into the stimulus or task. b. Personality Inventories: These tests are what are called self-report inventories. Clients are expected to answer a large number of questions about themselves including their behavior and emotions. Their answers provide a profile of the clients personality traits. c. Response Inventories: These tests are also self-report inventories and require the answering of a number of questions about themselves; however, the questions concern only one aspect of psychological functioning such as emotions. d. Psychophysiological Tests: These tests measure an aspect of physiological functioning such as heart rate, galvanic skin response or blood pressure. Disturbances in physiological functioning may accompany psychological disorders. e. Neurological and Neuropsychological Tests: Neurological and neuropsychological tests are used to detect the presence of damage to the brain. Such damage could be the cause of psychological problems. f. Intelligence Tests: These tests are used to diagnose mental retardation. They are also used to evaluate a clients possible intellectual impairment. III. Diagnosis All the above assessment methods are not used on every client. The types of tests given are determined by the psychological problems of the client and the theoretical orientation of the clinician. Once the clinician has completed the assessment process, this information is used to make a diagnosis of the psychological problems or symptoms. The question to be answered is do these symptoms constitute a specific psychological disorder? Particular symptoms that regularly occur together are called a syndrome. If a clients symptoms constitute a syndrome, then this syndrome may be a psychological disorder. In order to determine this, the syndrome must be compared to a classification system of psychological (mental) disorders.

The classification system used most widely in the United States is the Diagnostic and Statistical Manual of Mental Disorders (DSM) by the American Psychiatric Association. IV. Classification of Abnormal Behavior (DSM-IV-TR) A.

DSM-IV-TR DSM-IV was published in 1994. It was revised in 2000 and titled DSM-IVTR (text revision). It is a classification system of all known psychological (mental) disorders. It provides descriptions and specific diagnostic criteria for all psychological disorders. It does not explain the causes of these disorders. DSM-IV-TR is Multiaxial a. Axis I: Clinical Syndromes (Please see the inside back cover of your textbook for all the Axis I psychological disorders found in DSM-IV-TR) Listed here are the clinical syndromes, or psychological disorders, such as Anxiety Disorders or Schizophrenia. b. Axis II: Personality Disorders and Mental Retardation The disorders here are described as very rigid, maladaptive patterns of behavior and personality. The personality disorders involve personality traits that are rigid and maladaptive such as antisocial, paranoid or narcissistic. Mental retardation is not a disorder; however, it is evaluated because it will influence psychological functioning. A person can be diagnosed on both Axis I and II. Therefore, a person can potentially have a diagnosis on both axes depending upon the syndromes they present. c. Axis III: General Medical Conditions This axis is used to document physical or medical conditions. This is important because medical and psychological problems can influence each other. d. Axis IV: Psychosocial and Environmental Problems This axis is used to document stressors in the clients life that may influence their psychological disorder. Examples of stressors are divorce, academic problems, death of a close family member. e. Axis V: Global Assessment of Functioning The clinician makes a global assessment of the functioning of the client: psychological, social and occupational. 1.

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Treatment A. Treatment follows Theory 1. What type of treatment is provided a client depends upon the theoretical model or perspective professed by the clinician. You have already learned about the major theoretical models and what each believes is the cause of abnormal behavior. Hopefully, you will see that what a clinician considers the cause of abnormal behavior determines the treatment. What follows is a review of each theoretical model and what type of therapy would be provided. However, most clinicians would provide therapy from a combination of treatments. a. Biological Model: Abnormal behavior is caused by a malfunctioning nervous system or specifically, a malfunctioning brain. Thus, treatment would be designed to treat the brain. The primary treatment is clinical drugs such as antipsychotic drugs or antidepressant drugs that affect dysfunctional neurotransmitters. Other treatments that affect the brain would be electroconvulsive therapy (ECT) or psychosurgery. b. Psychodynamic Model: Abnormal behavior is caused by unconscious id conflicts usually originating in childhood. Thus, treatment would be designed to get at these unconscious conflicts and to learn about childhood experiences. c. Behavioral Model: The definition of abnormal behavior is that abnormal behavior is the learning of maladaptive, inappropriate behaviors. Thus, treatment, based on learning principles, would be designed so the client can learn new, more adaptive behaviors. d. Cognitive Model: Abnormal behavior is based upon dysfunctional thinking. Thus, treatment is aimed at getting the client to identify and correct dysfunctional thinking such as irrational thoughts or negative attitudes that are producing the abnormal behavior. e. Humanistic Model: Abnormal behavior is caused by obstacles that prevent one from self-actualization. The main obstacle that prevents self-actualization is having a negative self-concept. Thus, treatment is designed to get the client to focus on his immediate, personal and subjective experiences in order to know who he is and begin self-actualizing again. f. Sociocultural Model: Abnormal behavior results from social and cultural forces that do not effectively support the individual. Since abnormal behavior occurs within a context, treatment is based on including several people in the therapeutic situation, not just one-on-one therapy. Typically, the people involved in the treatment process are a social network such as a family.