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University of Toronto St. George

Assessment( on going process) THEN diagnosis THEN treatment -----assessment doesn’t stop with diagnosis or treatment -if treatment is unsuccessful then we may revisit diagnosis Assessment: 3 types of assessment 1) interview ---most common form of assessment. ---verbal *group in society in which the interview is not common in assessment: CHILDREN (because it’s based on verbal 2) observation --most common to use for children 3) testing ---most exclusive domain of psychologist -------what psychology grew out of ---statistically normed tests that measure the behavior to the norm. ---some of popular tests are published by well known publisher--book of norms.-- need to have credentials in psychology in order to buy them. Very exclusive -psychologists typically are not involved in testing. Process of Assessment: 1) Referral: someone who has a mental health creditial as a professional, who indicates that there may be a pathology in the patient and refer them for a more thorough investigation. -----basic information will also be collected at the referral ------- want to know basic medical status, age, name, occupation,( identifying information) and symptoms (complaints from patient) and onset of the disorder. -------usually comes from General practitioner -------2 new health professionals : psychiatric nurse, nurse practitioner -physician assistants (PA) able to refer a patient, and even prescribe drugs under the physician supervision ** we just want information to know who to refer you to** -if psychopathology they will refer to psychiatrist and psychologist WARNINGS TO KEEP IN MIND DURING ASSESSMENT things psychologists must keep in mind in an assessment because it may impact what data they collect from the patient 1) the psychologist is making the assessment at one point in time, at one location. ----artificial surrounding ****the client will be anxious: person’s behavior is not something that you’d usually see. -----your initial job will be to reduce the anxiety ********usually they are rushing because they don’t have that much time to assess, but you need to develop a relationship with the client. -----rapport (developing a relationship between you and your client) *if they are more relaxed they will tell you more. *with poor rapport, you will get poor and skewed data because the patients are guarded and anxious 2) observer bias -client sees you with a referral that is a working hypothesis (which may or may not be correct), need to keep in mind comorbidity, the fact that symptoms can be part of other disorders too. (misdiagnosis is very dangerous) Assessment Behavioral Observation: take notes on their behavior. 4 types of behavioral observations: 1) General appearance and attire: ----are there any obvious extremes in appearance? Physical abnormalities, deformities -bruises, scars and cuts: could suspect abuse, self-harm, impulsive behavior, clumsiness or loss of balance (common seizure disorder, they will have bruises and scratches). -cleanliness, does their appearance fit age and socioeconomic status. Take note of grooming (someone with poor grooming may be an indicator of psychosis). -thin teenager (indicator of eating disorder) 2) Emotional gestures and facial expressions (body language) -subtle, it is an art to pick up on these subtle gesture, only learnt through experience. ------subtle cues that we notice “pick up” -universal facial expressions (cross-cultural; suggesting that they are genetically preprogrammed ----basic emotions (happy, sad, disgust, fear, surprise, anger) -you need to reduce the nervousness that is evident in their body language 3) Gross and Fine motor acts Gross: large movements; fine=motor acts -area of responsivity that is affecting by neurological, physiological, pharmacological, and psychological variables -EX: tremor: neurological is our best guess. -EX: overactive: they can’t sit still. Constant fidget more than normal (even after they have gotten less nervous) now you suspect hyperactive disorder, or anxiety, substance abuse disorder. Or some type of chemical unbalance EX: extreme under-activity (catatonia? Symptom of psychotic disorder) EX: unusual ritualistic movements (OCD) 4) verbalization and context, structure, syntax -not interesting in the content. -is what they’re saying appropriate to their level of schooling, and socioeconomic status ----rough estimate of their level of intellect -neo-logism (making up new words) ----psychosis or some type of neurological disorder -client that makes up facts ---different identifying information than in the referral but they don’t look like they want to lie ------indication of neurological disorder--confabulation -hypoanmesia ---client remembers minute details in their past that people normally wouldn’t remember. ---can tell you where the objects they’ve touched in the last hour have possibly been placed ----------indication of OCD nd 2 method of assessment: the interview -formal observation; questions posed and verbal responses are expected ----questions based on information that you have gotten from the referral -3 areas of asking questions 1) identifying data: in more detail about the client themselves and their background ----i want to know what your functioning world is--most people only seek help if their functioning is dysfunctional in their lives -prognosis: what’s likely to happen. Divorce proceedings? 2) Primary complaint from patient: we need to know details about this (when it happens, what the behavior is like) 3) Collect data on family history ---i want to know the background of people related to you and you yourself *a number of disorders have a genetic component EX: alzheimer’s disease *If you are in an environment that is dysfunctional, I need to know about it. *Another purpose of the verbal interaction is to develop a rapport ------you may have to provide treatment, and you want to get ultimately accurate data 2 types of interview: 1) structured interviews: -set of questions that you are required to ask -exhaustive -structured so that you don’t miss any information ----very useful; less mistakes -high reliability low rapport -affects rapport; need to learn to do it in a way that does develop rapport; difficult 2) Unstructured interviews: -chance that you may miss information because you didn’t ask a question about it. -good for rapport (it’s like a conversation with the person) -low reliability high rapport *interview is used to formulate diagnosis *part of the art of interviews: knowing which questions are significant and which to ignore *observe a truthfulness and cooperation (thinking you have a disorder but you don’t: malingering) rd 3 type of formal assessment: testing -exclusive domain of psychologists -----profession was founded by testing the behavioral conditioning using norms -1940s is when psychology exploded ---WWII -----we need to find people that fit in the world in the effort to fight the other half of the world -----test you to see what you are behaviorally good at; testing an assessment -tests are carefully standardized (norms are develop, reference to the average (norm)) ----offer degree of precision and objectivity not obtainable from observation and interview. --------measuring and collecting data -Likert scale: anxiety; on a scale from 1-10, how anxious are you; assigning a number to an emotion that may not be obvious. *most common measurement of emotion. Self report measure. ----only measurement of pain we have is self report. ** people can malinger on these measures though -in psychoanalysis, the method is free association; defense mechanisms are denial, projection, transference. -counter transference: (freud) anger that the patient should have had because sh
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