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Chapter 14

PSYC 3090 Chapter 14: CHAPTER 14

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York University
PSYC 3090
Krista Trobst

CHAPTER 14 – CLINICAL AND COUNSELING ASSESSMENT Clinical Psychology: branch of psychology that’s primary focus is prevention, diagnosis and treatment of abnormal behavior -counseling psychology the same, but clinical more severe forms of behavior pathology, counseling I everyday problems An Overview -treatment plan, diagnoses -test data can confirm or refute hypotheses from clinical interview -case history can supplement if patient will/cannot cooperate Premorbid functioning: level of psychological and physical performance prior to the development of a disorder, illness or disability -how personality can best be described Diagnoses of Mental Disorders -use DSM 5 -crticisms of DSM4-TR include: • Rooted in medical model • Unreliable • No guidance on what treatment is effective • Not sensitive to culture -useful for finding more literature, people can never have perfect inter-diagnostician reliability -descriptive + atheoretical Evolutionary view of mental disorder: internal mechanisms that break down or fail are viewed has having been acquired through natural selection, includes 2 things: 1. Scientific judgment that such evolutionary failure exists 2. Value judgment that this failure is harmful to the individual -social rank theory: people disengage when no longer competitor for rescores, prevents from further injury -adaptive in short term, counterproductive in long term -some have other stances, culture, neuron etc -some think concept so broad doesn’t need any defining properties Making of the DSM5 -international conferences to fix issues -used continuous instead of categorical measures “dimensional” -hybrid approach for personality disorders -DSM5 wanted to address that it was not biopsychosocial enough Biopsychosocial assessment Biopsychosocial assessment: multidisciplinary approach to assessment that includes exploration of relevant bio, psycho, socio and environmental variables for evaluation how such variables may have contributed to the development + maintence of a presenting problem Fatalism: belief that what happens in life is largely beyond a persons control Self-efficacy: confidence in one’s own ability to accomplish a task Social support: expressions of understanding, acceptance, etc from friends/family/community The Interview in Clinical Assessment -pinpoint areas for therapy, determine if harmful, learn more about themselves -guides what needs to be done next Therapeutic contract: agreement between client and therapist setting forth goals, expectations, and mutual obligations with regard to a course of therapy -verbal and nonverbal cues -more skilled the better interviews are Types of interviews -content -structure -tone -state of consciousness -structured interviews have uniform method of exploration, can be standardized Stress interview: any interview where one objective is to place the interviewee in a pressured state for some particular reason -test personality, screening -source of stress varies for purpose of evaluation Hypnotic interview: one conducted while they interviewee is under hypnosis -Therapeutic assessment or intervention when eyewitness to crime or related situation -improve concentration + enhance recall -critics say recall may be offset by losses in accuracy and other possible negative outcome -might make people more confident in their memories regardless of their correctness -may be more suggestible to leading questions Cognitive interview: rapport established and the interviewee is encouraged to use imagery and focused retrieval to recall information -emphasis on open ended than closed questions Collaborative interview: allows interviewee wide latitude to interact with the interviewer -standard questions: • Demographic data • Reason for referral • Past medical history • Present medical history • Familial medical history • Past psychological history • Past history with medical or psychological professionals • Current psychological conditions -note subjective things as well Mental status examination: screen for intellectual, emotional and neurological deficits, involves observation/questioning things like appearance, behavior, mood etc Orientation: knows person, place, time, can note oriented x3 Psychometric aspects of the interview -structured interviews have higher inter-rater reliability -relability + validity increase when diagnostic criteria clear and specific -consistency of reliability conceptually parallels coefficient of test-retest reliability -criterion validity: degree to which interviewers findings concur with other test results Case History Data -biographical information can be found by interviewing person or significant others in that persons life -other public records -meaningful context in which to interpret data from other sources Psychological Tests -some diagnostic -can be focused on traits, states, interests, attitudes etc -BDI most common for depression – can be faked and theres no validity scales -more than one test always best Psychological test battery Test battery: group of tests administered together to gather information about an individual from a variety of instruments Standard battery: contains 1 intelligence, at least one personality, and a test for neurological deficit Culturally Informed Psychological Assessment Culturally informed psychological assessment: approach to evaluation that is keenly perceptive of and responsive to issues of acculturation, values, identity, worldview, language and other culture-related varialbes as they may impact the evaluation process or interpretation of resulting data -can carefully read case history data, others who know person -local cultural advisor -people may disagree on how assessment-related issues regarding members in particular groups -possibility of overpathologization -using family for translation not desirable under certain circumstances, could be rude -generalizability + appropriateness of evaluative measures used -no hard and fast rules, but focus on foundation in basic assessment, culture issues in assessment, and supervised training and experience -“shifting cultural lens” -critical thinking + hypothesis testing Cultural Aspects of the Interview -acronym “ADRESSING”: • Age • Disability • Religion • Ethnicity • Social status • Sexual orientation • Indigenous heritage • National origin • Gender -psychopathological responses that may be fairly commonplace in a particular culture Cultural Considerations and Managed care -culture refers to both: 1. Kind of clash in cultures between that of the care-drive one of mental health professionals and the more bureaucratic costsavings one of managed care agencies 2. Need for culturally informed approaches to clinical services to be built into managed care guidelines Managed care: defined as health care system wherein the products and services provided to patients by a network of participating health care providers are mediate by an administrative agency of the insurer that works to keep costs down by fixing schedules of reimbursement to service providers -cut backs to costs, unstable income -those who misrepresent clients difficulties by colluding with them to get additional benefits is problem -people work under this just to leave it for private practice – more experienced providers do not have insurance reimbursement -no cultural sensitivity in managed care system Special Applications of Clinical Measures Assessment of Addiction and Substance Abuse -blood/urine samples, psychophysiological responses, interviews/questionnaires -reducing widespread substance abuse leads to considering how culture may con
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