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Chapter 4

Chapter 4.doc

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PSYC 3230

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Chapter 4 Clinical Assessment I Clinical Assessment I • A. Basic elements of assessment • B. Assessment of the physical organism • Next class – C. Psychosocial assessment • (Psychological testing) – D. Classifying abnormal behavior • (Diagnosis) A. Clinical Assessment A. Clinical Assessment • Range of assessment problems: – Learning disorders, depression, panic attacks, ADHD, custody,  dangerousness, suicide risk, brain damage, epilepsy, retardation, sexual  dysfunction, eating disorder, addiction, senility, psychosis, insomnia, etc. • Range of factors to account for: – Physical, psychological, social, cultural Assessment vs diagnosis • Assessment: procedure by which clinicians use tests, observations,  • Assessment: procedure by which clinicians use tests, observations,  interviews, etc. to develop a summary of a client’s problems and  symptoms • Diagnosis: process by which clinicians arrive at ‘general  classification’ of symptoms following a defined system such as DSM IV or  classification’ of symptoms following a defined system such as DSM IV or  ICD­10 The Initial Clinical Assessment • In the initial clinical assessment an attempt is made to – Identify the main dimensions of a client’s problem – Predict the likely course of events under various conditions (e.g.  dangerousness) – Establish baselines for psychological functions so that the effects of treatment  can be measured (define criteria for improvement) Assessment Information: Sources and Modes • Source – Client – Others: spouse, parents, teacher • Mode – Face to face – Via telephone etc. – Direct via interview; indirect via tests Assessment Information (1) • (What the clinician is trying to learn during psychological  assessment) • Psychological assessments include: – 1. Identifying and describing symptoms (presenting problem) – 2. Determining the chronicity and severity of problems  • (continued) Assessment Information (2) • Psychological assessments include – 3. Evaluating the potential causal factors in the person’s background • Internal and external • Chronic and acute duration • Proximal and distal – 4. Exploring the individual’s personal resources that might be assets in treatment • liabilities and assets – (continued) Assessment Information (3) • Psychological assessments include: – 5. A social history noting: • A. Personality factors  – Predispositions – Problem solving strategies • B. The social context – Family stresses and supports – Social support and difficulties • C. Environmental demands and assets Goals of Assessment (1) • 1. To develop a good picture of the client – past and present;  strengths and weaknesses • 2. To get a good description of behavior – What it is, appropriateness, context • (continued) Goals of assessment (2) • 3. To develop an hypothesis about what is going on and what to do  about it – Based on psychological ‘picture’ of the client • Past and present stressors and experiences • 4. To find explanations based on causes, consequences  • 5. To establish goals for changing the situation The Assessment Process (1) • How clinicians go about the assessment process often depends on  their basic treatment orientations – Medical/biological – Psychological – Psychological • Psychodynamic • Behavioral • Cognitive­behavioral • Humanistic • Humanistic – Social/interpersonal The Assessment Process (2) • For psychological assessment to proceed effectively, the client must  feel comfortable with the clinician – Trust and rapport – Understanding – Confidentiality­ st is big between psychiatrist and patient, even if it means go to jail If you don’t become open with your therapist, it will be hard to figure out what is wrong The Assessment Process (3) • Psychological assessment is: – Essential for helping the client – Varies from client to client – Is on­going throughout treatment B. Physical assessment B. Physical assessment • Biological/physiological orientation • Medical personnel Assessment of the Physical Organism (Medical) • Many psychological problems have physical components either as – Causal factors biological factor can produce a psychological effect) – Symptom patterns • Therefore, it is often  important to include a  important to include a  medical examination  in the psychological  assessment  Assessment of the Physical Organism (Medical) • If organic brain damage is suspected, neurological tests can aid in  determining the site and extent of organic brain disorder • The neurological examination  may include – An EEG (brain waves) – A CAT scan (structure) – A CAT scan (structure) – A PET scan (function) – A functional MRI (function) Assessment of the Physical Organism (Medical) • EEG: electroencephalogram  (checks if brain waves are normal) – Assess brainwave patterns – If abnormal, may point to neurological prob. • CAT/MRI: anatomical brain scan – Location and extent of structural abnormality • PET: functioning of brain – Metabolic activity (epileptic seizures) • Functional MRI: blood flow  – Mapping of neurological activity Assessment of the Physical Organism (psychological) • The neuropsychological examination involves the use of an  expanding array of testing devices to measure a person’s cognitive,  perceptual, and motor performance as clues to the extent and location of  brain damage Assessment of the Physical Organism (psychological) • Sometimes there may be psychological and behavioral problems  without evidence of brain pathology yet caused by brain pathology • Psychological assessment may identify location and extent of brain  pathology Assessment of the Physical Organism (psychological) • One popular neuropsychological examination, the Halstead­Reitan  battery, is composed of the following tests: – Halstead Category Test (learning & memory) – Tactual Performance Test (motor) – Rhythm Test (attention & concentration) – Speech Sounds Perception Test – Finger Oscillation Test (motor speed) ` ` Clinical Assessment II • C. Psychosocial assessment – (Psychological testing) • D. Classifying abnormal behavior – (Diagnosis) C. Psychosocial assessment • Conducted by psychologists • Who take a                       Psychological/social orientation • Using direct and indirect methods Psychosocial Assessment (direct) Psychosocial Assessment (direct) • Psychosocial assessment attempts to provide a realistic picture of an  individual in interaction with his or her social environment • Includes information on personality functioning, stressors, resources, etc. • Involves gathering information in order to form hypothesis  Psychosocial Assessment (direct) • Two direct procedures commonly used in psychosocial assessments include: – Assessment interviews • Central to process of assessment • May be structured or unstructured • May be supplemented with observation – Clinical observation of behavior • Observe client’s behavior, appearance • May be in office, home, school • May be open (natural) or controlled (analogue) Psychological Tests (indirect) • In addition to direct methods of assessment, psychologists may  utilize indirect methods of assessment through psychological tests • Tests are standardized procedures or tasks to obtain samples of  behavior – Allows for comparisons with others – Involves interpretation by clini
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