Chapter 3

Assessment
Psychological Assessment: refers to a procedure by which clinicians
provide a formal evaluation using psychological tests, observation and
interviews which provide scorable information of the client’s
psychological functioning.

Clinical diagnosis: a general “summary classification” of the patient’s

symptoms following a clearly defined system such as the DSM V.

Note: Assessment is an ongoing process and may be important at

various points during treatment, not just in the beginning.
 Clinical Interview
Clinical Interview: a series of questions that clinicians administer in
face-to-face interaction with the client.

Unstructured interview: a series of open-ended questions aimed at

determining the client’s reasons for being in treatment, symptoms,
health status, family background and life history.
Areas covered in the clinical interview:
-Age and sex
-Reason for referral
-Education and work history
-Current social situation
-Physical and mental health history
-Drug/alcohol use and current medications
-Family history
-Behavioral observations
Structured interview: standardized series of assessment questions with
a predetermined wording order.

The most widely used clinical interview:

The Structured Clinical Interview for DSM-V (SCID-5-RV and SCID-5-CV)
SCID-1 Axis 1 diagnosis
SCID-2 Axis 2 diagnosis
 Clinical Assessment and Psychological Tests
In order to fairly and successfully treat individual, the ethics code of the
American Psychological Association recommends that psychologists
consider various test factors that could affect judgments or reduce the
accuracy of interpretations.

Three major concepts in clinical assessment and tests include:

reliability, validity and standardization.
Reliability: the degree to which an assessment measure produces the
same result each time it’s used to measure the same thing.

Validity: the degree to which the instrument actually measures what

it is supposed to measure.
-Standardization: process by which an instrument is administered,
scored and interpreted is consistent and clearly specifies a test’s
instructions and scoring methods.

-Instrument must be applicable to all backgrounds and diversity.

-Must have trust and rapport between clinician and client.
-Must only disclose info for the purpose of assessment otherwise kept
confidential.
 Overall Assessment

1. General Physical Examination: general check up and med hx

2. Mental Status Examination: assess current state of mind

3. Neurological Examination: the process of gathering information

about a client’s brain functioning on the basis of personality tests
and other methods.
Neuropsychological assessment may include any of the following:

Electroencephalogram (EEG): records brain wave patterns.

Axial tomography (CAT) scan: Anatomical brain scan that reveals images
and parts of the brain that might be diseased. (Limited)
Magnetic resonance imaging (MRI): sharper images, easier.
Positron emission tomography (PET) scan: provides metabolic portraits
such as glucose as they are metabolized by the brain and other organs.
Functional MRI (fMRI): measures changes in blood flow and other
changes in specific areas of brain tissue.
The neuropsychological assessment may also include a standard set of
tests when looking for psychological competencies.
Common test: The Halstead-Reitan battery:
1. Halstead Category test: measures ability to learn and remember.
2. Tactual Performance test: measures motor speed, ability to learn
and use cues, response to the unfamiliar.
3. Rhythm test: measures attention and sustained concentration.
4. Speech Sounds Perception test: determines if individual can identify
spoken words, concentration, attention and comprehension.
5. Finger Oscillation test: measures the speed at which an individual
can depress a lever with the index finger.
Overall assessment continued….
4. Psychological Tests: scientifically developed standardized set of
procedures or tasks for obtaining samples of behavior.

Two categories of psychological tests:

Intelligence tests and Personality tests
Intelligence tests: tests for measuring the intellectual abilities for
children and adults.

Most widely used with children:

Stanford-Binet Intelligence test. (receive a deviation intelligence (IQ)
score in relation to others of similar age and gender)
WISC-IV: The Wechsler Intelligence scale for Children-Revised

Most widely used with adults:

WAIS-IV: The Wechsler Adult Intelligence Scale-Revised
Personality Tests: included projective and self-reports (objective)

Projective Personality tests: unstructured and rely on various

ambiguous stimuli such as inkblots or vague pictures rather then verbal
questions.

2 most popular: Rorschach and TAT

The Rorschach Inkblot Test: use of inkblots developed by Hermann
Rorschach (1884 – 1922) to uncover unconscious motivations.

The Thematic Apperception Test (TAT): 1935, series of simple

ambiguous pictures some highly representational and other abstract of
which the subject is instructed to make up stories.
Self-Reports (Objective Personality Tests): structured, typically
questionnaires, self-report inventories or rating scales in which
questions or items are carefully phrased and alternative responses are
specified as choices.
Standardized questions, fixed response categories, completed
independently.

Most common: the MMPI

MMPI Minnesota Multiphasic Personality Inventory: a self-report
questionnaire consisting of 550 items covering topics ranging from
physical condition and psychological states to moral and social
attitudes.
5. Behavioral Assessment: record actions rather than responses to rating scales
or questions.
Target behavior: what client and clinician wish to change
-in Vivo observation: method of recording behavior in its natural context.
(classroom, home)
-analog observations: method of recording behavior in a clinicians office or lab
designed for observing the target behavior.
-behavioral self-report: “ “ individual provides information about the frequency
of particular behaviors.
-self-monitoring: self-report technique, client keeps records of the frequency of
behavior.
-behavioral interviewing: assessment involving asking questions about
frequency, antecedents and consequences of behavior.
6. Multicultural Assessment: assessment process takes into account the
person’s cultural, ethnic and racial background.

Might need to re-evaluate all instruments to ensure range of

understanding.
 Chapter 4
Theoretical Perspectives
Theoretical perspective: an orientation to understanding the causes of
human behavior and the treatment of abnormality.

Theoretical perspectives include:

1. Biological
2. Psychological: Psychodynamic, Behavioral, Cognitive, Humanistic
3. Sociocultural
1. Biological perspective: belief that abnormalities in the body’s
functioning are responsible for symptoms of psychological disorders
(disturbances in emotions, behavior and cognitive processes).

Focuses on four categories of study:

2. Neurotransmitter and hormonal abnormalities in the brain and

central nervous system. (main part of the viewpoint)
Five neurotransmitters related to psychopathology: Norepinephrine,
dopamine, serotonin, glutamate and gamma aminobutyric acid (known
as GABA)
2. Genetic vulnerabilities

Behavior genetics: the field that focuses on studying the heritability

of mental disorders.

Utilizes three primary methods of study:

1. Family history
2. Twin method
3. Adoption method
3. Temperament: refers to the child’s reactivity and characteristic ways
of self-regulation. Thought to be the basis of personality formation.

4. Brain dysfunction neural plasticity: flexibility in the brain for making

changes in organization and function.

Rarely a primary cause of psychiatric disorders, however, advances in

brain study implicating sublet deficiencies of the brain with mental
disorders.
 Treatment
Biological therapies involve:
-psychotherapeutic medications
-psychosurgery: targets specific regions of the brain, sometimes by
producing a lesion in the area believed to be involved in the cause of
symptoms to ultimately provide symptom relief.
Deep brain stimulation (DBS) also called Neuromodulation: a
microelectrode that delivers a constant low electrical stimulation is
implanted in a small region of the brain, powered by an implanted
battery to trigger responses as needed.
-electroconvulsive therapy (ECT): application of electrical shock to the
head to induce therapeutically beneficial seizures.
2. Psychological Perspectives

Psychodynamic perspective: first systematic approach to showing

how human psychological processes can result in mental disorders.
Emphasized the role of the unconscious motives and thoughts which
determined both normal and abnormal behavior.

Structures of personality: Id, Ego, Super Ego, Defense Mechanisms,

Psychosexual stages of development, Oedipus and Electra complex.
Began with the psychoanalytical perspective and later the
psychodynamic perspective as a result of moderations from theories
such as Yung, Adler, Horney, Erikson and Ainsworth.

Treatment: Psychoanalysis/psychodynamic therapy.

Psychoanalysis: Unconscious
Psychodynamic: Unconscious plus conscious wishes
Behavioral perspective: mental disorders are the result of maladaptive
behaviors.
Studied direct, observable behavior and offer explanations for explaining
and treating maladaptive behavior.

Pavlov: Classical Conditioning

Thorndike/Skinner: Operant conditioning
Treatment: counter conditioning
-systematic desensitization
-contingency management
-token economy
-participant modeling
Cognitive Perspective: assumes abnormality is caused by maladaptive
thought processes that result in dysfunctional behavior.

Treatment: psychotherapy
Change maladaptive thinking”
Stable to temporary
Global to specific
Internal to external
Cognitive Behavioral Perspective: focuses on how thoughts and
information processing can become distorted and lead to maladaptive
emotions and behavior.

Treatment
Combined behavioral and cognitive methods.
Humanistic Perspective: known as the 3rd force in psychology, people
are motived to strive for self fulfillment and meaning in life.
Emphasizes that disorders arise when people are unable to experience
living in the moment, to fully appreciate each moment as it occurs.

Ultimately due to modern society imposing restrictions on our ability to

express our inner selves.

Maslow & Rogers

Treatment: self-realization, unconditional positive regard, motivational

interviewing.
Sociocultural perspective: emphasizes the ways that individuals are
influenced by people, social institutions and social forces in the world
around us.

Causal factors: low socioeconomic status/unemployment,

prejudice/discrimination, social change and uncertainty, urban
stressors/ violence and homelessness, early deprivation or trauma,
inadequate parenting styles, marital discord and divorce, maladaptive
peer relationships.

Treatment: family therapy, group therapy and CBT