e will focus in this chapter on the initial clinical assessment and on arriving at a clinical diagnosis according to DSM-IV-TR. Psychological assessment refers to a procedure by which clinicians, using psychological tests, observation, and interviews, develop a summary of the client's symptoms and problems. Clinical diagnosis is the process through which a clinician arrives at a general"summary classification" ofthe patient's symptoms by following a clearly defined system such as DSM-IV-TR or ICD-l0 (International Classification of Diseases) published by the World Health Organization.
example, to evaluate outcome. In the initial clinical assess- ment, an attempt is made to identify the main dimensions of a client's problem and to predict the probable course of events under various conditions. It is at this initial stage that crucial decisions have to be made-such
and so on. Sometimes these decisions must be made quickly, as in emergency conditions, and without critical information. As will be seen, various psychologi- cal measurement instruments are employedto maximize assessment efficiencyin this type of pretreatment examination process (Beutler & Harwood, 2002).
A less obvious but equally important function of pretreatment assessment is establishing baselines for various psychological functions so that the effects of treatment can be measured. Criteria based on these measurements may be established as part of the treatment plan such that the therapy is considered successful and is terminated only when the client's behavior meets thesepre- determined criteria. Also, as we will see in later chapters, comparison of post- treatment with pretreatment assessment results is an essential feature of many research projects designed to evaluate the effectiveness of varioustherapies.
In this chapter, we will review some of themore com- monly used assessment procedures and show howthe data obtained canbe integrated into a coherent clinical picture for making decisions about referral and treat- ment. Our survey will include adiscussion of neurologi- cal andneuropsychological
assessment through theuseof projective and objective psychologicaltests.Later in this chapter wewill examine the process of arriving at a clinical diagnosis using DSM-IV-TR.
howis the person dealing with the problem? What, if any, prior help has been sought? Are there indications of self- defeating behavior andpersonality deterioration, or isthe
presentingproblem for a number of reasons. In many cases, aformal diagnosisis necessary beforeinsurance claims can be filed. Clinically, knowledge of a person's type ofdisorder canhelp inplanning andmanaging the appro-
among the patient orclient population and for which treatmentfacilities need to beavailable. If most patients at a facility have been diagnosed as having personality disor- ders, for example, thenthe staffing, physical environment,
intellectual functioning, personality characteristics, and environmental pressures and resources. That is, an ade- quate assessment includes much more than the diagnostic label.Forexample, itshould includean objective descrip- tion of the person's behavior. How does the person charac- teristicallyrespond toother people? Are there excesses in behavior present,suchas eating or drinking too much? Are there notable deficits, forexample, in social skills? How appropriate is the person's behavior? Is the person mani- festing behavior thatisplainly unresponsive or uncooper- ative? Excesses, deficits, and appropriateness
description of any relevant long-term personality charac- teristics. Has the person typically responded in deviant ways to particular kindsof situations-for
example, those requiring submission to legitimateauthority? Are there personality traitsor behavior patterns that predispose the
tend to become enmeshedwith others to the point of los- ing his or her identity, or is he or she so self-absorbed that intimate relationships are not possible? Is the person able to accept helpfromothers? Is the person capable of gen- uine affectionand ofaccepting appropriate responsibility
son, andwhat supportsor special stressors exist in his or her life situation? For example, being the primary care- takerfora spouse suffering fromAlzheimer's disease isso challenging that relatively few people can manage the task
because it not only describes the current situation butalso includes hypotheses about what is driving the person to behave in maladaptive ways. At this point in the assess- ment, theclinicianshould havea plausible explanation for why a normally passive and mild-mannered man suddenly flew into a rage andstarted breaking up furniture, for example. The formulationshould allowthe clinician to develop hypotheses about the client's future behavioras well. What is the likelihood of improvement or deteriora- tion if the person's problems are left untreated? Which behaviors should be the initial focus of change, andwhat treatment methods are likely to be mostefficientin pro- ducing this change? How much change might be expected from a particular type of treatment?
Where feasible, decisions about treatment are made collaboratively with the consent and approval of the indi- vidual. In cases ofsevere disorder, however, they may have to be made without the patient's participation or, in rare instances, even without consulting responsible family members. As has already beenindicated, knowledge of the patient's strengths and resources is important; in short, what qualities does the patient bring to treatment that can
assessment may involve the coordinated use of physical, psychological, and environmentalassessment procedures. As we have indicated, however, the natureand comprehen- siveness ofclinical assessments vary withthe problemand the treatmentagency's facilities.Assessment by phone ina
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