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Jedidiah K.

Singco
ASSESSMENT AND DIAGNOSIS MA Psych II
Psych 274
WHY DO CLINICAL PSYCHOLOGISTS DO
ASSESSMENT?
Clinical practitioners' main focus when faced with new clients is to
gather idiographic, or individual, information about them (Kral
et al., 2011). To help persons overcome their problems, clinicians
must fully understand them and their particular difficulties.
To gather such individual information, clinicians use the procedures
of assessment and diagnosis. Only then are they in a position to
offer treatment.
ASSESSMENT VS. DIAGNOSIS
Psychological assessment (clinical context) — Is used to answer the
following questions:
 How and why is the person behaving abnormally?
 How can this person be helped?
 How is the client’s progress?
 Should the treatment/intervention be changed or modified?
ASSESSMENT VS. DIAGNOSIS
Clinical diagnosis—The process by which the clinician arrives at an
diagnosis
 Formal diagnosis is made when the nature, frequency and duration of
the patient’s symptoms fulfil criteria set out in one of two medical
classification systems: The DSM 5 (Diagnostic and Statistical Manual of
Mental Disorders) and the ICD-10 (International Classification of Disease).
 The basis of diagnosis is symptoms—the physical and/or mental aspects of a
health issue.
TOOLS IN CLINICAL
ASSESSMENT
Neurological Tests
NEUROPSYCHOLOGICAL
TESTS
PROJECTIVE
PERSONALITY
TESTS
OBJECTIVE
PERSONALITY TESTS
INTELLIGENCE
TESTS
DIRECT OBSERVATION
INTERVIEWS
THE SPECIFIC TOOLS USED IN AN ASSESSMENT
DEPEND ON A CLINICIAN’S THEORETICAL
ORIENTATION.
1. Psychiatrists are biologically oriented practitioners.
2. Psychoanalytically oriented clinicians may prefer to use unstructured
assessment methods.
3. Behaviorally oriented clinicians determine the functional relationships
between environmental events, consequences, and behaviors.
4. Cognitively oriented clinicians focus on dysfunctional thoughts.
5. Humanistically oriented clinicians may use interview techniques to
uncover blocked or distorted personal growth.
6. Interpersonally oriented clinicians may use behavioral observations to
identify problematic relationships.
PUTTING IT ALL TOGETHER: THE
INTEGRATION OF ASSESSMENT DATA
A. Integration of assessment data prior to treatment allows the
clinician to formulate a plan for treatment and allows for the
discovery of gaps or discrepancies in knowledge about the
client.
B. Additional assessment data collected during treatment can allow
the clinician to determine how effective treatment is and allow for
modification to improve success.
C. Once complete, the assessment will help establish either a
tentative or definitive diagnosis.
DIAGNOSIS: DOES THE CLIENT’S SYNDROME
MATCH A KNOWN DISORDER?
1. Presenting problem - Major symptoms or behaviors the
client is experiencing
2. Signs – Are objective observations that the psychologist
may make either directly or indirectly
3. Symptoms - Refers to the patient’s subjective
description and the complaints he or she is experiencing
4. Syndrome – Refers to a cluster of symptoms
DIAGNOSIS: DOES THE CLIENT’S SYNDROME
MATCH A KNOWN DISORDER?
The principle behind diagnosis is straightforward. When
certain symptoms occur together regularly and follow a
particular course, clinicians agree that those symptoms
make up a particular mental disorder.
If people display this particular pattern of symptoms,
diagnosticians assign them to that diagnostic category.
DIAGNOSIS: DOES THE CLIENT’S SYNDROME
MATCH A KNOWN DISORDER?
A. Using all available information, clinicians attempt to paint a
“clinical picture”
- This picture is influenced by their theoretical orientation
B. Using assessment data and the clinical picture, clinicians attempt
to make a diagnosis— a determination that a person’s
psychological problems constitute a particular disorder
C. Classification systems are lists of categories, disorders, and
symptom descriptions, with guidelines for assignment, focusing on
clusters of symptoms (syndromes) upon which diagnosis is based.
DIAGNOSIS: DOES THE CLIENT’S SYNDROME
MATCH A KNOWN DISORDER?
There are two major
classification systems used
today. One, the ICD-10, is
used widely is Europe. The
DSM-5 is used in the United
States. Both systems are
similar in that they focus on
symptoms and define
problems into different
facets.
3 MAJOR APPROACHES IN CLASSIFYING MENTAL
DISORDERS
1. CATEGORICAL - We have particular defining criteria,
which everybody in the category or in the group should
meet.
 Emil Kraepelin was the first psychiatrist who classified
psychological disorders from a biological or medical point of
view. For Kraepelin, in terms of physical disorders, we have one
set of causative factors which do not overlap with other
disorders.
3 MAJOR APPROACHES IN CLASSIFYING MENTAL
DISORDERS
2. DIMENSIONAL - We note the variety of cognitions,
moods, and behaviors with which the patient presents
and quantify them on a scale.
 For example, on a scale of 1 to10, a patient might be rated
as severely anxious (10), moderately depressed (5), and
mildly manic (2) to create a profile of emotional functioning
(10, 5, 2).
3 MAJOR APPROACHES IN CLASSIFYING MENTAL
DISORDERS
3. PROTOTYPAL – We identify essential characteristics of
a disorder and allows for certain non-essential
variations that do not necessarily change the
classification.
 With this approach which classifies the disorder by different
possible features or properties, the person must meet (not
necessarily all of) them to fall in that category.
3 MAJOR APPROACHES IN CLASSIFYING MENTAL
DISORDERS
The categorical system has been questioned in recent years, as
the categories do not always result in within-class homogeneity
or between-class discrimination. This, in turn, can lead to high
levels of comorbidity among disorders. Several possible
solutions to this problem include dimensionalizing the phenomena
of mental disorder and the adoption of a prototypal approach
to the organization of the field.
For all of its problems, however, knowledge of the DSM-5 is
essential to serious study in the field of abnormal behavior.
IS DSM 5 AN EFFECTIVE CLASSIFICATION
SYSTEM?
1. A classification system, like an assessment method, is
judged by its reliability and validity.
2. Reliability in this context means that different clinicians are
likely to agree on a diagnosis using the system to diagnose
the same client.
3. Validity in this context means an accuracy of the
information that its diagnostic categories provide;
predictive validity is of the most use clinically.
CAN DIAGNOSIS AND LABELLING CAUSE HARM?
1. Misdiagnosis is always a concern
because of the reliance on clinical
judgment.
2. Also present is the issue of
labelling and stigma; for some,
diagnosis may be a self-fulfilling
prophecy.
REFERENCES
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (DSM-5®). American Psychiatric Pub.
Comer, R. J. (2010). Abnormal psychology. Macmillan.
Kessler, R. C. (2002). The categorical versus dimensional assessment controversy in the
sociology of mental illness. Journal of Health and Social Behavior, 171-188.
Kral, M. J., Idlout, L., Minore, J. B., Dyck, R. J., & Kirmayer, L. J. (2011). Unikkaartuit:
meanings of well-being, unhappiness, health, and community change among
Inuit in Nunavut, Canada. American journal of community psychology, 48(3-4),
426-438.