Introduction to clinical assessment

Clinical assessment

Clinical assessment refers to collecting information and drawing conclusions through the

use of observation, psychological tests, neurological tests, and interviews to determine the

person’s problem and the presenting symptoms. For a mental health professional to be able to

effectively help treat a client and know that the treatment selected worked (or is working), they

first must engage in the clinical assessment of the client. This collection of information involves

learning about the client’s skills, abilities, personality characteristics, cognitive and emotional

functioning, the social context in terms of environmental stressors that are faced, and cultural

factors particular to them such as their language or ethnicity. Clinical assessment is not just

conducted at the beginning of the process of seeking help but throughout the process. Methods

employed in clinical assessment involve collecting, evaluating, and interpreting data from

multiple sources. Most often, the decisions and treatment recommendations derived from clinical

assessment are applied to an individual patient or client who is the focus of therapeutic

intervention efforts.

Methods of assessment

Clinical interview: A clinical interview is a face-to-face encounter between a mental

health professional and a patient in which the former observes the latter and gathers data about

the person’s behavior, attitudes, current situation, personality, and life history. The interview

may be unstructured in which open-ended questions are asked, structured in which a specific set

of questions according to an interview schedule are asked, or semi-structured, in which there is a

pre-set list of questions but clinicians are able to follow up on specific issues that catch their

attention. A mental status examination is used to organize the information collected during the
interview and to systematically evaluate the client through a series of observations and questions

assessing appearance and behavior, thought processes and content, mood and affect, intellectual

functioning, and awareness of surroundings. The exam covers areas not normally part of the

interview and allows the mental health professional to determine which areas need to be

examined further. The limitation of the interview is that it lacks reliability, especially in the case

of the unstructured interview.

Physical Examination

Many mental health professionals recommend the patient see their family physician for a

physical examination which is much like a check-up. Some organic conditions, such as

hyperthyroidism or hormonal irregularities, manifest behavioral symptoms that are similar to

mental disorders and so ruling such conditions out can save costly therapy or surgery. It includes

both general examination and special examination.

Classification of clinical assessment:

Psychological test:

Psychological tests are used to assess the client’s personality, social skills, cognitive abilities,

emotions, behavioral responses, or interests and can be administered either individually or to

groups.

Projective tests consist of simple ambiguous stimuli that can elicit an unlimited number

of responses. The Rorschach test or inkblot test and the Thematic Apperception Test are two

projective tests which require the individual to write a complete story about each of 20 cards
shown to them and give details about what led up to the scene depicted what the characters are

thinking, what they are doing, and what the outcome will be. From these responses, the clinician

gains perspective on the patient’s worries, needs, emotions, conflicts.  Another projective test is

the sentence completion test  and asks individuals to finish an incomplete sentence. Examples

include ‘My mother’ …. Or ‘I hope.’

Personality inventories ask clients to state whether each item in a long list of statements

applies to them, and could ask about feelings, behaviors, or beliefs. Examples include the MMPI

or Minnesota Multiphasic Personality Inventory and the NEO-PI-R which is a concise measure

of the five major domains of personality – Neuroticism, Extroversion, Openness, Agreeableness,

and Conscientiousness. Six facets define each of the five domains and the measure assess

emotional, interpersonal, experimental, attitudinal, and motivational styles. These inventories

have the advantage of being easy to administer by either a professional or the individual taking

it, are standardized, objectively scored, and are completed either on the computer or through

paper and pencil. That said, personality cannot be directly assessed and so you can never

completely know the individual on the basis of these inventories. Other personality tests are-

MBTI-Myers–Briggs Type Indicator, 16PF- sixteen personality factor questionnaire, CPS-

Comrey Personality Scales, etc.…

Rating scale test

A rating scale is a set of categories designed to elicit information about a quantitative attribute in

social science. In psychometrics rating scales are often referenced to statement which expresses

an attitude or perception toward something. Rating scale is used by the observer or the examiner

while conducting the test. It is also used by the individuals during the self- repot tests. Rating
scale allow the convenient characterization of other people and their behaviour. Rating scale is

one approach to secure judgments while answering the test. Rating scales present an observer

with scalar dimensions along which those who are observed are to be placed.

Beck’s Depression Rating Scale and Hamilton Rating Scales are commonly used to measure

depression. Anxiety can be measured on State and Trait Anxiety Scale and Hamilton Anxiety

Scale.

Brief Psychiatric Rating Scale (BPRS) is the most widely used rating scale for recording

observations in clinical practice and in psychiatric research. Etc.….

Neurological Tests 

Neurological tests are also used to diagnose cognitive impairments caused by brain

damage due to tumors, infections, or head injury; or changes in brain activity. Positron Emission

Tomography or PET is used to study the brain’s functioning and begins by injecting the patient

with a radionuclide which collects in the brain. Patients then lie on a scanning table while a ring-

shaped machine is positioned over their head. Images are produced that yield information about

the functioning of the brain. Magnetic Resonance Imaging or MRI produces 3D images of the

brain or other body structures using magnetic fields and computers. They are used to detect

structural abnormalities such as brain and spinal cord tumors or nervous system disorders such as

multiple sclerosis. Finally, computed tomography or the CT scan involves taking X-rays of the

brain at different angles that are then combined. They are used to detect structural abnormalities

such as brain tumors and brain damage caused by head injuries.

Intelligence Tests

Intelligence testing is occasionally used to determine the client’s level of cognitive

functioning. Intelligence testing consists of a series of tasks asking the patient to use both verbal

and nonverbal skills. An example is the Stanford-Binet Intelligence test which is used to assess

fluid reasoning, knowledge, quantitative reasoning, visual-spatial processing and working

memory. These tests are rather time-consuming and require specialized training to administer. As

such, they are typically only used in cases where there is a suspected cognitive disorder or

intellectual disability. Intelligence tests have been criticized for not predicting future behaviors

such as achievement and reflecting social or cultural factors/biases and not actual intelligence.

Characteristics of assessment:

Important to the assessment process are three critical concepts – reliability, validity, and

standardization.

Reliability: the extent to which the obtained results are consistent or reliable. it describes the

degree to which an assessment measure produce the same result each time it is used to evaluate

the same thing.

Inter-rater reliability: Ensuring that two different raters are consistent in their assessments

is called interrater reliability.

Test retest reliability: when the same instrument is given to the group of people at two

different times and the results obtained is consistent both times.

Internal consistency: a measure based on the correlations between different items in each test.
 Split half reliability: it assesses the internal consistency of the test. This is done by

comparing the results of a test with the result of one half of a test with the result from the other

half. If the two halves of the test provide similar result this would suggest that the test has

internal reliability.

Validity: is the extent to which a measuring instrument actually measures what it is supposed to

measure.

Concurrent validity: the degree to which a test corresponds to an external criterion.

Predictive validity: A tool should also be able to accurately predict what will happen in

the future, called predictive validity.

Construct validity: to assess whether the test relates to the underlying theoretical

concepts.

Standardization: standardization is the process by which a psychological test is administered,

scored, and interpreted in a standard way it refers to the consistency and uniformity of how tests

are administered and scored. In order to compare one person to another on the same test, it is

important for the participants to have the same conditions under which they took the test and that

the scoring procedure is also the same. The standardization extends to exact materials given, time

limits and oral instructions.

Factor to consider while conducting the assessment

Assessments must always be conducted by a licensed psychologist or mental health

professional. They are the only professionals who can conduct a psychological assessment and

testing.
 A part of thorough assessment of an individual is they undergo a medical examination. It

is helpful in the individual does this before assessment.

The client and the informant should be psychoeducated about the procedure of the assessment.

Reference:

 Alexis bridley, Daffin jr. Lee.W. (2020). Abnormal psychology 2nd edition. Washington

state university.

Retrieved from: https://opentext.wsu.edu/abnormalpsychology/chapter/3-1-clinical-assessment/

 Carlson. J. F. (2016). Encyclopedia of mental health (2nd edition). Retrieved from:

https://www.sciencedirect.com/topics/medicine-and-dentistry/clinical-assessment