Clinical assessment, diagnosis, and treatment

Idiographic information - Information about a particular individual, as opposed to a larger population.

Clinical assessment - the systematic evaluation and measurement of psychological, biological, and social
factors in an individual presenting with a possible psychological disorder; used to determine whether,
how, and why a person is behaving abnormally and how that person may be helped. Enables clinicians
to evaluate people’s progress after they have been in treatment for a while and decide whether the
treatment should be changed. Three categories: clinical interviews, tests, and observations. To be
useful, these tools must be standardized and must have clear reliability and validity.
Characteristics of assessment tools:
 Standardization - The process in which a test is administered to a large group of people whose
performance then serves as a standard or norm against which any individual’s score can be
measured. In other words, it is the application of certain standards to ensure consistency across
different measurements
 Reliability - refers to the consistency of assessment measures. A good assessment tool will
always yield similar results in the same situation
o Test-retest reliability - the assessment tool yields similar results every time it is given to
the same people
o Interrater reliability – different judges independently agree on how to score and
interpret an assessment tool.
 Validity - A measure of the accuracy of a test or study’s results; it must accurately measure what
it is supposed to measure
o Face validity - A given assessment tool may appear to be valid simply because it makes
sense and seems reasonable.
o Predictive validity - a tool’s ability to predict future characteristics or behavior.
o Concurrent validity - the degree to which the measures gathered from one tool agree
with the measures gathered from other assessment techniques
Clinical interviews – core of most clinical work; the first contact between client and clinician. Clinicians
use it to collect detailed information about the person’s problems and feelings, lifestyle and
relationships, and other personal history. They may also ask about the person’s expectations of therapy
and motives for seeking it
 Unstructured interview – follows no systematic format; the clinician asks mostly open-ended
questions. The lack of structure allows the interviewer to follow leads and explore relevant
topics that could not have been anticipated before the interview
 Structured interview - made up of questions that have been carefully phrased and tested to
elicit useful information in a consistent manner, so clinicians can be sure they have inquired
about the most important aspects of particular disorders
 Mental status exam - a set of questions and observations that systematically evaluate the
client’s: 1) appearance and behavior, 2) thought process, 3) mood and affect, 4) intellectual
functioning, and 5) sensorium
 Limitations of clinical interview: 1) sometimes lack validity, 2) may make mistakes in
judgements as it heavily relies on first impressions, 3) may also lack reliability, particularly
unstructured interviews, and 4) different clinicians can obtain different answers and draw
different conclusions
Physical examination - If the patient presenting with psychological problems has not had a physical
exam in the past year, a clinician might recommend one, with particular attention to the medical
conditions sometimes associated with the specific psychological problem.
Behavioral assessment - using direct observation to formally assess an individual’s thoughts, feelings,
and behavior in specific situations or contexts. Target behaviors are identified and observed with the
goal of determining the factors that seem to influence those behaviors
 ABCs of observation
o Antecedents – what happened just before the behavior
o Behavior – the behavior itself
o Consequences – what happened afterwards
 Informal observation - relies on the observer’s recollection and on his or her interpretation of
the events
 Formal observation - involves identifying specific behaviors that are observable and measurable
 Self-monitoring - clients are instructed to observe themselves to find patterns
Clinical test - are devices for gathering information about a few aspects of a person’s psychological
functioning from which broader information about the person can be inferred.
o Projective tests - require that clients interpret vague stimuli, such as inkblots or ambiguous
pictures, or follow open-ended instructions such as “Draw a person.” Theoretically, when clues
and instructions are so general, people will “project” aspects of their personality into the task.
Projective tests are used primarily by psychodynamic clinicians to help assess the unconscious
drives and conflicts they believe to be at the root of abnormal functioning
o Rorschach test (1921) – Hermann Rorschach. Contains 10 inkblot pictures that serve as
the ambiguous stimuli. Clinicians administer the “Rorschach,” as it is commonly called,
by presenting one inkblot card at a time and asking respondents what they see, what
the inkblot seems to be, or what it reminds them of.
o Comprehensive system – Exner (2003). System of administering and scoring the
Rorschach specifies how the cards should be presented, what the examiner
should say, and how the responses should be recorded
o Thematic apperception test (1935) – Christiana Morgan and Henry Murray. Consists of a
series of 31 cards: 30 with pictures on them and 1 blank card, although only 20 cards are
typically used during each administration. Individuals are asked to make up a dramatic
story about each card. They must tell what is happening in the picture, what led up to it,
what the characters are feeling and thinking, and what the outcome of the situation will
be.
o Sentence completion test - the test-taker completes a series of unfinished sentences,
such as “I wish . . .” or “My father . . .” The test is considered a good springboard for
discussion and a quick and easy way to pinpoint topics to explore
o Draw-a-person test - individuals are first told to draw “a person” and then are
instructed to draw a person who is not the same sex
o Personality inventories - A test, designed to measure broad personality characteristics,
consisting of statements about behaviors, beliefs, and feelings that people evaluate as either
characteristic or uncharacteristic of them.
o Minnesota Multiphasic Personality Inventory (MMPI) - consists of more than 500 self-
statements, to be labeled “true,” “false,” or “cannot say.” The statements cover issues
ranging from physical concerns to mood, sexual behaviors, and social activities.
Individual responses on the MMPI are not examined; instead, the pattern of responses
is reviewed to see if it resembles patterns from groups of people who have specific
disorders (e.g., a pattern similar to a group with schizophrenia). MMPI consisted of 550
items while the current MMPI-2 has 567 items.
 o Hypochondriasis (abnormal concern with bodily functions), depression
(extreme pessimism and hopelessness), hysteria (The person may use physical
or mental symptoms as a way of unconsciously avoiding conflicts and
responsibilities), psychopathic deviate (a repeated and gross disregard for social
customs and an emotional shallowness), masculinity-femininity (separates male
and female respondents), paranoia (abnormal suspiciousness and delusions of
grandeur or persecution), schizophrenia (bizarre or unusual thoughts or
behavior), hypomania (emotional excitement, overactivity, and flight of ideas),
and social introversion (shyness, little interest in people, and insecurity)
o Response inventories - Tests designed to measure a person’s responses in one specific area of
functioning, such as affect, social skills, or cognitive processes.
o Affective inventories - measure the severity of such emotions as anxiety, depression,
and anger.
o social skills inventories - used particularly by behavioral and family-social clinicians,
respondents indicate how they would react in a variety of social situations.
o cognitive inventories - reveal a person’s typical thoughts and assumptions and can help
uncover counterproductive patterns of thinking
o Psychophysiological test - A test that measures physical responses (such as heart rate and
muscle tension) as possible indicators of psychological problems
o Polygraph (lie detector) - Electrodes attached to various parts of a person’s body detect
changes in breathing, perspiration, and heart rate while the person answers questions.
o Neuroimaging and neuropsychological test
o Neuroimaging techniques - designed to measure brain structure and activity directly

o Electroencephalogram (EEG) - records brain waves, the electrical activity that

takes place within the brain as a result of neurons firing. In an EEG, electrodes
placed on the scalp send brain-wave impulses to a machine that records them.
o Images of brain structure
 Computerized axial tomography (CT scan or CAT scan) - X rays of the
brain’s structure are taken at different angles and combined
 Magnetic resonance imaging (MRI) - a procedure that uses the
magnetic property of certain hydrogen atoms in the brain to create a
detailed picture of the brain’s structure
o Images of brain functioning
 Positron emission tomography (PET scan) - a computer-produced
motion picture of chemical activity throughout the brain
 Functional magnetic resonance imaging (fMRI) - converts MRI pictures
of brain structures into detailed pictures of neuron activity, thus offering
a picture of the functioning brain.
o Neuropsychological tests - measures cognitive, perceptual, and motor performances on
certain tasks; clinicians interpret abnormal performances as an indicator of underlying
brain problems. Clinicians often use a battery, or series, of neuropsychological tests,
each targeting a specific skill area
 Bender-Visual Motor Gestalt Test - consists of nine cards, each displaying a
simple geometrical design. Patients look at the designs one at a time and copy
each one onto a piece of paper. Later they try to redraw the designs from
 memory. Notable errors in accuracy by individuals older than 12 are thought to
reflect organic brain impairment.
 Luria Nebraska Neuropsychological Battery – a standardized test that identifies
neuropsychological deficiencies by measuring functioning on fourteen scales. It
evaluates learning, experience, and cognitive skills. Designed to provide
information useful in the diagnosis and treatment of brain damage or
dysfunction.
 Halstead Reitan Neuropsychological Battery - used to assess the condition and
functioning of the brain, including etiology, type (diffuse vs. specific), localization
and lateralization of brain injury.
o Intelligence tests - A test designed to measure a person’s intellectual ability.
o Intelligence - the capacity to judge well, to reason well, and to comprehend well
o Binet-Simon intelligence test – Alfred Binet and Theodore Simon. Consists of a
series of tasks requiring people to use various verbal and nonverbal skills. First
test of intelligence, developed to identify children who might have difficulty in
school. Developed the concept of mental age in children.
 Stanford-Binet Test – Lewis Terman’s adaptation of the Binet-Simon
test. Introduced a score known as intelligence quotient (IQ). Mental
age/chronological age X 100. Current tests use what is called deviation
IQ; a person’s score is compared only with scores of others of the same
age.
o Weschler test – David Weschler. Contains verbal scales (measures vocabulary,
knowledge of facts, short-term memory, and verbal reasoning skills) and
performance scales (assess psychomotor abilities, nonverbal reasoning, and
ability to learn new relationships). Wechsler Adult Intelligence Scale (WAIS-IV),
Wechsler Intelligence Scale for Children-Fifth Edition (WISC-5), and Wechsler
Preschool and Primary Scale of Intelligence Revised (WPPSI-IV)

Diagnosis - the process of determining whether the particular problem afflicting the individual meets
the criteria for a psychological disorder, as set forth in the DSM-5-TR; A determination that a person’s
problems reflect a particular disorder
o Comorbidity – when individuals are often diagnosed with more than one psychological disorder
at the same time
Classification systems - A list of such categories, or disorders, with descriptions of the symptoms and
guidelines for assigning individuals to the categories
 Syndrome – cluster of symptoms
 Emil Kraepelin - developed the first modern classification system for abnormal behavior. His
categories formed the foundation for the Diagnostic and Statistical Manual of Mental Disorders
(DSM), the classification system currently written by the American Psychiatric Association.
 International Classification of Diseases (ICD) - developed by the World Health Organization,
which lists both medical and psychological disorders.
 Classification approaches to diagnosis
o Classical categorical approach - originated from the work of Emil Kraepelin.
Assumption: every diagnosis has a clear underlying pathophysiological cause, such as a
bacterial infection or a malfunctioning endocrine system, and that each disorder is
unique. When diagnoses are thought of in this way, the causes could be psychological or
 cultural, instead of pathophysiological, but each disorder has only one set of causative
factors that do not overlap at all with other disorders.
o Dimensional approach - noting the variety of cognitions, moods, and behaviors with
which the patient presents and quantify them on a scale
o Prototypical approach - identifies certain essential characteristics of an entity so you
(and others) can classify it, but it also allows for certain non-essential variations that do
not necessarily change the classification. Thus, requiring a certain number of
prototypical criteria and only some of an additional number of criteria is adequate.
DSM-5 (2013)
 lists more than 500 mental disorders. Each entry describes the criteria for diagnosing the
disorder and the key clinical features of the disorder. The system also describes features that are
often but not always related to the disorder. The classification system is further accompanied by
background information such as research findings; age, culture, or gender trends; and each
disorder’s prevalence, risk, course, complications, predisposing factors, and family patterns.
 DSM-5 requires clinicians to provide both categorical and dimensional information as part of a
proper diagnosis.
o Categorical information - refers to the name of the distinct category (disorder)
indicated by the client’s symptoms.
o Dimensional information - a rating of how severe a client’s symptoms are and how
dysfunctional the client is across various dimensions of personality and behavior.
 DSM-5 is the first edition of the DSM to consistently seek both categorical and dimensional
information as equally important parts of the diagnosis, rather than categorical information
alone

Reference:

Barlow, D. H., Durand, V. M., Lalumiere, M. L., & Hofmann, S. G. (2021). Abnormal
psychology: An integrative approach. Nelson Education Ltd.

Comer, R. J. (2016). Fundamentals of Abnormal Psychology. Worth Publishers.