Chapter 14

Clinical and Counseling

Assessment

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Clinical and Counseling Assessment
• Clinical psychology: the branch of psychology
that has its primary focus the prevention,
diagnosis, and treatment of abnormal behavior
with a focus on the more severe forms of
psychopathology
– Clinical psychologists receive training in
psychological assessment and psychotherapy
– These professionals are employed in hospitals,
mental health centers, independent practice, and
academia

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Clinical and Counseling Assessment

• Counseling psychology: a branch of

psychology that shares similar concerns
with clinical psychology, but instead
focuses on the more “everyday” concerns of
human life (e.g., marriage, family,
academics, and career)
• The tools employed by both branches of
psychology overlap considerably
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 An Overview
• Various questions addressed through the use
of assessment tools in clinical or counseling
psychology include:
– Does this patient have a mental disorder?
– What is the diagnosis?
– What is this person’s current level of functioning?
– How does their current level of functioning
compare with others in their cohort?
– What type of treatment can benefit this individual?
– How can this person’s personality best be
described?
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 An Overview
Does this person have a mental disorder?
• Clinical assessment may be undertaken for various
reasons and to answer a variety of questions
• For clinical psychologists, assessment tools may be
used to clarify the problem, make a diagnosis, or
design a treatment plan
• Data derived may confirm or refute a clinician’s
preliminary hypotheses based on the clinical
interview

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 An Overview
What is this person’s current level of functioning?
• Premorbid functioning: the level of
psychological and physical performance prior to
the development of a disorder, illness, or
disability
• Periodic testing with various instruments can
also provide information about the kinds of
activities the patient should pursue and avoid

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 An Overview
What type of treatment can benefit this
individual?
• Not all individuals that seek psychotherapy are
suffering from a mental disorder.
• Many people seek psychotherapy for purposes
of personal growth or support in coping with a
difficult life circumstance.

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 The Diagnosis of Mental
Disorders
• Frequently, assessment tools are used to make
diagnoses
• The American Psychiatric Association’s Diagnostic
Statistic Manual (DSM) is the primary reference
source for diagnosis.
• The DSM-IV-TR names and describes all known
mental disorders and includes a category called
Conditions not attributable to a mental disorder
that are a focus of attention or treatment.

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 The Diagnosis of Mental
Disorders
• Much controversy surrounds the utility of the DSM
– It is firmly rooted in the medical model and thus
discounts patterns of thinking and behavior, concepts
arguably central to mental health.
– Different clinicians interviewing the same patient may
produce different diagnoses based on their
interpretation and use of the DSM.
– The DSM may be culturally insensitive and thus offers
limited use in diverse populations.

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 The Diagnosis of Mental
Disorders
• Proponents of the DSM believe it offers a wealth
of information.
– Perfect inter-diagnostician reliability cannot be
achieved due to the nature of the subject matter.
– Supporters maintain that the diagnostic system is
useful as a guide, whether or not any particular
diagnostic category is actually classifiable as a disease.
• DSM diagnoses are descriptive and atheoretical.

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 The Diagnosis of Mental
•
Disorders
Diagnoses are coded according to five axes:
– Axis I: Disorder of infancy, childhood, and adolescence;
dementias; substance use disorders; mood and anxiety
disorders; and schizophrenia. Also included are conditions
that may be the focus of treatment but are not cause for
diagnosis.
– Axis II: Mental retardation and personality disorders.
– Axis III: Physical conditions that may affect mental
functioning.
– Axis IV: Different problems or sources of stress, such as
financial, legal, marital, occupational, or other problems.
– Axis V: A global rating of overall functioning.
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 The Diagnosis of Mental
Disorders
• Evolutionary model of mental disorder
(Wakefield, 1992): a conceptualization of a
mental disorder as harmful failure of internal
mechanisms to perform their naturally-selected
functions
– Assumes a scientific judgment that such
evolutionary failure exists
– Involves a value judgment that this failure is
indeed harmful

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 The Diagnosis of Mental
Disorders
• Schjelderup-Ebbe (1921) coined the term
“pecking order” when observing the behaviors of
defeated hens in dominance contests.
– His observation is directly relevant to
evolutionary views of psychopathology.
– He observed that hens, when defeated, became
severely withdrawn; their behaviors were
similar to those displayed in depressed human
beings.

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 The Diagnosis of Mental
Disorders
• Social rank theory of depression (Price, 1969, 1972):
postulates the triggering of a yielding mechanism that
prompts the individual to disengage from competitive
endeavors, indicating that he is no longer a competitor
for resources and status
– This behavioral course has been termed an
“involuntary defeat strategy” (Sloman & Gilbert,
2000), which proves adaptive in the short-term but
is counterproductive when engaged for long
durations.

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 The Diagnosis of Mental
Disorders
• In development of the DSM-V, a DSM-V Research
Planning Conference convened in 1999.
– Planning work groups were created to examine
developmental issues, gaps in the current diagnostic system,
and cultural issues, among other topics.
• Between 2004 and 2008, 13 conferences were held to
address various questions and set the research agenda.
• From 2007 onward, the work groups met regularly to
discuss strengths and weakness of the DSM-IV and
review the literature.

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Proposed Changes in the DSM-V

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 The Interview in Clinical
Assessment
• A clinical interview may be conducted for
several reasons:
– To arrive at a diagnosis
– To pinpoint areas that must be addressed in
psychotherapy
– To determine whether an individual will harm
himself or others
– To guide decisions about what else needs to be
done to assess an individual

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 The Interview in Clinical
Assessment
• Types of interviews
– Interviews may be typed in respect to different
variables
• Content
• Structure
• Tone (e.g., stress interview)
• State of consciousness (e.g., hypnotic interview)

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 The Interview in Clinical
Assessment
• General interview questions
– Demographic data
– Reason for referral
– Medical history and present medical conditions
– Familial medical history
– Psychological history and present psychological
conditions
– History with medical or psychological professionals

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 The Interview in Clinical
Assessment
• Mental status examination
– An examination intended to screen for intellectual,
emotional, and neurological deficits
• Appearance
• Behavior • Sensorium
• Orientation • Affect
• Psychomotor activity • Mood
• State of consciousness • Personality
• Thought content • Memory
• Thought processes • Intellectual resources
• Judgment • Insight

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 Case History Data and Psychological
Tests
• Biographical and related data can be acquired from
interviewing the assessee and significant others in his
or her life.
– Additional sources of case history data include hospital,
school, military, and employment records as well as other
related documents.
• Some psychological tests are employed for diagnostic
purposes, while others are used to assess traits, states,
interests, and attitudes.

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 Culturally-Informed Psychological
Assessment
• An approach to evaluation that is keenly perceptive of
and responsive to issues of acculturation, values,
identity, worldview, language, and other culture-
related variables as they possibly impact the
evaluation process or interpretation of resulting data.
• ADRESSING: Age, Disability, Religion, Ethnicity,
Social status, Sexual orientation, Indigenous heritage,
National origin, Gender

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 Special Applications of Clinical
Measures
• Forensic psychological assessment: the theory
and application of psychological evaluation and
measurement in a legal context
– Dangerousness to oneself or others
• Tarasoff v. the Regents of the University of California
– Competency to stand trial
• Dusky v. United States
– Criminal responsibility
• Durham v. United States
– Readiness for parole or probation
– Diagnosis and evaluation of emotional injury
– Profiling 14-24
 Special Applications of Clinical
Measures
• Custody evaluation: a psychological
assessment of parents or guardians and their
parental capacity and/or of children and their
parental needs and preferences
– Evaluation of the parent
– Evaluation of the child
• Child abuse and neglect
– Physical signs of abuse and neglect
– Emotional and behavioral signs of abuse and
neglect 14-25
 The Psychological Report
• Psychological reports vary depending on their purpose
• Barnum effect: the finding that people tend to accept
vague personality descriptions as accurate descriptions of
themselves
• Clinical prediction: the application of a clinician’s own
training and clinical experience as a determining factor in
clinical judgment and actions
• Mechanical prediction: the application of empirically
demonstrated statistical rules and probabilities to the
computer generation of findings and recommendations

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