CLINICAL ASSESSMENT

Defining Normality and Abnormality

• Abnormality- mental disorders, psychiatric diagnosis, psychopathology

• What makes behavior abnormal?

• Personal distress to the individual (severe depression or panic disorder)

• Deviance from cultural norms (in many cases of schizophrenia)
• Statistical infrequency (rare disorders such as dissociative fugue)
• Impaired social functioning (social phobia, antisocial personality disorder)
• Jerome Wakefield a renowned scholar in the field of abnormal
psychology - put forth a simplified definition of mental disorders-
Harmful Dysfunction Theory

• ‘Harmful’ is a value term based on social norms

• ‘Dysfunction’ is a scientific term referring to the failure of a mental
mechanism to perform a natural function for which it was designed
by evolution
• Thus, the concept combines value and scientific components

• The theory proposes that in our efforts to determine what is abnormal,

we consider both scientific data (e.g. evolutionary data) and the social
values in the context of which the behavior takes place.
A Brief History: Before the DSM
• Abnormal behavior garnered attention long before the first version of
DSM appeared
• Discussion appears in writings of ancient Chinese, Hebrew, Egyptian,
Greek, and Roman societies
• Hippocrates (460-377 BCE) wrote extensively about abnormality
• He did not offer any supernatural explanation
• Instead, theories emphasized natural causes
• Specifically, imbalance of bodily fluids (blood, phlegm, black bile, and
yellow bile) as the underlying reason for various forms of mental illness.
• Fast forward to 19th Century
• Establishment of asylums in Europe and US
• Inpatient treatment settings gave opportunity to observe
• By-product: list of categories into which clients could be organized

• Philippe Pinel (France) - proposed specific categories such as melancholia,

mania, and dementia, among others.
• Emil Kraepelin- founding father of the current diagnostic system
• He labelled specific categories such as manic-depressive psychosis and dementia
praecox (roughly equivalent to bipolar disorder and schizophrenia, respectively).

• Most of Kraepelin’s specific terms have long since been replaced, but by offering
such specific terminology, he set a precedent for the creation of diagnostic terms
that eventually led to the Diagnostic and Statistical Manual of Mental Disorders
(DSM).
• In 1890, James McKeen Cattell coined the term mental tests.

• Alfred Binet
• French government asked Binet and collaborator Theodore Simon
to design a measure to assess children with cognitive deficits.
• 1905 Binet-Simon scale calculated intelligence quotient.
• 1916 Lewis Terman (US) translated it as Stanford-Binet Intelligence
Test, first widely available test of cognitive ability.

• During the late 1800s and early 1900s, the primary purpose of
diagnostic categories was the collection of statistical and census data.
• In the mid 1900s, the U.S. Army and Veterans’ Administration
developed their own early categorization system in an effort to
facilitate the diagnosis and treatment of soldiers returning from World
War II.
David Rapaport (Menninger Clinic)
His work at the Menninger Clinic became known for pioneering
advances in clinical psychology and psychoanalysis. Finally, Rapaport
became the founder and first secretary (1946-1949) of the newly
formed Division of Clinical and Abnormal Psychology of the American
Psychological Association.

 He introduced the use of test batteries in assessing different areas

of psychological functioning.
CLINICAL ASSESSMENT
ASSESSMENT
•SIMPLY MEANS:
•EVALUATION
 DEFINITION OF
CLINICAL ASSESSMENT

• “Clinical assessment is the process by which clinicians

gain understanding of the patient necessary for
making informed decisions.” (Korchin, 1976)
 PREFERRED TERMS FOR CLINICAL
ASSESSMENT
Psychodiagnosis

Diagnostic Psychological Testing

Psychiatric Evaluation
 DIAGNOSIS
Labeling or specifying a psychiatric label.

Diagnosis often involves a systematic study of the patient

through the use of specifically designed interviews, tests,
criteria, and observations.
 TEST BATTERY
A test battery includes:

Neuropsychological Tests

General Intelligence (IQ) Tests

Tests of Conceptual Thinking, Association, etc.

Projective Tests
 PURPOSE OF ASSESSMENT
To predict future behaviors

To diagnose

To provide baseline information

To evaluate the person after the treatment

To plan and guide therapeutic interventions.

 FOUR WAYS TO GAIN INFORMATION ABOUT
ANOTHER PERSON

• 1. Ask the person themselves.

• 2. Ask someone who knows the person.

• 3. Observe the person’s behavior as they behaves naturally.

• 4. Observe the person under standardized tests.

 DIFFERENCE BETWEEN TESTING AND
ASSESSMENT

• A test is a systematic procedure for observing behavior and

describing it with the aid of numerical scales or fixed categories.

• Assessment involves synthesizing information from many

sources, formulating an overall picture of the client and making
appropriate recommendations that take into account issues of
psychometrics, client history, culture, etc.
 STAGES IN THE
ASSESSMENT PROCESS

Preparation Input Processing Output

(Sundberg And Tyler, 1962)

Description of the Stages:

I. Planning the assessment

II. Data collection
III. Data processing
IV. Communicating findings
 ASSESSMENT PROCESSES
Formal Processes i.e.
Psychological Tests

Informal Processes i.e.

Interviews and Behavioural Observations
 METHODS OF ASSESSMENT
Psychological Tests –
 Standardized, valid, and reliable tests used for assessing
various psychological functioning.

Interviews –
 A conversation with purpose.

Behavioral Observations –
 Observations in Natural Settings
 Rating Scales/Checklists
 A-B-C Model
THE ASSESSMENT INTERVIEW
Interview conducted along with other tools (test battery or
behavioral observations) to evaluate and/or predict something
or to reach a decision.
STAGES OF INTERVIEW

Opening Middle Ending

CLINICAL INTERVIEW
• First encounter
• Foundation of all clinical procedures
• Ongoing process throughout therapy
• Commencement of a healing professional relationship
• Helps in rapport building
• Helps in gathering information and conceptualizing case.
BEHAVIORAL OBSERVATION
• Helps to formulate some diagnostic impressions.

• Focuses on direct observation of behavior-environment relations

• Purpose is to identify problematic behaviors, patterns, situations

and design a treatment plan accordingly.
 CLINICAL ASSESSMENT
• Any assessment technique used by a clinical psychologist should
possess the qualities of validity, reliability, and clinical utility (Wood,
Garb, & Nezworski, 2007).
1. Validity – is the extent to which the assessment technique measures
what it claims to measure.
2. Reliability – is the extent to which the assessment technique yields
consistent, repeatable results.
3. Clinical utility – is the extent to which the assessment technique
improves delivery of services or client outcome.
• Even the most valid and reliable test ever created wouldn’t be helpful
to a clinical psychologist if it didn’t benefit the clinician and ultimately
the client in some meaningful way.
 Of all the available clinical assessment procedures,
clinical psychologists rely most frequently on the clinical
interview.

The vast majority of clinical psychologists use interviews,

and few assessments are conducted without an interview
of some kind.
 THE INTERVIEWER
• A skilled interviewer is not only a master of the technical and
practical aspects of the interview but also demonstrates broad-
based wisdom about the human interaction it entails.
GENERAL SKILLS

• Quieting yourself (internal, self-directed thinking pattern)

• Being self-aware
• Developing positive working relationships
SPECIFIC BEHAVIORS

• LISTENING: Listening seems simple but includes certain attending

behaviors.

• Eye Contact
• Realize the connection between attentive listening and eye
contact. It not only facilitates but communicates listening.
Cultural differences.
• Body Language
• Face the client, appear attentive, minimize restlessness, display
appropriate facial expressions
 • Vocal Qualities
• How words sound to the client’s ears. Pitch, tone, volume, and
fluctuation.
• Verbal Tracking
• Repeating key words and phrases.
• Referring to the client by the proper name
• Using the client’s name correctly is essential. Ask in the first
interview how they would prefer to be addressed.

• Interviewer should carry out all these attending behaviors naturally and
authentically.
• Norms for physical touch also differ from culture to culture.
 INTERVIEW TECHNIQUE:
Directive Versus Nondirective Styles
• Directive questions tend to be targeted toward specific pieces of
information, and client responses are typically brief, sometimes as
short as a single word (e.g., “yes” or “no”). It can provide crucial
data on important historical information, the presence or absence
of a particular symptom of a disorder, frequency of behaviors and
duration of a problem, etc.
• Interviewers who use a nondirective style allow the client to
determine the course of the interview. Without direction from the
interviewer, a client may choose to spend a lot of time on some
topics and none on others.
 Pragmatics of the Interview
• Note Taking
• Audio and Video Recordings
• The Interview Room
• Confidentiality
ESSENTIAL ELEMENTS OF INTERVIEWS

Effective
Rapport Communication
Strategies
 RAPPORT
The sense of mutual trust and harmony that characterizes a good
relationship.

Rapport involves a comfortable atmosphere and a mutual

understanding of the purpose of the interview.

Establishing rapport: Conveying acceptance, understanding and

respect for the client.
 RAPPORT Contd.
• Strong rapport- client feels connected, discloses more information.

1. Put the client at ease. Engage in small talk about innocuous

topics (e.g. I haven’t been outside in a while- is it still cold out?).
2. Acknowledge client’s unique and unusual situation,
communicate empathy, invite clients to ask questions about
the process.
3. Notice how client uses language and follow the lead. Pick up
client’s vocabulary and speak as much in similar terms.
 EFFECTIVE COMMUNICATION
STRATEGIES
Open-Ended Questions Closed-Ended Questions

What did you think of the
movie?
How would you describe your
relationship with your parents?
Did you like the movie?
Do you have a good
relationship with your parents?
Listening Skills
Five Types of Interviewer’s Responses that Convey Listening:

Clarification

Confrontation

Paraphrasing

Reflection

Summarization
 CLARIFICATION

Definition/Purpose
Questioning that helps the
clinician understand an
ambiguous message.
Confirms the accuracy of the
clinician’s perception.
Example
“Are you saying that….”
“… do I have that right?”
“Could you please describe for
me…”
“I want to make sure I’m
understanding this correctly…”
 CONFRONTATION

Definition/Purpose Example
Used when there are
discrepancies or ‘Earlier you mentioned……but
inconsistencies in client’s then a few minutes ago… I am a
comments. bit confused’.
Focuses on contradictory
information.
 PARAPHRASING

Example
Definition/Purpose
Client: “School has always been
To help the client focus on the really difficult for me. I really
content of their message. have to work hard to do well. My
Restating client’s comments, grades have always been good
but it hasn’t been easy. Not like
using similar language. my sister. Megan has always just
To ensure client that the waltzed right through school. She
interviewer is paying attention just reads a chapter once and its
and comprehending. all there for her when test time
comes.”
Therapist: “So while you’ve done
well in school, you’ve had to work
very hard.”
 REFLECTION OF FEELING
Definition/Purpose
Describing the feelings of the
client’s message.
To encourage the client to
express more of his or her
feelings.
To have the client experience
feelings more intensely.
To help the client become more
aware of their feelings.
To help the client discriminate
accurately among feelings.
Example
Client: “Since I have had the
baby, my husband is always
busy at work and I have to do
everything by myself and it is
hard to keep up.”
Therapist: “It seems like you feel
overwhelmed by becoming a
new mother.”
 Paraphrasing and Reflection

Client: “Everything is humdrum. There’s nothing new going on,

nothing exciting. All my friends are away. I wish I had money to do
something different.”

Paraphrase: “With your friends gone and no money around, there is

nothing for you to do right now.”

Reflection: “You feel bored with the way things are for you right now.”
 SUMMARIZING
Definition/Purpose
To summarize client’s
comments.
Two or more paraphrases or
reflections that condense the
client’s message or the session.
To tie together multiple
elements of the client’s
message.
To identify a common theme.
To review progress.
Example
Clinician: “It seems as though
you are acknowledging that your
binging and purging have
become significant problems in
recent months, and while you’ve
kept it to yourself and you may
feel ashamed about it, you’re
willing to discuss it here with me
and you want to work toward
improving it.”
Final Summary and Ending the Interview
• At the conclusion of the interview, the clinician should attend to
the sensitive information that has been shared and may want to
thank the patient for sharing personal, potentially upsetting
experiences.
• The ending of the interview is also an opportunity to review
important themes addressed and provide a final summary to the
patient which recounts and highlights specific points including the
presenting problem.
• The clinician closes the interview by making sure they have enough
information for assessment as well as continuing to establish a
good rapport with the client.
 TYPES OF INTERVIEW
Diagnostic Interview
Mental Status Examination (MSE)
Intake Interview
Case History Interview
Crisis Interview
Interview with Informants
Research Interview
 DIAGNOSTIC INTERVIEW
• The purpose of the diagnostic interview is to diagnose.
• It includes questions that relate to the criteria of DSM disorders.
• At the end of a well-conducted diagnostic interview, the interviewer
is able to confidently and accurately assign DSM diagnoses to the
client’s problems.
• When an interview yields a valid, specific diagnosis, the
effectiveness of the recommendations and subsequent treatment
may be increased.
DIAGNOSTIC INTERVIEW
Structured diagnostic interviews specify:
Symptoms and disorders to be assessed.
Interview format.
Order of questions.
Wording of questions.
Guidelines for additional questions.
Structured Diagnostic Interviews
Clinicians:
Non-Clinician Interviewers:
Schedule for
• Diagnostic AffectiveSchedule
Interview Disorders and Schizophrenia (SADS) (semi-
(DIS)
structured)

• Structured Clinical Interview for DSM-IV (SCID) (semi-structured)

• Clinical Interview Schedule - Revised (CIS-R)

MENTAL STATUS EXAMINATION (MSE)
• Its primary purpose is to quickly assess how the client is functioning
at the time of evaluation.
• Does not delve into client’s personal history.
• Its yield is usually a brief paragraph that captures the psychological
and cognitive processes of an individual ‘right now’.
• A psychological snapshot.
• Level of functioning and self-presentation.
• Generally conducted during the initial session or intake interview.
• By systematically basing observations on verbal and non-verbal
behavior, it provides preliminary information about the likely
diagnosis experienced by the patient.
• Offers some direction for further assessment, case formulation and
intervention (e.g. referral to a specialist, admission to psychiatric
unit, and evaluation for medical problems that impact
psychological functioning).
• According to Daniel & Crider (2003), an MSE collects information
about the client’s

Physical Emotional Cognitive

State State State
 PHYSICAL
Appearance Motor Activity
Behavior
EMOTIONAL
Attitude Mood and Affect
COGNITIVE
Orientation Attention and Concentration
Memory Speech and Language
Thought (Form and Content) Perception
Insight and Judgment Intelligence and Abstraction
 INTAKE INTERVIEW
For the Clinician
 Determine the nature of the
client’s problems
 Determine the
appropriateness of services
offered
 Define problems to be worked
on and establish goals
 Balance gathering information
with establishing rapport
For the Client
 Determine
appropriateness of
services
 Find out about
psychologist’s fee,
procedures and policies
 CASE HISTORY/PSYCHOSOCIAL
INTERVIEW
• Sources of information other than the patient himself are utilized
when completing a personal and social history report.

• Information from friends, relatives, hospital, military, and other

records are also used for the history.

• But whatever the source of information, the purposes of the social

and personal history report is to gather information which will be
helpful in diagnosing and treating the patient's disorder.
• Detailed description of the client’s background which usually
includes:
• Birth and development
• Family of origin
• Education
• Employment
• Recreation/Leisure
• Sexual/dating/marital history
• Alcohol and drugs
• Physical health
 CRISIS INTERVIEW
• Crisis interview is when a person is brought in the middle of a crisis like
suicide, often a life-threatening situation.
• Hoff (1995) defines crisis as: “acute emotional upset arising from situational,
developmental, or sociocultural sources and resulting in a temporary
inability to cope by means of one’s usual problem-solving device.”
Goal: Method:
Resolve the problem to avoid Convey understanding.
catastrophic outcome. Projecting a calm and confident
Tasks: manner.
Provide reassurance.
Assess the problem at hand. Follow-up
Explore potential resources.
 INTERVIEW WITH CHILDREN
Developmental Milestones: Cognitive, Emotional, Motor, Speech.

Schooling: Teachers, Friends.

Family : Family, New Arrivals, Deaths, Siblings, Grandparents.

Others: Dreams, Interests, Fears.

PSYCHOLOGICAL TESTING
 DEFINITION OF A TEST

• It is a measurement instrument that consists of a sample of

behavior obtained under standardized conditions and evaluated
using established scoring rules.

• Tests are enormously varied in their formats and applications.

• Nonetheless, most tests possess these defining features:
• Standardized procedure:
• A test is considered to be standardized if the procedures for administering
it are uniform from one examiner and setting to another.
• Scores or categories:
• All participants are assumed to possess the trait or characteristic being
measured, albeit in different amounts.
• Norms or standards:
• An examinee’s test score is usually interpreted by comparing it with the
scores obtained by others on the same test.
• Norms—a summary of test results for a large and representative group of
participants.
• Prediction of non-test behavior:
• The purpose of a test is to predict additional behaviors, other than those
directly sampled by the test.
 NEUROPSYCHOLOGICAL TESTS
• Medical procedures such as computed tomography (CT), magnetic
resonance imaging (MRI), and positron emission tomography (PET) scans
can show certain part of the brain looks abnormal.
• Neuropsychological tests show how that part of the brain is actually
functioning.
• Such tests are especially useful for targeted assessment of problems that
might result from a head injury, prolonged alcohol or drug use, or a
degenerative brain illness.
• They can also be used to make a prognosis for improvement, plan
rehabilitation, determine eligibility for accommodations at school or
work, and establish a baseline of neuropsychological abilities to be used
as a comparison at a later time.
 NEUROPSYCHOLOGICAL TESTS
Focus on issues of cognitive or brain dysfunction, including the effects
of brain injuries and illnesses.

1. Bender Visual-Motor Gestalt Test (BG)

2. Slosson Drawing Coordination Test (SDCT)
3. Quick Neurological Screening Test (QNST)
 INTELLIGENCE TESTS
Clinical psychology has emphasized many abilities as central to intelligence:
Speed of Mental Process
Sensory Capacity
Abstract Thinking
Imagination
Adaptability
Capacity to Learn Through Experience
Memory
Reasoning
 INTELLIGENCE TESTS
1. The Wechsler Adult Intelligence Scale–Fourth Edition (WAIS-IV)
2. The Wechsler Intelligence Scale for Children–Fourth Edition (WISC-IV)
3. The Wechsler Preschool and Primary Scale of Intelligence–Third
Edition (WPPSI-III)
4. Stanford-Binet Intelligence Scales
5. Universal Nonverbal Intelligence Test (UNIT)
 ACHIEVEMENT TESTS

• They measure what a person has accomplished and learned.

• The discrepancy between IQ level and achievement is often
understood as “learning disability”.
 ACHIEVEMENT TESTS

1. Wechsler Individual Achievement Test (WIAT)

2. Wide Range Achievement Test – Fourth edition (WRAT-4)
 PERSONALITY TESTS
• Personality testing is a method of assessing human personality
constructs.
 PERSONALITY TESTS

1. Minnesota Multiphasic Personality Inventory – 2 (MMPI-2)

2. Rorschach Inkblot Method (ROR)
3. Thematic Apperception Test (TAT)
THANK YOU