1. The document provides information on clinical assessment and diagnosis of psychological disorders. It discusses various assessment tools including clinical interviews, tests, and observations that are used to evaluate a client's behavior and determine if it meets criteria for a known disorder. 2. Standardized assessment tools are important to have reliability and validity. Clinical interviews allow an in-depth exploration of a client's history and current issues. Psychological tests evaluate traits, symptoms, and cognitive abilities. 3. Assessment data is used to form a diagnosis based on the DSM classification system to determine if a client matches criteria for a known disorder and identify an appropriate treatment plan.

1. Imagine for a moment that you are a successful psychologist. A person comes to see you
because he’shaving a problem.How would you treat him?How do you evenknow what’s
wrong with him?
I. CLINICAL ASSESSMENT: HOW AND WHYDOES THE CLIENT BEHAVE ABNORMALLY?
A. What isassessment?
1. Assessmentisthe collectingofrelevantinformationinanefforttoreachaconclusion
 Clinical assessment is used to determine how and why a person is behaving
abnormallyandhowthat personmaybe helped
 The focus of assessmentisidiographic,thatis,onan individual person
 Assessmentsalsomaybe usedtoevaluate treatmentprogress
B. The specifictoolsusedinanassessmentdependonaclinician’stheoretical
orientation
C. Hundreds of clinical assessment tools have been developed and fall into
three categories:
1. Clinical interviews
2. Tests
3. Observations
II. CHARACTERISTICS OF ASSESSMENT TOOLS
A. To be useful,assessmenttoolsmustbe standardizedandhave clearreliabilityand
validity
B. To standardize a technique is to set up common steps to be followedwhenever
it isadministered
1. One muststandardize administration,scoring,andinterpretation
C. Reliabilityreferstothe consistencyof atest;agoodtestwillalwaysyieldthesame
resultsinthe same situation.There are twomaintypesof reliability:
1. Test-retestreliability
 To test for this type of reliability, participants are tested on two
occasionsand the scoresare correlated
 Because a good test will yield the same results in the same
situation, the higher the correlation, the greater the test’s
reliability
2. Interraterreliability
 Different judges independently agree on how to score and
interpretaparticulartest
D. Validityreferstothe accuracy of a test’sresults
 A goodtest mustaccuratelymeasure what it issupposedtobe measuring. There are
three specifictypesof validity:
1. Face validity—a test appears to measure what it is supposedto measure; does
not necessarilyindicatetrue validity
2. Predictive validity—atestaccuratelypredictsfuturecharacteristicsorbehavior

2. 3. Concurrentvalidity—atest’sresultsagreewithindependentmeasuresassessing
similarcharacteristicsorbehaviour
III. CLINICAL INTERVIEWS
• A dialogue between a psychologist and a client that is designed to help the psychologist
diagnose andplantreatmentforthe client.
• The process of evaluating the client to reveal important detailed information regarding his
past andcurrent condition.
IV: COMPONENTSOF CLINICAL INTERVIEW:
1. The Presentingproblem
a. Focuses on the Cognitive Status Assessment, Emotional Status Complaints, Suicidal
ideations,andHomicidal/Aggressive Ideation.
2. SymptomaticEvaluation
a. Focusesonthe client’sDevelopmentalHistory, PsychiatricHistory,Alcohol/Substance
Use History,Medical History,FamilyMedical History,andPsychiatricHistory.
3. Psychosocial Evaluation
a. Focusesonthe client’sFamilyHistory,Educational/Vocational History,Criminal/Legal
History,Social History,PsychosexualHistory,andthe Multicultural Evaluation.
A. Interviews are face-to-face encounters and often are the first contact
betweenaclientanda clinician/assessor
 They are used to collect detailed information, especially personal history, about a
client
 They are useful because they allow the interviewer to focus on whatever topics
he/she considersmostimportant
B. The focus of an interview depends on the interviewer’s theoretical
orientation
 Interviewscanbe eitherunstructuredorstructured
a. In unstructuredinterviews,cliniciansaskopen-endedquestions
b. Instructuredinterviews,cliniciansaskpreparedquestions,oftenfrom
a publishedinterviewschedule
These types of interviews also may include a
mental status exam—a systematic assessment
of the client’s awareness, orientation to time
and place, attention span, memory, judgment
and insight, thought content and processes,
mood,and appearance
C. What are the limitationsof clinical interviews?
1. Interviewsmaylackvalidityoraccuracy; individualsmaybe intentionallymisleading
2. Interviewersmaybe biasedormaymake mistakesin judgment
3. Interviews,particularlyunstructuredones,maylackreliability

3. V. CLINICAL TESTS
A. Clinical testsare devicesforgatheringinformationaboutspecifictopics
fromwhichbroaderinformationcanbe inferred
B. There are more than500 differenttests inuse,fallingintosixcategories:
1. Projective tests
 These tests require that subjects interpret vague and ambiguous
stimuli orfollow open-endedinstructions
 Theyare usedmainlybypsychodynamicpractitioners
 The most popular are the Rorschach test, Thematic Apperception
Test,Sentence
Completion,andDrawings
 What are the meritsof projective tests?
 Theyare helpful forproviding“supplementary”information
 Theyrarelyhave demonstratedmuchreliabilityorvalidity
 Theymay be biasedagainstminorityethnicgroups
2. Personalityinventories
 Usually self-response, these tests are designed to measure broad
personality characteristics and focus on behaviors, beliefs, and
feelings
 The most widely used is the Minnesota Multiphasic Personality
Inventory (MMPI)
 The MMPI consists of 550 self-statements describing physical
concerns; mood; morale; attitudes toward religion, sex, and
social activities; and psychological symptoms which can be
answered“true,”“false,”or“cannotsay”
 The MMPI has items to assess both careless responding and
lying
 What are the meritsof personalityinventories?
 They are easier, cheaper, and faster to administer than
projective tests
 Theyare objectivelyscoredandstandardized
 Theyappearto have greatervaliditythanprojectivetests
(i) Measured traits often cannot be directly examined—
how can we reallyknow the assessmentiscorrect?
 Testsfail to allow forcultural differencesinresponses
3. Response inventories
 Response inventories usually are self-response measures that focus
on one specificareaof functioning:
(a) Affectiveinventories:measurethe severityof suchemotionsasanxiety,
depression,andanger

4. (i) One of the most widely used affective inventories is the Beck
DepressionInventory(BDI)
(b) Social skill inventories: askrespondentstoindicatehow theywouldrespond
ina varietyof social situations
(i) These inventories usually are used by behavioral and
sociocultural clinicians
(c) Cognitive inventories:revealaperson’stypical thoughtsandassumptions
(i) These inventories usually are used by cognitive clinicians and
researchers
4. Psychophysiological tests
a. Psychophysiological tests measure physiological response as an indication of
psychological problems
(a) This includes measurement of heart rate, blood pressure, body
temperature,galvanicskinresponse,andmuscle contraction
b. The most popularpsychophysiological testisthe polygraph(liedetector)
c. What are the meritsof psychophysiological tests?
(a) These tests require expensive equipment that must be tuned and
maintained
(b) Theyalsocan be inaccurate and unreliable
(i) This weakness is described in more detail in A Closer
Look onp. 100 of the text
5. Neurological andneuropsychological tests
a. Neurologicaltestsdirectlyassessbrainfunctionbyassessingbrain structure and
activity
(a) Examples:EEG,PET scans, CAT scans,MRI
b. Neuropsychological testsindirectlyassessbrainfunctionbyassessingcognitive,
perceptual,andmotorfunctioning
(a) The most widelyneuropsychological testisthe BenderVisual-Motor
GestaltTest
c. What are the meritsof neurological andneuropsychological tests?
(a) These typesof testscan be veryaccurate
(b) These testsare,at best,onlyroughand general screeningdevices
(i) They are best when used in a battery of tests, each
targetinga spe-
cificskill area
6. Intelligencetests
a. Intelligence testsare designedtoindirectlymeasure intellectual abilityandare
typicallycomprisedof aseriesof testsassessingbothverbalandnonverbal skills
(a) Theygenerate anintelligence quotient(IQ)
b. The most popularof the intelligencetestsare the Wechslerscales(WAIS,WISC)
c. What are the meritsof intelligence tests?
(a) These are among the mostcarefullyproducedof all clinical tests
(b) Theyare highlystandardizedonlargegroupsof subjects,and,assuch,have
veryhighreliabilityandvalidity
(c) Performance can be influenced by non-intelligence factors (e.g.,
motivation,anxiety,test-takingexperience)
(d) Testsmay containcultural biasesinlanguage ortasks

5. (e) Members of minority groups may have less experience and be less
comfortable withthese typesof tests,influencingtheirresults
VI. CLINICAL OBSERVATIONS
A. Clinical observationsare systematicobservationsof behavior
B. There are several differentkinds:
1. NaturalisticandAnalog
a. Naturalistic observations occur in everyday environments, including
homes, schools, institutions (hospitals and prisons), and community
settings
b. Most focusonparent-child,sibling-child,orteacher-childinteractions
c. Observations generally are made by “participant observers” and
reported toa clinician
d. If naturalisticobservationisimpractical,analogobservationsare used
and occur inan artificial setting
e. What are the meritsof naturalisticandanalogobservations?
(a) Reliability is a concern as different observers may focus on
differentaspectsof behavior
(b) Validityisaconcern
(i) There isariskof “overload,”“observerdrift,”andobserver
bias
(ii) Clientreactivityalsomaylimitvalidity
(iii) Observationsmaylackcross-situational validity
2. Self-monitoring
a. People observe themselves and carefully record the frequency of
certainbehaviors,feelings,orcognitionsastheyoccur overtime
b. What are the meritsof self-monitoring?
(a) Self-monitoringisusefulinassessingbothinfrequentbehaviors
and overlyfrequentbehaviors
(b) It provides a means of measuring private thoughts or
perceptions(c) Validityoftenisaproblem:
(i) Clientsmaynotreceive propertrainingandinstruction
(ii) Clientsmaynotrecordinformationaccurately
(iii) Whenpeople monitorthemselves,theyoftenchange their
behaviour
VII. DIAGNOSIS:DOES THE CLIENT’S SYNDROME MATCH A KNOWNDISORDER?
A. Usingall available information,cliniciansattempttopainta“clinical picture”
1. Thispicture isinfluencedbytheirtheoretical orientation
B. Using assessment data and the clinical picture, clinicians attempt to make a
diagnosis—a determination that a person’s problems reflect a particular
disorderorsyndrome
1. Thisdiagnosisisbasedonan existingclassificationsystem

6. C. Classification systems are lists of categories, disorders, and symptom
descriptions,with guidelinesfor assignment,focusing on clusters of symptoms
(syndromes)
D. In current use in the United States is the DSM-IV-TR: Diagnostic and Statistical
Manual of Mental Disorders(4thedition,TextRevision)
1. The DSM-IV waspublishedin1994 and revised slightlyin2000 (TR);it
listsapproximately400disorders
2. The DSM describes criteria for diagnosis, key clinical features, and
relatedfeatureswhichare oftenbutnotalwayspresent
3. The DSMis multi-axial,thatis,ituses5axes(branchesof information)
to developafull clinical picture
a. People usuallyreceiveadiagnosisoneitherAxisIor AxisII, but
theymay receive diagnosesonboth
(a) Axis I: most frequently diagnosed disorders except personality
disordersandmental retardation
(b) AxisII:Personalitydisordersandmental retardation
(i) Long-standingproblems
(c) AxisIII:Relevantgeneral medical conditions
(d) AxisIV:Psychosocial andenvironmental problems
(e) Axis V: Global assessment of psychological, social, and
occupational functioning(GAF)
(i) Currentlyandinpast year
(ii) 0–100 Scale
E. Is DSM-IV-TRan Effective ClassificationSystem?
1. Aclassification system, like an assessment method, is judged by its
reliabilityandvalidity
2. Reliability in this context means that different clinicians are likly to
agree on a diagnosisusingthe systemtodiagnose the same client
a. DSM-IV-TRappearstohave greaterreliabilitythananyprevious
editionsdue tothe extensiveuse of fieldtrials
b. However,reliabilitystill isaconcern
3. Validity in thiscontext means an accuracy of the information that its
diagnostic categories provide; predictive validity is of the most use
clinically
a. DSM-IV-TR has greater validity than any previous editions due
to extensive literaturereviewsandfieldstudies
b. However,validitystill isaconcern
4. Beyond concerns about reliability and validity, a growing number of
theoristsbelievethattwofundamentalproblemsweakenthe DSM-IV-
TR:
a. The basic assumption that disorders are qualitatively different
fromnormal behavior
b. The reliance on discrete diagnosticcategories
5. With such concerns, DSM-V certainly will include some key changes,
but the new editionisnotimminent

7. F. Can DiagnosisandLabelingCause Harm?
1. Misdiagnosis is always a concern because of the reliance on clinical
judgment
2. Also present is the issue of labeling and stigma; for some, diagnosis
may be a selffulfillingprophecy
3. Because of these problems, some clinicians would like to cease the
practice of diagnosis
VIII. TREATMENT: HOW MIGHTTHE CLIENT BE HELPED?
A. Treatmentdecisions
1. Treatment decisionsbegin with assessment information and diagnostic decisions to
determine atreatmentplan
a. Cliniciansuse acombinationof idiographicandnomotheticinformation
b. Otherfactors importantfordeterminingatreatmentplanare:
(a) Therapisttheoretical orientation
(b) Currentresearch
(c) General state of clinical knowledge—currently focusing on
empiricallysupported,evidence-basedtreatment
B. The effectivenessof treatment
1. There are over400 formsof therapyinpractice,but istherapyeffective?
a. Thisis a difficultquestiontoanswer:(a) How doyou define success?
(b) How doyou measure improvement?
(c) How do you compare treatments—treatments differ in
range and complexity, therapists differ in skill and
knowledge,clientsdifferinseverityand motivation,etc.
2. Therapyoutcome studiestypicallyassessone of the followingquestions:
a. Is therapyin generaleffective?
(a) Research suggests that therapy is generally more effective than no
treatmentorthan placebo
(b) In one major study using meta-analysis, the average person who
received treatment was better off than 75 percent of the untreated
subjects
(c) Some clinicians are concerned with a related question: can therapy
be harmful?
(i) Therapydoeshave the potential tobe harmful
(ii) Studiesreportthatapproximately5percentof clients
getworse withtreatment
b. Are particular therapiesgenerallyeffective?
(a) Generally,treatmentoutcome studieslumpall therapiestogetherto
considertheirgeneral effectiveness
(i) One critic hascalledthisthe “uniformitymyth”
(b) It isarguedthat scientistsmustlookatthe effectivenessof particular
therapies
(i) There is a movement (“rapprochement”) to look at
commonalitiesamongtherapies

8. c. Are particular therapieseffectiveforparticularproblems?
(a) Studies now are being conducted to examine the effectiveness of
specifictreatmentsforspecificdisorders:
(i) “What specific treatment, by whom, is the most
effective for this individual with that specific
problem, andunderwhich setof circumstances?”
(b) Recentstudiesfocusonthe effectivenessof combinedapproaches—
drug therapy combined with certain forms of psychotherapy—to
treat certaindisorders.

9. MAKING A CASE ANALYSIS
Guidelines in preparing a case analysis:
1. Read and examine the case thoroughly.
a. Take notes, highlight relevant facts, underline key problems.
2. Focus your analysis.
a. Identify key problems.
b. Why do they exist?
c. What are its impact to the client?
3. Uncover possible interventions or changes needed.
a. Review your readings and researches.
4. Select the best intervention.
a. Choose the intervention that best fit the client]
b. Interventions may depend on the theoretical orientation of the clinician.
Case Analysis Template
1. Background Information
a. This includes the client’s age, gender, work, health status, family mental
health history, family and social relationships, drug and alcohol history, life
difficulties, goals, and coping skills and weaknesses.
2. Description of the Presenting Problem
a. Describe the problem or symptoms that the client is presented with.
b. Describe any physical, emotional, or sensory symptoms reported by the
client.
c. Thoughts, feelings, and perceptions related to the symptoms should also be
noted.
3. Assessment procedure
a. Includes the processes made during the clinical assessment (interviews and
tests administered.
4. Diagnosis
a. Provide your diagnosis and give the appropriate Diagnostic and Statistical
Manual code.
b. Explain how you reach the diagnosis, how the client’s symptoms fit the
diagnostic criteria for the disorder(s), or any possible difficulties in reaching a
diagnosis.
5. Intervention
a. Focus on the intervention that will be used to help the clients.

10. CHAPTER 4:
CLINICAL ASSESSMENT,
DIAGNOSIS AND
TREATMENT
SUBMITTED BY:
CHRISTINE JOY C. PAGARAN