Chapter 4

Clinical Assessment,
Diagnosis, Treatment

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Ice Breaker: Introduction to Clinical
Assessment and Diagnosis
 Break into pairs or small groups
of students.
 Consider this scenario: You are
seeing a clinician for a
psychological assessment. What
do you think will happen?
• What kinds of questions will
the clinician ask?
• What kinds of assessments
will you take?
 Discuss what you think will
happen in your group and in the
class.

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 Assessing Psychological
Disorders
 Clinical assessment
• Systematic evaluation and measurement of
psychological, biological, and social factors
• Reliability
• Validity
• Standardization

 Diagnosis
• Degree of fit between symptoms and diagnostic criteria
• DSM-5-TR – Diagnostic and Statistical Manual, 5th edition,
text revision (2022)

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 The Clinical Interview

 Clinical interviews are the core of clinical work

 Who is present? Who is asking/answering the questions? STAKEHOLDERS
• Presenting problem
• Current and past behavior
• Detailed history
• Med, fam, school, occ, psych
• Attitudes and emotions
• Structured, semi-structured, and unstructured interviews

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Discussion Activity

Why Did You Ask That?

People are often anxious before
seeing a psychologist or other
mental health professional for the
first time. They may be particularly
concerned about all of the
questions they will be asked and
wonder why some things, like
perhaps family history or physical
health, are relevant.
Why do clinicians ask so many
questions about so many issues
when conducting an assessment?

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Mental Status Exam

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Behavioral Assessment

Behavioral assessment uses direct observation to assess formally an

individual’s thoughts, feelings, and behavior in specific situations or contexts

Target behaviors are identified, May use analogue settings that are similar
antecedents, consequences to real-life settings

Formal observation - specific behaviors that are observable and measurable,

may involve checklists or behavior rating scales

Self-monitoring involves an individual monitoring their own behavior

Reactivity can distort any Knowing you are being observed can
observational data change behavior

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Psychological Testing

 Projective Testing  Self-Report Cognitive Testing

 Rorschach Inventories IQ Tests
 Personality Tests
 TAT Achievement Test
 Interest
Aptitude Test
Inventories
Neuropsych. Test
 Values
Clarification
Exercises

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Additional Biological Assessments
 Neuroimaging
 Structural, eg CAT scan,
MRI
 Functional, eg PET,
SPECT, fMRI, BOLD
 Psychophysiological
assessment
 EEG
 GSR
 biofeedback

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Diagnosing
Psychological Disorders

 Classification: any effort to construct groups or

categories and to assign objects or people to
these categories on the basis of their shared
attributes or relations
 Taxonomy: classification of entities for scientific
purposes
 Nosology: application of a taxonomic system to
psychological or medical phenomena or other
clinical areas
 Nomenclature: the names or labels of the
disorders that make up the nosology
 Most mental health professionals in North
America use the DSM-5-TR (or ICD-11)

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Classification Systems
Classical (or pure) categorical approach:
• Assumes every diagnosis has a clear cause & each disorder is unique
• Therefore we need only one set of defining criteria
• Useful in medicine, but psychological DOs have many causes

 Dimensional approach: Notes the variety of cognitions, moods, and behaviors with which the patient
presents and quantifies them on a scale

 Prototypical approach: Identifies certain essential characteristics of an entity, also allows for
nonessential variations

 Reliability, Validity considerations for any classification system

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 Knowledge Check Activity

Match each approach to classification with how diagnoses are made under that
approach:
DESIGN EXAMPLE
Classical categorical approach Uses scales to quantify the cognitions, moods, and behaviors
associated with mental disorders and makes diagnoses based
on those results
Dimensional approach Identifies the essential characteristics of each disorder and
makes diagnoses based on those characteristics, while
allowing other characteristics to vary
Prototypical approach Makes diagnoses based on the unique pathophysiological
causes of each disorder

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Discussion Activity When the DSM-5-TR was issued, a new
diagnosis, prolonged grief disorder, was
added. This diagnosis is characterized by
intense yearning/longing for or
preoccupation with a deceased loved one
that lasts longer than social norms (more
than 12 months for adults and more than 6
months for children and adolescents) and
causes distress or problems functioning.
Reactions?
• Questions?
• Benefits?
• Drawbacks?

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General Treatment Considerations
 Access to treatment
 Willingness to seek treatment
 Informed Consent
 Efficacy of treatment
 Client factors
 Therapist factors
 Therapeutic alliance
 Treatment techniques/strategies
 Other concurrent events
 Evidence-Based Treatment AND Treatment-Based
Evidence
14

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