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Chapter 3 Handouts - Chapter 3 Handouts Chapter 3 Handouts...

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Unformatted text preview: Chapter 3 Handouts Chapter 3 Handouts Clinical Assessment: How and Why Does the Client Behave Abnormally? What is assessment? 0. _______________________________________ 1. ______________ assessment is used to determine how and why a person is behaving abnormally and how that person may be helped 0. Focus is _____________ – on an individual person 1. Also may be used to evaluate treatment progress The specific tools used in an assessment depend on the clinician’s theoretical orientation Hundreds of clinical assessment tools have been developed and fall into three categories: 2. Clinical interviews 3. Tests 4. Observations Characteristics of Assessment Tools To be useful, assessment tools must be _________ and have clear _________ and _________ 5. To standardize a technique is to set up common steps to be followed whenever it is administered 6. One must standardize _____________ , ___________ , and _______________ Reliability refers to the _______________ of a test 2. A good test will yield the same results in the same situation 3. Two main types: 0. __________________ reliability 0. To test for this type of reliability, a subject is tested on two different occasions and the scores are correlated – the higher the correlation, the greater the test’s reliability 1. __________________ reliability 1. Independent judges agree on how to score and interpret a particular test Validity refers to the __________ of a test’s results 4. A good test must accurately measure what it is supposed to be measuring 5. Three specific types: 2. ________________ – a test appears to measure what it is supposed to measure; does not necessarily indicate true validity 3. ________________ – a test accurately predicts future characteristics or behavior 4. ________________ – a test’s results agree with independent measures assessing similar characteristics or behavior Clinical Interviews Face­to­face encounters 9. Often the first contact between a client and a clinician/assessor Used to collect detailed information, especially personal history, about a client Allow the interviewer to focus on whatever topics they consider most important 0. 1. 2. 3. 7. 8. 4. 5. 6. 7.. Conducting the interview 7 10. Focus depends on theoretical orientation 11. Can be either ___________ or ___________ 6. In unstructured interviews, clinicians ask open­ended questions 7. In structured interviews, clinicians ask prepared questions, often from a published interview schedule 5. May include a mental status exam 8. Limitations: 12. May lack _________________ or accuracy 13. Interviewers may be biased or may make mistakes in judgment 14. Interviews, particularly _______________ ones, may lack reliability Clinical Tests 9. Devices for gathering information about a few aspects of a person’s psychological functioning, from which broader information can be inferred 10. More than 500 different tests are in use 15. They fall into six categories … _________________ tests Require that subjects interpret vague and ambiguous stimuli or follow open­ended instruction Mainly used by ______________ practitioners Most popular: Rorschach Test Thematic Apperception Test Sentence Completion Test Drawings Clinical Test: Sentence­Completion Test 11. “I wish ___________________________” 12. “My father ________________________” Clinical Test: Drawings 16. 8. 9. 10. 6. 7. 8. 9. 13. Draw­a­Person (DAP) test: 17. “Draw a person” 18. “Draw another person of the opposite sex” Clinical Tests 14. Projective tests 19. Strengths and weaknesses: 11. Helpful for providing “supplementary” information 12. Have rarely demonstrated much________________ 13. May be biased against __________________ 15. ________________ inventories 20. Designed to measure broad personality characteristics 21. Focus on behaviors, beliefs, and feelings 22. Usually based on self­reported responses 23. Most widely used: Minnesota Multiphasic Personality Inventory 14. For Adults: MMPI (original) or MMPI­2 (1989 revision) 15. For Adolescents: MMPI­A Clinical Test: MMPI­­ Minnesota Multiphasic Personality Inventory Clinical Tests Clinical Tests 16. Consists of more than __________________________ that can be answered “true,” “false,” or 10. Hypochondriasis (HS) 11. Depression (D) 12. Conversion hysteria (Hy) 13. Psychopathic deviate (PD) 14. Masculinity­femininity (Mf) 17. Scores range from 0 – 120 15. Above 70 = deviant 16. Graphed to create a “profile” 17. Paranoia (P) 18. Psychasthenia (Pt) 19. Schizophrenia (Sc) 20. Hypomania (Ma) 21. Social introversion (Si) Clinical Tests 17. Personality inventories 26. Strengths and weaknesses: 18. Easier, cheaper, and faster to administer than projective tests 19. ________________ scored and standardized 20. Appear to have greater validity than projective tests 22. Measured traits often cannot be directly examined – how can we really know the assessment is correct? 21. Tests fail to allow for __________________ in responses Clinical Tests 16. Comprised of __________ clinical scales: “cannot say” 24. Statements describe physical concerns; mood; morale; attitudes toward religion, sex, and social activities; and psychological symptoms 25. Assesses careless responding & lying 18. Response inventories 27. 27. 28. 22. 23. 24. Usually based on self­reported responses Focus on one specific area of functioning Affective inventories (example: Beck Depression Inventory) _________________________________ Cognitive inventories Clinical Tests 19. ____________________ tests 29. Measure physiological response as an indication of psychological problems 25. Includes heart rate, blood pressure, body temperature, galvanic skin response, and muscle contraction 30. Most popular is the __________ (lie detector) Clinical Tests 20. Psychophysiological tests 31. Strengths and weaknesses: 26. Require expensive equipment that must be tuned and maintained 27. Can be ___________________________ Clinical Tests 21. ____________________________ tests 32. Neurological tests __________ assess brain function by assessing brain structure and activity 28. Examples: EEG, PET scans, CAT scans, MRI 33. Neuropsychological tests __________ assess brain function by assessing cognitive, perceptual, and motor functioning 29. Most widely used is the ________________________________________ Clinical Tests 22. Neurological and neuropsychological tests 34. Strengths and weaknesses: 30. Can be very accurate 31. At best, though, these tests are general screening devices 23. Best when used in a battery of tests, each targeting a specific skill area 23. _______________________ tests 35. Designed to measure intellectual ability 36. Composed of a series of tests assessing both verbal and nonverbal skills 37. Generate an ______________________ (IQ) 24. Intelligence tests 38. Strengths and weaknesses: 32. Are among the most carefully produced of all clinical tests 33. Highly standardized on large groups of subjects Have very high reliability and validity 35. Because intelligence is an inferred quality, it can only be measured indirectly 25. Intelligence tests 39. Strengths and weaknesses: 36. Performance can be influenced by nonintelligence factors (e.g., ____________ , ____________ , ______________________) 37. Tests may contain _________ in language or tasks Clinical Observations 26. Systematic observation of behavior 27. Several kinds: 40. _______________________ 41. Analog 42. Self­monitoring 43. Naturalistic and analog observations 38. Naturalistic observations occur in ____________ environments 24. Can occur in homes, schools, institutions (hospitals and prisons), and community settings 25. Tend to focus on parent–child, sibling–child, or teacher–child interactions 26. Observations are generally made by “________________” and reported to a clinician 39. If naturalistic observation is impractical, analog observations are used in __________________ 28. Naturalistic and analog observations 44. Strengths and weaknesses: 40. ___________________________ is a concern 27. Different observers may focus on different aspects of behavior 41. ___________________________ is a concern 28. Risk of “overload,” “observer drift,” and observer bias 29. ______________________ may also limit validity 30. Observations may lack _____________________ validity Clinical Observations 29. Self­monitoring 45. People observe themselves and carefully record certain behaviors, feelings, or cognitions as they occur over time Clinical Observations 46. Self­monitoring 42. Strengths and weaknesses: 31. Useful in assessing infrequent behaviors 32. Useful for observing overly frequent behaviors 33. Provides a means of measuring private thoughts or perceptions 34. 34. 34. Validity is often a problem 34. 35. Clients may not receive proper training and instruction 36. Clients may not record information accurately 37. When people monitor themselves, they often change their behavior Diagnosis: Does the Client’s Syndrome Match a Known Disorder? 47. Using all available information, clinicians attempt to paint a “_______________” 43. Influenced by their _________________ 48. Using assessment data and the clinical picture, clinicians attempt to make a ________________ 44. A determination that a person’s problems reflect a particular disorder or syndrome 45. Based on an existing _________________ Classification Systems 30. Lists of categories, disorders, and symptom descriptions, with guidelines for assignment 49. Focus on clusters of symptoms (syndromes) 31. In current use in the US: DSM­IV­TR 50. _________________________________________ (4th edition), Text Revision DSM­IV­TR 32. Published in 1994, revised slightly in 2000 33. Lists approximately 400 disorders 51. Listed in the inside back flap of your text 34. Describes criteria for diagnoses, key clinical features, and related features which are often but not always present 35. Most widely used classification system in the US 36. _____________ 52. Uses 5 axes (____________________) to develop a full clinical picture 53. People usually receive a diagnosis on either Axis I or Axis II, but they may receive diagnoses on both The DSM­IV­TR 37. Axis I : 54. Most frequently diagnosed disorders, except personality disorders and mental retardation 38. Axis II 55. Personality disorders and mental retardation 46. Long­standing problems 39. Axis III 56. Relevant general medical conditions 40. Axis IV 57. Psychosocial and environmental problems 41. Axis V 41. 58. Global assessment of psychological, social, and occupational functioning 47. Current functioning and highest functioning in past year 48. 0–100 scale Is DSM­IV­TR an Effective Classification System? 59. Classification systems are judged by _________________________ and ________________________ 60. Here reliability = different diagnosticians agreeing on a diagnosis using the same classification system 49. DSM­IV­TR has greater reliability than any previous editions 38. Used field trials to increase reliability 50. Reliability is still a concern 42. The validity of a classification system is the accuracy of information that the diagnostic categories provide 61. ____________ validity is of the most use clinically 62. DSM­IV­TR has greater validity than any previous editions 51. Conducted extensive literature reviews and ran field studies Validity is still a 43. Beyond concerns about reliability and validity, a growing number of theorists believe that two fundamental problems weaken the DSM: 63. Basic assumption that disorders are _____________ different from normal behavior 64. Reliance on _____________ diagnostic categories Can Diagnosis and Labeling Cause Harm? 44. Misdiagnosis always a concern 65. Major issue is reliance on __________________ 45. Also present is the issue of _______________ 66. Diagnosis may be a self­fulfilling prophecy 46. Because of these problems, some clinicians would like to cease the practice of diagnosis Treatment: How Might the Client Be Helped? 67. Treatment decisions 52. Begin with assessment information and diagnostic decisions to determine a treatment plan 39. Use a combination of ___________________________ 53. Other factors: 40. ___________________________________________ 41. ___________________________________________ 42. General state of clinical knowledge – currently focusing on ___________________________________________ The Effectiveness of Treatment The Effectiveness of Treatment 47. More than 400 forms of therapy in practice, but is therapy effective? 68. Difficult question to answer: 54. How do you define success? 55. How do you measure improvement? 56. How do you compare treatments – treatments differ in range and complexity; therapists differ in skill and knowledge; clients differ in severity and motivation… 48. Controlled clinical research and therapy outcome studies typically assess one of the following questions: 49. Is therapy generally effective? 72. Research suggests that therapy is generally more effective than ____________ or _________ 73. In one major study using ____________ , the average person who received treatment was better off than 75% of the untreated subjects 50. Is therapy generally effective? 74. Some clinicians are concerned with a related question: Can therapy can be harmful? 57. Has this potential 58. Studies report ~5% get worse with treatment 51. Are particular therapies generally effective? 75. Generally, therapy­outcome studies lump all therapies together to consider their general effectiveness 59. One critic has called this the “__________________” 76. It is argued that scientists must look at the effectiveness of ______________ therapies 60. There is a movement (“______________”) to look at __________________ among therapies 77. Are particular therapies effective for particular problems? 61. Studies now being conducted to examine effectiveness of specific treatments for specific disorders: 43. “ ______ specific treatment, by ______, is the most effective for ______ individual with ______ specific problem, and under ______ set of circumstances?” 62. Recent studies focus on the effectiveness of combined approaches – ________________ combined with certain forms of _______________ – to treat certain disorders 69. Is therapy in general effective? 70. Are particular therapies generally effective? 71. Are particular therapies effective for particular problems? ...
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