Assessment in Clinical Psychology

Question 1

What is the information gathered in a clinical assessment crucial for?

Answer 1

Diagnosis; formulation; treatment planning; to predict the future course of a mental disorder

Question 2

What do assessment processes typically commence with?

Answer 2

A clinical intake interview, and mental status examination

Question 3

What areas of functioning need to be assessed in a clinical assessment?

Answer 3

Emotional, behavioural and cognitive

Question 4

What factors need to be assessed according to the bio-psych-social model?

Answer 4

Biological; psychological; and social

Question 5

What is the DSM-5, and in what settings is it used?

Answer 5

The diagnostic and statistical manual of mental disorders, used in private practice

Question 6

What is the ICD-10, and in what settings is it used?

Answer 6

Classification of mental and behavioural disorders, used in hospitals

Question 7

In what ways can a diagnosis be helpful?

Answer 7

It allows for communication between clinicians; helps guide questioning and for differential diagnoses; helps with treatment options; makes clients feel at ease

Question 8

In what ways can a diagnosis be unhelpful?

Answer 8

Potential stigma; self-fulfilling prophesy; can be used as an excuse for their behaviour

Question 9

In order to diagnose a major depressive episode, five symptoms must have occurred for at least 2 weeks. From these, at least one of which two symptoms must be present (either from subjective self-report or observation)?

Answer 9

Depressed mood most of the day, nearly every day (can be irritable mood in children and adolescents); and diminished interest or pleasure in activities, most of the day, nearly every day

Question 10

List seven other symptoms that may be present in a person with major depression

Answer 10

1. Significant weight loss or weight gain, or decrease or increase in appetite nearly every day;
2. Insomnia or hypersomnia nearly every day;
3. Psychomotor agitation or retardation;
4. Fatigue or loss of energy;
5. Feelings of worthlessness or inappropriate guilt;
6. Diminished ability to concentrate;
7. Recurrent thoughts of death/suicide ideation

Question 11

List the different assessment options

Answer 11

Interview (parent, child or teacher); self-report questionnaires; self-monitoring; behavioural observation (e.g. family observation scale); standardized neuropsychology assessment (e.g. WAIS/WISC); medical examination; collateral information

Question 12

What are the different types of interviews that can be used in an assessment process?

Answer 12

Intake interviews; structured clinical interviews; anxiety and related disorders interview schedule for DSM-5

Question 13

What kinds of scales are generally used for self-report questionnaires?

Answer 13

Beck depression inventory; Depression, anxiety, stress scale

Question 14

What kinds of collateral information may be helpful for a clinician?

Answer 14

Report cards (if child/adolescent); previous reports or referral information (e.g. GPs, OTs, speech therapists); psychiatric referrals

Question 15

In the assessment process, what are some ways of ensuring honest, detailed and comprehensive reporting from the client?

Answer 15

Explaining the purpose and role of assessment; explaining yours and the client’s role; if using psychometric tools, ensure the client understands what’s expected of them

Question 16

What are two broad aims of a clinical interview?

Answer 16

1. To gather information (diagnosis, formulation, implementation of appropriate assessment strategies)
2. To establish a therapeutic relationship – micro-counselling skills (active listening, sensitivity)

Question 17

What areas need to be identified and recorded in regards to a client’s presenting problems?

Answer 17

Symptom domains - cognitive, behavioural, affective, physiological, medical; Typography – frequency, duration, intensity, contexts, course and duration; Recent precipitants (loss, conflict); Impact of problems (occupation, family and social relationships, interests, etc)

Question 18

When looking at a client’s history, what should be considered in terms of past psychiatric problems?

Answer 18

Past episodes of illness not already covered; previous treatment; effects; and compliance with treatment

Question 19

What things need to be considered when recording medical history, and drug/alcohol use?

Answer 19

General health; major illnesses; hospitalisations; prescribed or over-counter drugs and when last taken; recreational drugs used

Question 20

What things are usually noted in terms of family history?

Answer 20

Psychiatric or medical illness in relative; family membership and atmosphere; parental occupational status

Question 21

When taking down personal and social history, as well as assessing prenatal and perinatal history, what areas need to be looked at in early/middle childhood, late childhood, and adulthood?

Answer 21

Early/middle childhood: any behavioural problems, friendships, intellectual and motor development;
Late childhood: social relations; school history; sexuality;
Adulthood: educational; occupational; relationship; forensic; religious, and sexual history

Question 22

What information can tell us about the strengths, resources and needs of the client?

Answer 22

Whether they have a support system; coping skills; friendships/social relationships; general health; emotional, spiritual and cultural needs

Question 23

What is a Mental State Exam (MSE)?

Answer 23

Therapist’s observations and impressions of client’s mental functioning at the time of interview

Question 24

What categories can information in an MSE be divided into?

Answer 24

Appearance; behaviour; mood and affect; speech; perceptual disturbance; thought process and content; cognition; insight, judgment and reliability

Question 25

What areas of a client’s appearance will be assessed?

Answer 25

Physical characteristics (body type/physique); facial features; grooming/hygiene; dress

Question 26

Describe four areas of behaviour that may be assessed and provide examples

Answer 26

1. Posture – tense, rigid, poised, slumped
2. Facial expression – appropriateness; variability of expression
3. General body movements – activity level (agitation, acceleration, retardation, stupor); gait, balance, coordination; peculiar or inappropriate (e.g. tics)
4. Attitude towards examiner – cooperative; friendly; attentive; defensive/hostile; level of rapport established

Question 27

Describe how mood and affect would be assessed

Answer 27

Mood: predominant mood reported by client (depressed, anxious, irritable, angry, guilty);
Affect: expression of emotion as observed by others; appropriateness to thought content; range of affect (flat, blunted, restricted); liability

Question 28

How are client’s levels of insight, judgment and reliability examined?

Answer 28

Insight: awareness of being unwell; awareness of the nature of the problem; whether they blame others/circumstances for problems;
Judgment: ability to assess a situation correctly and act appropriately within that situation;
Reliability: client’s approach to report accurately

Question 29

What three factors largely guide the selection of appropriate assessment measures?

Answer 29

Theoretical orientation of clinician; presenting problems; resources available

Question 30

What do self-monitoring approaches, such as a thought diary, focus on, and in which area of therapy is this largely used?

Answer 30

They often focus on the belief behind the behaviour, and are commonly used in CBT

Question 31

What areas are generally assessed in neuropsychology assessments?

Answer 31

Cognitive based problems, such as verbal/performance functioning (e.g. word processing, visuo-spatio tasks, etc); attention; intelligence/academic performance; working memory

Question 32

What are some advantages of creating a formulation in clinical assessment?

Answer 32

Explains processes that caused and maintained the problems; provides guides for intervention; it’s an active and ongoing process, responsive to new data; influenced by theoretical orientation

Question 33

List the categories involved in the 7 P formulation

Answer 33

Presentation; Pattern; Predisposition; Precipitation; Perpetuation; Potentials; Prognosis

Question 34

List the order of the overall process of therapy

Answer 34

Initial contact > first session > assessment > formulation > goal setting > therapy sessions (homework) > termination

Question 35

List the overall approach with clients

Answer 35

Assessment > diagnosis > formulation > treatment > evaluation (hypotheses about diagnosis is likely to change over sessions as you learn more)

Question 36

What difficulties can occur in the formulation process?

Answer 36

Client may not understand (too complex; too abstract; not well explained); client may not agree with formulation

Question 37

If a client doesn’t agree with the formulation, what should you do?

Answer 37

Explore areas of concern; modify formulation; if no agreement, discuss options

Question 38

What are process issues?

Answer 38

Processes that take place during therapy within and outside the therapy setting (content of therapy = WHAT, process of therapy = HOW)

Question 39

Which kind of therapy is all about the process; and in which kind is there less use of process?

Answer 39

Psychodynamic group therapy; CBT

Question 40

Why is process important?

Answer 40

It can significantly impact on the outcome of therapy; if the therapist simply responds to the content, they could miss important process issues

Question 41

What are some possible process issues for a client in terms of initial contact?

Answer 41

Expectations of their role as client; anxious to be understood; fearful of being judged/labeled; uncomfortable with perceived power differential; they may ask if it’s worthwhile; cost issues; commitment; expectations based on prior counseling; trust/confidentiality

Question 42

In the first session with a client, it’s important to establish a therapeutic framework. What are some ways of doing this?

Answer 42

Set the scene for the client – explain goals of the initial session; explain roles of client and therapist; communicate hope; set boundaries;
Establish a therapeutic relationship – show sensitivity; empathy; unconditional positive regard; genuineness

Question 43

What do clients tend to report as helpful in terms of establishing a therapeutic relationship?

Answer 43

Talking (to someone who listens); being understood; hope; warmth; calmness and objectivity; truthfulness/honesty

Question 44

What are some process issues that can occur at assessment?

Answer 44

Can be seen as an extra burden; wonder if private information will be secure; client’s report may be different from others’ reports; what is the meaning of the assessment findings for the client?