Copyright © 2010 Allyn & Bacon This multimedia product and its contents are protected under...

Copyright © 2010 Allyn & Bacon

This multimedia product and its contents are protected under copyright law. The following are prohibited by law: • any public performance or display, including transmission over any network; • preparation of any derivative work, including the extraction, in whole or part, of any images; • any rental, lease, or lending of the program. ISBN: 0-205-50294-6

PowerPoint for

Abnormal Psychology

Fourteenth Edition

James N. Butcher

Susan Mineka

Jill M. Hooley

Prepared by Andy PomerantzSouthern Illinois University

Edwardsville


Chapter 4Chapter 4

Clinical Assessment and Diagnosis

Clinical Assessment and Diagnosis

Copyright © 2010 Allyn & Bacon 3

The Basic Elements in AssessmentThe Basic Elements in AssessmentThe Basic Elements in AssessmentThe Basic Elements in Assessment

First, the presenting problem must be First, the presenting problem must be identified identified Situational or pervasive?Situational or pervasive? Duration?Duration? Prior attempts to help or treat?Prior attempts to help or treat? Self-defeating or resourceful?Self-defeating or resourceful? How does problem impact social roles?How does problem impact social roles? Does problem match any DSM-IV disorder Does problem match any DSM-IV disorder

criteria? criteria?

First, the presenting problem must be First, the presenting problem must be identified identified Situational or pervasive?Situational or pervasive? Duration?Duration? Prior attempts to help or treat?Prior attempts to help or treat? Self-defeating or resourceful?Self-defeating or resourceful? How does problem impact social roles?How does problem impact social roles? Does problem match any DSM-IV disorder Does problem match any DSM-IV disorder

criteria? criteria?


The Relationship Between The Relationship Between Assessment and DiagnosisAssessment and DiagnosisThe Relationship Between The Relationship Between Assessment and DiagnosisAssessment and Diagnosis

Classifying the presenting problem is Classifying the presenting problem is important for numerous reasonsimportant for numerous reasons Planning treatmentPlanning treatment Knowledge of range of diagnostic problems in Knowledge of range of diagnostic problems in

client population, which dictate needs for client population, which dictate needs for facilitiesfacilities

Insurance paymentInsurance payment

Classifying the presenting problem is Classifying the presenting problem is important for numerous reasonsimportant for numerous reasons Planning treatmentPlanning treatment Knowledge of range of diagnostic problems in Knowledge of range of diagnostic problems in

client population, which dictate needs for client population, which dictate needs for facilitiesfacilities

Insurance paymentInsurance payment


Taking a Social or Taking a Social or Behavioral HistoryBehavioral HistoryTaking a Social or Taking a Social or Behavioral HistoryBehavioral History

A good assessment should include a A good assessment should include a social history noting:social history noting: Personality factorsPersonality factors The social contextThe social context

A good assessment should include a A good assessment should include a social history noting:social history noting: Personality factorsPersonality factors The social contextThe social context


Ensuring Culturally Sensitive Ensuring Culturally Sensitive Assessment ProceduresAssessment Procedures

Ensuring Culturally Sensitive Ensuring Culturally Sensitive Assessment ProceduresAssessment Procedures

U.S. population has grown increasingly U.S. population has grown increasingly diverse in recent yearsdiverse in recent years

It is critical for practitioners to conduct It is critical for practitioners to conduct culturally competent assessment culturally competent assessment

APA ethical code addresses need for APA ethical code addresses need for cultural competencecultural competence

Cultural variables can include ethnicity, Cultural variables can include ethnicity, language, SES, gender, and otherslanguage, SES, gender, and others

U.S. population has grown increasingly U.S. population has grown increasingly diverse in recent yearsdiverse in recent years

It is critical for practitioners to conduct It is critical for practitioners to conduct culturally competent assessment culturally competent assessment

APA ethical code addresses need for APA ethical code addresses need for cultural competencecultural competence

Cultural variables can include ethnicity, Cultural variables can include ethnicity, language, SES, gender, and otherslanguage, SES, gender, and others


The Influence of The Influence of Professional OrientationProfessional Orientation

The Influence of The Influence of Professional OrientationProfessional Orientation

How clinicians go about the How clinicians go about the assessment process often depends assessment process often depends on their basic treatment orientationson their basic treatment orientations

How clinicians go about the How clinicians go about the assessment process often depends assessment process often depends on their basic treatment orientationson their basic treatment orientations


For psychological assessment to For psychological assessment to proceed effectively, the client must proceed effectively, the client must feel comfortable with the clinicianfeel comfortable with the clinician

For psychological assessment to For psychological assessment to proceed effectively, the client must proceed effectively, the client must feel comfortable with the clinicianfeel comfortable with the clinician

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Trust and Rapport Between Trust and Rapport Between the Clinician and the Clientthe Clinician and the Client

Trust and Rapport Between Trust and Rapport Between the Clinician and the Clientthe Clinician and the Client


Assessment of Assessment of the Physical Organismthe Physical Organism

Assessment of Assessment of the Physical Organismthe Physical Organism

Assessment of the physical organism Assessment of the physical organism incorporatesincorporates The general physical examinationThe general physical examination The neurological examinationThe neurological examination The neuropsychological examinationThe neuropsychological examination

Assessment of the physical organism Assessment of the physical organism incorporatesincorporates The general physical examinationThe general physical examination The neurological examinationThe neurological examination The neuropsychological examinationThe neuropsychological examination


Many psychological problems have Many psychological problems have physical components either asphysical components either as Causal factorsCausal factors Symptom patternsSymptom patterns

Therefore, it is often important to include Therefore, it is often important to include a medical examination in the a medical examination in the psychological assessment psychological assessment

Many psychological problems have Many psychological problems have physical components either asphysical components either as Causal factorsCausal factors Symptom patternsSymptom patterns

Therefore, it is often important to include Therefore, it is often important to include a medical examination in the a medical examination in the psychological assessment psychological assessment

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The General Physical ExaminationThe General Physical ExaminationThe General Physical ExaminationThe General Physical Examination


The Neurological ExaminationThe Neurological ExaminationThe Neurological ExaminationThe Neurological Examination

If organic brain damage is suspected, If organic brain damage is suspected, neurological tests can aid in determining neurological tests can aid in determining the site and extent of organic brain the site and extent of organic brain disorderdisorder

The neurological examination may The neurological examination may include:include: An EEG An EEG A CAT scanA CAT scan A PET scanA PET scan A functional MRIA functional MRI

If organic brain damage is suspected, If organic brain damage is suspected, neurological tests can aid in determining neurological tests can aid in determining the site and extent of organic brain the site and extent of organic brain disorderdisorder

The neurological examination may The neurological examination may include:include: An EEG An EEG A CAT scanA CAT scan A PET scanA PET scan A functional MRIA functional MRI

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The Neuropsychological The Neuropsychological ExaminationExamination


The neuropsychological examination The neuropsychological examination involves the use of an expanding array involves the use of an expanding array of testing devices to measure a person’s of testing devices to measure a person’s cognitive, perceptual, and motor cognitive, perceptual, and motor performance as clues to the extent and performance as clues to the extent and location of brain damagelocation of brain damage

The neuropsychological examination The neuropsychological examination involves the use of an expanding array involves the use of an expanding array of testing devices to measure a person’s of testing devices to measure a person’s cognitive, perceptual, and motor cognitive, perceptual, and motor performance as clues to the extent and performance as clues to the extent and location of brain damagelocation of brain damage




One popular neuropsychological One popular neuropsychological examination, the Halstead-Reitan battery, examination, the Halstead-Reitan battery, includes the following tests:includes the following tests: Halstead Category TestHalstead Category Test Tactual Performance TestTactual Performance Test Rhythm TestRhythm Test Speech Sounds Perception TestSpeech Sounds Perception Test Finger Oscillation TaskFinger Oscillation Task

One popular neuropsychological One popular neuropsychological examination, the Halstead-Reitan battery, examination, the Halstead-Reitan battery, includes the following tests:includes the following tests: Halstead Category TestHalstead Category Test Tactual Performance TestTactual Performance Test Rhythm TestRhythm Test Speech Sounds Perception TestSpeech Sounds Perception Test Finger Oscillation TaskFinger Oscillation Task


Psychosocial AssessmentPsychosocial AssessmentPsychosocial AssessmentPsychosocial Assessment

Psychosocial assessment attempts to provide Psychosocial assessment attempts to provide a realistic picture of an individual in interaction a realistic picture of an individual in interaction with his or her social environmentwith his or her social environment

Three procedures commonly used in Three procedures commonly used in psychosocial assessments include:psychosocial assessments include: Assessment interviews (which may be structured Assessment interviews (which may be structured

or unstructured)or unstructured) Clinical observation of behaviorClinical observation of behavior Psychological testsPsychological tests

Psychosocial assessment attempts to provide Psychosocial assessment attempts to provide a realistic picture of an individual in interaction a realistic picture of an individual in interaction with his or her social environmentwith his or her social environment

Three procedures commonly used in Three procedures commonly used in psychosocial assessments include:psychosocial assessments include: Assessment interviews (which may be structured Assessment interviews (which may be structured

or unstructured)or unstructured) Clinical observation of behaviorClinical observation of behavior Psychological testsPsychological tests


Assessment InterviewsAssessment InterviewsAssessment InterviewsAssessment Interviews

A face-to-face interaction in which the A face-to-face interaction in which the clinician obtains information about the clinician obtains information about the client’s situation, personality, and client’s situation, personality, and behaviorbehavior

Structured interviews restrict freedom to Structured interviews restrict freedom to explore but increase reliabilityexplore but increase reliability

Unstructured interviews allow for more Unstructured interviews allow for more exploration but decrease reliabilityexploration but decrease reliability

A face-to-face interaction in which the A face-to-face interaction in which the clinician obtains information about the clinician obtains information about the client’s situation, personality, and client’s situation, personality, and behaviorbehavior

Structured interviews restrict freedom to Structured interviews restrict freedom to explore but increase reliabilityexplore but increase reliability

Unstructured interviews allow for more Unstructured interviews allow for more exploration but decrease reliabilityexploration but decrease reliability


The Clinical Observation The Clinical Observation of Behaviorof Behavior

The Clinical Observation The Clinical Observation of Behaviorof Behavior

Ideally, clinical observation takes place in Ideally, clinical observation takes place in a natural environment, such as a child’s a natural environment, such as a child’s behavior in a classroom or at homebehavior in a classroom or at home

However, it often takes place at the clinic However, it often takes place at the clinic or hospital where the client seeks helpor hospital where the client seeks help

Rating scales can augment clinical Rating scales can augment clinical observations of behavior and can observations of behavior and can increase reliability and validity increase reliability and validity

Ideally, clinical observation takes place in Ideally, clinical observation takes place in a natural environment, such as a child’s a natural environment, such as a child’s behavior in a classroom or at homebehavior in a classroom or at home

However, it often takes place at the clinic However, it often takes place at the clinic or hospital where the client seeks helpor hospital where the client seeks help

Rating scales can augment clinical Rating scales can augment clinical observations of behavior and can observations of behavior and can increase reliability and validity increase reliability and validity


Psychological TestsPsychological TestsPsychological TestsPsychological Tests

Two general categories of psychological Two general categories of psychological tests for use in clinical practice aretests for use in clinical practice are Intelligence tests such as the WISC-IV and Intelligence tests such as the WISC-IV and

WAIS-IIIWAIS-III Personality tests Personality tests

Projective personality testsProjective personality tests Objective personality testsObjective personality tests

Two general categories of psychological Two general categories of psychological tests for use in clinical practice aretests for use in clinical practice are Intelligence tests such as the WISC-IV and Intelligence tests such as the WISC-IV and

WAIS-IIIWAIS-III Personality tests Personality tests

Projective personality testsProjective personality tests Objective personality testsObjective personality tests



The most commonly used intelligence The most commonly used intelligence tests include:tests include: The WISC-IV and the Stanford-Binet (for The WISC-IV and the Stanford-Binet (for

children)children) The WAIS-III (for adults)The WAIS-III (for adults)

These tests are individually administered These tests are individually administered and typically take 2-3 hours to administer, and typically take 2-3 hours to administer, score, and interpretscore, and interpret

The most commonly used intelligence The most commonly used intelligence tests include:tests include: The WISC-IV and the Stanford-Binet (for The WISC-IV and the Stanford-Binet (for

children)children) The WAIS-III (for adults)The WAIS-III (for adults)

These tests are individually administered These tests are individually administered and typically take 2-3 hours to administer, and typically take 2-3 hours to administer, score, and interpretscore, and interpret



In projective personality tests In projective personality tests Unstructured stimuli are presented to a Unstructured stimuli are presented to a

subjectsubject The subject projects meaning or structure The subject projects meaning or structure

onto the stimuli onto the stimuli These projections reveal hidden motivesThese projections reveal hidden motives

In projective personality tests In projective personality tests Unstructured stimuli are presented to a Unstructured stimuli are presented to a

subjectsubject The subject projects meaning or structure The subject projects meaning or structure

onto the stimuli onto the stimuli These projections reveal hidden motivesThese projections reveal hidden motives



Projective personality tests include:Projective personality tests include: The Rorschach Inkblot TestThe Rorschach Inkblot Test The Thematic Apperception TestThe Thematic Apperception Test The Sentence Completion TestThe Sentence Completion Test

Projective personality tests include:Projective personality tests include: The Rorschach Inkblot TestThe Rorschach Inkblot Test The Thematic Apperception TestThe Thematic Apperception Test The Sentence Completion TestThe Sentence Completion Test



In objective personality testsIn objective personality tests A subject is required to read and respond to A subject is required to read and respond to

itemized statements or questionsitemized statements or questions

Objective personality tests include:Objective personality tests include: The MMPI-2The MMPI-2

The MMPI includes ten clinical scales measuring The MMPI includes ten clinical scales measuring psychopathology and a few validity scales psychopathology and a few validity scales measuring straightforwardnessmeasuring straightforwardness

In objective personality testsIn objective personality tests A subject is required to read and respond to A subject is required to read and respond to

itemized statements or questionsitemized statements or questions

Objective personality tests include:Objective personality tests include: The MMPI-2The MMPI-2

The MMPI includes ten clinical scales measuring The MMPI includes ten clinical scales measuring psychopathology and a few validity scales psychopathology and a few validity scales measuring straightforwardnessmeasuring straightforwardness


Advantages and Limitations of Advantages and Limitations of Objective Personality TestsObjective Personality Tests


Objective personality tests have the benefits of Objective personality tests have the benefits of being cost-effective and highly reliablebeing cost-effective and highly reliable

They have been criticized for being too They have been criticized for being too mechanistic and requiring too much reading mechanistic and requiring too much reading ability and cooperationability and cooperation

Actuarial procedures are used for MMPI and Actuarial procedures are used for MMPI and other scientifically constructed objective testsother scientifically constructed objective tests

Objective personality tests have the benefits of Objective personality tests have the benefits of being cost-effective and highly reliablebeing cost-effective and highly reliable

They have been criticized for being too They have been criticized for being too mechanistic and requiring too much reading mechanistic and requiring too much reading ability and cooperationability and cooperation

Actuarial procedures are used for MMPI and Actuarial procedures are used for MMPI and other scientifically constructed objective testsother scientifically constructed objective tests




Computers are increasingly used in Computers are increasingly used in psychological testingpsychological testing To gather information and to interpret or To gather information and to interpret or

evaluate data collected via other meansevaluate data collected via other means Some clinicians are more reluctant than Some clinicians are more reluctant than

others to employ computers into their others to employ computers into their practicespractices

Computers are increasingly used in Computers are increasingly used in psychological testingpsychological testing To gather information and to interpret or To gather information and to interpret or

evaluate data collected via other meansevaluate data collected via other means Some clinicians are more reluctant than Some clinicians are more reluctant than

others to employ computers into their others to employ computers into their practicespractices


Developments in Practice 4.4: Developments in Practice 4.4: Esteban’s MMPI-2 Profile and ReportEsteban’s MMPI-2 Profile and Report

Developments in Practice 4.4: Developments in Practice 4.4: Esteban’s MMPI-2 Profile and ReportEsteban’s MMPI-2 Profile and Report


The Integration The Integration of Assessment Dataof Assessment Data

The Integration The Integration of Assessment Dataof Assessment Data

Assessment data from various sources must be integrated into a coherent working model

Integration can be done by one mental health professional or a team

Sometimes, a definitive picture emerges Sometimes, there are discrepancies that

necessitate further assessment

Assessment data from various sources must be integrated into a coherent working model

Integration can be done by one mental health professional or a team

Sometimes, a definitive picture emerges Sometimes, there are discrepancies that

necessitate further assessment

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Ethical Issues in AssessmentEthical Issues in AssessmentEthical Issues in AssessmentEthical Issues in Assessment

Ethical issues in assessment include:Ethical issues in assessment include: Potential cultural biasPotential cultural bias Theoretical orientation of the clinicianTheoretical orientation of the clinician Underemphasis on the external situationUnderemphasis on the external situation Insufficient validationInsufficient validation Inaccurate data or premature evaluationInaccurate data or premature evaluation

Ethical issues in assessment include:Ethical issues in assessment include: Potential cultural biasPotential cultural bias Theoretical orientation of the clinicianTheoretical orientation of the clinician Underemphasis on the external situationUnderemphasis on the external situation Insufficient validationInsufficient validation Inaccurate data or premature evaluationInaccurate data or premature evaluation


Classifying Abnormal BehaviorClassifying Abnormal BehaviorClassifying Abnormal BehaviorClassifying Abnormal Behavior

Classification involves the attempt to Classification involves the attempt to delineate meaningful subvarieties of delineate meaningful subvarieties of maladaptive behaviormaladaptive behavior

The benefits of classification include:The benefits of classification include: The introduction of orderThe introduction of order The enabling of communicationThe enabling of communication The enabling of statistical researchThe enabling of statistical research Insurance issuesInsurance issues

Classification involves the attempt to Classification involves the attempt to delineate meaningful subvarieties of delineate meaningful subvarieties of maladaptive behaviormaladaptive behavior

The benefits of classification include:The benefits of classification include: The introduction of orderThe introduction of order The enabling of communicationThe enabling of communication The enabling of statistical researchThe enabling of statistical research Insurance issuesInsurance issues


Reliability and ValidityReliability and ValidityReliability and ValidityReliability and Validity

A classification system’s usefulness A classification system’s usefulness depends largely on its reliability and depends largely on its reliability and validityvalidity

A classification system’s usefulness A classification system’s usefulness depends largely on its reliability and depends largely on its reliability and validityvalidity


Differing Models of ClassificationDiffering Models of ClassificationDiffering Models of ClassificationDiffering Models of Classification

Three basic approaches include:Three basic approaches include: The categorical approachThe categorical approach– –

a patient is healthy or disordered, but there a patient is healthy or disordered, but there is no overlapis no overlap

The dimensional approachThe dimensional approach––the patient may fall along a range from the patient may fall along a range from superior functioning to absolutely impaired superior functioning to absolutely impaired functioningfunctioning

The prototypal approachThe prototypal approach––a conceptual entity depicts an idealized a conceptual entity depicts an idealized combination of characteristics, some of combination of characteristics, some of which the patient may not havewhich the patient may not have

Three basic approaches include:Three basic approaches include: The categorical approachThe categorical approach– –

a patient is healthy or disordered, but there a patient is healthy or disordered, but there is no overlapis no overlap

The dimensional approachThe dimensional approach––the patient may fall along a range from the patient may fall along a range from superior functioning to absolutely impaired superior functioning to absolutely impaired functioningfunctioning

The prototypal approachThe prototypal approach––a conceptual entity depicts an idealized a conceptual entity depicts an idealized combination of characteristics, some of combination of characteristics, some of which the patient may not havewhich the patient may not have


Formal Diagnostic Classification of Formal Diagnostic Classification of Mental DisordersMental Disorders


The Diagnostic and Statistical Manual of The Diagnostic and Statistical Manual of Mental Disorders (DSM) and the Mental Disorders (DSM) and the International Classification of Disease International Classification of Disease (ICD) are the two major classification (ICD) are the two major classification systems in use systems in use ICD is more commonly used in EuropeICD is more commonly used in Europe DSM is more commonly used in the U.S.DSM is more commonly used in the U.S.

DSM purports to be a categorical system, DSM purports to be a categorical system, but it is in fact prototypalbut it is in fact prototypal

The Diagnostic and Statistical Manual of The Diagnostic and Statistical Manual of Mental Disorders (DSM) and the Mental Disorders (DSM) and the International Classification of Disease International Classification of Disease (ICD) are the two major classification (ICD) are the two major classification systems in use systems in use ICD is more commonly used in EuropeICD is more commonly used in Europe DSM is more commonly used in the U.S.DSM is more commonly used in the U.S.

DSM purports to be a categorical system, DSM purports to be a categorical system, but it is in fact prototypalbut it is in fact prototypal




DSM has five axesDSM has five axes Axis I: The particular clinical syndromes or Axis I: The particular clinical syndromes or

other conditions that may be the focus of other conditions that may be the focus of clinical attentionclinical attention

Axis II: Personality disorders, mental Axis II: Personality disorders, mental retardationretardation

Axis III: General medical conditionsAxis III: General medical conditions Axis IV: Psychosocial and environmental Axis IV: Psychosocial and environmental

problemsproblems Axis V: Global assessment of functioningAxis V: Global assessment of functioning

DSM has five axesDSM has five axes Axis I: The particular clinical syndromes or Axis I: The particular clinical syndromes or

other conditions that may be the focus of other conditions that may be the focus of clinical attentionclinical attention

Axis II: Personality disorders, mental Axis II: Personality disorders, mental retardationretardation

Axis III: General medical conditionsAxis III: General medical conditions Axis IV: Psychosocial and environmental Axis IV: Psychosocial and environmental

problemsproblems Axis V: Global assessment of functioningAxis V: Global assessment of functioning




Mental health professionals should be Mental health professionals should be aware of the downsides of labelingaware of the downsides of labeling It may close off further inquiryIt may close off further inquiry Patients may play out the expectations of Patients may play out the expectations of

their “role”their “role” Others may stigmatize the labeled personOthers may stigmatize the labeled person

Nevertheless, arriving at such a Nevertheless, arriving at such a diagnosis is usually required before the diagnosis is usually required before the commencement of clinical servicescommencement of clinical services

Mental health professionals should be Mental health professionals should be aware of the downsides of labelingaware of the downsides of labeling It may close off further inquiryIt may close off further inquiry Patients may play out the expectations of Patients may play out the expectations of

their “role”their “role” Others may stigmatize the labeled personOthers may stigmatize the labeled person

Nevertheless, arriving at such a Nevertheless, arriving at such a diagnosis is usually required before the diagnosis is usually required before the commencement of clinical servicescommencement of clinical services


Unresolved IssuesUnresolved IssuesUnresolved IssuesUnresolved Issues

DSM is periodically revisedDSM is periodically revised Revision efforts are currently underwayRevision efforts are currently underway Personality disorders may be revised to Personality disorders may be revised to

reflect a more dimensional perspectivereflect a more dimensional perspective PTSD criteria may be revised to allow for PTSD criteria may be revised to allow for

“indirect” traumatization (e.g., 9/11 “indirect” traumatization (e.g., 9/11 attacks)attacks)

DSM is periodically revisedDSM is periodically revised Revision efforts are currently underwayRevision efforts are currently underway Personality disorders may be revised to Personality disorders may be revised to

reflect a more dimensional perspectivereflect a more dimensional perspective PTSD criteria may be revised to allow for PTSD criteria may be revised to allow for

“indirect” traumatization (e.g., 9/11 “indirect” traumatization (e.g., 9/11 attacks)attacks)


End of Chapter 4End of Chapter 4

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