Download ICMH LP1 Clinical Assessment Paper

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Clinical assessment
Clinical assessment
Lindsey Rasmussen
Introduction to Community Mental Health
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Clinical assessment
The purpose of a clinical assessment is to evaluate an individual’s psychological
health to determine if s/he has a mental health disorder. If the evidence indicates the
presence of such, the clinical assessment serves a second purpose – it helps the
clinician assign the individual an appropriate diagnostic label. Lastly, the results of a
clinical assessment help the clinician decide on the best course of treatment for the
individual and their disorder. So overall, a clinical assessment has three primary
purposes: evaluation, diagnosis, and treatment planning.
In general, there are four types of clinical assessments: (1) physical examination;
(2) clinical interview; (3) observation; and (4) psychological testing. To begin with, a
person suffering from a mental health disorder may manifest physical symptoms and
thus go to his/her primary care physician. The physician may then conduct a clinical
assessment known as the physical examination. If no physical cause for the patient’s
symptoms can be identified, the physician may conclude the problem is psychological
and refer the patient to a mental health profession, such as a clinical psychologist or a
psychiatrist. However, it is always important for the clinician keep in mind, that physical
symptoms may be the consequence of, or secondary to, a psychological problem
(Seligman, Walker, & Rosenhan, 2001).
The second type of clinical assessment, the clinical interview, is the most
common method used to assess mental health disorders. However, this method
requires an experienced professional, especially if the interview is unstructured. This is
because an unstructured clinical interview requires the interviewer to observe not only
what the client is saying, but how s/he is saying it (intonation and rate of speech), and
what they’re nonverbal behavior is (facial expression, posture, and gestures). On the
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Clinical assessment
other hand, structured interviews involve a set of standardized questions automatically
scored by a computer, which reduces the influence of clinical judgment and also makes
it quite a reliable and valid method. Although the clinical interview is sometimes used as
the sole method of clinical assessment, it is more often used along with several other
methods (Telch, 2000).
Another accurate clinical method of assessing the presence of a mental health
disorder is through observation of an individual’s behavior in a variety of contexts.
These observations may include one or more of the following: (1) a behavioral
assessment: a record of when and how often a behavior occurs as well as its duration
and intensity; (2) psychophysiological assessment: the measure of psychological
processes which are the result of autonomic nervous system activity; and (3)
neuroimaging: MRIs, fMRIs, PET scans, and MEGs (Seligman et al., 2001).
Psychological testing is the fourth type of clinical assessment that may be utilized
to assess the presence of mental health disorders. There is an overwhelming amount of
these tests, which differ according to their focus and format. The following are general
categories of psychological tests: (1) psychological inventories such as the MMPI; (2)
“projective” tests such as the Rorschach; (3) intelligence tests like the WAIS and (4)
neuropsychological assessments like the Bender Visual-Motor Gestalt Test (Seligman et
al., 2001).
As previously stated, the main goal of a clinical assessment is to evaluate,
diagnose, and treat people with mental health disorders. However, this is challenging
because a number of methods must be utilized so that the professional has a variety of
sources and information from which to draw conclusions, and thus a diagnosis and
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Clinical assessment
treatment plan, from. In addition, methods vary in accuracy, reliability, and validity and
because the stakes are so high (this is a person’s life after all) a professional must be
very systematic in their assessment, minimize their personal bias as much as possible,
and acknowledge the limitations and benefits of each method h/she utilizes. The MMPI
is one such method that although widely used, may not be a very “good” psychological
assessment after all.
The Minnesota Multiphasic Personality Inventory (MMPI) is the most commonly
used personality test in the U.S. It was published by Hathaway and McKinley in 1943
and was an attempt to develop a more objective means of psychological testing (as
compared to projective tests which rely almost exclusively on clinical judgment). One
criticism of the MMPI is that it was developed using a “normal” group made up of
relatives and visitors to patients in the University of Minnesota Hospitals. The “clinical”
group was the patients the “normal” were coming to visit. This group was further divided
into subgroups based upon the following diagnostic labels: hypochondriasis,
depression, hysteria, psychopathic deviate, paranoia, psychasthenia, schizophrenia,
and hypomania. However, if a patient’s diagnostic label was questionable or if the
patient had more than one label (i.e. co-occurring disorders), that patient was not used.
Years later, two additional scales were added: (1) the Masculinity-Femininity (Mf) scale
(intended to discriminate between heterosexual men and women); and (2) a scale
attempting to measure social introversion (Si). The MMPI also has 4 additional scales
meant to detect “deviant test-taking attitudes” (Brannic, n.d.).
About a decade after the MMPI was first introduced it was determined that it
really didn’t do what it was supposed to, which was assign a diagnostic label to the test-
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Clinical assessment
taker depending on what their score was. As a result, the scale names have since been
replaced by numbers so that individuals with high scores on various scales are less
likely to be inappropriately labeled. And although the MMPI isn’t really a “good”
psychological test, virtually every clinical psychologist is taught how to administer and
score the MMPI in grad school and it is widely used in clinical practice. The thought is
that research and experience with people with certain scores gives meaning to the
scores (Brannic, n.d.).
On the other hand, the MMPI has a significant advantage that other clinical
assessments may not have. Because the MMPI was designed to be a “broad-width
measure” of a number of mental health disorders, it has the ability to provide information
about the existence of co-existing or dual disorders in clients suffering from both (Evans
& Sullivan, 2001, p.62). For example, the MMPI has the ability to indicate the presence
of both a substance use disorder and a mental health disorder, thus making it a clinical
assessment that has the ability to recognize the presence of co-existing disorders or a
dual diagnosis.
Every clinical assessment, no matter what type it is, has strengths and
weaknesses. This being said, it is obvious that competent clinical assessment requires
a clinician that meets the following minimum requirements: (1) be formally trained in
clinical assessment; (2) thoroughly understand the benefits and limitations of each
assessment s/he is trained to use; and (3) the ability to correctly administer, score, and
interpret the results of a number of clinical assessments. These are the minimum
requirements necessary for competent evaluation, diagnosis, and treatment of mental
health disorders in the clinical setting.
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Clinical assessment
References
Brannic, A. (n.d.). MMPI. Retrieved from http://luna.cas.usf.edu/ambrannic/files/tnm
/mmpi.htm.
Evans, K. & Sullivan, J. (2001). Dual diagnosis: Counseling the mentally ill substance
abuser. New York: The Guilford Press.
Kline, K. (n.d.). Assessment interviewing and observation in clinical psychology
[PowerPoint slides]. Retrieved from http://www.kelleykline.com.
Seligman, M., Walker, E., & Rosenhan, D. (2001). Abnormal psychology. New York:
W. W. Norton & Company.
Telch (2000). Clinical interview [PowerPoint slides]. Retrieved from
http://homepage.psy.
utexas.edu/homepage/class/Psy364/Telch/Lectures/OnScreenPresentations/
Interviewing/index.htm.