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1 Clinical assessment Clinical assessment Lindsey Rasmussen Introduction to Community Mental Health 2 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 3 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 4 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- 5 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. 6 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.