Chapter 13
Clinical Assessment
Assessment Procedures for Counselors and Helping Professionals, 7e
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Clinical Assessment
Clinical assessments are used in
counseling to:
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diagnose mental disorders
guide treatment decisions
monitor treatment progress
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DSM-IV-TR
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The Diagnostic and Statistical
Manual of Mental Disorders, Fourth
Edition, Text Revision is commonly
used by mental health workers in
numerous fields to categorize mental
disorders in clients.
Written by the American Psychiatric
Association (ApA)
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DSM-IV-TR
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The DSM-IV-TR has 17 categories and
over 300 different disorders.
Each disorder has a list of specific
diagnostic criteria that are used to
evaluate the presence of the disorder.
Each disorder is coded for easy
reference.
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DSM-IV-TR
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The DSM-IV-TR uses a multiaxial
diagnostic system.
Axis I: Clinical Disorders
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Axis
Axis
Axis
Axis
II:
III:
IV:
V:
Personality Disorders or Mental Retardation
General Medical Condition
Psychosocial or Environmental Problems
Global Assessment of Functioning (GAF)
Additional Information on my Website
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DSM-IV Explained
DSM-IV Axis Examples
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Interviews in Clinical Assessment
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Interviews are commonly used in
conjunction with other forms of assessment.
Interviews may be structured, semistructured or unstructured.
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Structured Interviews
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Structured interviews have increased in use
since the development of the DSM-IV-TR.
Common structured interviews include:
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Anxiety Disorders Interview Schedule for the DSM-IV (ADIS-IV)
The Child Assessment Schedule (CAS)
Composite International Diagnostic Interview (CIDI)
Diagnostic Interview Schedule (DIS)
Diagnostic Interview Schedule for Children (DISC-IV)
Substance Use Disorders Diagnostic Schedule (SUDDS-IV)
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Semi-Structured Interviews
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Semi-structured interviews provide greater flexibility
than structured interviews, but provide greater
reliability than unstructured interviews.
Some semi-structured interviews include:
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Diagnostic Interview for Children and Adolescents (DICA-IV)
Schedule for Affective Disorders and Schizophrenia (SADS)
Semistructured Clinical Interview for Children and Adolescents
(SCICA)
Structured Clinical Interview for DSM-IV Axis-I Disorders,
Clinical Version (SCID-CV) (see Figure 4.1)
Structured Clinical Interview for DSM-IV Axis-II Disorders
(SCID-II)
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Unstructured Interviews
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Despite the increasing use of structured
interviews, unstructured interviews are the
most common style of interviews used in
clinical settings.
Unstructured interviews often focus on core
domains relating to the client issue and
general functioning.
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Unstructured Interviews
Includes assessing client’s presenting
problem in three main areas:
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Onset/Course: When did the problems begin? Was
there a time when the client felt worse or better? Was
there any particular pattern?
Severity: Do the problems interfere with the client’s
life and/or lead to suffering or distress?
Stressor: Does the client believe that some external
event brought on the problems? Are any stressful life
events associated with the problem?
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Mental Status Exam (MSE)
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The MSE is a structured assessment
modeled after physician medial exams.
Focuses on core areas of psychiatric
functioning.
Commonly used in medical and psychiatric
settings.
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Common MSE Categories
Appearance
Behavior/Psychomotor
Activity
 Attitude toward Examiner
 Affect and Mood
 Speech
 Perceptual Disturbances
 Thought
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
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12-12
Orientation
Memory
Concentration and
Attention
Intelligence
Judgment and Insight
Reliability
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Instruments Used in Clinical Assessment
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Often focus on pathology
May have a broad or narrow scope.
Tests with a broad scope include:
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Brief Symptom Inventory
Minnesota Multiphasic Personality Inventory
Millon Multiaxial Inventory
Symptom Checklist 90-Revised
Tests with a narrow scope include:
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Beck Depression Inventory
Eating Disorder Inventory
Posttraumatic Stress Diagnostic Scale
Substance Abuse Screen Inventory
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Symptom Checklist 90-Revised
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The SCL-90-R measures nine scales of
psychological symptoms and provides three
global scales.
The SCL-90-R uses T scores to measure
outcomes.
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Beck Depression Inventory (BDI-II)
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Most commonly used measure of depression
21-items
Each item is scored on a scale from 0 to 3
Normed for adults 17 to 80 years in age
Higher scores indicate greater levels of
depression.
There is also a Beck Anxiety Inventory (BAI)
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Suicide Risk Assessment
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Assessing suicidality involves evaluating
client risk factors and warning sites.
Risk factors are ongoing client
characteristics that increase suicide risk
Warning signs are client behaviors that
warn of imminent suicide risk
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Suicide: Risk Factors
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Male
Single
Widowed
Divorced/separated
Elderly
Psychiatric illness
Psychosis
Hopelessness/helplessness
Previous suicide
attempt(s)/self-harm
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• Social isolation/rejection by others
• Physical illness (lifethreatening/chronic/debilitating)
• Unemployed/retired
• Family history of affective disorder,
alcoholism, or suicide
• Bereavement/loss
• Childhood bereavement
• Social classes at the extremes
• Family destabilization
• Recent trauma (physical/psychological)
• Specific suicide plan formulated
• intense negative emotions
• Preoccupation with earlier abuse
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Suicide: Warning Signs
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Giving away prized possessions*
Putting personal affairs in order
Radical changes in characteristic
behaviors or moods
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Suicide: Risk Factors
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Unstructured interviews are the most
common method for assessing suicide.
Many standardized assessments for assessing
suicidality are also available.
Core indicators of suicidality are also
embedded in many inventories (such as the
BDI-II)
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Observation and Clinical Assessment
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Observation can be used for many
purposes in clinical settings:
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to
to
to
to
help determine a diagnosis
target specific patterns of behavior
provide behavioral baseline data
identify effective treatment approaches
Assessment Procedures for Counselors and Helping
Professionals, 7e
Drummond/Jones
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Types of Observations
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Formal/Informal
Direct/Indirect
Intrusive/Unobtrusive
Informal, director observation is often the
initial type of observation used in clinical
settings.
Assessment Procedures for Counselors and Helping
Professionals, 7e
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Neuropsychological Assessment
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Neuropsychological assessment involves
assessing :
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attention
concentration
learning and memory
sensory-perceptual abilities
speech and language abilities
visuospatial skills
overall intelligence
executive functions
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Neuropsychological Tests
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Halstead-Reitan Neuropsychological Test
Battery
Luria-Nebraska Neuropsychological Battery
(LNNB)
Bender Visual-Motor Gestalt Test, Second
Edition (Bender-Gestalt II)
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Cultural Considerations in Clinical
Assessment
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Assessors should be sensitive to cultural
differences when performing clinical assessments.
Actively exploring and being open to differences is
essential to working with all clients.
Counselors should take care not to confuse
cultural differences for psychopathology.
Assessment Procedures for Counselors and Helping
Professionals, 7e
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