Tuesday February 4 2014 Abnormal Psychology Chapter 4 Treatment Clinical Assessment Diagnosis and The Practitioner s Task Clinical practitioners are interested primarily in gathering idiographic information about their clients They seek an understanding of the specific nature and origins of a client s problems through clinical assessment and diagnosis Clinical Assessment To be useful assessment tools must be standardized reliable and valid Most clinical assessment methods fall into three general categories clinical interviews tests a nd o b s er v a t i o n s A c lin i cal interview permits th e practitioner to interact with a client and generally get a sense of who he or she is It may be either unstructured or structured Types of clinical tests include projective personality response psychophysiological neurological neuropsychological and intelligence tests Types of observation include naturalistic observation and analog observation Practitioners also employ self monitoring clients observe themselves and record designated behaviors feelings or cognitions as they occur Diagnosis After collecting assessment information clinicians form a clinical picture and decide upon a diagnosis The diagnosis is chosen from a classification system The system used most widely in the United States is the Diagnostic and Statistical Manual of Mental Disorders DSM IV TR The most recent version of DSM known as DSM IV TR lists approximately 400 disorders Clinicians must evaluate a client s condition on five axes or categories of 1 Tuesday February 4 2014 information The reliability and validity of DSM IV TR continue to receive broad clinical review and criticism Call for Change DSM 5 Over the past decade a task force and numerous work groups have been developing a new version of the DSM called DSM 5 which is scheduled for publication in 2013 DSM 5 will contain numerous additions and changes to the diagnostic categories criteria and organization found in DSM IV Releases of early drafts of this new classification and diagnostic system have been greeted with considerable debate Dangers of Diagnosis and Labeling Even with trustworthy assessment data and reliable and valid classification categories clinicians will not always arrive at the correct conclusion They are human and so fall prey to various biases misconceptions and expectations Another problem related to diagnosis is the prejudice that labels arouse which may be damaging to the person who is diagnosed Treatment The treatment decisions of therapists may be influenced by assessment information the diagnosis the clinician s theoretical orientation and familiarity with research and the field s state of knowledge Determining the effectiveness of treatment is difficult because therapists differ in their ways of defining and measuring success The variety and complexity of today s treatments also present a problem Therapy outcome studies have led to three general conclusions people in therapy are usually better off than people with similar problems who receive no treatment the various therapies do not appear to differ dramatically in their general effectiveness certain therapies or combinations of therapies do appear to be more effective than others for certain disorders 2 Tuesday February 4 2014 Some therapists currently advocate empirically supported treatment the active identification promotion and teaching of those interventions that have received clear research support 3