CLINICAL ASSESSMENT AND THE INFLUENCE OF PROFESSIONAL

DIAGNOSIS ORIENTATION
• Clinical Assessment – one of the oldest How clinicians assess depends on their basic
and most widely developed branches of treatment orientation (e.g. behaviorism,
modern psychology. psychoanalysis, behaviorism, and cognitive
• Psychological Assessment – procedure psychology)
where clinicians develop a summary
classification of a client’s problem
through following the defined system by RELIABILITY, VALIDITY, AND
DSM-5 and as well as conducting STANDARD DEVIATION
psychological tests, observation, and
• Reliability – degree to which an
interviews.
assessment presents consistent results.
• Relationship Between Assessment and
• Validity – degree to which an
Diagnosis
assessment measures what it intends to
Adequate Knowledge of measure.
classification a Person’s • Standardization – process of
of presenting Type of administering, scoring, and interpretating
problem Disorder psychological tests in a consistent
manner.
Managing
Appropriate
Treatment IMPORTANCE OF TRUST AND
RAPPORT BETWEEN CLIENT AND
CLINICIAN

TAKING SOCIAL OR BEHAVIORAL To effectively conduct a psychological

HISTORY assessment and understand a client, they
must be comfortable with the clinician.
• Personality Factors – indication
whether a person has a history of The client must feel:
maladaptiveness and deviancy.
• The testing will help the clinician to
• Social Context – includes further understand his or her problem
environmental factors and other and how the psychological tests and its
extraneous social variables that could results will be used for clinical
affect a person’s state or traits.
evaluation.
• Have their feelings, beliefs, attitudes,
and personal history they disclose be
ENSURING CULTURALL SENSITIVE assured with strict confidentiality.
ASSESSMENT PROCEDURES
• Be oriented what will happen during
• Cultural Competence – is when a assessment and how the information
psychologist is informed with the issues gathered will help in providing a clearer
involved in multicultural assessment. picture of the problem.
ASSESSMENT OF THE PHYSICAL ORGANISM VS. PSYCHOSOCIAL ASSESSMENT
Assessment of the Physical Organism Psychosocial Assessment

Assessing brain damage and discovering the Provides a realistic picture of an individual in
how organic brain damage affects a person’s interaction with their social environment.
present functioning through new procedures
developed medical and neuropsychological Includes relevant information about a person’s
sciences. personality makeup and present level of
functioning as well as information about
Medical Evaluation stressors in their life.

• General Examination Psychosocial Assessment

• Neurological Examination • Assessment Interviews

- Electroencephalogram (EEG) - Structured Interview
- Computerized Axial Tomography - Semi-structured Interview
(CAT) Scan - Unstructured Interview
- Magnetic Resonance Imaging (MRI)
- Positron Emission Tomography (PET) • Clinical Observation of Behavior
- Functional Magnetic Resonance
- Role-playing
Imaging (fMRI) - Self-monitoring
- Rating Scales
• Neuropsychological Examination
- Halstead Category Test • Psychological Tests
- Tactual Performance Test - Intelligence Tests
- Rhythm Test - Projective Personality Test
- Speech Sounds Perception Test - Objective Personality Test
- Finger Oscillation Task

ETHICAL ISSUES IN ASSESSMENT

• Potential cultural bias of instrument or
clinician.
• Theoretical orientation of clinician.
• Underemphasis on external situation.
• Insufficient Validation
• Inaccurate data or premature evaluation.
CLASSIFICATION
It is the attempt to describe subvarieties of maladaptive behavior.
It is a necessary first step in introducing a discussion of the nature, causes, and treatment of
maladaptive behavior.
It makes it possible to communicate and cluster behavior in precise ways

CLASSIFYING ABNORMAL BEHAVIOR

Categorical Approach Dimensional Approach Prototypal Approach

• All human behavior is • A person’s behavior is • A psychologist compares

divided between made up of different a client’s traits and
“healthy” and traits (e.g. mood, anxiety, personality to a general
“disordered”. trust, social skills) that “prototype” instead of
• In a larger category, there exists on a scale of low to using a list of symptoms
exists smaller categories high. to diagnose.
of disorders that does not • People differ based on
overlap with one another. how strong or weak
these traits are, rather
than being classified as
having a specific disorder.

GENDER DIFFERENCES IN • The Cultural Formulation Interview

DIAGNOSIS (CFI) – contains 16 questions that a
practitioner could use in a mental health
Some disorders show a higher prevalence
assessment to obtain information on how
rate for male patients, while others are more
a client’s culture impacts his or her
present with the female population.
mental health care.

APPRAISAL OF CULTURAL
THE PROBLEM OF LABELING
BACKGROUND
When someone is diagnosed or labeled with
Cultural background might have an impact
a mental disorder, they might be seen as
to the values and attitude that a client brings
only that label, and it has negative effects
in an interview or assessment.
(e.g. decline in self-esteem, stigma,
It is extremely important for clinicians to reinforcement due to labeling).
consider a client’s personal cultural
While diagnoses are useful for treatment, it
background to lessen negative impact on
can create harmful stereotypes and limit a
decision-making process.
person’s potential.
ANNXIETY VS. FEAR • Anxiety – considered as a classic
neurotic disorder involving
• Fear – it is considering a basic emotion,
maladaptiveness and self-defeating
alarm reaction to an immediate danger.
behaviors, feeling of apprehension for a
future danger.
It involves activation of fight and flight
response.

COMPONENTS / RESPONSE PATTERN OF ANXIETY

Cognitive/Subjective Physiological Behavioral

Anxiety involves negative Creates a state of tension Anxiety makes people avoid
mood and worry about and chronic overarousal situation even if there are
possible future threats and (e.g. alertness) even if there no danger. It leads to
danger. are no danger. It doesn’t avoidance, hesitation, and
activate fight or flight cautiousness, but not an urge
“I am worried about what response, but it gets the body to immediately escape.
might happen.” ready in case something bad
happens. General Avoidance.

Tension, chronic arousal.

COMPONENTS / RESPONSE PATTERN OF FEAR

Cognitive/Subjective Physiological Behavioral

Immediate response when a Fight or flight response, an A desire to escape or run in

danger is present. immediate urge to act when presence of an immediate
there’s danger present. danger.
“I am in danger!”
Increased heart rate, A desire to escape.
sweating.

ANXIETY DISORDERS • Specific Phobia

• Social Anxiety Disorder (Social Phobia)
Characterized by unrealistic and irrational
fears and anxieties that causes significant • Panic Disorder
distress or impairments in functioning. • Agoraphobia
• Generalized Anxiety Disorder (GAD)
Anxiety disorders include the following:
SOCIAL ANXIETY DISORDER (SOCIAL PHOBIA) VS GENERALIZED ANXIETY
DISORDER (GAD)
Social Anxiety Disorder (Social Phobia) Generalized Anxiety Disorder (GAD)

• It is the constant anxiety or fear of social • Excessive fear and worry of many
situations wherein an individual is different aspects of life, including minor
exposed to be judged by others. events that becomes chronic, excessive,
• When an individual shows symptom of and unreasonable.
anxiety on how she or he might act in a • Anxiety occurs more days than not in the
way that would be negatively evaluated span of 6 months.
by those around her. • The individual finds it difficult not to
worry by many things.
• Social situations almost always provoke • Should at least show three (ore more) of
fear or anxiety. the following symptoms for the past 6
• Social situations are avoided or endured months or so: (1) Restlessness, (2) Easily
with intense fear or anxiety. Fatigued, (3) Difficulty in Concentration,
• The anxiety and worry cause (4) Muscle Tension, (5) Irritability, (6)
maladaptiveness. Sleep Disturbance.

Behaviorism Viewpoint: Psychoanalytic Viewpoint:

Social phobia originates from instances Anxiety occurs when conflicts within the
wherein one experiences social defeat or mind are not properly handled or struggles to
humiliation as well as being a target of anger control.
or criticism.
Biological Viewpoint:
Evolutionary Viewpoint: People who are highly anxious have
In a group where one dominates and other functional deficiency in GABA which plays
submits, those who submits show fear instead an important role on how our brain manages
of fighting back. They don’t run away, they stressful situations.
avoid confrontation as a means of survival,
hence some of us adapted.

Cognitive Viewpoint: Comorbidity of GAD with other Disorders:

One expects others to reject or negatively It often co-occurs with other disorders,
evaluate them which leads to vulnerability especially anxiety and mood disorders such as
when they are exposed with such “threat”. panic disorder, social phobia, specific phobia,
PTSD, and major depressive disorder.
Biological Viewpoint:
Children who inhibits shyness and avoidance
are more likely to be fearful as a child and Treatment: Anxiolytics and Antidepressants
develop social phobia by adolescence.
PANIC ATTACKS VS. PANIC DISORDER
Panic Attacks Panic Disorder

• It is an intense surge of fear and • It is defined as the recurrent unexpected

discomfort that reaches its peak within panic attacks.
minutes that can also occur when in both • Constant worry of having additional
calm and anxious states. panic attacks or their consequences.
• A single episode that could happen to • Changes in behavior to avoid situations or
anyone, even without mental health objects that might cause panic attacks.
condition. • The disturbance is not attributable to any
forms of substance abuse.

Biological Viewpoint:
People who have overactive amygdala, the fear center of the brain, are more likely to
experience sudden panic attacks.

Cognitive Viewpoint:
People with panic disorders are hypersensitive to their bodily sensations; they have biases with
the way they process threatening information and situations, specifically the ambiguous ones.

The Panic Circle:

When a threat is felt, this leads to worry and fear which will then manifest physically. The fear
gets stronger once the person overthinks these sensations, and the cycle continues.

Comorbidity of Panic Disorder:

People with panic disorder (83%) have at least one comorbid disorder. More commonly
generalized anxiety disorder, social phobia, specific phobia, PTSD, depression, and substance
use disorder.

Panic disorder is also a strong predictor of suicidal behavior.

Timing of Panic Attack:

All people can experience panic attack “out of the blue” when faced with some highly stressful
life circumstance, but not all who experienced panic attacks will develop panic disorders.
SPECIFIC PHOBIA VS. AGORAPHOBIA
Specific Phobia Agoraphobia

• It is a marked fear about a one specific • Fear of being in places where escaping might be
hard, or help is not available.
object or situation. • Fear of open spaces, as well as losing control in
public
• The phobic object or situation always • Fear or anxiety of two (or more) of the following
provokes immediate fear. situations:
• Persistent fear that is triggered by a - Using public transportations.
- Being in open spaces.
specific object or situation.
- Being in enclosed spaces.
• Phobic object or situation is actively - Standing in line or being in a crowd.
avoided or endured with intense fear and - Being outside of home, alone.
anxiety.
• Leads to significant distress that causes
• The agoraphobic object or situation always
impairments to a person’s functioning. provokes immediate fear.
• Persistent fear that is triggered by the agoraphobic
object.
• Agoraphobic object or situation is actively avoided
or endured with intense fear and anxiety.
• Leads to significant distress that causes
impairments to a person’s functioning.

Psychoanalytic Viewpoint:
EXPOSURE THERAPY
People redirect their anxiety unto something
that represents a symbolic relationship to their Form of behavior therapy that involves
actual fear. controlled and gradual exposure to
stimuli or situations that might invoke
Behaviorism Viewpoint: phobic fears.
Phobias are learned from experience: (1)
learned from others, when people around a Considered as an effective way to treat
child show fear of something, the child may specific phobia.
also learn to be afraid of it, (2) evolutionary
survival, we humans have learned to fear • Participant Modeling – the clinician
things that might possibly threaten our lives gradually shows the client how to
because this is how our ancestors stayed alive face their fear. Overtime, the fear
over time. decreases.

Biological Viewpoint:
Phobias can be influenced by: (1) genes, some
people inherit genes that makes them more
sensitive to fear, (2) personality traits, babies
who are naturally shy and anxious are more
likely to develop phobias when they grow
older.
AGORAPHOBIA WITH PANIC DISORDER VS. WITHOUT PANIC DISORDER
Agoraphobia With Panic Disorder Agoraphobia Without Panic Disorder

• Fear or anxiety of being in an open space • Fear of being in places where escaping
wherein there is no escape or help might be hard, or help is not available.
available in case of a sudden surge of • Fear of open spaces, as well as losing
panic attack. control in public
• The fear of being in an open space is still
related to one’s anxiety of having another
panic attack.

Treatment for agoraphobia with or without panic disorder:

• Introspective Exposure – deliberate exposure to feared internal situation.
• Panic Control Treatment (PCT) – teaching clients about the nature of anxiety and imposing
logical reanalysis through making it known that logical errors are prone to people with panic
disorders before exposing them to feared situations to build tolerance to the discomfort.

• People with panic disorders are also offered anxiolytics and antidepressants.