Assessment and Diagnosis

To continue with various questionnaires that one can use with various clients and patients. The next one on the list is the 'Children's Behavior Checklist' that has over 100 items for parents to rate their children. This is a personality inventory along with a few others that have tendencies to identify typical ways of responding behaviorally, cognitively, emotionally, show well-being. It also shows attitudes of the child. The MMPI (Minnesota Multiphasic Personality Inventory-III) is widely used and is empirically based for this test can detect lies (a lie scale) which is highly standardized and not flexible. There are also projective tests that have ambiguous stimuli and may have no specific meaning give. There is no set way of interpretation. The person thinks of something and current feelings will be revealed in what is seen. You will tap into the unconscious. There are the famous Rorshach tests (the famous inkblots) that have many interpretations on what is seen. There could be a part or a whole picture presented on the inkblot, but they are still standardized. Another teat is the 'Thematic Apperception Test' which is a series of ambiguous pictures that tell a story. The theme is what is seen in the story pictures. Still another test is the 'Sentence Completion Test' that is a series of open-ended sentences to be completed by the client/patient. The pros to this test is that it helps the clients to see clues to identify issues and concerns but still not directly revealed. The cons is that is has poor validity and reliability for clinicians' bias so some scores are so vulnerable.

Therapist and counselors observe behaviors systematically to see the frequency of various behaviors along with the situations that occur, for example the issue of anxiety they will count how many sessions that the issue is noticed and what is going on around the client at that time. The client can also help by using self-observation and when going back to the clinic during therapy they can discuss any disagreement even with a limited time for this limit may effect the subject to have a bias on how he or she observed. There is and expectation of the clients doing this.

What is meant by 'diagnosis'? This is the label of a set of symptoms that tend to go together for an issue or problem. The DSM (The Diagnostic and Statistical Manuel of Mental Disorders III and IV TR now V is used for primary rules for insurance purposes. It will allow the counselor/therapist a consistency with criteria that are related to the various disorders and offers at times vague descriptions with the psychoanalytic theory in changes made in 1952. In 1968 there were new disorders but not much different for there were still abstract definitions of the issues and problems and theory based and still the reliability was low. There were more interpretations made, then in 1980 along came the DSM III that illustrated that observable and theoretical based manual is used and not just theory based, but more specific and concrete characteristics along with criteria and various behaviors exhibited that were engaged by the people. It also gave a time frame for how long these symptoms exhibit symptoms the patient shows. Diagnosis will change in time along with a differential diagnosis made too. Assessment of how much interference of occupational and social problems does it cause. The DSM III has more improved validity and reliability. The DSM III is for diagnositic purposes not for treatment based solutions. This version still has its criticisms which tended to lean to the pathology to 'What is normal?' for now could be 'abnormal' it seems especially for women in subtle ways. This manual favors a biological approach for the purpose is that nature labels people and all the risks in the Western view which could be culturally insensitive for now we have culture bound syndromes in various specific cultures like the Asians.

*A Multi-Axial Diagnosis

AXIS I- all significant clinical syndromes and symptoms but no personality disorders but for MR (mentally retarded). There is a specific focus on ego dystonic that is unwelcome and distressing.

AXIS II- This is for personality disorders and MR (mentally retarded) and long term chronic ego syntonic, but not really realized but also not distressing to client.

AXIS III-General medical conditions that have the potential relevance to a certain condition.

AXIS IV- This is for psychosocial/environmental problems and the patient is failing and has family and work problems as contributing factors.

AXIS V- Global level of functioning and the current GAF is 100 to 1 but the client/patient is still able to function in everyday life.

Next article lesson is on Anxiety disorders

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