By the end of this post, you will be able to describe the four broad categories of clinical assessment: clinical interviews, psychological tests, behavioral assessments, and psychophysiological assessments. If you were to imagine what a therapy session looks like, most people imagine sitting across from the psychologist and having a conversation about what brought them to therapy in the first place. Well, this is an example of a clinical interview, which is the first category of clinical assessment. A clinical interview is a conversation between an interviewer and a client. The purpose is to gather a variety of information and make judgments related to the client’s situation and future goals.
Clinical interviews can be unstructured, where the clinician decides what questions to ask and how to ask them. In the classic movie, What About Bob?, Bob Wiley’s first therapy session is an initial interview with Dr. Leo Marvin. The interview is unstructured in order to help the clinician build a therapeutic relationship with the client and to determine what other assessments may be useful. The psychologist asks a combination of open-ended and closed-ended questions. Open-ended questions allow for the patient to decide how much they feel comfortable sharing, such as “What brings you here today?” Closed-ended questions allow the psychologist to ask for more specific information, such as “How many alcohol drinks do you consume per day?” In addition, the unstructured interview addresses the presenting problem from the theoretical perspective of the clinician.
Additionally, clinical interviews can be structured, where the clinician asks the patient the same standard set of questions. Structured interviews tend to be more reliable and consistent—in other words, making sure that the required information is gathered. Thus, structured interviews are used frequently in scientifically based clinical practice and in clinical research, such as this scene from The Big Bang Theory. Let’s go to the second category of clinical assessments, which is psychological tests. Psychological tests measure a variety of patient variables, from personality to neurological functioning. There are five sub-categories of psychological tests.
So, let’s get started.
The first type of psychological test is the personality test. Personality tests do not measure if “you’re crazy or not”, such as this scene from The Big Bang Theory. Rather, these tests measure personality characteristics and are useful in determining certain abnormal behavior. The best-known objective personality test is the Minnesota Multiphasic Personality Inventory (also known as the MMPI). This test is able to identify personality traits consistent with individuals who may be experiencing abnormal behavior or a psychological disorder. The MMPI has ten clinical subscales that can reliably identify clients who may be demonstrating symptoms consistent with hypochondriasis, depression, schizophrenia. The Millon Clinical Multiaxial Inventory (MCMI) is another objective personality test. This photo is of a Rorschach inkblot. Unlike objective tests, projective tests measure personality from a psychoanalytic (or Freudian) perspective.
The two most commonly known projective tests are the Rorschach Inkblot Test and the Thematic Apperception Test (TAT). Both tests rely on the client’s description of ambiguous stimuli, like an inkblot, where the client supposedly “projects” a unique interpretation that reflects his or her underlying unconscious processes. The second type of psychological test is general tests of psychological functioning. In this scene from What About Bob, Bob is telling himself, “I feel good. I feel great. I feel wonderful.” He’s doing in order to make him feel better in general. Therefore, these assessments do not focus on one specific symptom, such as depression. Rather, the test gives a broad overview of how well a person is doing psychologically. An example would be the General Health Questionnaire, which gives a quick snapshot of the client’s mental health status over the previous weeks.
The third type of psychological test is neuropsychological testing. The purpose of these tests are to detect cognitive impairments or abnormal functioning involving language, memory, perception, and learning abilities for example. One instrument is the Halstead-Reitan Neuropsychological Battery, which is widely used to evaluate the presence of brain damage. During my undergraduate research at Stanford, I worked in a lab that studied children with Fragile X syndrome. In the lab, we used the Bender Visual Motor Gestalt Test to detect problems in visual-motor development in these children and in control samples and to detect general brain damage and neurological impairment.
The fourth type of psychological test is intelligence testing. In the TV show Psych, Shawn is a psychic detective who is intelligent enough to solve crimes; however, he lacks some common sense like, in this scene, where he cannot jump the fence. Intelligence tests are often used to generally predict academic performance in traditional learning environments. It is important to note that intelligence scores do not represent general intelligence, which may include such things as creativity, artistic, and athletic behaviors. The two most commonly used intelligence tests are the Stanford-Binet Intelligence Scale and the Wechsler Adult Intelligence Scale (WAIS). The fifth and final type of psychological test is tests for specific symptoms. As the title suggests, these tests are created specifically to assess for targeted symptoms, such as crying and emotional eating as Gus is doing in this scene from the TV show Psych. They do this in order to determine specific psychological disorders, such as depression. There are tests that also assess for broader abnormal symptoms, such as the Brief Psychiatric Rating Scale. There also are disorder-specific instruments, such as for depression and anxiety. I have provided a copy of the Beck Anxiety Inventory on Canvas as a sample of a disorder-specific test.
Let’s get to the third category of clinical assessments, which is behavioral assessment. As the title suggests, the clinician examines how problem behaviors are related to or are the result of the client’s environment and/or individual situation. A clinician wants to determine the cause and the effect, or the antecedents and the consequences of the behavior. Behavioral assessment begin with a behavioral interview, and includes additional assessment tools, such as self-monitoring and behavioral observation. An example of self-monitoring would be to keep track of every time you had a panic attack and provide a written report of physical symptoms, thoughts, and feelings that occurred before, during, and after the panic attack. An example of behavioral observation would be having the psychologist observe a classroom session of a child who may be experiencing symptoms of ADHD to monitor and record the problem behavior. The fourth and final category of clinical assessments is psychophysiological assessment. These types of tests measure brain structure, brain function, and nervous system activity.
Different types of measurements assess a broad range of functional and structural challenges in the brain or physical changes in the rest of the body. This scene from The Big Bang Theory illustrates how anxiety can be measured in the lab using the following tools: The electroencephalogram (or EEG) measures the electrical activity in the brain. EEG patterns are useful in determining relaxation, sleep, waking, coma, and seizures. Now, have you ever had sweaty palms when you were nervous? Electrodermal activity can measure your sweat response in reaction to emotional states. Biofeedback uses both EEG and electrodermal activity to help people learn to control body functions that are typically outside of conscious awareness. Biofeedback is often used for relaxation and pain reduction. In this case, Sheldon may benefit from biofeedback in reducing his anxiety in the lab. In summary, there are four categories of clinical assessment, and each form of assessment is valuable in helping a client reach their personal goals. The photos and GIFs used in this video are property of the TV shows, Psych and The Big Bang Theory, and the movie, What About Bob? Thank you.
February 7, 2017