What are the key elements of a psychological assessment for a mental health problem?"

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“What are the key elements of a psychological assessment for a mental health problem?”

        A psychological assessment is a method of gathering the information required to be able to diagnose someone with a mental health problem, or alternatively to monitor the treatment or progress of someone already diagnosed. To officially assess someone for a particular mental disorder, their behaviour or feelings must correspond to a specified amount of the criteria laid out in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition™ (DSM-IV). For example, to be diagnosed with a panic disorder the person must experience fear that peaks within 10 minutes and must display 4 of 13 precise symptoms during this time. The DSM is updated as new illnesses are discovered and others dismissed to keep it relevant, such as the DSM-III removed homosexuality as it was no longer considered to be a ‘condition’. The DSM-IV added a mulitaxial classification system, where each patient is to be rated on each of the five axes which ensures the person’s diagnosis has taken into account many different types of disorders.

        One key element of psychological assessment is therefore that the data must be collected. It is, however, usually more complicated than simply matching the behaviour with that stated in the DSM-IV as diagnosis cannot be dependant on a matter of opinion. Additionally, sometimes even the patient themselves are unable to identify the exact nature of their problem (according to the psychodynamic paradigm), and therefore this needs to be assessed and objectively recognised as being congruent with the DSM-IV.  There are several ways to do this, each producing different sorts of data that can be analysed or collated in different ways. They all aim to highlight aspects of a person’s behaviour or personality in order to infer a mental disturbance of some kind, or allow for this to occur.

One type of data is qualitative, deeply detailed data that is mainly obtained in this area through clinical interviews. This requires the interviewer to pay considerable attention to not only the client’s responses themselves but also the manner in which they are expressed and with what emotion they are accompanied. Additionally, it is recognised that the client is likely to be agitated or stressed and so may be unlikely to volunteer deeply personal information (even if perfectly willing to) unless a sort of relationship is forged between the interviewer and client in which the latter can feel comfortable. These are both common features, although each clinical interview is not bound to the same school of thought. Consequently, the information obtained, the method in which this is achieved and the interpretation of said information is dependant on the interviewer’s own theories and belief’s. For example, a psychodynamic interviewer will be much more likely to search for repressed sexual urges and do this through word association than one who does not have as much faith in their importance. Because of this, it is very unlikely the interviewer will find any information that was not specifically looked for.  The clinical interview is seen a very good source of information although there are doubts concerning its reliability. This is because of the unstructured nature of the interview, as this prevents it being replicable. This presents a problem, as due to the confidential relationships required for them to work, the reliability cannot be tested. However, as the interviewer is unlikely to just conduct a singular interview, a “self corrective process” may occur, meaning that the psychologist can, after a few sessions, filter out information that appears to be incorrect or inconsistent. The data cannot always be used in relation to the DSM-IV but can still be very useful in identifying and assessing mental disorders in a less formal manner.

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        This problem is combated by the structured interview as a method for psychological assessment, as standardised information needs to be collected in certain circumstances such as in direct reference to DSM IV. Structured clinical interviews are characterised by a predetermined set of questions, and normally instructions on how and when to enquire for more information. An example of this is the Structured Clinical Interview (SCID) established by Spitzer, Gibbon and Williams in 1996 which used a ‘branching’ structure. This means that the answer the client gives to one question will determine the later questions the interviewer will ask. This has ...

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