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Psychological Assessment

VIEWS: 96 PAGES: 79

									Psychological Assessment
   William P. Wattles, Ph.D.




            Francis
            Marion             1
            University
        Psychological Report
• The end product of assessment.
• More than merely test results
• Must “interact with the data” to make useful
  conclusions about
  – Referral question
  – Making decisions
  – Problem solving
                        Francis
                        Marion               2
                        University
          Referral Question
• A brief description of the client
• general reason for conducting the evaluation




                   Francis
                   Marion                    3
                   University
           Referral Question
• Orients the reader to the initial focus of the
  report and what follows.
• Clinician must clarify the referral question.




                     Francis
                     Marion                        4
                     University
            Referral Question
• “Referred for a psychological”
  – lacks focus and precision
  – leads to “shotgun” reports
     • A wide variety of often-fragmented descriptions in
       the hope that something useful can be found.




                        Francis
                        Marion                              5
                        University
          Referral Question
• Example
• “Mr. Smith is a 35-year-old, white, married
  male with a high school education who
  presents with complaints about depression
  and anxiety.”



                   Francis
                   Marion                       6
                   University
            Report Format
• Please follow example
• Add Discussion (case conceptualization)
  section before Impressions and
  recommendations.




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                   Marion                   7
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          Discussion Section
• This is where you put it together.




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                    Marion             8
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                  clarity
• She was attractive, well spoken, and had
  high mannerisms




                   Francis
                   Marion                    9
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  Translate Technical concepts
• Examples page 631




                 Francis
                 Marion          10
                 University
               Be concise
• Jesse S is a 23-year-old Caucasian
  female who presents with having the
  desire to feel “fully fulfilled”. She wants
  to feel settled in her life. The current
  evaluation was designed for the patient
  to gain personal insight regarding
  dissatisfaction with her current daily
  activities. (44)
                   Francis
                   Marion                       11
                   University
              Be concise
• Jesse S is a 23-year-old Caucasian
  female who is dissatisfied with her daily
  activities and wants to feel “fully
  fulfilled.” (21)




                  Francis
                  Marion                  12
                  University
                Be concise
• The patient answered all:
  – The inquiries presented to him
  – my questions.




                     Francis
                     Marion          13
                     University
           Simple language
• When this issue was further questioned, MT
  ….
• Asked to elaborate, MT …




                   Francis
                   Marion                  14
                   University
          Simple language
• She displayed a euthymic mood, which she
  described as “great”.




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                  Marion                     15
                  University
       Avoid pejorative terms
• She was low on the Lie scale indicating that
  she received a normal score and appeared to
  answer honestly and openly.




                    Francis
                    Marion                   16
                    University
               Avoid jargon
• People with this profile tend to be
  narcissistic, selfish, and self-indulgent.




                     Francis
                     Marion                    17
                     University
           Seek active verbs
• The older sister was described as stubborn
  implying a strain in the relationship.




                   Francis
                   Marion                      18
                   University
        watch for redundancy
• Her past work history consists of working
  on a local




                   Francis
                   Marion                     19
                   University
             Seek clarity
• Mrs. L’s Mother is a resigned OB/GYN
  nurse




                  Francis
                  Marion                 20
                  University
                   Short
• She made no eye contact even though she
  was familiar with the interviewer. Her eyes
  focused on the hairline of the interviewer.
• She appeared to look over my head rather
  than making eye contact.



                   Francis
                   Marion                       21
                   University
        Don’t over do quotes
• “we weren’t poor but we weren’t well off
  either.”




                   Francis
                   Marion                    22
                   University
                   quotes
• because “the other students think [she gets]
  all of the questions correct but [she] still
  doesn’t know everything [she feels] like
  [she needs] to know.”




                    Francis
                    Marion                       23
                    University
                Be concise
• Given the behavioral observations, length
  and depth of clinical interview and MMPI-2
  test profile, I believe this evaluation is an
  accurate assessment of TS’s current level of
  functioning.



                    Francis
                    Marion                    24
                    University
        Details and examples
• She admits that they sometimes
  “overcompensate” in caring for their
  children because neither of them received
  enough attention from their parents growing
  up



                   Francis
                   Marion                   25
                   University
        Be direct, don’t repeat
• After high school, she felt that college was the
  next logical step for her. She felt that “my
  parents were completely behind me as
  though it was the next natural step, but also
  to make sure that I did end up going to
  college”. She repeated many times that “you
  don’t really have a choice about college in my
  family; they make you think you do, but you
  really don’t”. Ms. Davis went on to say that
  she had been brought up thinking this, and
  she didn’t even consider any other options
  after high school. (95)
                      Francis
                     Marion                     26
                     University
 Interpretation goes in discussion
• The results of CA’s WAIS-III indicates that she
  has above average intelligence especially with
  regards to her phenomenal attention span and her
  ability to solve visual problems using her visual
  motor skills. Her very high scores on her WAIS-
  III could be contributing to her unhappiness in her
  present occupation. She may feel that she is not
  using her strengths in the best possible fashion and
  that she has not lived up to her expectations.
                       Francis
                       Marion                       27
                       University
        Case Conceptualization
•    S.L. is currently experiencing a great deal of
    subjective distress. Her current difficulties with
    depressive and anxiety symptoms are likely
    related to her self-concept, which has been shaped
    and distorted by her long-term interpersonal
    relationships with her family and her ex-
    boyfriend. The unreasonably high demands she
    places on herself set the stage for what she views
    as “failure”.
                        Francis
                        Marion                      28
                        University
         Details and behavior
• During this time, G admitted to having been
  in trouble with the law. She refused to
  specify the type trouble. She also reported
  that she got into a lot of “other” trouble due
  to her sexual behavior. Again, she would
  specify what this “other” trouble was


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                    Marion                     29
                    University
            Initial Reports
• Length of papers 627-1960 words
• Best paper was relatively long
• You can check length




                  Francis
                  Marion            30
                  University
           Referral Section
• Brief
• Guides report




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                  Marion       31
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  General Comments on Papers
• Appearance example: wearing house
  slippers, relevant to psy functioning.
• Good use of quotes: Would keep cats “until
  it killed her”




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                   Marion                  32
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             Use examples
• One patient had strict parents
• Examples help identify where the blame lies
• Didn’t want to “rat” on her friends




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                   Marion                   33
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                Language
• Proof read. One paper good content many
  errors in verbs etc.
• Avoid slang or colloquial language (I.e.,
  blew it off) unless they are the client’s
  words in quotes



                   Francis
                   Marion                     34
                   University
• She did not display irregular emotion during
  the interview.




                   Francis
                   Marion                    35
                   University
        Colloquial Language
• Kim was kicked out of college her freshman
  year because of poor grades.
• The university suspended Kim her freshman
  year due to poor grades.




                   Francis
                   Marion                  36
                   University
            Simple language
•   Ms. Heather presented, in the interview,
    congruent behaviors to that of someone
    with lower self-esteem.
•   Ms. Heather shows signs of low self-
    esteem.
•   Low self-esteem may contribute to her
    eating problems.
                    Francis
                    Marion                     37
                    University
      Psychological Functioning
•   Conceptualize
•   Collect facts and observations
•   Don’t stop there
•   Synthesize those observations and data into
    a picture of psychological functioning


                     Francis
                     Marion                   38
                     University
     Strengths and Weaknesses
• Important to identify strengths to use and
  encourage




                    Francis
                    Marion                     39
                    University
                Example
• The client was alert and oriented to all
  spheres. Her affect was full range, and
  her mood was euphoric. Her speech
  rate, quality, and content were within
  normal limits.



                  Francis
                  Marion                     40
                  University
   Observation vs Interpretation
• Her calm demeanor while discussing her
  anxiety about graduate school, and her
  boyfriend suggested that this client keeps
  her emotional reactions to herself and
  maintains an intellectual stance on her
  personal issues.


                    Francis
                    Marion                     41
                    University
                Example
• Mrs. H is a 57-year-old, Caucasian, married
  female who presents with concerns
  regarding a specific goal, her future
  retirement in order to spend time with her
  grandchildren.



                   Francis
                   Marion                   42
                   University
            Passive voice
• Also, should his emotional situation
  persist or worsen, it is recommended
  that Andrew seeks the help of a
  counselor.




                 Francis
                 Marion                  43
                 University
  Referral Section vs. Summary
• C.S. states “this is not what I imagined
  doing with my life.” This dissatisfaction
  results in physical, emotional and social
  problems whose effects she seeks to
  minimize.



                    Francis
                    Marion                    44
                    University
    Good but can we improve?
• The client was very articulate and well
  educated, but her appearance was
  incongruent. She was dressed in very
  sloppy and causal attire.




                    Francis
                    Marion                  45
                    University
           Precise Language
• Articulate
  – Expressing oneself easily in clear and effective
    language.
• Redundant
  – Needlessly repetitive; verbose



                      Francis
                      Marion                       46
                      University
               Example
• When describing her family background,
  however, the possible use of reaction
  formation became evident.




                  Francis
                  Marion                   47
                  University
            Explore for data
• She also stated that she felt inferior and
  lacked confidence in herself as a teacher,
  but offered no substantial reason why.




                    Francis
                    Marion                     48
                    University
               Example
• his mood changed from enthymic to closed
  and quiet




                  Francis
                  Marion                     49
                  University
              Diagnosis
• Andrew is a 24-year-old man referred
  because of his current unemployment
  and because he has been unable to find
  a job. Due to this situation, Andrew is
  going into a state of depression



                 Francis
                 Marion                 50
                 University
• Kim is a 23-year-old white female who
  presents with difficulties coping with stress
  brought upon her by school.
• Better:




                    Francis
                    Marion                        51
                    University
• Kim is a 23-year-old white female college
  student complaining of stress related to
  school.




                   Francis
                   Marion                     52
                   University
• Kim approached the interview very willingly and
  appeared to be excited to do the interview. She
  wore sweatpants and a tee shirt. Her hair was
  pulled back into a clip. She was very talkative and
  maintained appropriate eye contact. She was very
  cooperative and answered all questions willingly,
  many times volunteering information beyond what
  had been asked of her but still remaining on the
  subject. She willingly expanded on all of her
  answers, many times without being prompted.

                       Francis
                       Marion                       53
                       University
• He is the only child of John and Vickie
  Xxxxxx . He has an older brother that his
  mother gave birth to out of wedlock prior to
  marrying Eric's father.




                    Francis
                    Marion                   54
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• She wore coordinating accessories and
  seemed very contentious of her attire and
  posture.




                   Francis
                   Marion                     55
                   University
• At age ten his father became a member of
  AA,




                   Francis
                   Marion                    56
                   University
• Laura C. is a 23 year old woman who is
  self-referred because she not happy with her
  current living situation. She says that she
  feels “so alone”. She reportedly has gained
  weight over the last several months. She
  claims it is due to her “ unhappiness about
  being alone”.



                   Francis
                   Marion                   57
                   University
• Laura also reports that her weight gain has
  not affected her relationship with her
  boyfriend.




                    Francis
                    Marion                      58
                    University
        Verify with examples
• Her problems stem from her current
  occupation as a teacher. She has undergone
  significant life events in the last year.




                   Francis
                   Marion                  59
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        Verify with examples
• She reports that she makes friends easily …




                   Francis
                   Marion                   60
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               Use Examples
•       In addition to confronting his wife’s
    mortality, Harold is being forced by her
    illness to recognize his own vulnerabilities




                      Francis
                      Marion                       61
                      University
        Verify with examples
• quit her job as a registration representative
  at _______ because of the unfair working
  conditions.




                     Francis
                     Marion                       62
                     University
                 Example
• His affect was full range, although his
  mood was quite dysphoric.




                    Francis
                    Marion                  63
                    University
               Example
• In an effort to alleviate her frustration
  and anger, and to come to a
  compromise with Mr. Oranda about their
  differences in their expected roles, Mrs.
  Oranda states that she has made a
  conscious effort to talk to, rather than
  argue with, Mr. Oranda.

                  Francis
                  Marion                  64
                  University
               Example
• Her affect was full range, however her
  mood was agitated.




                  Francis
                  Marion                   65
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                Example
• Within normal limits.




                   Francis
                   Marion       66
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               Example
• She states she has many friends, and
  socializes with them on a weekly basis.




                  Francis
                  Marion                    67
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               Example
• Ms. A described her high school
  academic performance as above
  average, stating that she never studied




                  Francis
                  Marion                    68
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                  Wordy
• Brittany was explicit during the interview
  when discussing her home environment in
  reference to how physically violent it is.
• Brittany explicitly described the violence in
  her home.



                    Francis
                    Marion                    69
                    University
                Example
• Brittany’s academic and behavior problems
  began when her parents started drinking and
  fighting 2 years ago.




                   Francis
                   Marion                   70
                   University
           Be succinct 38 vs 29
• In order to improve her      • To help with fatigue
  sleep schedule, she could      she could be given
  be given information on
                                 information on sleep
  sleep principles. For
  example, some principles       such as going to bed
  are going to bed at the        that same time each
  same time each night and       night and not doing
  not doing anything in the      anything in bed but
  bed but sleeping.              sleeping.

                         Francis
                         Marion                         71
                         University
        The “You” in a Report
• Personal opinion
  versus observation and
  hypothesis
• Sort through the
  abundant information




                     Francis
                     Marion       72
                     University
Presenting problem versus reason for
              referral
• reported that she “wished to be thinner”
• She reports 9-10 year struggle with anorexia. As a
  result of this, she has had to seek medical
  treatment to pass four kidney stones and treat
  multiple stomach ulcers. Ms. Heather has had
  difficulty in maintaining a regular menstrual cycle
  and has experienced fainting spells due to low
  blood sugar a few times per month.

                       Francis
                       Marion                       73
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• She is approximately 5 foot tall, 100 pounds
• She appears …
• She reported that she is …
•



                   Francis
                   Marion                    74
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       5 feet 100 lbs is BMI 19.5
•   BMI Categories:
•   Underweight = <18.5
•   Normal weight = 18.5-24.9
•   Overweight = 25-29.9
•   Obesity = BMI of 30 or greater


                     Francis
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• she stated that being the only child made
  them “over protective” and that she hoped
  they would “ease up” after she finished
  college. She explained that the more they
  monitored her plate, the more stress she felt
  and the more creative she got with hiding
  her food. She is still living at home. (24)

                    Francis
                    Marion                    76
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           Questions to ask
• Ms. Dubose is a 22 year old white female
  whose reason for referral was unhappiness
  with current job and disappointment with
  her “professional direction.”




                   Francis
                   Marion                     77
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1. Despite the time difference between her
   recent return to academia and completion
   of her nursing studies, Mrs. J’s
   performance in Francis Marion
   University’s graduate program is
   excellent.


                   Francis
                   Marion                     78
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The End

   Francis
   Marion       79
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