Clinical Assessment in Clinical Psychology

The word assessment means evaluating or judging something.

In clinical psychology, assessment is the evaluation and judgement of the client’s personality, problems, motivations, and behaviours; and finding the causative factors of these aspects of the client.

Psychologist generally treats people with psycho-social problems. Therefore, they carry out an assessment of the person to find out the causative factors of psycho-social issues of the person. In such clinical assessments, different psychological tests are used. It is a multi-stage assessment where therapists observe the client and gain information about him to reach a conclusion about what possibly have caused the issues of the client.

   Why clinical assessment is required?

Clinical assessment is the first step towards making decisions to resolve the psycho-social problem of the client. It is important that these decisions are based on the proper assessment of the client so that the decisions and strategies must address the problem correctly. For instance, whether the client should be hospitalized or not, and that what kind of therapy should be carried out for treatment. Without proper assessment, the strategies of treatment would be misdirected and ineffective. For instance, if a child is a slow learner, the clinician has to make a wise decision whether the school of the child should be changed, or if there is a need for some special learning program for the child, or if there are some other issues in the context which needs to be addressed.

Clinical assessment is carried out for the following reasons:

   Prediction of future behaviour 

Clinical assessment helps the clinician to evaluate the current behaviour as well as to predict future behaviour. If the clinician predicts future risks associated with the client’s behaviour, he will be able to tackle the problem in advance. For instance, while assessing an aggressive client, the clinician may find that the client has suicidal inclinations or a tendency to harm others. In such a case, the clinician will adopt certain strategies to address the issue of the expected dangerous behaviour of the client. Therefore, the clinician may advise the patient to be hospitalized or may not allow the patient (if already hospitalized) to be discharged from the hospital until his full recovery. If the client is expected to harm others, the clinician may advise the hospital staff members and family members of the client to arrange measures accordingly.

On the other hand, if a client is behaving well and has overcome the problem, he may be allowed to be discharged from the hospital. In short, clinical assessments are carried out periodically to make such important decisions in relation to the treatment of the client.

   Differentiation between disorders – correct diagnosis

There are many disorders whose most symptoms overlap with each other. In such a case, the clinician has to look at the specific differences to make a differential diagnosis. For instance, major depressive disorder and persistent depressive disorder may share some symptoms but the time of the disorder varies in both cases. If the issue remains for a period of up to two weeks, it is likely to be diagnosed as major depressive disorder. However, if the time of the issue exceeds up to two years with recurrent symptoms, it is more likely to be diagnosed as persistent depressive disorder. This is a simple example, but the clinical assessment is a systematic inquiry that involves taking the history of the client and gathering other background information of the client, and thus many things are explored during the assessment. This leads to correct diagnosis of the disorder which share symptoms with other disorders.  

   Deciding treatment method

There are many therapies and each of which uses multiple techniques. Different problems require different techniques of treatment. For instance, the technique, systematic desensitization works best for the treatment of certain phobias. Similarly, another technique, the token economy works best for schizophrenic patients. Clinical assessment helps the clinician to understand the problem and decide which therapy to be used for better outcomes.

For example, maladaptive behaviour in most cases is a learnt behaviour. If the clinician traces back to how the person learned those behaviors, he can help the person unlearn those behaviors. Without tracing the root, the clinician would be unable to help the person unlearn maladaptive behaviour or may use the wrong technique to help the person cope with the situation.

Using a correct technique also involves deciding the time and the number of sessions required for treatment. Clinical assessment is the tool that unveils such important aspects of the treatment.

   TYPES OF CLINICAL ASSESSMENT

There are two main types of clinical assessment. 

   Formal Assessment 

It is the type of clinical assessment where the clinician uses standardized tests in a structured format for the evaluation of the patient. For instance, a questionnaire is made with a number of questions and their possible answers (as options) which is used to interview the patient. The process of evaluation follows a pre-determined format such as in terms of parts of the interview and questions to be asked according to the nature of the problem.

This type of assessment is generally used for probing into the complex as well as a simple problem. However, it is mostly used in cases where the problem seems to be easily grasped by the clinician with the help of a predetermined format of the interview. This is because such a problem is generally a common problem, however, the assessment is carried out to confirm the problem and to confirm the use of the correct treatment style.

   Informal Assessment 

This type of clinical assessment does not use standardized tests or interviews in a pre-determined format. It involves a flexible style of assessment such as semi-structured or non-structured interviews (with no or less predetermined format) or observation. For the interview, the clinician starts a general conversation with the client where the questions arise from within the conversation. Another method of assessment is observation, where the clinician observes the client either by engaging with the client personally or by observing the client without engaging with him personally. The interview and observation methods are explained in detail as follows.

   TYPES OF INFORMAL ASSESSMENT

Informal assessment has the following four subtypes.

(A) Interviewing the client

The clinician interviews the patient about the problem. He asks questions such as the nature of the problem, symptoms of the problem, about family, relatives and friends of patient, social and economic circumstances of the patient, past experiences, job-related questions. By asking these questions, the clinician attempts to figure out if any factor from the background of the patient is causing the problem such as relationship problems, economic crises, job-related stress, education-related stress and miserable experiences in the past.

The clinician may also ask other questions which seem to be irrelevant but may have an indirect causal relationship to the problem of the patient. It is a semi-structured flexible interview where a number of such questions may arise from within the discussion of the patient.

Since it is a flexible style of assessment, it allows the clinician to observe the patient closely. For instance, the clinician observes the verbal (such as speech, thought content, the appearance of the patient) as well as non-verbal behaviour of the patient (such as eye contact, facial expressions, body language). Both the verbal and non-verbal expression helps the clinician to assess the patient correctly. For instance, if the clinician asks the patient, ‘how are you feeling now?’. The patient may answer, ‘I am feeling good’. However, if the patient’s hand trembling and he is tapping his feet frequently on the floor, this might give a hint to the clinician that the patient is actually not feeling good or is under stress, or he is hiding something or does not want to share it. Observing such disparity in verbal and non-verbal behaviour helps in correct assessment.  

(B) Interviewing the attendant or a person close to the patient

The clinician may sometimes interview the attendant or someone who is close to the patient. This happens when 1) a grossly psychotic or mentally retarded patient is not in a state to provide correct information, 2) the patient intentionally hides the valid information and shares false information because he does not want to be treated or due to the fear of being labelled as a mentally ill person, and 3) the patient provides valid information but knowing their problem from another person’s perspective is required.

In such cases, the clinician interviews a person close to the patient who has spent considerable time with the patient and knows well about the patient. It can be one of the parents, spouse, close friend, co-worker, or teacher of the patient.

Sometimes the clinician may interview both the patient as well as the person close to him. For instance, some patients fear the stigma of mental illness and thus, refrain from consulting with the clinician. When the family take such a patient to the clinician, he tries to deceive the clinician with false answers to prove himself as having no psychological problem. In such a case, the clinician does not base his judgement only on the information given by the patient but also on the information provided by his family members.

(C) Observing the patient in a natural setting

In some cases, the patient requires to be assessed in their natural settings such as their home, workplace, college or university, playground, or market. These are the places where the patient is likely to behave quite naturally and project their real status of behaviour. This is because when the patient is in a clinical setting, he thinks that he is under the observation of the clinician, which may change the real expression of his behaviour. In such a situation, the observation may lead to a false assessment. Therefore, in some complex cases, it is important to observe how the patient behave naturally to reach the correct assessment.

Moreover, as noted earlier, the fear of the stigma of mental illness is quite common. Therefore, some patients refuse from getting assessed at the clinic or intentionally provides false information to the clinician to prove himself as a psychologically sound person when indeed he has a problem. In such a case, observing him in the natural environment is necessary. If the patient becomes aggressive on petty things in a natural setting such as becoming angry while waiting in a queue for his turn at a bank may give the observer a clue that the person might be behaving slightly abnormally.

(D) Observing the person through standardized test situation

As opposed to the observation in a natural setting, the patient may also be observed in a standardized test situation. In such a situation, the patient may be put to a test situation that assesses how he behaves in response to certain stimuli. Through this situation, it is assessed whether the patient remains calm or became anxious while undergoing the situation; and that what is his attitude while he is in the situation. This style of observation is generally done in an informal manner, however, sometimes some predetermined situations are presented to the patient.