Applied Fields: Clinical

Introduction

Psychological assessment is utilized in clinical psychology primarily for purposes of differential diagnosis, treatment planning, and outcome evaluation. Differential diagnosis involves drawing on assessment information to describe an individual's psychological characteristics and adaptive strengths and weaknesses. These descriptions provide a basis for determining (a) what type of disorder an individual may have, (b) the severity and chronicity of this disorder and the circumstances in which it is likely to be manifest, and (c) the kinds of treatment that are likely to provide the individual relief from this disorder. With respect to further treatment planning, adequate assessment information helps to guide treatment strategies and anticipate possible obstacles to progress in therapy. As for outcome evaluation, pre-treatment assessments establish an objective baseline against which treatment progress can be monitored in subsequent evaluations, and by which the eventual benefits of the treatment can be judged at its conclusion. These clinical contributions of psychological assessment can be implemented during each of four sequential phases in delivering psychological treatment: deciding on therapy, planning therapy, conducting therapy, and evaluating therapy.

Deciding on Therapy

The first step in the clinical utilization of assessment information consists of deciding whether a patient needs treatment and is likely to benefit from it. Accurate differential diagnosis identifies pathological conditions (e.g. depression, paranoia) and maladaptive characteristics (e.g. passivity, low self-esteem) for which treatment is usually indicated, and adequate psychological evaluation helps to distinguish such conditions and characteristics from normal range functioning that does not call for professional mental health intervention. Assessment methods also provide valuable information concerning two factors known to predict whether people are likely to become involved in and profit from psychotherapy: their motivation for treatment and their accessibility to being treated (Garfield, 1994; Greencavage & Norcross, 1990).

Motivation for treatment usually corresponds to the amount of subjectively felt distress that people are experiencing. Accessibility to psychological treatment typically depends on how willing people are to examine themselves, to express their thoughts and feelings openly, and to make changes in their customary beliefs and preferred ways of conducting their lives. Information derived from appropriate assessment procedures can provide clinicians with objective indices of each of these variables, and these assessment data can in turn be used as a basis for determining whether to recommend and proceed with some form of treatment.

Planning Therapy

Planning therapy for patients who need and want to receive psychological treatment involves [Page 50](a) deciding on the appropriate setting in which to deliver the treatment, (b) estimating the duration of the treatment, and (c) selecting the particular type of treatment to be given. With respect to deciding on the treatment setting, assessment data provide reliable information concerning the severity of a patient's disturbance, the patient's ability to distinguish reality from fantasy, and his or her likelihood of becoming suicidal or dangerous to others, all of which bear on whether the person requires residential care or can be treated safely and adequately as an outpatient. The more severely disturbed people are, the farther out of touch with reality they are, and the greater their risk potential for violence, the more advisable it becomes to care for them in a protected environment.

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