Comments xFabianDraft x
Topic: Assessment of Clients for Counselling and Psychotherapy
Pls kindly find your draft with comments attached herein. The first section on the “Model of Assessment” is much better written and addresses the question posed in the Assessment this time round. Pls see comments.
Hi doc, that was the comments given..
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Module: Assessment Of Clients For Counselling and Psychotherapy
Assignment Title: The
Assessment Report
Student ID: S 7813475 E
Date:
Assessment Report
Confidential Psychological Evaluation
1. Details of Patient
2. Model of Assessment
3. Application of Model
a. Referral Question
b. Evaluation Procedures
c. Observations
d. Results of Tests
e. Relevance of Findings
4. Formulation
5. (a) Clinical Presentation
(b) Diagnosis ( c) Treatment
1. Meta-analysis
Name: Clara Lim Age: 14
Sex: Female Ethnicity: Chinese
Date of Report: 27-June-2021 Name of Examiner: Fabian William
*Name changed to preserve anonymity
According to Cohen and Swerdlik (2010), it is noted that psychological assessment may be conceived as a problem-solving process. This could be considered that the assessment process must not be conceived of as a homogenous exercise but must instead be viewed in light of the problems it seeks to solve (Cohen, 2010). Hence, a model of assessment can incorporate many tools and methods to cater to the issues faced by clients successfully. These tools may range from unstructured interviews, which have often been found in therapeutic sessions, to psychological testing, with the appropriate tests to be determined in the course of the assessment (Othman et al., 2020). Therefore, the fundamental difference between assessment and mere psychological testing is that it is concerned with the accumulated results and “how an individual is processed.” What this means is that the individual who has come to the examiner must not only be a source of empirical data or, as Groth-Marnat puts it, “Clinicians should not merely administer, score, and interpret tests, but should also understand the total process and procedure in its broadest sense” (Groth-Marnat, 1984). Understanding the total process and procedure is crucial in ensuring every assessment is best designed for the specific patient. In this case, the total process and procedure has a significant impact in influencing the overall observations and outcomes and should be considered carefully by a psychologist to align with the per case special needs. However, there is a limitation of focusing on the process of testing instead of the results in that the latter lacks objectivity and it is significantly subjective which can lead to biasness in observations (Reynolds et al., 2021). As a practitioner, I believe it is important to integrate both the process of testing and the results in patient assessment since both when used together has more to offer than relying on one for the assessment.
In the statistical or actuarial method, the conclusions depend solely on the empirical interactions between the event or condition and the data with the human judge eliminated. On the other hand, clinical judgment lies on the decision-maker (Flora & Flake, 2017). The study results show that there exist cases where the actuarial methods are out-performed by clinicians even when the statistical models are rules of linear classification. In this case, the experiments do not present the clinical judgment’s natural conditions showing that clinicians may not actually comprehend their decision-making manners, and the thought-of factors may not be relevant to them (Cohen, 2010). An actual case’s representative sample is probably required to compare normal clinicians’ judgment to those of statistical models.
The psychotherapeutic integrative practice, for this study, integrates different specific therapy elements in that each client requires consideration as a whole, and the techniques referred are designed to meet their circumstances and needs. Cognitive-behavioural therapy and client-centred psychotherapy were supported by quantitative scientific research that contained the principles of existential, psych-dynamic, cognitive, and behavioural aspects. According to this approach, the mechanisms of assessment must be determined (Cohen, 2010). Comment by kim quek: Provide examples illustrated with empirical evidence of therapeutic utility or effectiveness. Comment by kim quek: Okay, need to cite reference. Comment by kim quek: Unclear what this means. Comment by kim quek: This sentence is unclear.
The assessment was performed in a counselling setting and including a structured interview which allowed dialogue between the examiner and the client. The model provided results of tests conducted during the assessment aimed at helping the examiner reach a formulation and a subsequent diagnosis. The tests and diagnosis were made as per many established sources, particularly the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-V (APA, 2013). This assessment method also ensured that the tests applied were not extended past their intended use and that the tests used were within the skill level of the examiner, meaning that the examiner had the requisite training. With the assessment of procured case data, an illustration of the prior behavioural traits of the client was developed. Where a need is, the evaluation method was also open to the notion of role playtests. The client in question is a child, and “children have the right to be assessed through the use of the most appropriate instruments and techniques available.” Comment by kim quek: Good. Pls cite or quote the ethical standards this was adopted from. Comment by kim quek: Reference?
Overall, there is great improvement in this draft particularly when addressing the question directly. This section is recommended to be approximately 1000 words of your essay.
The referral question:
Clara Lim is a 14-year-old student referred to the counsellor by her school on account of her exhibiting depressive behaviour and anxiety disorders, which a mental health doctor diagnosed during one of her visits accompanied by both parents. The exhibition indicated prima facie by her behaviour in some instances. The doctor performed psychological tests which aimed to evaluate her intellectual capabilities, which were believed to be relatively lesser than that of the other students around her, which were presented through significant tiredness, sleeping problems, low energy, withdrawal from activities and friends, and extreme guilt feelings, fears or worries.
Aside from the conduction of the face-to-face interview, Clara was administered some tests, including Wechsler Intelligence Scale for Children-3rd ed. (WISC-III), Bender
Visual-Motor Gestalt Test ((Wehry, 2015), Rorschach, and Minnesota Multiphasic Personality Inventory-Adolescent test. There was also an evaluation of the case reports and other information that was obtained before the interview.
Clara’s appearance in the interview was fairly similar to other individuals her age. She wore a t-shirt with jeans and wore her hair back in a ponytail. The t-shirt and jeans were new
whereas her shoes appeared to be old and slightly torn. Clara was tall for her age, around 1.72 meters, and had clear skin. She also seemed to represent an aversion to jewellery and had no ornaments or trinkets on her.
When Clara first arrived at the interview, she did not greet the examiner and instead appeared to be awaiting the end of the interview. Her speech was reasonably normal and did not represent any clear signs of aggression. Her facial expressions also appeared dismayed at certain moments but were normal, with a hint of ambivalence; otherwise, despite her asking when the interview would end, her answers and interactions were nonetheless cooperative, and there was scant reluctance on her part to engage with the examiner. This was also the case when she was given the tests that were deemed appropriate regarding her issues. She interacted with the tests with determination, and even where she found significant difficulty, she was never entirely infuriated with herself and appeared to take her failures in her stride. However, when she faced difficult problems in succession or was asked a series of difficult questions, Clara would exhibit restlessness and appear exhausted.
At certain moments she would also express a particular annoyance if the conditions seemed to irritate her. Clara’s memory was adequate but could be prone to error if asked to recall distant events. Finally, it could also be said, quite clearly, that Clara took good care of her hygiene and cleanliness but was a little lax when it came to physical exertion and had gained some weight over the past six months. When asked about this, she proclaimed it to be the result of a lack of exercise, which itself had been caused by the fact that she felt a little tired on most days.
Background information derived from interview and case history.
Clara was born to a single mother as her father died six months before she was born.
When questioned about how she felt about her father dying, Clara responded,” It used to make me sad, but then it got easier.” Her relationship with her mother, who never remarried, is strained as Clara believes that “she expects too much of her.” This, she explained, meant that she was to be resilient through life and not give in to weakness which Clara felt was more complicated than what her mother made it out to be. Clara was raised in the heartlands and, despite being alone, her mother had decent employment as a lawyer, which meant there were never significant worries about money. Clara’s first issues started when she was eleven, and she began to cut herself with a penknife. She made the cuts around the thighs and, upon asking, said she chose
them because “that way, my mother wouldn’t see them.” Her mother, however, did find out later. Clara also began to lag in school examinations when she was thirteen. Previously having been a stellar student, this raised concerns among her teachers and her mother as now, despite not failing, she was placed near the lower rung of the class. Things came to light when she had a verbal argument with a teacher at school and was later caught smoking cigarettes. When asked why she did this, she responded that she “felt it made her look better than she looked otherwise.” Clara had also complained of not concentrating and of feeling fatigued even when she had just woken up. This, coupled with an inability to discuss these problems with her mother and a general worsening of her condition, led her to be referred for assessment.
Clara appeared to exhibit no neurological problems when assessed with Bender, Minnesota Multiphasic Personality Inventory-Adolescent, and Rorschach tests (Cohen, 2010). The results showed that hand-eye coordination was not impaired, and the client could adequately control the movements in the given circumstances. Furthermore, the client displayed appropriate cognitive ability and acted in a sufficiently elaborate manner.
That being said, Clara displayed a general reluctance to consider herself a “productive member of society” in her own words. She tended to undervalue herself and to consider herself inferior to the other individuals around her. She even told the examiner that “you are better than me too.” When given the intelligence test on WISC-III, Clara scored a total IQ of 89, according to Sattler’s measures for determining children’s behaviour (Sattler, 1992). Her general intellectual functioning and conceptual formation were found to be similar to that of her peers. However, her perceptive and block reasoning capabilities were reduced compared to that of other children in her age group. This was made even more apparent when she displayed somewhat compromised cognitive functioning when it came to her memory.
Her ability to concentrate was also brought into question when she could not focus her visual attention. However, when it came to the auditory concentration category, she did reasonably well and was above most individuals in her age group. Clara’s judgment of people appears to be the most impaired, which seems to be derived from her distinct evaluation of herself. This leads her to be incapable of seeing individuals and relationships for who they are and does appear to be holding herself back for fear of failure. This makes it harder for her to perform most tasks that demand a more optimistic outlook. Her academic performance was also Comment by kim quek: How was this judged? What are the implications of this on Clara’s life?
erratic, with her sometimes displaying an advanced understanding and then faltering in the next instance (Wehry, 2015). It was also seen that she displayed difficulty persisting in her efforts over some time if success proved elusive. She grows worried about most tasks to a significant degree beyond other individuals her age. Clara also appears emotionally withdrawn because she restrains those very emotions and has major emotional problems. These include low self-esteem, low confidence, inability to communicate feelings, and a generally pessimistic outlook on life.
Clara also displays an internalized affinity for rebellion, which she attempts to hide in many instances, and a dislike for societal pressure, which may have manifested in the smoking. This shows that she would prefer not to be constrained by the workings of society and appears to exhibit certain anxieties when asked to do so.
It is important to remember that the theoretical model of this assessment is highly individualized and aims to put the examiner “In our client’s shoes” (Finn, 2007). The background information enables us to do just that, with a whole idea of childhood and the problems that have assuaged Clara forming a complete picture of her psychological condition, especially regarding her depression and anxiety. Furthermore, the tests were relevant as they signify that despite being similar to her peers in many areas, she does not entirely emulate them and is, in many instances, impaired in her ability to function (Wehry, 2015). The causes for this, as stated above, are both due to how she envisages herself and the circumstances within which she finds herself. The context for this assessment was indeed psychiatric, on referral from her educational institute, and hence the need was to find out why she felt this way rather than just accumulate tests results. The findings from both the questions asked inside the interview and the various test results show that Clara has an underlying issue that will allow us to move towards a more substantive formulation in the next section. Comment by kim quek: What does this sentence mean? Is Clara on medication?
Formulations are an essential part of the assessment process. This is true even where many see them as an “alternative to psychiatric diagnosis” (Johnstone, 2017). Although there is no one universal definition, a formulation has been found to: Comment by kim quek: Consider placing this under the first section- My model of Assessment.
1. Summarize the problem faced by the client
2. Draw connections between problems
3. Provide explanations and plans of interventions (Johnstone, 2006)
Gillian Butler defines formulations as “A formulation is the tool used by clinicians to relate theory to practice… It is the essence that holds theory and practice together… Formulations can best be understood as hypotheses to be tested” (Butler, 1998). Comment by kim quek: Consider summarizing your understanding of clinical formulation and how it fits into your model of assessment in the previous section.
In this section, you can showcase your formulation based on psychological theories.
A formulation, in this case, must then cater not only to particular issues but also attempt to offer a collective resolution. We must, therefore, look at Clara’s problems together with the information gained during the assessment. As Anna (2015) suggests, an initial formulation may look at the depression and anxiety resulting from a troubled childhood. The loss of a father figure, and the fact that her mother never remarried, may point towards a deficiency that was never cured. Additionally, despite the presence of some degree of wealth, the mother’s overbearing attitude might have caused significant changes inside Clara’s perceptions of both her life and herself. She must have felt weak and given to faltering under the pressure of life. That may have also manifested in her aversion towards the structures of society, as she did not find solace in the first one she encountered (Anna, 2015). That being the family vis a vis, the mother. It is crucial to consider the realm in which she lives, a child in an environment where she feels uncomfortable. Sattler (1992) also agrees that there may also be a need to look at the possibility of an absence of stimuli that might force her to look after herself or continue her earlier academic successes. This may be either at the school where she studies or at her home. Her rebellion is represented through the cigarettes, which are also a way to make herself look more appealing. Comment by kim quek: What are the ways you can conceptualise the client’s problems- example 5Ps/
That draws on both her depression and anxiety, which are premised on her feeling inadequate and inferior (Sattler, 1992).
It is crucial to consider the nature of a formulation. As opposed to the more “final” diagnosis, the formulation is more constructive and considers the client’s views. That also explains its appeal and why many clients are easier to convince of their problems when using formulations as opposed to a diagnosis. This may be because “Moreover, as the psychological story is rooted in the meta-narratives of science and professionalism, it is likely to be more powerful than the client’s story” (Corrie, 2010).
Clara’s formulation fits into the integrative model as it takes a holistic view of her condition and how the problems she faces currently arose. It offers the possibility of taking a more nuanced approach. The formulation also moves past questions surrounding the “validity of current diagnostic systems.” The client’s issues remain rooted in how she perceives herself, Comment by kim quek: Sentence structure. Comment by kim quek: Questions such as?
which can be traced back to her childhood. Hence, the formulation appears to be appropriate. Within this integrative model, where the client is supported as they work to develop the cognitive ability independently using their thinking skills, it also moves past merely viewing the slight impairment shown on the tests and takes us towards acknowledging that the depression and the anxiety might be interconnected. This returns us to the original conception of the assessment model as being centred on “problem-solving.” The client is a child who has begun to question her value to society and has, thus, chosen to act in a manner both caused by and causes depression and anxiety. This, cumulatively, results in the current problems that the client presents in this assessment. Comment by kim quek: superfluous
To arrive at a diagnostic conclusion that would best serve the assessment findings and the problems faced by Clara, we must take into account the relevant criterion for the presentation of depression and anxiety as is found in resources such as the DSM-V. A correct diagnosis is necessary to allow prevention and intervention plan to be drawn up following the assessment. It is essential to critically examine the interviews and the tests, such as the WISC-III, to arrive at the correct conclusion regarding Clara.
Depression is often linked to individuals finding inadequate or perceiving themselves as failures (Beck, 1979). The DSM-V lays down a criterion for determining whether or not an individual is depressed. For a clinical presentation of depression, the individual must be experiencing five of the specified symptoms in two weeks. These include feelings of inadequacy, depressed moods, weight gain or loss when not dieting, excessive fatigue, less thinking and physical exercise, a diminished ability to think, and suicidal tendencies. Looking at this list, one can see that Clara does indeed exhibit some of these symptoms, including significant tiredness, sleeping problems, low energy, and withdrawal from activities and friends, and extreme guilt feelings, fears, or worries for over two months. He had indeed reduced physical exercise and has gained some weight, as was described earlier. She does feel fatigued and is often struggling with a depressive mood. As the test results show, with impaired memory and difficulty concentrating, she is experiencing some problems in thinking. Furthermore, as recounted, her self-worth is also considerably reduced as per the assessment. Therefore, the presence of six concurrent symptoms does lead one to assume that a diagnosis of depression is possible via the DSM=V criterion. Comment by kim quek: cite source.
Depressed individuals may also exhibit other tendencies such as annoyance or irritability, which
was witnessed to a slight degree at the onset of the interview. The presence of depression in children is thought to be presented in a manner similar to that of adults (Patra, 2019). The symptoms which Clara is currently exhibiting appear to be significant and point towards a finding of depression. However, the one positive finding is that Clara appears not to experience suicidal tendencies and has yet to showcase that severe symptom. Her other symptoms are also currently only in the initial stages, and, with the proper treatment, they can be prevented from escalating into a more significant crisis.
As far as anxiety is concerned, it can manifest itself in a number of ways. These include multifarious but are not limited to panic, worry, agoraphobia, health anxieties, and OCD (Sanders, 2003). Clara exhibits symptoms of general social anxiety such as significant tiredness, sleeping problems, low energy, withdrawal from activities and friends, and extreme guilt feelings, fears, or worries, which causes her to worry and have self-esteem issues. That appears closest to a diagnosis of Generalized Anxiety Disorder. The DSM-V outlines a criterion for assessing whether or not an individual has GAD.
Excessive worry over events and occurring within the last six months is one requisite. It must also be difficult to control, and individuals suffering from GAD must exhibit three symptoms or only one in the case of children. These include irritability, restlessness, impaired concentration, and difficulty sleeping, and so on. The most common symptom in most studies is often the mood (Nair, 2013). As Clara is a child, only one symptom need have been present, and as she has more than one, for she does have impaired concentration and irritability, it is possible to diagnose her with GAD. The excessive worry that she has overfitting into society and being productive also fits well within the definition of GAD and leads to a diagnosis is likely. The extent of overthinking is also well before us and is significant. However, it is difficult to determine if the anxiety is pathological after just one interview and whether the “emotional processing theory” (Rothbaum, 2006) can be used in this instance.
It is, hence, that a diagnosis of depression and GAD is most appropriate following the assessment of Clara in the interview.
For diagnosing depression in children, “Psychosocial management of depression in childhood remains the mainstay.” As Clara does not exhibit suicidal tendencies or psychosis, her treatment for depression is likely to be that for mild depression. In such cases, it has been found
that 1-4 weeks of psychotherapy has often been enough for the measurable changes in the client’s quality of life and behavioural health, including symptom reduction, which was brought about through monitoring the outcomes, highlight role induction into the care process, and theoretically explicit change rationale (Birmaher & Bernet, 2007). Nonspecific psychotherapies include psych education and supportive psychotherapy, whereas specific methods include Cognitive Behavioral Therapy and Interpersonal Therapy. Given the facts at hand, it is likely that a recommendation of psych education in which both Clara and her mother are made aware of her depression and are taught how to navigate their association around it would be recommended. However, CGT can also be likely to search for success as it will eradicate her current negativity and replace them with positive thoughts. Comment by kim quek: What is CGT?
Psychological treatments for anxiety disorders include CGT and Mindfulness-Based Psychotherapy, and Psychodynamic Psychotherapy (Wehry, 2015). With CBT, extensive treatment is required for significant periods (Ginsburg, 2014). However, it is preferable to the other two methods, which despite being significantly enticing, “warrant further investigation.” Therefore, it is preferable for Clara and her mother to choose CBT for her GAD and resort to the other methods would result in more uncertainty than any particular guarantee of success. That being said, both these conditions are significantly treatable, and further problems can be prevented. Comment by kim quek: Pls state the basis for preferring CBT explicitly to justify your rationale for the treatment plan.
The purpose of this study was stated for the client, results, and intervention and defined the comprehensive inclusion criteria. Various potential reports’ sources were located and explored through the assessment session, which proved to be a determination of what problems Clara had and a test of how capable the examiner was when it came to communication. The conversation was initially difficult, given the constrained nature of the client. Still, repeated excursions and the appropriate tests made it possible for a move natural and open dialogue to emerge. There were a few issues as the interview became a little restrictive at times. The constrained nature of testing, particularly IQ tests similar to WISC-III (Hargreaves, 2006), left them open to criticism. However, the focus of the model on problem-solving and a more expansive approach to understanding Clara made it more successful. Comment by kim quek: Specific example of this?
The examiner understood the therapeutic relationship to grow over some time. It relied on notions of trust and respect, without which the client would never have been amenable to an
honest sharing of their problems. As the examiner treated the client as more than just a means to exhibit test results, their association became more truthful and real. This echoes the suggestion made by Meyer and Finn that,” Future investigations should move beyond an examination of test scales to focus more on the role of psychologists who use tests as helpful tools to furnish patients and referral sources with professional consultation.” (Meyer, 2001)
The results reached during this assessment can be compared with the prior case history that was obtained. The examination reveals consistency among the results in Clara’s case, albeit the more open method of assessment in use here made the issues more apparent. This showed that although Clara had exhibited those problems before, a directed and measured approach was necessary (Wehry, 2015).
Having not continued that line of assessment with the client, the examiner cannot adequately speculate on the long-term implications of the diagnosis or the treatment. However, the method and model of assessment do open the possibility for future interactions and studies to be carried out and for this deficit to be filled (Wehry, 2015).
The entire assessment reveals that a stronger therapeutic bond is necessary not only to make clients divulge potentially personal information about themselves but for adequate judgments to be made when either making formulations or diagnoses about the problems faced by those very clients. This shows that the relationship between the examiner and the one being examined is not merely one of control or testing but a real human interaction that must be carefully navigated. Comment by kim quek: PCT??
Emphasis must be placed on understanding the problems faced by the individual and then formulating plans of intervention and prevention based on that learning. That can only be possible if assessments are carried out not only to take tests and garner results but to solve problems at their very core (Wehry, 2015). Only then can psychiatric assessments be both credible and human and successful when it comes to helping clients.
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