Course Title: Clinical Psychology
Course Description: This course deals with the nature, scope, and other
aspects of the contemporary clinical psychology profession, as well knowing
the roles, functions, and ethical considerations involved in the practice of the
field. Various approaches and methods in treating personality and emotional
disturbances are discussed.
Course Objectives:
●Discover the historical roots of clinical psychology and its implication to the
present field.
●Identify the difference between normal and abnormal behaviors, its
diagnosis and treatment.
●Discuss the importance of understanding of abnormal behavior, psycho
diagnosis and psychological treatment and its impact to society.
Chapter 1: INTRODUCTION TO ASSESSMENT IN CLINICAL PSYCHOLOGY
A. General Learning Objectives
● Gain a clear perspective on the techniques and responsibilities of a Clinical Psychologist
● Relate theoretical orientation to various clinical functions and practice.
● Recognize the importance of culture in relation to conflict and symptomatic beliefs.
● Application of the basic perspectives on disorders and manifestation of symptoms to case writing.
● Learn the advantages and limitations of a psychological test as a clinical tool.
● Exposure to actual administration of projective test, personality test and to outline the proper clinical
assessment procedure and make psychological test writing.
● Appreciate the diversity issues in relation to the actual testing.
● Demonstrate and understand how a clinical psychologist approaches mental health issues from a
biological, cognitive, and social standpoint.
★ The interpretation of each projective test that will be administered in class will be provided by the
professor after each test administration. The administration of psychological tests will be in a direct
supervision of the professor/ clinical psychologist.
B. Introduction, Definition, and Purpose of Clinical Assessment
Clinical assessment involves evaluation of an individual’s and family’s strengths and weaknesses, a
conceptualization of the problem at hand (as well as possible etiological factors) and some
prescription for alleviating the problem.
Assessment is not something that is done once and then in forever finished; it is an ongoing
process--even an everyday day process. Whether the clinical psychologist is making decisions or
solving problems, clinical assessment is the means to the end.
C. The Referral
The assessment process begins with a referral. Someone--a parent, a teacher, a
psychiatrist, a judge, or perhaps a psychologist--poses a question about the patient.
Clinicians thus begin with the referral question. It is important that they take pains to
understand precisely what the question is or what the referral source is seeking.
D. 10 Steps in Clinical Assessment
5 Phases and 10 Steps in Clinical Assessment
The Introductory Phase:
1. Establishing Rapport
2. Behavioral Observation
3. The Test Administration/ Assessment Phase
Intelligence Test/s
Battery of Personality Tests
Behavioral Assessment
The Clinical Interview and Inquiry Phase
4. Test Items Inquiry;
Mental Status Examination
5. History of Present Illness
6. Personal History (Anamnesis)
The Interpretation, Evaluation, and Analysis Phase
7. Interpretation,
8. Evaluation, and
9. Analysis of Test Protocols and Interview Data Gathered
The Psychological Test Report Writing Phase
10. Psychological Test Report Writing
Chapter 2: THE INTRODUCTORY PHASE
A. Establishing Rapport
a. Introduction
• When you first meet a client/patient, greet him or her by first name and introduce yourself, telling the client/patient
your name. A brief and frank account of the purpose of the examination may be helpful, especially with older
children.
• Opening statements should not be standardized but flexible and adaptable to meet each child’s needs. Introductory
talk can be kept to a minimum.
• Be confident and encouraging, making it clear that you want the child to do his or her best.
• Convey that you are sincerely interested in seeing the client/ patient to succeed, yet unconditionally accepting and
supportive in the event of failure.
• While the client/ patient is working, observe inconspicuously. Do not stare or do anything that might distract,
embarrass, or irritate the child.
• Try to be discreet when recording observations and scoring responses.
b. Helping the Client/Patient Feel at Ease
The client/patient should be encouraged to respond to each question—to take a chance even when
he or she is reluctant. By giving encouragement, you may both reduce the client/patient’s anxiety
and help to sustain his or her interest level. When fatigue occurs, testing should be discontinued. If
you sense that the client/patient has experienced some frustration on a previous item, you might say
something like “That was a bit difficult, but no one is expected to get them all right. Now let’s try
another one.” Because directions cannot cover every situation, be prepared to use tact and common
sense when difficulties arise. Stereotyped and routine manners of interacting with children should
be avoided.
Clients/Patients who are superficially cooperative should be encouraged to participate as fully as
possible. Appropriate facial expressions and modulations of voice, in addition to supportive
comments, may help. Early experiences of success in answering test questions will help the
client/patient relax more quickly than almost any other procedure.
c. Factors that May Affect Rapport
Examiner characteristics that lead to good rapport include empathy, genuineness, warmth, and
respect for client/patient. Helping client/patient maintain a sense of self-esteem and self-
acceptance is a key to ensuring a successful relationship.
Rapport may be affected in a number of ways , some obvious and others not so obvious. For
example, do not say "Good answer" or "That's right" or "You're doing great" every time the
client/patient responds. If you use excessive praise early in the test, you will be faced with a
dilemma when the test questions become more difficult and failures more common. You must
then either abandon your previous approach, with the obvious implication that praise is no longer
deserved, or continue to use praise in situations where the client/patient is aware that his or her
performance is inadequate.
d. The Ebb and Flow of the Relationship
Being relatively unprotected by age, experience, skill, and insight, children referred for testing
may attempt to control the test situation in indirect ways, whereas examiners usually try to
accomplish their goals in more direct ways, however, less for adult clients/patients.
For example, youngsters, who are seldom aware of their explicit role as examinees, may try to
control the situation by requesting water frequently or by being silently negativistic; examiners
may try to control the situation by never varying the test procedures. You must learn to
recognize and understand these and other dynamics involved in the assessment relationship.
Such understanding requires an awareness of nonverbal as well as verbal communications;
where, when, and why the examination is occurring; and the child's age and background.
B. Behavioral Observation
a. Observing a Client/ Patient
In observation the behavior of the client/ patient at actual testing or clinical setting, observe his
or her behavior from entry, before the actual testing, during the actual testing, after the actual
testing, and exit from the testing room. Behavioral observation is very vital in the assessment
process and in the psychological test report since it gives the reader/ the referrer a glimpse of
how the client/ patient behaved in the testing session and can be drawn by the psychologist
inferences about the mental activity of the client/patient.
Important factors to observe about the child during the evaluation include the following:
➔ Appearance (including physical condition, hygiene, and clothing)
➔ Adjustment to the test situations
➔ Degree of cooperation, effort, and attention
➔ Attitudes toward the tests, the examiner and the child’s own abilities
➔ Speech (including vocabulary level, fluency, articulation, and irregularities)
➔ Thought patterns
➔ Spontaneity and initiative
➔ General mood and sociability
➔ General response style
➔ Responses to failure and success
➔ Anxiety level
➔ Activity level
➔ Flexibility in shifting from one activity to another
➔ Problem-solving approach
➔ Impulse control
➔ Fine and gross motor control
➔ Distractibility
Skill in observing behavior requires training and practice; it does not arise automatically
when you find yourself in a situation where observation is required. You must develop
various kinds of skills. For example, in order to report accurately you must be alert,
perceptive, and attentive to the client/patient’s behavior, making notes of observed
behavior rather than relying on memory. Try to arrive at a general impression of the
client/patient, paying particular attention to the rapport that you have established and
your reactions to the client/patient. Then you need to be able to make appropriate
inferences from your observations.
b. List of Behavioral Cues
1. Attitudinal Features
Attitude Toward You, the Examiner
1. How does the child relate to you (and how do you relate to the child)?
2. Is the child shy, frightened, aggressive, or friendly?
3. Is the child negativistic, normally compliant, or overeager to please?
4. Does the child’s attitude toward you change over the course of the test?
5. Does the child try induce you to give answers to questions?
6. Does the child watch you closely to discover whether his or her responses are correct?
Attitude Toward Test Situation
1. Is the child relaxed and at ease, tense and inhibited, or restless?
2. In the child interested or uninvolved?
3. Does the child seem confident of his or her ability?
4. Is the child eager or reluctant of her ability?
5. Are the tasks viewed by the child as games, as opportunities to excel, or as threatening sources
of failure?
6. How well does the child attend to the test?
7. It is necessary to repeat instructions or questions? If yes, does this need for repetition suggest a
hearing problem, limited understanding of English, attention difficulties, poor comprehension,
or an effort on the child’s part to obtain more time to think about the question? Asking the
child to repeat the question may provide clues about what factors account for the behavior
(Zimmerman & Woo-Sam, 1985)
8. Is it easy or difficult to regain the child’s attention once you lose it?
9. Does the child appear to be making his or her best effort?
10. Does the child try only when urged by you?
11. Does the child give up easily, or does he or she insist on continuing to work on difficult items?
12. Does the child’s interest vary during the examination?
13. How does the child react to probing questions (for example, does the child reconsider the
Attitude Toward Self
1. Does the child have poise and confidence?
2. Does the child make frequent self-derogatory or boastful remarks, or is he or she fairly objective
about his or her achievement?
3. How aware is the child of the adequacy of his or her answers?
Work Habits
1. Is the child’s work tempo fast or slow?
2. Does the child appear to think about and organize answers, or does he or she give them
impulsively or carelessly?
3. Does the child revise any answers?
4. Does the child think aloud or only give final answers?
5. Does the child write out answers on the table with a finger, continually ask you for clarification,
or use other means to solve the problems?
Reactions to Test Items
1. What type of test item produces reactions such as anxiety, stammering, or blushing?
2. Are there any areas of the test in which the child feels more or less comfortable?
3. Is the child more interested in some types of items than in others?
4. Does the child block on some items (“I know, but I just can’t think”)? If blocking occurs,
is it easy items, difficult items, or all items?
5. Does the child need to be urged to respond? If yes , does the urging lead to a
response? Does the response indicate that the child had the knowledge to respond correctly
and merely wanted to be coaxed (Zimmerman & Woo-Sam, 1985)?
Reaction to Failure
1. How does the child react to difficult items? Does the child retreat, become aggressive, work
harder, try to cheat, become evasive, or openly admit failure?
2. If the child becomes aggressive, toward whom or does the child direct the aggression?
3. How does the child react to failure?
4. Does the child apologize, rationalize, brood, accept failure calmly, or become humiliated?
5. If humiliated, does the child express impotence or perplexity suggesting loss of ability
(Zimmerman & Woo-Sam, 1985)?
6. Can the child accept reassurance?
Reaction to Praise
1. How does the child react to praise?
2. Does the child accept praise gracefully or awkwardly?
3. Does praise motivate the child to work harder?
2. Language
1. How clearly does the child express himself or herself? If the child’s speech is fluent,
halting, articulate, inexact, or precise?
2. How accurately does the child express himself or herself? Are the child’s responses direct
and to the point, vague, evasive, free-associative, perseverative, or bizarre?
3. Do the responses reflect personal concerns or egocentrism?
4. Are the responses grossly immature?
5. If the child gives extraneous information, does this information suggest a compulsive
need to cover all possibilities or is it completely irrelevant (Zimmerman & Woo-Sam,
1985)?
6. Does the child converse spontaneously or only in response to questions?
7. Does the child’s conversation appear to derive from friendliness or from a desire to evade
the test situation?
3. Visual-Motor
1. Are there any movements the child makes with his or her hands, feet, and face that are
worth noting?
2. Is the child right or left handed?
3. Is the child’s reaction time fast or slow?
4. Does the child proceed systematically or in a trial-and-error manner?
5. Is the child skillful or awkward?
6. Does the child execute bilateral movements skillfully or awkwardly?
7. Is the child aware of time limits on timed tasks? If yes, how does this awareness affect his
or her behavior?
8. Does the child verbalize while performing tasks? If yes, are the verbalizations congruent with
his or her actions?
4. Comparison of Verbal and Nonverbal Tasks
1. Are there differences in the child’s reactions to verbal and nonverbal tasks (for example,
is the child more anxious or more at ease with one type of task)?
2. Does the child understand the instructions for the verbal and nonverbal tasks equally
well?
C. Behavioral Observation Supplementary Outline
BEHAVIORAL OBSERVATION
1. Sensory and Motor Proficiency
a. Vision
b. Hearing
c. Manual Control
Marked Deficient, Limited, Average or Better
2. Performance Rate
a. Extremely Rapid
b. Rapid
c. Average
d. Slow
e. Extremely Low
3. Orientation to Examination
a. Seems to have complete understanding of nature and purpose of examination
b. Shows some insight as to purpose
c. Accepts the explanation of purpose of examination
d. Occasional evidence of distorted ideas.
e. Completely misinterprets situation
4. Initial Adjustment
a. Completely at ease, makes good social contact.
b. Better than average social confidence
c. May show some anxiety, but manages to control it.
d. Rather anxious and poorly poised.
e. Extremely ill, at ease and apprehensive.
5. Interest
a. Enthusiastic and absorbed
b. Definitely interested in the test.
c. Shows an adequate amount of interest
d. Lack of interest shown
e. Completely uninterested
6. Cooperation
a. Cooperates enthusiastically – does everything requested.
b. Cooperates readily – offers no resistance
c. Generally good, but may resist certain assignment
d. Somewhat negativistic.
e. Negativistic and uncooperative, reducing reliability of the test.
7. The amount of speech
a. Moderate amount of speech, recognizing limits imposed by test routine.
b. A typical speech pattern, tending towards volubility or taciturnity.
c. Abnormal amount of speech-extreme loquacity/or extreme taciturnity.
8. Expressive ability
a. Excellent
b. Good
c. Adequate
d. Poor
e. Very poor
9. Attention
a. So attentive to test as to be oblivious to extraneous stimuli.
b. Relatively undisturbed by extraneous stimuli.
c. Moderately attentive.
d. Easily distracted by extraneous stimuli or inner preoccupation.
e. Almost impossible to get the hold attention.
10. Self- Confidence
a. Extremely self-confident, gives replies with assurance.
b. Rather self-confident and assured.
c. Somewhat confident but exercises doubts.
d. Definitely inclined to distrust ability.
e. Painful uncertainty and vacillation.
11. Motivation
a. Intensely motivated but not to such a degree as to reduce efficiency.
b. Strongly motivated to succeed.
c. Motivated sufficiently to permit fairly reliable evaluation.
d. Rather unconcerned about performance.
e. Motivation is completely out of proportion so strong as to render patient over anxious.
12. Effort
a. Works diligently at most tasks.
b. Strives for success, through possibly not at full pitch.
c. Works perfunctorily.
d. Lackadaisical, listless, indifferent.
13. Persistence
a. Dogged persistence, unable to give up when failure is obvious.
b. Persists even on tasks that are too difficult.
c. Persists for a reasonable length of time.
d. Admits defeat quickly when difficulty is encountered.
e. Anticipates failure- refuse to try.
14. Ability to shift
a. Extreme rigidity, preservation of ideas.
b. Shows difficulty in shifting from one idea to another
c. Adequate amount of flexibility
d. Shifts to readily, finds it difficult to carry one task to completion.
e. Thought content unstable and fleeting, cannot hold one topic in mind.
15. Reaction to Praise and Encouragement
a. Shows renewed or increased self-confidence, but still recognizes limits of ability.
b. Stimulated to try harder, even when approaching maximum ability level
c. Stimulated to try a bit harder or persist slightly longer.
d. Accepts with considerable reserve any change in motivation temporarily
e. Unmoved and unimpressed.
16. Reaction to failure
a. Adversely affected, manifesting emotional reactions offering rationalization and excuses, etc.
b. Somewhat upset by failure, tends to magnify it.
c. Shows some disappointment, but accepts it realistically as something to expect.
d. Less disturbed than would be expected under the circumstances.
e. Unconcerned; no observable reaction.
17. Self-criticism
a. Markedly hypercritical
b. Shows a general tendency to be over critical.
c. Appraises performance accurately
d. Shows a tendency to overrate performance.
e. Decidedly uncritical and naïve.
18. Miscellaneous Indicators
a. Inappropriate laughter and private jokes
b. Irrelevant and bizarre verbalization
c. Tangential thinking
d. Emotional outbursts
e. Hallucination
f. Euphoria
g. Flat affect
h. Personal Association
i. Speech Blocking
19. Representative of Results
a. Obtained results definitely not indicative of patient’s true capacity
b. Results on most tests contaminated and not optimum.
c. Some result satisfactory, other contaminated
d. Some doubts as to complete representativeness or results.
e. Obtained findings considered to be reliable of a patient’s behavior potential.