Assessment and Treatment Approaches

Introduction
Therapists use a variety of assessment procedures to gather information important to the diagnostic process. Most clinicians complete a thorough intake interview with new clients and often include a biopsychosocial assessment to provide important information about several key areas in the client’s personal history and current sociocultural context. When working with couples and families, therapists use a systems approach to assess behavioral interactions and patterns of communication between people rather than focusing solely on the intrapsychic processes within each individual.
In addition to interviewing techniques, therapists can use assessment tools such as symptom questionnaires, behavioral observations, personality inventories, and other diagnostic processes to collect data that will help them to make an accurate diagnosis.
A guidebook for clinicians, the DSM-5 is organized on developmental and lifespan considerations.
It begins with diagnoses thought to reflect developmental processes that manifest early in life (e.g., neurodevelopmental and schizophrenia spectrum and other psychotic disorders), followed by diagnoses that more commonly manifest in adolescence and young adulthood (e.g., bipolar, depressive, and anxiety disorders), and ends with diagnoses relevant to adulthood and later life (e.g., neurocognitive disorders)” (American Psychiatric Association, 2013, p.13).
The DSM-5 uses a dimensional diagnostic approach while being sensitive to culture, gender, and age. Assessing clients using a dimensional and lifespan approach allows clinicians to make more accurate diagnoses, develop fully informed treatment plans, and provide better treatments.
In making a DSM-5 diagnosis, the client must meet a certain number of very specific criteria used to define each diagnostic category. For most diagnoses, the client must also be experiencing significant distress or impairment in social or occupational functioning in order to receive the diagnosis. Although the DSM-5 allows for documentation of interpersonal difficulties and relational problems, the main emphasis of a DSM diagnosis is to describe the symptoms presented by individuals.
The assessment measures in Section III of the DSM-5 are to be used as additional clinical tools to enhance clinical decision making and develop effective treatment plans. These measures address symptoms in childhood, adolescence, and adulthood and help to understand the cultural context of mental disorders.
In Section II of the DSM-5, V and Z codes (“Other Conditions That May Be a Focus of Clinical Attention”) allow the clinician to note important psychosocial and environmental problems that are impacting a client’s symptoms, and it may be important to consider these codes when formulating a treatment plan. Although V and Z codes are not mental disorders, the principal reason for a client entering treatment may be a psychosocial or environmental factor.
Several approaches for the treatment of mental disorders have been developed, including biological, psychological, interpersonal, and systems therapies. Treatment choices need to address the client’s presenting symptoms, age and development, gender, and sociocultural background. Many clinicians use an integrated treatment approach, combining interventions from different models in order to target each client’s unique background and current needs.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
Nolen-Hoeksema, S. (2014). Abnormal psychology (6th ed.). New York, NY: McGraw-Hill.

Objectives
To successfully complete this learning unit, you will be expected to:
1. Discuss the purpose of making a DSM-5 diagnosis.
2. Evaluate the limitations of using the DSM-5 with couples and families.
3. Examine the purpose of V and Z codes in understanding a client’s symptoms.
4. Discuss methods used to gather information for making a DSM-5 diagnosis.
5. Analyze the impact of diagnostic labels on clients.
6. Discuss appropriate methods for the assessment and diagnosis of couples and families.

Learning Activities
Unit 2 Study 1
Studies Readings
DSM-5 Review
From this point forward in the course, you will be focusing on specific sections in the DSM-5 in each learning unit. You will need to set aside 1–2 hours each week to review the main diagnoses included in the listed sections. It will be most important for you to read the diagnostic criteria and diagnostic features sections of each diagnosis. For the specific diagnoses that are included in your discussion questions (or those that you will be using in your final paper), you will want to read through the other sections included with each diagnosis as well: specific culture and gender issues, prevalence, development and course, risk and prognostic factors, differential diagnosis, and other informational sections.
Use your Abnormal Psychology text to read Chapter 3, “Assessing and Diagnosing Abnormality,” pages 58–81.

Use the DSM-5 to complete the following:
• Review “Other Conditions That May Be a Focus of Clinical Attention,” pages 715–727, from Section II.
• Review “Assessment Measures,” pages 733–757, from Section III.

• Review “Other Conditions That May Be a Focus of Clinical Attention,” pages 715–727, from Section II.
• Review “Assessment Measures,” pages 733–757, from Section III.

Use the Library to complete the following:
• Read the following articles:
o Jones’s 2010 article, “The Unstructured Clinical Interview,” from Journal of Counseling and Development, volume 88, issue 2, pages 220–226.
o Rashid and Ostermann’s 2009 article, “Strength-Based Assessment in Clinical Practice,” from Journal of Clinical Psychology, volume 65, issue 5, pages 488–498.
• Read one of the following two articles:
o Whisman and Baucom’s 2012 article, “Intimate Relationships and Psychopathology,” from Clinical Child and Family Psychology Review, volume 15, issue 1, pages 4–13.
o Kaslow and Patterson’s 2006 article, “Relational Diagnosis: A Retrospective Synopsis,” from Contemporary Family Therapy, volume 28, issue 3, pages 269–284.

Optional – Readings
Refer to Optional Readings for Principles of Psychopathology for a list of additional articles about the mental disorders and current issues regarding assessment, diagnosis, and treatment you are studying in this unit.

Unit 2 Discussion 1: 1 page needed with minimum of 250 words and 2 references.
Making a DSM-5 Diagnosis
Take the perspective of a counselor working in a community mental health clinic. Review the media Intake Report for Ricardo S. This illustration is about a client who has phoned your clinic for an appointment and will be seeing you for his first appointment later in the day. Your agency requires you to complete a DSM-5 diagnosis by the end of the second session, so you will need to begin collecting relevant information during the first appointment with this client. (Do not list any formal DSM-5 diagnosis for Ricardo.)
Use your text and each of the articles assigned in this unit to answer the following:
1. What are three or four specific questions you will ask Ricardo to gather information needed to make a principal diagnosis?
o What would you ask Ricardo in order to identify other conditions that may be the focus of clinical attention (V and Z codes)?
o What social, cultural, and family factors will you need to know about in order to accurately assess Ricardo?
o Why is it important to consider medical conditions in your assessment?
2. What additional assessment instruments or diagnostic processes would you consider using in addition to your interview with Ricardo in order to gather the information you would need to formulate a DSM-5 diagnosis?
3. How might you assess Ricardo’s strengths and coping skills, and why is this important to do in the assessment process?
4. What would be the potential impact of diagnosing Ricardo as having a mental disorder?
Support your ideas with references to the course texts, articles from this learning unit, articles from the Optional Readings for Principles of Psychopathology list, or articles from peer-reviewed journals that you locate in the Capella library.

Resources:
Intake Report for Ricardo S.
Community Counseling Center: Telephone Intake Report
Name:
Ricardo S.
Age:
24
Background:
Born in Puerto Rico; moved to the U.S. six months ago. Family still residing in Puerto Rico; client saving money to bring mother and younger brother to U.S. Fluent in both English and Spanish.
Relationships:
Describes self as being gay; one previous long-term relationship (three years); not currently in a relationship. No close friends; reluctant to join in social activities and appears to be somewhat isolated.
Work:
One full-time job and a part-time job on the weekend; reports good attendance at work and good work evaluations.
Living situation:
Describes living in an “unsafe” neighborhood and has been fighting with his landlord to get more locks installed on his windows and doors. Would like to move but does not have a car for transportation to work.
Health:
Headaches; stomach pain (previous ulcers treated by physician in late teens). Has not seen a physician since moving to the U.S.
Life Goals:
Wants to attend college and work in computer field.
Current symptoms/issues:
Fatigue, constant worrying, lonely, feels “jittery.”
Reason for seeking therapy:
Supervisor at work recommended he speak with someone about his fears and worries after Ricardo reported late to work three days in a row due to sleeping poorly and having nightmares.

Optional Readings for Principles of Psychopathology
Unit 2 – Assessment and Treatment Approaches
Articles
Celano, M. P., & Kaslow, N. J. (2000). Culturally competent family interventions: Review and case illustrations. The American Journal of Family Therapy, 28, 217–228.
Denton, W. H. (2007). Issues for DSM–V: Relational diagnosis: An essential. Psychiatry, 164(8), 1146–1147.
Gorman, P. (2001). Teaching diagnosis from a postmodern perspective. Journal of Systemic Therapies, 20(1), 3–12.
Kaslow, F., & Patterson, T. (2006). Relational diagnosis: A retrospective synopsis. Contemporary Family Therapy: An International Journal, 28(3), 269–284.
LeBow, J., & Jordon, K. (2006). You cannot choose what is not on the menu: Obstacles to and reasons for the inclusion of relational processes in the DSM–V: Comment on the Special Section. Journal of Family Psychology, 20(3), 432–437.
Sporakowski, M. J. (1995). Assessment and diagnosis in marriage and family counseling. Journal of Counseling and Development, 74(1), 60–64.

Unit 2 Discussion 2: 1 page needed with minimum of 250 words and 2 references.
Diagnosing Relational Problems
Throughout this course, you will explore your approach to the diagnostic process when working with individuals, couples, and families. In this discussion, consider your approach to formulating diagnoses when working with couples and families, using the following questions:
1. What factors are important to assess or diagnose in families or couples in order to make effective choices about therapy goals and interventions?
2. What specific instruments or diagnostic processes would you use during your assessment of a couple or family? How are these similar to and different from the processes you would use with an individual?
3. How would you incorporate the DSM-5 into the assessment phase with a couple or family? (Include the relational V codes and Z codes in your discussion).
o Would you also formulate a separate DSM-5 diagnosis for any of the individuals you see in a couple or family? Why or why not?
o What are the limitations of the DSM-5 when working with couples or families?
4. What are your reflections about the role of diagnosis in the profession of counseling, or marriage and family therapy? How will you approach the diagnostic process when working with couples and families?
Support your ideas with references to the course texts, articles from this learning unit, and articles from the Optional Readings for this course.

 

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