By:
SOPHIA F.
DZIEGIELEWSKI
The features inherent in a
diagnostic assessment can overlap with the subsequent practice strategy. The
distinction, which is present, is that the term diagnosis is utilized to describe a presenting
condition, and an assessment
is utilized to acquire information
to describe and/or verify the presence of a condition. Furthermore, assessment can be used more broadly to include
taking into account a larger context at each step of the process, including
understanding a client’s personality, problems, strengths, and
related information about relevant social and interpersonal considerations that influence his or her mental health (Corcoran & Walsh, 2010; Dziegielewski, 2013).
These terms are often used
interchangeably, but the primary difference lies in the fact that the focus of the assessment is applied to practice strategy. In this text, the
term diagnostic
assessment is used
simply as a combination of both terms. In diagnostic assessments, the
foundation and goals for therapy are established, and confirmatory and disconfirmatory strategies are utilized to
elicit information to confirm diagnosis and/or test the viability
of an alternative diagnosis (Owen, 2011).
Much of the client–provider interaction is asking questions, establishing mutual
goals for therapy and alliance, and acquiring information to formulate a
diagnostic impression. In addition to the diagnostic criteria, a comprehensive
assessment goes further by seeking information on a wide variety of personal
and environmental factors.
Gathering this additional
information contributes to increased understanding of the mental health
disorder and supplements the treatment context by taking into account the influence of the individual’s
relational systems. Five factors guide the initiation of accurate diagnostic
assessment that will ultimately relate to the implementation of practice
strategy.
When working with individuals and preparing to complete the diagnostic assessment, professional practitioners should:
1. Examine carefully how much
information the client is willing to share and
the accuracy of that information. This ensures the depth and application of what is presented, as well
as the subsequent motivation
and behavioral changes
that will be needed in the intervention process. Gathering information
from the DSM and evaluating whether it matches what the client is reporting requires an awareness of this
phenomenon as it relates to how the symptoms are reported. Focusing
on information that
is readily available and forming quick impressions and conclusions can lead to incomplete or inaccurate
information (Owen, 2008).
Pay special
attention not only to what the client is saying but also to the context in which this information is revealed. What
is going on
in the client’s life at this time? What systemic factors could be influencing certain behaviors? What will revealing the information mean to family
and friends,
and how will it affect the client’s
support system?
Gathering this information is important because a client may fear that stating accurate
information could
have negative consequences. For example, clients may withhold information if they feel
revealing it may have legal ramifications (imprisonment), social consequences (rejection from family or friends), or medical
implications (rehospitalization).
2. Gather as accurate a definition of the problem as possible. It will guide not only the diagnostic assessment
but also the
approach or method of intervention that will be used. Furthermore, the temptation to let the
diagnostic impression or intervention approach guide the problem rather than allowing
the problem to guide the approach should always be resisted (Sheafor
& Horejsi, 2012).
So much of the problem identification process in assessment
is an intellectual activity. The practitioner must never lose sight of the ultimate purpose of the assessment
process, which is to
complete an assessment that will help to establish a concrete service plan to address the
client’s needs.
3. Be aware of how a client’s beliefs can influence or affect the interpretation of the problem. An individual’s worldview or paradigm shapes the way the events that surround the situation
are viewed. Most
professionals agree that what an individual believes creates the foundation for who he
or she is and influences
how he or she learns. In
ethical and moral
professional practice, these individual influences must not directly
affect the assessment process.
Therefore, the practitioner’s values, beliefs, and
practices influencing treatment outcomes need to be clearly identified at the onset of treatment Practitioners need to ask themselves, “What is my immediate reaction to the client and the problem expressed?” Clients have a right to make their own decisions, and the helping professional must do
everything possible to ensure this right and
not allow personal opinion to impair the completion of a proper assessment.
Because counseling professionals are often part of an interdisciplinary team, the
beliefs and values
of the team members must also be considered.
Awareness of
value conflicts that might arise among
team members is critical to prepare for how personal feelings and resultant opinions
might inhibit them from
accurately perceiving and assessing the situation. As part of a team, each member holds
the additional responsibility of helping others on the team be as objective as
possible in the assessment
process. Values and beliefs can be influential in identifying factors within individual decision-making strategies; they remain an important
factor to consider and identify in the assessment process (Sue & Sue,
2013).
4. Openly address issues
surrounding culture and race in the assessment phase to ensure that the most open and receptive environment is created. Simply
stated, the
professional practitioner needs to be aware of his or her own cultural limitations, open to
cultural differences, and able to recognize the integrity and uniqueness of the client while
utilizing the client’s own learning style,
including his or her own resources and
supports (Dziegielewski, 2013;
Sue & Sue, 2013).
Ethnic identity
and cultural mores can
influence behaviors and should
never be overlooked or ignored. For
example, in utilizing
the DSM-5, cultural factors are stressed prior to establishing a diagnosis.
The DSM-5 emphasizes that delusions and hallucinations may be difficult to separate from the
general beliefs or practices related to a client’s specific cultural custom or lifestyle. For this reason, the
DSM-5, like the DSM-IV-TR, includes an appendix that describes and defines culture-bound syndromes affecting the diagnosis and assessment
process (APA, 1995, 2000, 2013).
5. The assessment process must
focus on client strengths and highlight
the client’s own resources for addressing problems that affect his or her
activities of daily living and for providing continued support (Lum,
2011). Identifying strengths and resources and linking them to problem behaviors
with individual, family, and social functioning may not be as easy as it sounds. There is a
tendency to focus on the individual’s negatives rather than praising the positives,
which is further complicated
by time-limited intervention settings in which mental health professionalsmust
quickly identify individual and collectively based strengths (Dziegielewski,
2008).
Accurately
identifying client strengths and support networks in the diagnostic assessment is critical, as they
will be incorporated
into the suggested intervention plan to provide a means for
continued growth and
wellness beyond the
formal treatment period.
In the diagnostic assessment, three aspects must always be considered:
1. Determine the existence of a disorder, disease, or illness supported by somatic, behavioral, or concrete features.2. Ascertain the cause or etiology of the disorder, illness, or disease based on features in the client that are severe enough to influence occupational and social functioning.
3. Base any diagnostic impression on a systematic, scientific examination of the client’s reported symptoms, always taking into account the client’s situation (Kraemer,Shrout,&Rubio-Stipec,2007).
References
SOPHIA F. DZIEGIELEWSK, 2015, DSM-5TM in Action, by John Wiley & Sons,
Inc.
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