CLASSIFICATION AND TREATMENT PLANS
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1 CLASSIFICATION AND TREATMENT PLANS C H A P T E R 2
2 EXPERIENCES OF CLIENT AND CLINICIAN
3 PSYCHOLOGICAL DISORDER: EXPERIENCES OF CLIENT AND CLINICIAN Psychologist: Healthcare professional offering psychological services Client: Person seeking psychological services
4 CASE STUDY Kristen is a 38 year-old divorced mother of two teenagers. She has had a successful, well-paying career for the past several years in upper-level management. Even though she has worked for the same, thriving company for over 6 years, she s found herself worrying constantly about losing her job and being unable to provide for her children. This worry has been troubling her for the past 8 months. Despite her best efforts, she hasn t been able to shake the negative thoughts. Ever since the worry started, Kristen has found herself feeling restless, tired, and tense. She often paces in her office when she s there alone. She s had several embarrassing moments in meetings where she has lost track of what she was trying to say. When she goes to bed at night, it s as if her brain won t shut off. She finds herself mentally rehearsing all the worse-case scenarios regarding losing her job, including ending up homeless.
5 GENERALIZED ANXIETY DISORDER Persistent worrying or obsession about small or large concerns that's out of proportion to the impact of the event Inability to set aside or let go of a worry Inability to relax, restlessness, and feeling keyed up or on edge Difficulty concentrating, or the feeling that your mind "goes blank" Worrying about excessively worrying Distress about making decisions for fear of making the wrong decision Carrying every option in a situation all the way out to its possible negative conclusion Difficulty handling uncertainty or indecisiveness Physical signs and symptoms may include: Fatigue Irritability Muscle tension or muscle aches Trembling, feeling twitchy Being easily startled Trouble sleeping Sweating Nausea, diarrhea or irritable bowel syndrome Headaches
6 THE CLIENT Client - People in treatment collaborate with those who treat them Patient carries with it the connotation of a passive rather than active participant
7 THE CLINICIAN Clinician: The person providing treatment Psychiatrists: People with degrees in medicine (MDs) Receive specialized advanced training in diagnosing and treating people with psychological disorders Clinical psychologist: A mental health professional with training in the behavioral sciences who provides direct service to clients
8 THE CLINICIAN Two types of doctorates in psychology: Doctor of philosophy (PhD) Doctor of psychology (PsyD)
9 DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS
10 DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS (DSM) Reliability: The degree to which clinicians provide diagnoses consistently across individuals who have a particular set of symptom Validity: The extent to which a test, diagnosis, or rating accurately and distinctly characterizes a person s psychological status
11 DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS (DSM) A book published by the American Psychiatric Association that contains standard terms and definitions of psychological disorders Axis: A class of information in DSM-IV regarding an aspect of the individual s functioning
12 DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS (DSM) Multiaxial system A multidimensional classification and diagnostic system that summarizes a variety of relevant information about an individual s physical and psychological functioning
13 THE FIVE AXES OF THE DSM-IV Axis I: Clinical disorders Axis II: Personality disorders and mental retardation Axis III: General medical conditions Axis IV: Psychosocial and environmental problems Axis V: Global assessment of functioning (helps assess prognosis)
14
15 TABLE 2.1- AXIS I DISORDERS OF THE DSM-IV-TR SOURCE: Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Copyright 2000 American Psychiatric Association.
16 TABLE 2.1- AXIS I DISORDERS OF THE DSM-IV-TR SOURCE: Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Copyright 2000 American Psychiatric Association.
17 TABLE EXAMPLES FROM AXIS IV OF THE DSM-IV-TR
18 TABLE AXIS V: GLOBAL ASSESSMENT OF FUNCTIONING SCALE (GAF)
19
20
21 CULTURE-BOUND SYNDROMES Recurrent patterns of abnormal behavior or experience that are limited to specific societies or cultural areas
22 THE INTERNATIONAL CLASSIFICATION OF DISEASES (ICD) Mental health professionals outside the U.S. and Canada use the World Health Organization s (WHO) diagnostic system, which is the International Classification of Diseases (ICD)
23 THE DIAGNOSTIC PROCESS Principal diagnosis: The disorder that is considered to be the primary reason the individual seeks professional help Comorbid: The situation that occurs when multiple diagnostic conditions occur simultaneously within the same individual
24 THE DIAGNOSTIC PROCESS Differential diagnosis: The process of systematically ruling out alternative diagnoses Case formulation
25 CULTURAL FORMULATION Includes the clinician s assessment of the client s degree of identification with the culture of origin The culture s beliefs about psychological disorders, the ways in which the culture interprets particular events, and the cultural supports available to the client
26 PLANNING THE TREATMENT Treatment plan: The outline for how therapy should take place Goals of treatment Immediate goals Short-term goals Long-term goals
27 PLANNING THE TREATMENT Determine treatment site Psychiatric hospitals Specialized inpatient treatment centers Outpatient treatment Halfway houses and day treatment programs Other treatment sites w&list=plzvhggkrywgdxazwkc9ue5qpageaenfku
28 MODALITY OF TREATMENT Modality: Form in which the clinician offers psychotherapy Individual psychotherapy Family therapy Group therapy Milieu therapy
29 EVIDENCE-BASED PRACTICE IN PSYCHOLOGY Clinical decision making that integrates the best available research evidence and clinical expertise in the context of the cultural background, preferences, and characteristics of clients
30 TREATMENT IMPLEMENTATION Course of Treatment The clinician s role in treatment The client s role in treatment Outcome of Treatment
31 For more information on material covered in this chapter, visit our Web site:
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