Importance of History and Context Considerations for Clients

Importance of History and Context Considerations for lymph nodesHistorical and contextual Considerations for nodesSiobhan L. HealyAbstractThis paper discusses four references in total, twain from the perspective of a psychologist in private serve and two from the perspective of a trail psychologist.First, we entrust be covering two clients who visited Dr. Goldsteins private practiceClient 1 Brian, a 28 grade old, married return of a two course old daughter and a sixer month old infant son, is speaking a feeling of unhappiness. He states that he is miser satisfactory, making everyone around him miser competent.Client 2 Cindy, a 41 year old, recently divorcementd woman with kayoed children and high take aim education is non qualified to relax and worries ab surface something all the time. She experiences a feeling of handout crazy.Next, we will be discussing two clients Dr. Venneman, the school psychologist, is coveringClient 1 Rosie, a 7-year-old randomness-grade r from an intact family has recently moved into the school soil and was referred for experiencing academic roughies concerning reading and writing, as well as loving difficulties with her classmates.Client 2 Marco, a 17 year old high school student was referred for failing grades and refusal to follow course sequences. He is examineing dropping out of school.The hypothesis for this paper is, that, when clinicians ar able to gather enough entropy about their clients history and weave to standher liable(p) data to get a clear picture of individually case, they will be able to use the mark opinion in rank to design a word plan.According to Groth-Marnat, the evaluation of the referral question in each case is of great sizeableness. An inaccurate clarification of a line backside way out in practical limitations of psychological evaluations. It is the clinicians responsibility to provide recyclable study and to clarify the requests they receive, and each clinician is aw are of the value and the limitations of psychological tests. Further more than, clinicians should not postulate that requests for evaluation and referrals are adequately described or elaborated on. In fact, clinicians whitethorn read to uproot unspoken expectations of clients and uncover inter ad hominem relationships and unsung be onndas. Limitations of psychological tests fill to be explained to clients and the clinician is required to fully understand the vocabulary, dynamics, referral saddle horse, and abstract model (Groth-Marnat, 2003).Because clinicians are rarely asked to provide a general or global assessment, exactly are instead expected to answer originateicular questions, they need to address these questions and should contact the line of the referral at various stages in the assessment process. In an educational evaluation, such as in Rosies and Marcos case, the school psychologist should observe the student in the classroom environment. The breeding gathere d from such an observation should then be relayed back to the source of the referral (school) in order to get further clarification and, possibly, a modification of the initial referral question (Groth-Marnat, 2003). aft(prenominal) gaining insight into the referral question, clinicians should proceed with the collection of information. A variety of sources whitethorn be used for this purpose, such as someoneal history, audience data, behavioural observations, and test scores. Furthermore, clinicians could apply any previous psychological evaluations, aesculapian temperaments, police reports, school books, or they could discuss the flow rate issues with the client and/or with parents or teachers (Groth-Marnat, 2003). For example, Dr. Goldstein could ask his client, Brian, the 28 year old overprotect of two small children, a few background questions, such as, when did you runner experience the feeling of unhappiness and what exactly do you do to beat everyone around you mi serable, or how was your marriage before the birth of your children, what whitethorn be additional stress factors besides the overwhelming task of having two young children, and how is your social life?Furthermore, Dr. Goldstein should explore any practicable checkup reasons for Brians unhappiness. Once the clinician has ruled out certain factors that whitethorn be contributing to Brians condition, he whitethorn be able to pinpoint the cause of his unhappiness and determine that Brian is simply and temporarily overwhelmed by the addition of a bracing baby to an already stressful life. after(prenominal) all, additionally to having to go to work to financially support a family of four, Brian is close wish wellly sleep deprived due to his infant sons irregular sleep pattern. Ultimately, Brians wife and daughter may be placing unreasonable demands on him by asking for more help and attention. close to likely this phase will pass and the clinician will be able to design a solid assessment and treatment plan.Dr. Goldsteins second case of Cindy, the 41 year old, divorced female, may be a complex one to examine. Once again, Dr. Goldstein should ask Cindy questions such as what were the reasons for your recent divorce, and when did you initial experience the feeling of going crazy and how does it bear, what kind of worries are the most prevalent and what allow you tried to do in order to relax? After view out a medical problem, the clinician should examine Cindys situation carefully, as it sounds like she may be suffering from anxiety and depression due to her recent divorce. After the divorce, she may have also lost common friends she shared with her partner. The divorce may have left her financially and emotionally drained and she may be going finished a midlife crisis. In cases like that, the strength for substance abuse as a coping mechanism batch be high. With detailed information about Cindys background, Dr. Goldstein should be able to create a t horough assessment and a feasible treatment plan.In the case of Rosie, the 7-year-old second-grader from an intact family who recently moved to a tender school district, the school psychologist, Dr. Venneman, should obtain any and all school and medical records and he should gather as much information from Rosies parents and current and former teachers (or principals). Dr. Venneman should explore whether Rosie had any academic issues in her former school. She may have to get an eye exam to rule out a vision problem since her decreasing performance involves reading and writing. After reigning out any medical problems, Dr. Venneman should find out if Rosie may be missing her old friends and social activities. He should ask parents and teachers questions such as has she made any friends at all yet, or is she restrained involved in the sports activities that she used to enjoy? It is very likely that Rosie is skilful experiencing a temporary loss of a sense of stability (of a predict able environment and routine) and the loss of her friends due to the move. Once she is used to her immature situation, she will most likely be able to adapt, make new friends, and catch up with school work.In the case of Marco, the 17 year old high school student who is considering dropping out of school, Dr. Venneman may have to explore his school and police records and conduct interviews with his family and teachers. After ruling out a medical condition or a come-at-able criminal past, the clinician should ask Marco and everyone concerned a number of questions, such as how long has the lack of interest in school work persisted and what was make to intervene, what are his peers like, and what does Marco want for his future? Fortunately, Marco is a minuscule time away from graduating from high school and the clinician should put emphasis on finding a quick and solid solution to jump-start Marcos motivation.In all of these cases, it is serious to realize that any tests themselve s are middling one tool (or source) for gathering data. Each case history is of importance as it provides the clinician a context for understanding each clients current issue and with this knowledge the test scores become meaningful. A number of ethical guidelines have emerged for conducting formal assessments, ensuring that appropriate professional relationships and procedures are developed and maintained (Groth-Marnat, 2003, p.48).When assessing all of the above clients, the clinician must carefully consider what constitutes his or her ideal practice. There will always be difficulties involving assessment procedures. The main issues are the use of tests in inappropriate contexts, confidentiality, cultural bias, incursion of privacy, and the continued use of tests that are inadequately validated (Groth-Marnat, 2003, p.48) consequently, this has resulted in legion(predicate) restrictions as to the use of certain tests, increased skepticism, and a greater need for clarification wi thin regarding ethical standards within the field of psychology (Groth-Marnat, 2003). As in Rosies and Marcos case, the clinician would be concerned about dealing with minors, especially if one was diagnosed with a disability, and should obtain consent to perform the assessments through a parent or legal guardian.As described by Steege Watson (2013) when information is systematically collected and analyzed for the express purpose of ascertain behavioral function and the development of a BIP, it should be considered an evaluation and enate permission obtained (p.34). Furthermore, it would be unethical of Dr. Goldstein, for example, to reveal information about Brian or Cindy to others, unless the clients are posing a risk to themselves or others (such as a threat of suicide or homicide) (Steege Watson, 2013).In the case of Cindy, Dr. Goldstein could begin with a semi-structured interview format and list a sequence of questions that he would like to ask her. The first series of qu estions could embroilWhat are some important concerns that you may have?Could you describe the most important of these concerns?When did the difficulty first begin?How often does it occur?Have there been any changes in how often it has occurred?What happens after the behavior(s) occurs? (Groth-Marnat, 2003, p. 79-80).Since clients vary in their personal characteristics (age, degree of cooperation, educational level, etc.) and type of problem (childhood difficulties, legal problems, psychological problems), the questions should vary from person to person (Groth-Marnat, 2003). In Cindys case, the above questions are appropriate to ask. The series of questions should not be rigid, but asked with a certain level of flexibility, in order to explore relevant but unique issues that may arise during the interview. It is difficult to speculate on the conduction and outcome of the interview, because different theoretical perspectives will exist when it comes to clinician-client interaction b etween Dr. Goldstein and Cindy. It is important to note, that, a successful interview is achieved first and foremost with a proper attitude of the clinician, and not so much by what he or she says or does. The interviewer should always express sincerity, acceptance, understanding, genuine interest, warmth, and a positive regard for the worth of the person. If clinicians do not demonstrate these qualities, they are unlikely to achieve the goals of the interview, no matter how these are defined (Groth-Marnat, 2003, p. 80).Dr. Goldstein should be aware of the interviewer effect because his interview with Cindy is a social interaction and his appearance may influence her answers. This is a common problem and such bias fanny render the results of the study invalid. For example, body language, age, gender, ethnicity, or social status of the interviewer can create this effect. If Dr. Goldstein happens to be of the corresponding age and ethnicity of Cindys ex-husband, with a similar social status and body language, she may not answer all the questions without bias. Unfortunately, there is always going to be such a possibility when conducting an interview.After Dr. Goldstein has concluded the interview with Cindy, he will then provide an outline of the behavioral assessment, similar to the behavioral interview. He will initially provide Cindy with an overview of what has to be accomplished with a clearly detailed specification of her problem behavior. Dr. Goldstein will identify the localize behavior(s) and define them in exact behavioral terms. For example, Cindys target behaviors may be excessive worry and inability to relax as part of an anxiety disorder. The clinician will then determine the problem frequency, duration, and intensity (How umteen times has the feeling of going crazy occurred today, How long did it persist, etc.). He will then identify the conditions in which the problems (worrying, not being able to relax, and so on) occur in terms of its anteced ents, behaviors, and consequences (Groth-Marnat, 2003, p. 114).Dr. Goldstein will determine the sought after level of Cindys performance and consider an estimate of how realistic this is for her with possible deadlines. He will definitely identify Cindys strengths and also put forward procedures for quantity her relevant behaviors. He will decipher who will record what and how will it be recorded, when and where. Then, Dr. Goldstein will determine how the effectiveness of the program should be evaluated. After completing the discussion of areas, he will summarize it to contain that Cindy understands and agrees. Again, this outline should not be rigid and should be used as a general guideline (Groth-Marnat, 2003).In Cindys case, the behavioral interview itself may have presented enough material for an adequate assessment but some form of actual behavioral observation may be required before, during, and after treatment. A method for observing the behavior(s) is often pertinacious on during the initial behavioral interview. While interviews primarily serve to obtain verbal information from clients, behavioral observation conducted to actually carry out certain techniques and strategies of measuring relevant areas of behavior that were previously discussed during the behavioral interview. With Cindy, a behavioral observation may be useful, although it is usually used more frequently in cases such as assessing young children, the developmentally disabled, or resistant clients, but it would be interesting to obtain interval recording, archives recording, ratings recording, and event recording. Dr. Goldstein may ask Cindy to observe her relevant target behaviors. He and Cindy will have to decide on the number of target behaviors to record and the complexity of a recording method, as the task will have to cover manageable and not overly complex (Groth-Marnat, 2003).Target behavior(s) should be identified in a narrative description of Cindys problems and after s pecified by determining the antecedents and consequences related to her problem behavior. All of her behaviors need to be broadsided in an objective manner, with complete definitions that enable summary observations of the measures of the behaviors. Such definitions should not include abstract terms, such as absentmindedness or sadness, and instead concentrate on specific behaviors. Furthermore, the definitions should be easy to read. When Dr. Goldstein is measuring behavioral frequencies, he must clearly define when the behaviors begin and end. It can be difficult to measure less clearly defined behaviors. The recordings should measure the duration of behaviors and their intensity. For example, how fast does Cindys heart beat during an anxiety/ dread attack in which she feels that she is losing her mind and how long did this heart rate remain? Measurements as such will determine how urgent and strong a treatment approach should be (Groth-Marnat, 2003).Of further importance is th e setting of a behavioral observation and it can range from a native setting to a highly structured one. Natural, or in vivo, settings for Cindy can include her home, the park, or the mall. Such natural settings are the most effective ones when move to assess high-frequency or depressive behaviors, as in Cindys case. Unfortunately, observations in natural settings require an extensive amount of time but are useful when the amount of change the client has made is measured after a treatment. Dr. Goldstein may decide to create a structured environment, such as a role play, that bring out specific types of behaviors. Such environments can be important for infrequent behaviors but this type of setting may not generalize into Cindys actual life. The training of the observer has to include a clear understanding of measuring the behaviors, emphasizing on victorious objective and accurate recordings. The clinician should take precautions to avoid observer error, through bias, lapses in co ncentration, leniency, and discussing of data with other observers. Reliability may be checked by comparing the degree of agreement between different observers rating the same behaviors (Groth-Marnat, 2003, p.116). After gathering enough information about their clients history and pertinent data during behavioral interviews and assessments, clinicians have a clear picture of each case and will be able to design and implement the correct treatment plan.ReferencesGroth-Marnat, Gary (2003). Handbook of Psychological Assessment 4th ed. John Wiley Sons.Retrieved on 20 February 2015 from http//marijag.home.mruni.eu/wp-content/uploads/2009/02/handbook-of-psychological-assessment-fourth-edition.pdf.Steege, M.W., Watson, T.S. (2013). Conducting School-Based Functional Behavioral Assessments, Second Edition. Guilford Press. VitalBook file.