STEP 1: "His primary physician referred John to a clinical psychologist after several episodes of sudden violence and rage. John claimed to have limited or no memory of the incidents. His mother described him as typically being a shy, quiet, and even withdrawn adolescent. This was the 15-year-old's first psychological evaluation. During one of John's episodes, his anger was so out of control that he broke dishes, punched holes in the wall, and did hundreds of dollars of damage to his room. His mother worried that John's anger might soon turn to violence against himself or others. She further described him as having low energy, sometimes being sullen, and wanting to sleep a lot. He was unhappy in school, falling far behind his classmates, and in danger of repeating the ninth grade."

STEP 2:Apply these six steps in the reflection as you utilize the information to formulate an idea of how to continue this interview if you were the therapist. Consider these questions when navigating through the steps of the clinical assessment process. What do we want to know? What sort of questions will you ask the client to find out more? What potential data collection procedures will you use? When you interpret the data, you may go on and make an assumption of the data tool you used and the outcome you think it will be to aid with completing step 4. What are your recommendations? Will you make any referrals?

The clinical assessment process consists of the following six steps:

1. deciding what we want to know
2. planning data collection procedures
3. collecting assessment data
4. interpreting the data and formulating hypotheses
5. making recommendations and decisions based on the data
6. communicating information from the assessment data

How the Clinical Psychologist Proceeded in the Case of John

Step 1. Deciding what we want to know

• Is John depressed?
• Could there be a neurological problem contributing to the episodes?
• What factors in his environment might be contributing to his problems?
• Might John have a learning disorder that causes his difficulties in school?

Step 2. Planning data collection procedures

• Choose appropriate personality assessment tests such as theMMPI-Ato assess for depression or other psychopathology.
• Choose cognitive tests of aptitude (e.g.,WISC-V) and achievement (e.g.,WJ-IV) to rule out the possibility of a learning disorder.
• Refer John for a neurological examination to rule out medical problems (e.g., seizure activity).

Step 3. Collecting assessment data

• Conduct a thoroughclinical interview.
• Administer and score tests.

Step 4. Interpreting the data and formulating hypotheses

• Medical tests ruled out neurological problems.
• Cognitive testing ruled out learning disorders and found average intelligence.
• Personality testing as well as information and behavioral observations from the clinical interview indicated clinical depression.

Step 5. Making recommendations and decisions based on data

• John was referred for psychotherapy and a medication evaluation to treat his depression.
• It was recommended that John be monitored for suicidal or homicidal ideations because of his episodes of violence.
• John may be referred for an inpatient evaluation if therapy and medication fail to improve his condition.

Step 6. Communicating information from the assessment

The clinical psychologist conducted a feedback session with John and his mother communicating the impressions and recommendations gained from the assessment. She then referred John to an appropriate therapist for psychotherapy and a psychiatrist for medication evaluation. Finally, the psychologist documented the diagnosis (i.e., major depressive disorder) and wrote a formal report summarizing data, impressions, and recommendations to communicate information to other mental health professionals.

Referrals and the Referral Question

The assessment process generally begins with areferral, meaning someone such as a doctor, teacher, parent, or judge asks a question for the psychologist to answer. In John's case, the referral came from his primary physician. Thereferral questionwas, "What is causing John to have episodes of rage and violence?" The psychologist answered this question by conducting a clinical interview and gathering data from several psychological tests. Several possibilities (e.g., learning disorder, seizure activity) had to be ruled out. Hence, a clinical psychologist must use both inferential reasoning (collect and assess various forms of data) and deductive reasoning (operate with a working hypothesisin this case, the referral questionand eliminate competing explanations).

Ultimately, the answer to the referral question in the case of John was clinical depression. Some referral questions may be difficult or impossible to answer. For example, in John's case the question, "Will he become violent toward people?" may have been very difficult to answer. Sometimes, psychologists may ask the referral source to rephrase or change their referral question to a more reasonable, more answerable question.