Topic: Reply to Michelle’s post Week 3 -Case Studies in Assessment

Details: PSY 640 Week 3 Discussion Case Studies Assessment

(SEE Michelle’s POST BELOW)

Guided Response: You are encouraged to post your required replies earlier in the week to promote more meaningful interactive discourse in this discussion. Was your colleague’s proposed assessment battery appropriate for the case they were referred to? Evaluate the instrument(s) suggested by your colleague. Would these measures provide reliable, valid, and culturally appropriate results for the given scenario? Use your research to support your assertions. What other measure(s) would you suggest your colleague use in this situation?
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Michelle Medina Week 3 Post – Case Studies Assessment

Case Summary

This case is about a 57-year old man named Larry Goranov. Larry has been previously diagnosed with dysthymic disorder. The patient explains that he has had a low-grade depressed mood and less energy since he lost his job 3 years ago, his relationship ended shortly after, and he is living with his mother. He has previously been treated with SSRI, SNRI, and atypical antidepressants with minimal improvement. He is resistant to CBT or other psychotherapy and quit treatment early in the process. During the diagnosis process, the previous therapist used countertransference responses to build rapport and a sense of connection to Larry. It was uncovered that Larry feels exceptional and others are beneath him. He has issues trusting as he believes most people have ulterior motives for wanting a relationship with him. He also exercises daily and is very concerned with his body image or appearance. He stays up to date on modern trends and dresses in styles popular to people in their 20’s. He is very goal-directed. The diagnosis for Larry is narcissistic Personally Disorder (NPD) (Barnhill, 2014).

Ethical and Professional Interpretations

In the previous assessment, the doctor used a method of countertransference responses to gain information from the client. This method could potentially be considered unethical and has the potential of creating boundary issues. According to the American Psychological Association (2010) standards, there are strict guidelines that prohibit psychologists from building a personal relationship with the client regarding therapy. Although countertransference was used during the assessment phase, it is possible for boundaries to be crossed. Additionally, this method could potentially hurt the clients since they are being deceived. Unless the method of gathering information was disclosed during the informed consent stage, this method of gathering information could be considered unethical.

Recommendations

• Clinical Interview – Clinical interviews will be conducted to understand previous experiences with prior evaluations and gauge how the individual responds to previous treatments and how he relates to his environment.
• Mental Status Exam (MSE) – This is conducted as an interview to determine the patient’s mental function of memory, feelings, thoughts, and judgment are within a healthy range.
• Physical Examination – A physical examination will be conduction to examine bloodwork to ensure that all vital organs and physical functions are operating properly and not creating an underlying issue.
• Intelligence Test – A formal intelligence test is not needed and will be included within the interview process.
• Personality Diagnostic Questionnaire 4 (PDQ-4) – The PDQ-4 is a self-reported questionnaire of 99 questions that identify key features often associated with personality disorders (Miller et al., 2008).
• Millon Clinical Multi Inventory III (MCMI-IV) – MCMI-IV is the fourth edition of the MCMI and provides information on the personality traits of a person, including specific psychiatric disorders (Gregory, 2014).
• Observation – General observation will be conducted throughout the entire process to determine how the patient interacts with others, including staff and people administering the psychological tests.

Pros and Cons of Test Procedures

The pros of using two individual personality tests of the PDQ-4 and the MCMI-IV is that this will allow the psychologist to evaluate the individual traits within the personality to determine if the individual truly does have a personality disorder. By only using an interview process during the previous diagnosis, the psychologist was only able to make assumptions based on the client’s perception, which may have been impacted by potential bias from the interviewer. Using both interviews and psychological tests, there will be a more holistic overview of what is happening with Larry.
One potential con to using these recommendations would be that Larry may be resistant to participating in this many tests. People with NPD often are unwilling to accept that there may be something wrong with them and want to find a quick fix for the problem. This is one reason the patient has not been able to follow through with previous therapy options. If the patient does not want to admit or discover that there is something wrong with him, it is possible that the assessment process may not proceed any further than the initial interview phase.

References

American Psychological Association. (2010). Standard 9: Assessment, http://www.apa.org/ethics/code/index.aspx?item=12 (Links to an external site.)
Barnhill, J. W. (Ed.). (2014). DSM-5 Clinical Cases. Washington, D.C.: American Psychiatric Association
Gregory, R. J. (2014). Psychological testing: History, principles, and applications (7th ed.). Boston, MA: Pearson.
Miller, J. D., Campbell, W. K., Pilkonis, P. A., & Morse, J. Q. (2008). Assessment Procedures for Narcissistic Personality Disorder: A Comparison of the Personality Diagnostic Questionnaire-4 and Best-Estimate Clinical Judgments. Assessment, 15(4), 483–492.

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