First Week

First, I am happy to be back! I look forward to this course and learning more about assessments. I appreciate that we are incorporating Hays's book into the class as well.     

The short paragraph about illness behavior in the article was interesting to read. I think it would be essential for not only doctors, but clinicians to be aware of this. With how easily accessible the internet is, clients can find out anything and everything about certain disorders and change their behavior based on this information or previously held notions. Though stigma around mental illness has decreased in some ways, much of the dangerous, false information still lingers. Telling someone that they have depression does not mean the same thing to me as it does to them. They may automatically assume the worst about it. I think this is also important to consider when it comes to assessment. Someone could leave your office that day thinking that they have depression and anxiety because you gave them an assessment for both, even if they did not endorse enough symptoms. In my experience with assessments, we were always taught to avoid showing the names of the tests to the patients so that 1) they couldn't look up the answers or anything about it in case they needed to be retested, 2) because patients may get upset if they are given certain assessments that they felt they didn't need., and 3) they may leave thinking they have problems based on the assessments given and not the results of it. 

    Though I like assessments and I agree that they have great clinical utility, they can be very tricky to interpret at times. In my opinion, it can be dangerous to just consider assessment results if they are in the distress range. Even if the responses on a depression scale are not high enough to be clinically significant, does that mean that none of their answers are significant? Should we look at individual items on short assessments and not just overall scores? I think item-level analyses can still provide important information. 

    Assessments can get particularly tricky when it comes to justice-involved people. It is very important that the right assessments are used when measuring treatment success with people who are incarcerated. Is the tool measuring a change in behavior and cognition or is it measuring a lack of opportunity to commit crimes or get into trouble? There are also limited assessments that have forensic standardizations. Is depression the same for people who are outside of prison and one who has been incarcerated for 40 years? If your future is already laid out for you in a life sentence, how does that affect your assessment responses? In addition, the social/ interpersonal aspects of diagnosing and treating patients can be difficult in forensic populations. Say an individual completes treatment and is released with little risk to re-offend, but they return to a family that expects them to continue a life of crime. How, as clinicians, do we equip our clients to continue to help themselves when everyone outside tells them differently? The incarcerated population, like any specific population, requires special care when it comes to assessment, treatment, and diagnosis.