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Chapter 6: Client Assessment and Diagnosis
Chapter Overview
The authors provide an understanding of the role of assessment in mental health counseling and they
discuss the use of the DSM in the diagnosis of mental health disorders. The authors go on to provide an
explanation of the use of formal and informal assessment tools, incorporating frequently used assessment
instruments as examples.
Multiple Choice Questions
1. Which of the following is NOT a characteristic of formal assessment?
a) Testing instrument is psychometrically sound.
b) The test provides a comprehensive understanding of client issues.
c) Assessments are objective.
d) Tests are culturally appropriate for the client being evaluated.
e) Client’s results can be compared to a broad sample population.
2. What would be the most likely reason for a practitioner to choose an informal assessment over a
formal assessment?
a) Provides a more accurate assessment of client issues.
b) They allow for a more accurate analysis.
c) They are more cost effective.
d) None of the above.
e) All of the above.
3. Which of the following is NOT a formal test?
a) MMPI-II test.
b) Stanford Binet intelligence test.
c) The Rorschach Test.
d) Mental Health Exam.
e) MBTI
4. Which of the following best describes a structured interview?
a) Allows for the collection of consistent and specific information.
b) Structured questions allow practitioner to explore topics most relevant to the client.
c) Issues raised by clients can be explored in depth.
d) Structured interviews promote a strong rapport between client and counselor.
e) All of the above.
5. The Mental Health Exam assesses which of the following characteristics?
a) Level of functioning and self-preservation.
b) The emotional state of the client.
c) Speech and language of the client.
d) b) and c) only.
e) All of the above.
6. Ethical guidelines for testing and diagnosis ensure clients are protected from harm. Which of the
following reflects ethical practice for diagnosis?
a) Counselor must be trained and experienced in the assessment tool.
b) Counselor must meet state law criteria for administering assessment tool.
c) Administering the test in the primary language of the client.
d) a) and b) only.
e) All of the above.
7. Informed consent is an important component of ethical diagnosis. What must a counselor
consider for ethical informed consent?
a) Provide consent before administering the test.
b) Ensure client understands the written informed consent.
c) Communicate benefits and consequences of the test.
d) Agree with client any changes in the test after the initial informed consent.
e) All of the above.
8. The MMPI-II is one of the most frequently used personality tests. Which of the following best
describes the characteristics assessed by the instrument?
a) Depression, hysteria, social introversion/extroversion, and thinking/feeling.
b) Schizophrenia, paranoia, thinking/feeling, and sensing/intuition.
c) Social Introversion/extroversion, thinking/feeling, schizophrenia, and depression.
d) Depression, social introversion/extroversion, hysteria, and paranoia.
e) Social Introversion/extroversion, thinking/feeling, sensing/intuition, and paranoia.
9. Which of the following tests is most often used in career counseling?
a) The MMPI-II
b) The MBTI.
c) The Rorschach.
d) Stanford Binet.
e) All of the above.
10. The Rorschach test has lost some of its earlier popularity. What is(are) the main criticism(s)
leveled at the test?
a) Lack of research to support the interpretation of the results.
b) Clients’ negative perception of the test.
c) Scoring is difficult requiring specialized training.
d) a) and c) only.
e) All of the above.
11. The importance of behavioral assessment in diagnosis of client problems has steadily gained
wider acceptance. This has occurred because:
a) Comprehensive behavioral assessment involves the identification, analysis, solution and
evaluation of the problem.
b) Personality tests are inadequate and lack reliability.
c) Direct observation and interpretation of behavior is more accurate.
d) It complements the growing preference for the use of cognitive behavioral therapy.
e) All of the above.
12. What is the purpose of the DSM?
a) Provide diagnosis and treatment of mental health disorders.
b) Provide descriptions and criteria for classifying mental health disorders.
c) Promote credibility and clarity in communication between healthcare professionals.
d) a) and c) only.
e) All of the above.
13. Many counselors have concerns about the use of the DSM by counselors. Which of the following
concern(s) do they have?
a) They are not given sufficient training to use the DSM.
b) Counselors do not have input in the compilation of the DSM.
c) It goes against the strength-based approach used in counselors’ work with clients.
d) Counselors are often legally prohibited by state law to formally diagnose clients.
e) All of the above.
14. The DSM is revised periodically to reflect new developments in the classification and diagnosis
of mental health disorders. The main changes in the latest revision for the DMS-5 are:
a) Shift from Roman numerals to Arabic numerals.
b) Incorporate the influence of gender, race, and ethnicity on diagnosis.
c) Shift from a Multiaxial Diagnostic System to a Dimensional-Categorical Model.
d) Eliminate the Not Otherwise Specified label.
e) All of the above.
15. The definition to describe mental disorder has also been revised over time. In the last century
what has been the most important change in the definition?
a) Linking the definition directly to the ICD-10.
b) Providing a definition that attempts to eliminate cultural bias.
c) Basing the definition on behavioral observations alone.
d) All of the above.
e) None of the above.
Activities
1. Psychotherapy and counseling theories have different emphasis and approaches to assessment and
diagnosis. Some theories may be strongly aligned to conducting an initial assessment, such as
psychodynamic theories, while other theories may consider assessment irrelevant and a contradiction of
the theoretical orientation, such as person-centered. Reflect on your theoretical orientation, whether it is
pure or integrated, and discuss the role of assessment in your theoretical orientation. Formal assessment is
essential for insurance reimbursement while also contributing towards evidence-based practice. How
would you integrate this into your theoretical orientation if your theoretical orientation does not closely
align with formal assessments?
2. The MBTI personality test is popular test for career counseling. Take an online MBTI test. Write a 3-4
page paper with an analysis of how well you think the results reflect your personality as you know
yourself. Consider the following questions as a part of that analysis:
• How accurately does the test reflect your personality? Would you consider it a fair interpretation?
• What impact has knowing your personality indicator type made on you?
• How relevant do you think the test is? Provide reasons for your opinions.
• How comfortable do you feel using it for your clients? Substantiate your reasoning.
• What concerns may you have using personality tests for your clients?
3. Review your state licensure board website. Describe the scope and limitations for assessments and
diagnosis for licensed counselors in your state. How may this affect how you would like to practice once
you are licensed?
Discussion
1. While the DSM plays a central role in diagnosis, it has always been controversial too. Specifically,
many counselors believe it contradicts the philosophical approach of the counseling profession which
comes from a strength based approach. Where do you sit with this argument? How do you feel about
using the DSM to diagnose your clients? Provide a substantive argument for your position?
2. Counselors work from a wellness model rather than a medical model. However, some cultures, such as
some collectivist cultures, may be more comfortable working from a medical model. Discuss how you
may work with such a client and still work from a wellness model.
3. Mental status exams are routinely used at intake to assess and diagnose clients. They are informal
assessments and this lends to its ease of administration. However, they still pose a number of ethical
issues while using them. Identify two ethical issues and discuss how they impact the assessment process
and how you may minimize or resolve the issues.
Multiple Choice Questions – Answer Key
