Comprehensive Examination

STUDENT ID: Student A

Fall A 2017

PSYCHOLOGICAL THEORY AND PRACTICE: ASSESSMENT (A)

Grade: Unacceptable (1)

The student demonstrates insufficient knowledge of how the assessment process might be utilized to enhance understanding of the client’s presenting problems, as well as aiding in formulating diagnostic impressions and a treatment plan. The student states that he/she would conduct “personality assessment, family relationship assessment and mental health assessment to analyze the problems of the Abby” but does not detail any specific assessment instruments that would be recommended (other than a structured interview). There is also no mention of specific mental health issues that would be addressed in assessment (e.g. intellectual functioning, suicidality, homicidality, psychosis, sociopathy). There are statements in this section that reflect a lack of familiarity with and accuracy of understanding the assessment process, e.g. discussion of psychiatrists rather than psychologists conducting diagnostic testing and the statement that assessment results increase patient confidence and make them more aware of their own capacity. Finally, this section is poorly written grammatically, making it somewhat difficult to follow the student’s communications.

PSYCHOLOGICAL THEORY AND PRACTICE: DIAGNOSTIC IMPRESSIONS (B)

Grade: Emerging (2)

The student lists Obsessive Compulsive Disorder and Schizophrenia Spectrum Disorder as possible diagnoses, but the student’s provided list of diagnostic criteria is not matched to these diagnoses. One of the criteria listed in the DSM-5 for a diagnosis of OCD is that the disturbance is not better explained by the symptoms of another mental disorder. In this case, Trichotillomania (Hair Pulling Disorder) would more precisely describe the client’s presenting symptoms. The student identifies some specific disorders within the broad category of Schizophrenia Spectrum Disorders (e.g. Delusional Disorder, Schizoaffective Disorder, “Personality Disorder”, and Schizophrenia), but does not indicate why one of these diagnoses might better fit the presenting data than another.

The student does not include any discussion of whether the client’s symptoms might merit a diagnosis within the category of Disruptive, Impulse Control and Conduct Disorders. Additionally, there is no mention of whether Bulemia Nervosa and Pyromania might be listed as provisional (rule out) diagnoses meriting further investigation, along with consideration of possible organic factors, exposure to trauma and possible intellectual disabilities. Finally, the student mentions that the client’s level of openness should be considered in formulating a diagnosis, but does not elaborate on this point or offer other individual/cultural factors which might be considered.

Overall, this section does not represent a proficient understanding of the diagnostic process.

LEGAL THEORY AND APPLICATION: THEORETICAL FORMULATION

Grade: Emerging (2)

The key task in this section is to conceptualize the client utilizing a specific theoretical framework. The student provides a description of social, biological and learning theories, but does not seem to understand the meaning of these theories and does not link them at all to actual events in the client’s history/presentation which may explain her symptoms, such as pregnancy and birth complications, developmental delay, sexual trauma by father and brothers, etc. Further, the student does not sufficiently address the topic of victim/offender psychology, as there is much in this client’s history which suggests that her history of trauma (biological and psychological) may have contributed to her forensic presentation. In conclusion, the student does not sufficiently grasp the purpose of a theoretical formulation as a means of understanding the client’s behavior and their alleged crime.

LEGAL THEORY: DESCRIPTION OF CRIME

Grade: Unacceptable (1)

The student describes the crime in the present case as arson. While this is a component of the crime, it would be important to note that the client was charged with attempted murder of her brother by arson. Furthermore, life imprisonment is not necessarily the penalty for arson. Additionally, if convicted, this client would be convicted of attempted murder, not just of arson. The student offers one scholarly citation discussing the general impact of arson on its victims.

LEGAL THEORY AND APPLICATION: LEGAL IMPLICATIONS

Grade: Unacceptable (1)

The student provides a sufficient description of the legal definition of Competency to Stand Trial, but does not provide a specific legal standard/landmark case precedent relevant to this standard, focusing incorrectly instead on the forensic psychologist’s evaluation of the patient facing trial.

The student’s description of the concept of Duty to Warn is poorly written, with confusion about references to therapist, client, and victim. It is not accurate that clinicians fail to warn out of fear of being found liable under Duty to Warn; in fact, liability would more likely arise out of a failure to warn an identifiable victim. Again, the student provides no landmark cases in this area, misunderstanding the concept of a landmark case precedent.

The student’s description of the concept of Insanity is also poorly written, with references to “abnormal” behavior…violation of community norms, …and dangerousness.” This definition is not accurate and also does not reference the important point that the insanity defense pertains to the defendant’s mental state at the time of the commission of the crime. The student cites a case where a defendant was found to have feigned insanity, rather than a case where a defendant was found to be criminally insane at the time of the commission of the crime.

This section is poorly written and demonstrates an unacceptable level of understanding of the three key legal concepts.

RESEARCH AND EVALUATION: FORENSIC EVALUATION

Grade: Unacceptable (1)

The student discussed no specific instruments which might be used to address the forensic questions in this case. In fact, the student seems not to understand the idea of how specific assessment instruments might be used to determine the client’s psycho-legal status. The student mentions seeking a patient history, which is valid, but focuses on potential data such as interviewing police officers and people who have interacted socially with her, rather than actual police/court records and records from her lengthy mental health settings and services.

While evaluating context is always useful, and assessment of the patient’s current state of arousal may offer clues, there is no mention of standardized measures to assess the client’s possible insanity at the time of the crime, risk of danger to self/others and competency to stand trial.

Finally, rather than rendering a judgment as to whether the client meets the three psycho-legal standards, the student states that the client may be suffering from a “personality and mental health disorder” such as OCD, which the student offers as an explanation for the behavior which led to the alleged crime of attempted murder by arson.

Overall, there is no meaningful linkage of clinical data with legal standards to address the relevant forensic questions in this section.

RESEARCH AND EVALUATION: RESEARCH PROPOSAL

Grade: Emerging (2)

The student begins by proposing the following research question:

“What are the effects of personality aspect of Abby to her criminal behavior?”

Not only is this statement poorly written grammatically, it focuses on researching the client rather than a broader sample of persons charged with a similar crime. The student correctly states that personality factors would be the independent variable in this study and criminal behavior would be the dependent variable. The student states that a survey method would be used, but does not state who would be surveyed, what instruments might be used, what specific aspects of personality would be addressed, etc. The potential contribution of this proposed study is very generic, rather than offering something more specific like identifying predictive factors that might contribute to prevention of such behavior.

The student does not express a clear understanding of the value of research methodology in contributing to an understanding of criminal behavior in this section.

LEADERSHIP, CONSULTATION AND ETHICS: ETHICAL ISSUES

Grade: Unacceptable (1)

The student erroneously states that the ethical/legal dilemma is the present case is whether the client is a candidate for a community resource program. This is the referral question, not an ethical/legal dilemma. The student displays further confusion about ethical/legal dilemmas by stating that the client’s potential conflicting issues or professional duties should be explored, rather than addressing those issues regarding the clinician. As the student continues to detail a step by step plan, there is no mention of any actual ethical/legal dilemmas in the present case. Further, the student fails to identify any specific important ethical considerations, consistent with the APA Ethics Code and SGFP, such as informed consent, steps to ensure privacy and confidentiality, avoidance of harm and steps that would be taken if the client reveals current risk of harm to self or others. It should also be noted that the court is the "client" in this case. Therefore, the client must be informed that he is not entitled to confidentiality with respect to the court, though his record is otherwise confidential with respect to outside parties. It would also be useful to voice caution about serving in a potential Multiple Relationship, if serving simultaneously in both an assessment/referral role to the court and a treatment role.

INTER-PERSONAL EFFECTIVENESS: DIVERSITY AND MULTICULTURAL COMPETENCE

Grade: Unacceptable (1)

The student begins this section by stating that sexual orientation, SES and physical disability are the relevant diversity factors that would be a focus in this case. This is curious as there is no mention of the client’s sexual orientation or of her being sexually active and there is no mention of the client having a physical disability. The student otherwise only mentions culture and historical context in a general way as important, but offers no specific aspects of the client’s identity that may be important to consider in assessing, diagnosing, conceptualizing or treating this patient. There is no mention of key salient cultural factors which were identified in this case such as intellectual/developmental functioning, family constellation, trauma history,

age, obesity and other medical concerns and psychiatric status.

It is very unclear why the student offered the following additional statement regarding diversity: “However, the aspect of globalization has facilitated multiculturalism thus making it hard for the psychiatrists to determine the cultural competence of the patients (Hays, 2016).”

Finally, there was also no discussion of specific areas of competence which the assessing or treating clinician should possess in order to work within the boundaries of their competence and to serve the client effectively. Likewise, areas of cultural similarity or difference between therapist and client would also be important to consider.

INTER-PERSONAL EFFECTIVENESS: WRITING IN APA STYLE

Grade: Unacceptable (1)

The quality of the student’s writing and expression of ideas is very poor throughout the paper and is not at all consistent with graduate school scholarship. There are citations provided in the paper and listed in the reference list, though quotations did not include page numbers in the citation per APA guidelines.

Total Points: 13/40 FAIL