Clinical Psychology

inferences from them. Following that, several inte-
grative statements are made.
At the same time, occasional examples of
Barnum statements are apparent in the report—for
example,“It is likely that his reality testing is some-
what impaired under conditions of high stress.”
There were also occasional predictions or statements
that were somewhat vague. For example, how
would one validate the prediction“It is likely that
he can return to premorbid levels of functioning if
he receives appropriate treatment?”In many cases, it
is unclear what test data were used to support the
stated interpretations and predictions. Were these

based on MMPI-2, WAIS-R, or Rorschach results?

What specific test scores from any or all of these

measures were used as the basis for these

statements?

Despite these few critical comments, we want

to emphasize that this report has many more

strengths than it has limitations. Reports will vary

with regard to structure, style, and language. What

is most important, however, is that the test report

contribute to an increased understanding of the

patient so that the appropriate course of action/

treatment can be undertaken. After all, that is the

primary goal of psychological assessment.

CHAPTER SUMMARY

Clinicians are an integral part of diagnosis and
assessment. Clinicians make important decisions as
to what data are gathered, how they are gathered,
and how they are interpreted. Data can be viewed
as a sample of behavior, as a sign of some

underlying condition, or as a correlate of other

behavioral or emotional constructs. Likewise, inter-

pretations can take many forms, ranging from the

more straightforward and less inferential to the

highly complex and highly inferential variety.

psychosocial stressors. He re-experiences these events;

avoids stimuli associated with the events; and suffers

from loss of interest in significant activities, poor con-

centration, exaggerated startle response, and intense

irritability. These symptoms having persisted for at

least 1 month. A diagnosis of Post-Traumatic Stress

Disorder is warranted.

Axis I 309.89, Post-Traumatic Stress Disorder

Axis II No diagnosis on Axis II

Axis III None

Axis IV Psychosocial stressors: Injury of partner; wife

attacked; discovery of dead children in

“crack”house

Severity: 4–5 (acute events)

Axis V Global Assessment of Functioning (GAF):

Current, 53; highest past year, 75

Recommendations

Mr. Ramirez’s responses to his environment are increas-

ingly atypical and therefore unpredictable. His current

assignment requires self-discipline and cool judgment,

which he may no longer be able to produce reliably at

premorbid levels. Furthermore, he has apparently

almost no insight into his condition, is experiencing

anger, and is capable of acting aggressively. It is

recommended, therefore, that he be relieved of those

duties that involve direct confrontation with violence or

danger to himself or to others, with return to active

duty contingent upon psychological change.

It is further recommended that Mr. Ramirez seek

behavioral psychotherapy—in a group, if possible—that

takes a self-management approach. His defensiveness,

self-sufficiency, assumption of a conventional male role,

and resistance to psychological material indicate that he

is unlikely to be a good candidate for insight-oriented

psychotherapy, which he would be likely to see as evi-

dence of personal failure. However, it is essential that

he learn to modify his need to control every aspect of

life, especially if he wishes to continue his present career

path. The behavioral/self-management approach seems

most likely to present the process of self-examination

and change in an acceptable light.

A Case Illustration of a Clinical Report (Continued)

306 CHAPTER 10