Clinical psychological assessment is a systematic professional process for examining and understanding a person's mental functioning. Its aim is to build a comprehensive picture of the current psychological state, cognitive and emotional functioning, personality characteristics, behaviour, resources and difficulties of the individual concerned, within the context of their personal, social and medical history.
Clinical psychological assessment is not equivalent to psychological testing. A psychological test is only one of the possible instruments within a considerably broader process, which includes clinical interview, observation, analysis of anamnestic and medical information and, where necessary, the use of standardised psychological measures. The main task of clinical assessment is not simply to establish the presence or absence of a particular symptom, but to help understand its significance in the context of the specific person.
How does clinical psychological assessment proceed?
The process begins with the formulation of a specific clinical question. The reason for the assessment may be the presence of psychological or behavioural symptoms, the need to clarify emotional or cognitive functioning, a referral from a physician or another specialist, preparation for a particular treatment, or the need to assess psychological adaptation to illness.
The clinical interview is a core part of this process. It examines the current difficulties, their onset and development, personal history, significant relationships and events, prior mental and physical health, the current medical condition, treatment received, social environment and the ways in which the person copes with difficulties. Depending on the question posed, the specialist determines whether additional standardised instruments are needed and which of them are appropriate.
When assessing depressive symptomatology, for example, the Patient Health Questionnaire-9 (PHQ-9) or the Beck Depression Inventory-II (BDI-II) may be used, and for assessing anxiety, the Generalized Anxiety Disorder-7 (GAD-7) or the Beck Anxiety Inventory (BAI). In a medical context, the Hospital Anxiety and Depression Scale (HADS) is widely applied, allowing the assessment of anxiety and depressive symptoms in people with somatic illnesses. These instruments do not independently establish a diagnosis. The results obtained are meaningful only when interpreted by a qualified specialist within the context of the remaining clinical information.
What can be assessed?
Clinical psychological assessment may be directed at various aspects of mental functioning – anxiety, depression, psychological distress, stress, adaptation, emotional regulation, personality functioning, behavioural difficulties, interpersonal relationships, and the way a person experiences and copes with significant life changes. Where necessary, cognitive functions such as attention, memory, concentration and executive abilities may also be examined. A brief cognitive screening may include, for example, the Montreal Cognitive Assessment (MoCA), and, where specific indications are present, a more in-depth neuropsychological examination using specialised measures may be conducted.
When the clinical question requires assessment of personality functioning and psychopathological characteristics, complex standardised instruments such as the Minnesota Multiphasic Personality Inventory (MMPI) or other appropriate personality measures may be used. Where a traumatic event has been experienced and post-traumatic symptomatology is suspected, the assessment may include specialised instruments such as the PTSD Checklist for DSM-5 (PCL-5). To assess subjectively experienced stress, instruments such as the Perceived Stress Scale (PSS) may be used.
An important place in clinical assessment is also given to identifying the person's resources – their coping strategies, social support, motivation, adaptive abilities and the factors that may support their recovery and quality of life.
Clinical psychological assessment in somatic illness
The diagnosis and treatment of a severe, chronic or life-threatening illness may be associated with significant psychological burden. Uncertainty, prolonged treatment, pain, physical limitations, changes in appearance or bodily functioning, disruption of usual social and professional roles, and fear for the future may affect the mental state of the patient and their loved ones. In this context, clinical psychological assessment allows the identification of both normal psychological reactions to the illness and treatment, and conditions requiring additional psychological, psychotherapeutic or psychiatric help. The assessment may be directed at psychological distress, anxiety, depression, adaptation to illness, quality of life, cognitive functioning, social relationships and coping resources. This allows psychological support to be planned according to the individual needs of the patient, rather than applying the same model of support to everyone.
Clinical assessment in psycho-oncology
Clinical psychological assessment is a particularly important part of contemporary psycho-oncological care. Oncological illness may be associated with significant psychological distress at every stage – from diagnosis and active treatment through remission, follow-up, relapse, progression, or palliative care. For initial distress screening, the Distress Thermometer (DT) may be used in combination with a problem list, through which practical, family, emotional, physical and other difficulties are identified.
For a more detailed examination of quality of life, instruments such as the EORTC Quality of Life Questionnaire – Core 30 (EORTC QLQ-C30) and the Functional Assessment of Cancer Therapy – General (FACT-G) may be used. These allow various dimensions of functioning and the impact of illness and treatment on the patient's daily life to be assessed. In patients following completion of active treatment or during long-term follow-up, a significant concern may be fear of recurrence or progression of the illness. Where necessary, this may be examined using specialised instruments such as the Fear of Cancer Recurrence Inventory (FCRI). Psycho-oncological assessment may also include anxiety, depression, body image, sexuality, family and social functioning, treatment adherence, cognitive difficulties, coping strategies, and needs for psychological and social support.
The aim is not to pathologise psychological suffering. Fear, sadness, uncertainty and anxiety may be natural reactions to a serious illness. Clinical assessment helps to understand their intensity, duration and impact on functioning, and to determine when a person would benefit from professional help.
Quality of life and psychosocial functioning
Quality of life is an important part of contemporary clinical assessment, especially in chronic and prolonged illnesses. Where necessary, standardised instruments such as WHOQOL-BREF, which assesses physical, psychological, social and environment-related aspects of quality of life, and EQ-5D, for assessing health-related quality of life and functional status, may be used. This data can be particularly valuable in tracking changes over time and in assessing the impact of illness and treatment on daily functioning.
From assessment to the individual care plan
Clinical psychological assessment has meaning when it leads to a better understanding and a better decision regarding subsequent care. Once the process is complete, information from the interview, observation, standardised measures and other sources is integrated into a comprehensive clinical formulation.
Depending on the results, psychological counselling, psychotherapy, psycho-oncological support, psychiatric or other medical consultation, neuropsychological assessment, social support, work with the family, or involvement of other specialists from the multidisciplinary team may be recommended. When the assessment is conducted within the framework of medical care and the patient has given the necessary consent, the results may also support the work of the treating team.
Assessment is not a diagnosis in itself
The result of a single test, questionnaire or screening scale must not be interpreted independently as a clinical diagnosis. Psychological instruments measure specific characteristics or symptoms and have their own capabilities, but also limitations. The results are therefore interpreted in the context of the clinical interview, observation, personal and medical history, and other available information. When the results indicate a probability of a mental disorder or the need for medical diagnosis and treatment, the patient is referred to the relevant specialist.
Professional and ethical standards
Clinical psychological assessment requires specialised professional competence. The choice of instruments is determined by the purpose of the assessment, the specific clinical question, the patient's characteristics, and evidence of the reliability and validity of the relevant measure. Instruments are applied for which the specialist possesses the necessary competence and right of use, taking into account the availability of appropriate linguistic and cultural adaptation, normative data and the limitations of the measure. The process is based on informed consent, confidentiality, protection of personal information, professional ethics, and respect for the person's autonomy and dignity.
Our approach
At the Institute of Medical Psychology, Psycho-Oncology and Psychosomatics, we regard clinical psychological assessment as a process of professional understanding, rather than mechanical measurement or labelling. Not every person needs the same assessment, and not every clinical situation requires psychological testing. Methods are selected individually according to the question that needs to be answered. We combine the clinical interview, observation, standardised instruments and professional expertise in order to understand not only the presence of symptoms, but also their significance for the specific person, their functioning, relationships, health condition and quality of life.