Clinical Psychology Clinical Psychology, Exams of Psychology

Download Clinical Psychology Clinical Psychology and more Exams Psychology in PDF only on Docsity! Clinical Psychology Goals of Clinical Psychology - o Integrate Science and Practice o Apply integrated knowledge o Alleviate suffering and promote health Clinical Approach - o Combine knowledge of research and individual assessment in order to understand and help a particular person o Strong interest in people, honesty and integrity dealing with others, emotional stability, and intellectual curiosity Clinical Psychologist Education Requirements - PhD or PsyD from an accredited program Clinical internship (Accrue hours) Often a postdoctoral fellowship (clinical or research) Clinical Psychologist Legal Requirements - Licensure • EPPP is national and there are state tests • 6 months prep time Clinical Psychologist Ethical Requirements - Good character Letter of recs Absence of ethical or legal violations Must know and follow the APA Ethics Code What is the most popular sub-field of psychology? - o Clinical Psychology ->Psychology, General ->Educational Psychology Differences between clinical psychology and counseling psychology? - o Clinical psychology almost always housed in psych departments while counseling is often housed in education departments o Counseling psychologists often deal with normal transitions and adjustments while clinical psychologists tend to deal with more serious psychopathology Differences between clinical psychology and psychiatry? - Clinical Psychologists Has PhDs or PsyDs Have more training and experience in assessment and therapy Cannot prescribe medication except for in NM,LA, and HIS Psychiatrists Have medical degrees Complete a psychiatric residency Can prescribe medications Often do not do much therapy What are the activities of clinical psychologists? - Psychotherapy (34%) Assessment (15%) Research (14%) Administration (13%) Teaching (10%) Consultation (7%) Supervision (6%) How did the percent of women earning doctorates in clinical psychology change from the 1950s to 2010? - It increased it went from under 20% to over 70% Are women still underrepresented in certain faculty positions? - Yes, women are still underrepresented in senior faculty positions Who else may be underrepresented in graduate programs in the field? - Ethnic and racial groups They make up 20% of new degrees African Americans Hispanic Asian Native Americans Gay, lesbian, bisexual, or transgendered individuals make up 7% What is the overall trend of diversity in the U.S.? - It is increasing By 2050, minorities will make up 50% of the population Why is diversity in the field important? - Diversity in the field is important because sometimes individuals might not want to see someone of a particular race and they might feel comfortable with someone of a particular race because they would understand their cultural problems. What is "cultural competence?" - It is having an awareness of one's own cultural identity and views about difference, and the ability to learn and build on the varying cultural and community norms of students and their families. What do clinical psychologists spend the most time doing? - They spend most of their time doing Psychotherapy What is the major activity which distinguished clinical psychologist from other practitioners? - Research Do many clinical psychologists pursue research careers? - No - many don't even publish a single paper Why is strong research background important for clinical psychologists? - Because of 4 reasons Clinicians must critically evaluate literature to determine best treatments Clinicians in academia must supervise student research Clinicians in community agencies may be asked to evaluate agencies' programs Clinicians must critically evaluate success of their own treatments Gives additional metrics to measure success of intervention What is an assessment report? - It is the final stage in the assessment process, it is the creation of an organized presentation of results The psychiatrist must Transfer data into interpretable scores Assessment data should limit inferences required by clinicians Can be complicated by incorporating multiple sources of information What should clinical psychologists always remember when writing assessment reports? (e.g., can one use pejorative language?). - Report should be written in a way easily understood by the referral source. ALWAYS write a report with the possibility that the client will read it in mind. NEVER EVER USE PEJORATIVE LANGUAGE Theoretical focus in DSM-I - Characterized primarily as reactions to psychological, social, and biological factors Heavily reflected psychodynamic thought When shifted to "medical model - DSM-III Influence of managed care - Companies would request DSM diagnosis before reimbursement would be made Insurers wouldn't reimburse for problems that did not have a DSM Diagnosis Ex: Vets with PTSD Shifted to empirical approach - DSM-IV-V When included cultural content in DSM - DSM-IV-TR DSM-5: Changes - Removal of multi-axial system Moved to more dimensional approach Single autism spectrum disorder Depressive and bipolar disorder in different categories OCD and PTSD moved from anxiety disorders New trauma and stress-related disorders created Substance abuse and dependence disorders merged Addition of diagnostic categories to reduce use of NOS Criticisms of the DSM - It's more of a political and economic art than a science Pharmaceutical companies have played a big part in maintaining a "medical model" classification system Also fund research The writers of DSM have also benefited from the medical model Pathologies from groups over others Children, Ethnic Minorities, Geriatric populations, women and sexual minorities are at an increased risk for being unfairly diagnosed with mental illness Certain diagnoses have received more attention than others throughout different eras What is a multi-axial system? - Focused on symptoms rather than causes Allowed clinicians to describe clients along different dimensions or axes, providing a more complete picture of clients' problems and the factors affecting them Axis's 1: Clinical Disorders 2: Personality disorders and developmental/intellectual disability 3: medical conditions 4: psychosocial factors What are some alternative diagnostic approaches? - Dimensional approaches Avoids dichotomization of disorder Psychodynamic psychologists argue for more discussion of ego strength, defense style, etc Created own diagnostic manual Positive psychologists argue for more inclusion of strengths What is a dimensional approach for mental disorder classification? - Clinicians could rate from 1 to 5 the degree to which a client's behavior matched a prototypical description of each disorder How are assessments used in treatment? - They are used to predict behavior Used to determine effectiveness of treatment Can also be an explicit component of treatment Assessments of dangerousness (how good are clinicians?) - Clinicians are NOT good at predicting dangerousness Low base rate events and they end to over predict Positive predictive power is very low Less than 1% of predicted murderers would actually kill someone What are 3 different types of cognitive biases that clinical judgment is subject to? - Availability heuristic Confirmation bias Illusory correlations Availability heuristic - When therapists rely too heavily on experiences that are recent or remarkable enough to make especially available to recall Illusory correlations - Clinical "folklore" that causes clinicians to draw false inferences from assessment data Confirmation bias - The tendency to interpret new information in line with existing beliefs, the clinicians may ignore contradictory evidence, discount its validity, or even distort it to fit initial impressions Statistical prediction vs. clinical prediction - Statistical prediction usually outperforms clinical judgment. Statistical Prediction involves inferences based on probability data and formal procedures for combining information, all usually derived from research Clinical prediction involved inferences based primarily on a practitioner's training, assumptions, and professional experiences Reliability - Consistency in measurement or agreement among different raters Interrater-reliability - Same or similar scores when independent raters complete the same assessment Test-Retest reliability - Same or similar scores when assessment is completed multiple times Internal Consistency - Different parts of instrument are similar to one another Validity - Instruments can be reliable but not valid and valid but not reliable Content Validity - How well it taps all the relevant dimensions of its target Predictive validity - How well assessment predicts behavior or outcome Clinicians avoid directive language Uses responses designed to encourage client to talk Semi-structured - Clinicians places some limits on topics by asking specific questions, but still encourages client to talk Structured - Clinicians asks specific set of questions with specific wording and established order Pros of structured and semi-structured interviews - Provides systematic way of assessing relevant information Less flexible but less prone to error Clinicians places some limits on topics by asking specific questions, but still encourages client to talk Errors Information variance Different answers when question is asked two slightly different ways Criterion Clinicians make different judgments about same client responses Reduce variance in clinicians information gathering, recall, and judgment Could be administered by computer Cons of structured and semi-structured interviews - Clinicians may become "protocol-bound" and miss important information Very broad focus Can alienate clients Feels impersonal Reliability is usually good, but validity can be questionable if client misunderstands the question Less structured interviews re most common and require more training Beginning of the interview - Setting Comfortable, quiet office, and nothing too bold, should have equal height in chairs, and personal effects. Opening Rapport most important Appear warm and approachable Don't look surprised or disappointed Interview should begin within minutes Frame Setting and Transition Explain the norms + expectations that surround an interview, consultation, or therapy session Set basic ground rules for assessment Enlist client as an ally "we" language Non-directive and open-ended questions Middle - Information gathered during this stage Nondirective techniques Open ended questions (how did that make you feel) Use active listening Paraphrase what the client says Directive techniques Used to supplement nondirective techniques Avoid leading questions Nonverbal communication Look at appearances and movements and such Caveat: these things may mean different things to different psychologists based on training and orientation Also look at your own nonverbal communication Closing - Frame settings Signal the end of the interview Provide client with emotional support for completing the interview Always remember that it's a big deal for a client to seek help and trust you with details of their life that are difficult to talk about Doorknob effect Clients wait until the last minute to tell you important information May not be ready to discuss problem, letting down defenses, not want interview to end What's the best way to communicate well with clients and avoid miscommunications? - Avoid Jargon Request feedback from client Avoid biases Preconceived notions about clients may color the way you evaluate them Can be affected by clients' age or ethnicity or by the clinicians clinical orientation How can you measure reliability of interviews ( - Test-retest reliability If test is taken multiple times are the answers the same Interrater reliability Do different clinicians make same inferences about interview results? If they see a video of the same interview, do they come to the same conclusion? When are interviews less valid? - When Clients Intentionally omit information Are intellectually disabled Suffer from brain disorders Malinger What is impression management? - Clients provide specific responses to give a good impression What are concurrent and discriminant validity? - Concurrent Results are similar to other instruments intended to measure the same thing Discriminant Results are different from other instruments intended to measure different things What five areas are assessed by mental status exam? - Appearance and behavior Thought processes Ex: rate and flow of speech and content speech Mood and affect Is there a predominant feeling state? Affect is feeling state that accompanies what we say at a given point Intellectual functioning Rough estimate Ex: reasonable vocab, metaphors, and memory Sensorium General awareness of surroundings Ex: what time of day it is, where they are, and who you are Observational assessment goals and use - The selection, provocation, recording, and encoding of behaviors Select people/behaviors/events/situations/time periods to focus on Decide whether to provoke, or artificially elicit the behavior Record behaviors through memory, record sheets, video/audio recording Encode behaviors into usable data Used to collect data no available through other methods or to supplement other data Also useful when self-report data may not be accurate or sufficient What is emotional intelligence? - The ability to perceive, understand, and use emotions Controversial thought - should intelligence extent to emotions? Intelligence Quotient (IQ): How is the score constructed? What qualifies as intellectually disabled? - Score is grouped into 5 scales Fluid reasoning Knowledge Quantitative Reasoning Visual-Spatial processing Working factors Intellectually disabled - IQ below 70 What qualifies as high intelligence? - An IQ above 130 Wechsler Adult Intelligence Scale (WAIS) and Wechsler Intelligence Scale for Children (WISC) - Adult vs child test WAIS follow a normal distribution in a bell-shaped pattern Measures overall intelligence and 11 other aspects related to intelligence and are designed to assess clinical and educational problems Reflect points earned by client to those of equal age in a standardized sample What is Flynn effect? - Throughout the past 60 years, intelligence scores have raised steadily by an average of 27 points Each generation IQ scores increase Achievement - Proficiency in specific domains Aptitude - Capacity for a skill or knowledge Personality - Is made up of the characteristic patterns of thoughts, feelings, and behaviors that make a person unique; arises from within the individual and remains fairly consistent throughout life Trait theory - An individual's unique constellation of durable dispositions and consistent ways of behaving (traits) constitutes his or her personality Each personality is uniquely made up of multiple traits One way to condense the immense list of personality traits is through factor analysis, a statistical approach used to describe and relate personality traits Influence from genes - Brain-imaging procedures show that extraverts seek stimulation because normal brain arousal is low Genes influence temperament and behavioral style Ex: babies temperaments Objective - Relative clear, specific stimuli to which the client response with direct answers, choices, or ratings Projective - Clients respond to ambiguous or unstructured stimuli with complex verbal or graphic productions Ex: stories or drawings NEO-PI and Five Factor Model of Personality - Objective test of personality trait Measures Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness Five factor model 240 items 5-pt agree-disagree Neuroticism - Anxiety, hostility, depression, self-consciousness, impulsiveness, and vulnerability to stress Extraversion - Warmth, gregariousness, Assertiveness, Activity, Excitement, Seeking, and positive emotion Openness - Fantasy, Aesthetics, Feelings, Actions, Ideas, and Values Agreeableness - Trust, Straightforwardness, Altruism, Compliance, Modesty, and Tendermindnes Conscientiousness - Competence, Order, Dutifulness, Achievement Striving, Self-Discipline, and Deliberation Minnesota Multiphasic Personality Inventory (MMPI) - Current is MMPI-2 566 true-false questions 10 clinical scales Hypochondriasis Preoccupation with health Depression Depressive symptoms Hysteria Emotionality of a person Psychopathic Deviate Need for control Femininity/Masculinity Stereotype of a man/woman Paranoia Inability to trust Psychasthenia Anxiety levels Schizophrenia Unusual/odd cognitive, perceptual, and emotional experiences Mania scale Person's energy Social Introversion Scale Enjoy and comfort around other people 4 validity scales F scale Endorsement of unusual symptoms High means faking bad or true distress L Scale Endorsement of socially laudable but unusual traiting Faking good K Scale Defensiveness More subtle scale to measure faking good or bad True Response inconsistency scale Response bias - negative or positive Variable response inconsistency scale Responding to similar content consistently Takes 90-120 minutes Good Psychometric properties 13/31 common for women 14/41 more common for men F scale - Endorsement of unusual symptoms High means faking bad or true distress L Scale - Endorsement of socially laudable but unusual traiting Faking good K Scale - Measures anxiety as both state and trait PCL PTSD checklist and measures symptoms of PTSD Rorschach inkblot test - 10 ink-blocks Projective tests Little incremental validity, poor overall validity and reliability Thematic apperception test (TAT) - 31 cards 10 chosen b tester are administered Analysis can focus on content and structure Client tells a story of what led up to the scene, what is happening now, and what is going to happen Treatment utility - Still unevaluated for many tests MMPI results had no influence on clinicians' treatment decisions What is Psychotherapy? - The treatment offered by trained mental health professionals and administered within the confines of a professional relationship to help clients overcome psychological problems Is there a single approach to psychotherapy? - No there are as many as 400 "brand name" therapies What are some reasons that people might seek psychotherapy? - Unhappy marriage Nagging fear Identity crisis Depression Coping with trauma What are most common psychological disorders? - Anxiety disorders Moods disorders Impulse control disorders Substance use disorders What are some characteristics of individuals most likely to seek treatment? - Female 35-54 years old White Separated, divorced, or widowed Educated (>17 years) Publicly insured Unemployed Rates of mental illness vs. rates of treatment utilization - Mental illness are significantly higher than rates of treatment utilization What are good predictors of treatment outcomes? - Client motivations Cooperation vs. resistance Openness vs. defensiveness Level of distress and coping style Autonomy Ability to choose treatment What are some skills that effective therapists have? - Genuineness, empathy, and unconditional positive regard Self-awareness/ self-management Self-monitoring skills Master therapists show strong commitment to Personal development Professional development relationships Competency-related - Does the therapist have the skills for specific treatments? Personality-based - Does the therapist have the characteristics to be effective? Ex: maturity, emotional awareness, relationship skills Situational difficulties - Is the work setting or client base particularly difficult? Ex: clients who have committed interpersonal or sexual violence? What are 3 ways to cope with therapy challenges? - More training in specific areas/treatments Continuing ed, workshops, and conferences Work on personal characteristics Therapy - nearly 85% of psychotherapists have sought therapy at least once Changing situation Seek, new job setting or better work / life balance Therapeutic alliance - Relationship between therapist and client - predicts therapy outcome Two important dimensions of therapeutic alliances - Emotional bonds that develop between therapist and client Shared understanding of tasks and goals What do research findings tell us about the importance of therapeutic alliance for therapy outcomes? - Meta-analytic reviews support important of alliance to therapy outcomes Effects are small to moderate; vary depending on number of variables including how alliance is measured Some suggest that more careful measurement of alliance produced larger effect of alliance on outcome What are 3 ways therapeutic alliance can be promoted? (e.g., what both parties should bring). - Role investment Personal effort both devote to therapy Empathic resonance Degree to which both parties are on the same wavelength Mutual Affirmation Extent to which both parties care for each other's well-being Inpatient - Many settings Public, private, and VA hospitals Residential rehab and treatment center, prisons, etc More likely to be treating severe problems Schizophrenia, bipolar, etc Therapists often coordinate with other health service providers Outpatient - By far more common Usually soundproof, comfortable rooms Private but not too far removed Variety of settings Office buildings, hospitals, community centers What are common goals that different clinical approaches may share? - Reducing emotional discomfort Mediate ide and superego Give two examples of unconscious mental processes used by the ego to reduce distress from intrapsychic conflict. - Denial Repression Regression Projection Reaction Formation Displacement Rationalization Intellectualization Compensation Sublimation Reaction Formation - Adopting thoughts and behaviors that are opposite of those prompted by one's unacceptable impulses Displacement - Directing pent-up impulses toward a safer substitute rather than the target that aroused the feelings Rationalization - Providing socially appropriate but fundamentally untrue, explanations for one's unacceptable behavior Intellectualization - Approaching upsetting experiences in an overly logical manner, without acceptance of the emotional components Compensation - Coping with feelings of inferiority in one are by working to become superior in another Sublimination - Channeling the expression of unacceptable impulses into more socially acceptable activities Transference - Client unconsciously brings maladaptive relational pattern into therapeutic relationship (e.g. client who has battle over aggression views therapist as aggressive) Countertransference - Therapists reaction to client influenced by their own history and conflicts (can be reduced by undergoing psychoanalytic therapy) Psychic Determinism - Memories, impressions, or experiences that occur in client's mind are related (e.g. Freudian slip) Resistance - Increase in therapy interfering behaviors as core conflicts are addressed (e.g. skipping appointment) Interpretation - Analyst suggest ways current behaviors are related to past conflicts (i.e. how the past intrudes in the present) Those based on in-session behavior often involves transference Insight - Client sees behavior pattern or problem in new light Basic requirement for positive change. What are goals of psychoanalysis? - Intellectual and emotional insight into underlying causes of client's problem Working through or fully exploring implications of insights Strengthening the ego's control over the id and superego What 3 components should pscyhologists consider for case formulation? - Historical / developmental data Specific interest in early conflict or trauma Mental status, distress level, ego strengths & weaknesses, "psychological mindedness" Defense mechanisms, themes or patterns of relationship difficulty. What is therapy that closely follows Freud's guidelines is called? - Psychoanalytically oriented psychotherapy or psychodynamic What is Humanistic theory? - More optimistic approach - humans are not bound by uncontrollable biological urges Focus on self-actualization and realization of human potential Importance of therapeutic relationship - more important than techniques used Immediate experience - developmental history is not important Theory of Human Needs Physiological safety love/belongingesteem self-actualization Who is Carl Rogers, and what contribution has he made to Humanistic theory and therapy? - Person-centered therapy "the client knows what hurts, what directions to go, what problems are crucial, and what experiences have been deeply buried" Nondirective except with severe pathology Provide supportive environment for self-exploration What is a person-centered therapy? - "the client knows what hurts, what directions to go, what problems are crucial, and what experiences have been deeply buried" Nondirective except with severe pathology Provide supportive environment for self-exploration Unconditional positive regard - Therapist conveys that they care about the client, accept the client, and trust the client's ability to change Conditions of worth - Worth as an individual depends on thinking and acting in certain ways Empathy - Try to see the world as the client sees it Done through reflection - still and playback client's feelings. Communicates therapists desire for emotional understanding Makes client more understanding of their own feelings. Client: "This has been such a bad day. I've had to keep from crying three or four times. I'm not even sure what's wrong" Therapist: "You really do feel bad. And it sounds like it is scary to not know why you feel this way." Congruence - The more genuine a therapist is in session, the more helpful they are Therapist is a real person not "expert" or "solution provider". Need authenticity of therapist. If you just tell clients what they want to hear, it may undermine the relationship. Express genuine feelings to client in appropriate way Outcome - As client experiences empathy, unconditional positive regard, and congruence in a therapeutic relationship, they become: More self-aware and accepting