Exam 2 - Clinical Psychology

Why do clinical psychologist conduct research? What kinds of topics do they study?

• Goals and Methods

• Goals

  • Describe

  • Explain

  • Predict

  • Control

• General Method

  • Scientific method

 Hypothesis, Design, Data Collection, Analysis, Conclusions, Dissemination

• In Clinical Psych – primary reason for research: to gain knowledge about mental health and psychological functioning

Some sample topics and issues of interest in clinical research studies

• Psychopathology/Diagnosis

  • Defining symptoms and characteristics: What are the relationships/differences between the disorders?

  • What causes abnormal behavior? How does it progress?

  • Incidence and prevalence rates – general and within specific populations

  • How to assess symptoms

• Interventions

  • Do they work? How well? With whom? What interventions work best for which targeted problems?

  • Efficacy vs Effectiveness

  • What goes on in therapy? What aspects of therapy impact client outcome? How do they impact client outcome? (aka “Process” research)

• Assessment

• Developing and validating instruments and method

• Evaluating reliability and utility of existing instruments and methods

• Teaching/Training

▫ Studying the education in clinical psych

▫ How to best teach/train; comparing methods and content; how to and when to train in specializations

▫ Methods of effective supervision

• Professional Issues

▫ Examining elements of the profession

▫ E.g., what do clinical psychs do; identifying and managing ethical dilemmas; balance of work life and personal lives; attitudes of clinical psychs toward issues and/or groups

Be able to determine the differences between the following types of research methods -- and when they are most appropriate to use: epidemiological, case studies, surveys, and experimental (both single-subject and group designs

Epidemiological - incidence and prevalence

Case studies - research methods that involve a thorough and detailed examination of a person or situation

Surveys

Experimental -

• Group Designs

  • Cause/Effect

  • IV/DV

  • Controls/Comparison

  • e.g., Randomized Clinical Trials (RCTs)

• Single Case Designs

▫ ABAB/reversal/withdrawal

▫ Multiple Baseline

efficacy vs effectiveness - what is each and how are they different?

• Efficacy - the success of a particular therapy in a controlled study conducted with clients who were chosen according to a specific criterion of study (internal validity) 

  • Participants are selected from meeting strict diagnostic criteria and can resemble textbook cases

• Effectiveness - the success of a therapy in actual clinical settings in which clients’ problems span a wider range and are not necessarily chosen based on rigid diagnostic criteria (external validity) 

What is a meta-analysis and why are meta-analyses useful in clinical psychology?

• Meta-analysis - the statistical method of combining results of separate studies to create a summary of the findings  

  • cross-sectional studies

  • longitudinal studies

be familiar with the following terms: incidence, prevalence, independent variable, dependent variable

• Incidence - new cases

• prevalence - overall rate

• Independent variable - the variables in the study that are manipulated by the researcher

• dependent variable - the variables that are expected to change as a result of changes to the independent variable

How do we define behavior as “abnormal” in clinical psychology? Discuss the four “D”s.

• Abnormal - criteria such as personal distress to the individual, deviance from cultural norms, statistical infrequency, and social functioning.

• Historically

  • Supernatural forces: possession by evil or gods

  • Natural causes (e.g., imbalance of bodily fluids posed by Hippocrates)

  • Medical model illness

  • Szasz: psychosocial model (deviance)

• Currently in Mental Health:

  • 4Ds: deviance, distress, dysfunction, dangerousness

What is the DSM-5TR

o how was it developed, why is it important, how is it used in clinical psych, what are some criticisms of it?

•  Early Diagnostics

  • Kraeplin: late 1800s/early 1900s (exogenous, endogenous)

  • US Census Bureau: 1840 “idiocy/insanity”; 1880 - seven categories of mental disorders

•  Diagnostic and Statistical Manual of Mental Disorders

  • The system was first introduced in 1952 by the American Psychiatric Association

•  First DSM: 1952

•  Revisions: DSM – II, III, III-R, IV, IV-TR

•  Versions I & II

  •  3 categories (psychoses, neuroses, and character disorders)

  •  Descriptive and theoretical (no empirical)

•  Versions III through IV-TR

  • Empirically based

  • Expanded categories and specific disorders

  •  Multiaxial system introduced

•  Current Version: DSM-5 TR (2013/2021)

  •  based on empirical data

  • Includes

    •  changes to diagnostic categories, labels, and criteria for various disorders

    •  Does not include the traditional “multiaxial” system of the previous DSMs

    •  New section: set of conditions warranting further investigation before potential inclusion

    •  Revisions heavily criticized...

DSM-5: The Current Edition—Controversy Surrounding DSM-5

•  Many “work group” members quit midway

•  Leaders of mental health organizations boycotted DSM-5

•  Most vocal critic was Allen Frances

  • Changes are unsafe and scientifically unsound

  • Medical illnesses diagnosed as somatic symptom disorder

  • DSM-5 will mislabel “normal people”, promote diagnostic inflation, and encourage inappropriate medication use

•  Specific criticism by others

  • Diagnostic overexpansion

  • Transparency of the revision process

  • Membership of the Work Groups (mostly researchers, not clinicians)

Discuss pros and cons of classification/diagnostic systems in clinical psych

•  Pros

  • can lead to most effective services

  • some behavior may be more acceptable b/c of label

  • facilitates communication

  • funding is dependent on labels

  • can spur legislation and special interest groups

• Cons

  • often focuses on negative aspects of person

  • can facilitate low expectations and self-fulfilling prophecy

  • may be permanent

  • doing it well takes lots of time and energy/resources

  • gives false impression of explanation

what are reliability and validity? Why are they important factors in the assessment process?

• Validity - the extent to which a technique measures what it claims to measure 

• Reliability - the extent to which a technique yields consistently reliable results 

The extent to which a technique benefits the clinician and ultimately the client in a meaningful way (clinical utility) 

role of empathy, sincerity, and acceptance in clinician-client relationship

• rapport

• An early way to put clients at ease is small talk

• Acknowledge the unique, unusual situation of the clinical interview

• Client’s language: visual imagery & touch words

how to effectively use questions in interviewing and assessment process

• directive style questions - info, their asking specifically for

• nondirective - allows clients to determine the course of the interview

• open-ended questions and closed-ended questions

• clarification questions - interviewer has accurately understood the client

• confrotation

• pharaphasing

• reflection of feeling

• summerizing 

Uses and types of interviews - when to use, info to gather, specific tools available for use

• intake, mental status, diagnostic interviews

• intake interview - determines client needs treatment & where the facility can help or should be referred 

• Diagnostic interview - the primary purpose is to diagnose the client’s problems 

  • purpose is to produce a diagnosis

  • DSM

• mental status exam - used in medical settings & the primary purpose is to assess the client’s functioning at the time of evaluation

Intake Interview / Clinical History Interview

▫ goal is to determine personal history and current situation

▫ topics usually covered

 educational

 health/medical/developmental

 alcohol/drug

 psychological/psychiatric

 family/marital/sexual

 interpersonal/social relations

 Occupational

 Military

 legal

 current problems/concerns (what, when, affects life, anything done yet?

Mental Status Exam

▫ Goal: to determine current level of functioning, particularly cognitively and motorically

▫ Involves interview + observations

▫ helps to identify potential psych disorders and to screen for organic brain disorders

▫ topics covered:

 general appearance

 motor behavior (fine and gross)

 mood and affect

 speech and thought process

 sensorium (x4 - person, place, time, and situation)

 cognitive (basic facts, abstractions)

 judgment (what do if...)

 memory (serial 7s; digit span)

Diagnostic Interview

▫ goal: to determine occurrence & nonoccurrence of diagnostic features of disorders; outcome is diagnosis or“ label”

▫ more common in recent decades

 Diagnostic process: more reliable/valid

 Many managed care/insurance companies require a diagnosis for reimbursement

▫ examples (child and adult tools)

 Schedule for Affective Disorders and Schizophrenia (SADS); also has Ka iddie version

 Structured Clinical Interview for Axis I Disorders (SCID)

 Diagnostic Interview Schedule for Children

listening skills - what are they, how are they used

Paraphrasing, reflecting, summarizing

• eye contact - facilitates & communicates listening

• body language

• vocal qualities - pitch, tone, volume, & fluctuation

• verbal tracking - repeating key words or phrase back to client

• Skills involved (based on process research (e.g., Rogers, Strupp)

▫ Listening skills

 Paraphrasing, reflecting, summarizing

▫ Action responses

 Probing, clarifying, information giving

▫ Silence

▫ Terminology

 defining all terms

 use client’s terms

 use “sensory” equivalents

use of silences - how to use, what they might indicate

how do we define intelligence

• aptitude or intelligence, the exact definition has a long been a subject of debate among psychologist & may or may not include the speed of mental processing, sensory capability, imagination, adaptability, capacity to learn through experience, memory, reasoning, or inhibition of instinct

• Verbal comprehension

• Verbal expression

• Perceptual reasoning

• Visual-perceptual processing

• Visuospatial skills

• Visual-motor skills

• Attention

• Creativity

  • Word and idea generation

  • Divergent thinking

• Executive Functioning

  • Organization and Planning

  • Inhibitory control

  • Concept formation

  • Set shifting.

• Memory

  • Short-term and Long term

  • Working memory

  • Visual, Verbal/Auditory, Tactile

history of IQ testing: contributions of Binet, Simon, Spearman, Goddard, Terman

• Galton’s “hereditary genius” projects

  • Testing for individual differences (stats)

  • Heritability of intelligence

  • Current issues: heritability, reaction range

• Binet and Simon (France)

  • first IQ test for children

  • concept of “mental age”

• Goddard and Terman (America)

  • Translated Binet’s work: Stanford Binet (1916)

  • scoring as mental age/chronological (Intelligence Quotient)

• Wechsler (America)

  • first standardized test for adults

  • new scoring on the normal curve

IQ – what does that term mean? how is an IQ determined (i.e., ratio vs deviation)?

• Psychometric devices consisting of standardized questions and tasks used

for assessing a person’s potential for purposeful and useful behavior

• Standardized

▫ Refers to specific set of procedures for administering and scoring tests

• Psychometrics

▫ Refers to reliability and validity

How are Cognitive assessments used?

• Screening

• Diagnosis

• Selection and Placement

• Evaluation and research

• Monitoring cognitive effects of disease and dysfunction

heritability and stability of intelligence

For each of the major standardized IQ tests (Stanford Binet, Wechsler series, Kaufman series), know:

• who developed/when

• description – that is, what aspects of intelligence does it measure?

• different versions and normative ages for each

Wechsler Series

• intelligence is an aggregate of abilities

• Specific factors:

  • verbal comprehension,

  • perceptual organization

  • working memory

  • processing speed

• Wechsler Adult Intelligence Scale (WAIS-5)

  • 2024

  • ages 16 thru 90

  • 20 subtests

• Wechsler Intelligence Scale for Children (WISC-V)

  • 2014

  • ages 6-0 thru 16-11

  • 16 subtests

• Wechsler Preschool and Primary Scale of Intelligence (WPPSI-IV)

  • 2013

  • ages 2-6 thru 7yr7mo

  • Developmental focus on expressive and receptive language

Stanford Binet – Fifth Edition

• 3-level hierarchy of intelligence

•  (based on Spearman, Horn-Cattell-Carroll theories)

  •  2002 (most recent; long history of assessment tools – back to 1916)

  •  for ages 2-0 thru 85+

• Five factor scores – each is tested verbally and nonverbally

  •  Fluid Reasoning

  • Knowledge

  • Quantitative Reasoning

  • Visual-Spatial Processing

  • Working Memory

• Uses adaptive testing format (uses the first section to determine the difficulty level for the client)

•  Has an abbreviated battery; can also give Nonverbal Administration

Kaufman Series

•  2 types of intelligence (Horn-Cattell theory of intelligence):

  • Fluid: reasoning ability, nonverbal abilities, ability to solve new problems

  • Crystallized: acquired skills and knowledge; influenced by educational and cultural opportunities

•  Kaufman Adolescent and Adult Intelligence Test (KAIT)

  • Ages 11-0 thru “over” 85

  • Includes a mental status exam

  • 10 subtests

  •  Has strong Neurological focus

•  Kaufman Assessment Battery for Children (KABC-2)

  •  Ages 3 thru 18

  • 18 subtests – different ones for different ages

  •  Has nonverbal scale, too

Potential uses/misuses of cognitive assessments

Wechsler Series

• intelligence is an aggregate of abilities

• Specific factors:

  • verbal comprehension,

  • perceptual organization

  • working memory

  • processing speed

• Wechsler Adult Intelligence Scale (WAIS-5)

  • 2024

  • ages 16 thru 90

  • 20 subtests

• Wechsler Intelligence Scale for Children (WISC-V)

  • 2014

  • ages 6-0 thru 16-11

  • 16 subtests

• Wechsler Preschool and Primary Scale of Intelligence (WPPSI-IV)

  • 2013

  • ages 2-6 thru 7yr7mo

  • Developmental focus on expressive and receptive language

Stanford Binet – Fifth Edition

• 3-level hierarchy of intelligence

•  (based on Spearman, Horn-Cattell-Carroll theories)

  •  2002 (most recent; long history of assessment tools – back to 1916)

  •  for ages 2-0 thru 85+

• Five factor scores – each is tested verbally and nonverbally

  •  Fluid Reasoning

  • Knowledge

  • Quantitative Reasoning

  • Visual-Spatial Processing

  • Working Memory

• Uses adaptive testing format (uses the first section to determine the difficulty level for the client)

•  Has an abbreviated battery; can also give Nonverbal Administration

Kaufman Series

•  2 types of intelligence (Horn-Cattell theory of intelligence):

  • Fluid: reasoning ability, nonverbal abilities, ability to solve new problems

  • Crystallized: acquired skills and knowledge; influenced by educational and cultural opportunities

•  Kaufman Adolescent and Adult Intelligence Test (KAIT)

  • Ages 11-0 thru “over” 85

  • Includes a mental status exam

  • 10 subtests

  •  Has strong Neurological focus

•  Kaufman Assessment Battery for Children (KABC-2)

  •  Ages 3 thru 18

  • 18 subtests – different ones for different ages

  •  Has nonverbal scale, too

what are projectives (overview and general characteristics of projective methods)

• based primarily on psychoanalytic theory

• used to uncover a person’s characteristic modes of behavior (personality)

• Involve interpreting responses to situations or stimuli that are ambiguous – they don’t elicit or compel particular responses – thus the client will “project” their personality

• earliest techniques by Galton and Kraeplin (e.g., word association, cloud interpretation)



• Ambiguous, unstructured stimuli are presented

• forces client to impose structure, thus revealing part of “self”

• method is indirect (i.e., purpose is disguised)

• freedom of responses (no options)

• interpretations involve many factors

• Not as “fake-able” as objective tests

• Shortcomings

  • Lack of objectivity

  • Scoring and interpretation can vary across psychologists

  • Insufficient psychometrics

•  Rorschach’s Inkblots

•  Thematic Apperception Test (TAT)

•  Children’s Apperception Test (CAT) and Senior Apperception Test (SAT)

• Drawings

  • DrawAPerson

  • House-Tree-Person

  • Kinetic Family Drawing/kinetic school drawing 

•  Association Tasks

  • Free Association

  • Sentence completions (like Rotter’s Incomplete Sentences Blank)

•  Dream Analysis

•  Play Interpretation (esp with children

advantages and disadvantages of objective and projective tests of personality

Projective test: 

• Shortcomings

  • Lack of objectivity

  • Scoring and interpretation can vary across psychologists

  • Insufficient psychometrics

Objective Personality: 

•  advantages:

  •  economical, easy to score and administer,

  • strong psychometrics,

  • objectivity

• disadvantages:

  • focus is on behavior and not as much on motives or dynamics

  • overall type scores can be misleading

  • some face validity, so can be faked

  • forced choices not always representative

MMPI - 3

 how are they used and interpreted

 reliability and validity

•  Most recent version is MMPI-3 published in 2020.

  •  MMPI was revised in 1990 by Butcher, Graham, et al; also developed the MMPI-A

  • Original MMPI in 1943 by Hathaway and McKinley

• Most popular and psychometrically sound

• 335 questions; “t/f/cannot say” format

• has validity scales which measure “test taking attitude”

• control for malingering, carelessness, misunderstanding, random responding, etc.

• Has clinical scales that compare the client’s responses to those with psych conditions

• interpret full profiles - not just single answers (get “content/clinical scales” and validity scales)

• used to screen for variety of personality characteristics (e.g., depression, paranoia, hypochondriasis)

NEO-PI

 how are they used and interpreted

 reliability and validity

• Revised NEO-PI

  •  based on 5 factor personality theory

    • Neuroticism, extraversion, openness to experience, agreeableness, conscientiousness

• assesses “normal personality” not abnormal behavior

theoretical and historical context of personality testing

The theory behind them drives how we see personality. The earliest techniques were based on psychoanalytic theory. The word association, cloud interpretation, the TAT, and the Rorschach inkblots. Later, we found out that we gotta use objective assessments bc psychodynamic doesn't work as well. Things changed from using less projective tests and more objective tests in the 1950s because researchers found that test takers can best answer questions about themselves and therefore we can get a more accurate personality assessment. This is a better way than using projective tests because the unconscious can be taken in different ways depending on the person's perspective, which could make these tests unreliable. they have insufficient psychometrics.

what are the theoretical assumptions on which use of projectives and objective assessments are based

• Techniques used to gather information about personality characteristics

•  Definition of personality

  •  Varies –

  • Consistency/stability?

  • Awareness?

• Influences characteristics assessed

  • e.g., typical, pathological, defenses, etc

•  Influences techniques used

  • Projective/Objective

  • Evidence Based Assessment

projective: 

• Ambiguous, unstructured stimuli are presented

• forces client to impose structure, thus revealing part of “self”

Objective: 

• Administration of a standard set of questions or statements (unambiguous stimuli) to which the examinee responds using a fixed set of options

significant people and “events” in development and use of projectives (e.g., Galton, Kraeplin, Rorschach)

Galton:
Francis Galton conceptualized the projective techniques with an experiment, in 1897. He chose a number of words and allowed himself to associate as many as words to each of them within four seconds. (word association). He founded psychometrics tests. Galton was interested in understanding the psychological differences between people rather than common traits. This led to Introduction of Differential Psychology.

Kraeplin:
cloud interpretation test; using ambiguous stimuli to assess a person's personality. In the early 1900s, he divided all mental illnesses into exogenous (curable) and endogenous (incurable) categories, thus pioneering the classification of mental illness that continues with the current version of the DSM.

Rorschach:
In 1921, Herman Rorschach created the Rorschach Inkblot Method. This psychological test can help doctors analyze your personality and was once used to diagnose mental illnesses like schizophrenia.

5 /

Rorschach’s Inkblots

 what are they, how are they used and interpreted?

 reliability and validity of use

• Clients were shown 10 inkblots and where asked what it might be. This allowed the clients to free associate and respond.  

Thematic Apperception Test/Children’s Apperception Test

 what are they; how are they used and interpreted

• created by Henery Murray and Christina Morgan

• It is like the Rorschach card, but instead the TAT cards feature interpersonal scenes rather than inkblots. Clients are then asked to make up a story to go along with each scene. Also asked to consider what happened before and what might happen after the scene. 

• nonempirical scoring and interpretation process 

House/Tree/Person and Draw A Man / Kinetic Family Drawings

 what are they; how are they used and interpreted

• was shown in class 

The house-tree-person test (HTP) is a projective test intended to measure different aspects of personality. Test takers are asked to draw a house, a tree, and a person. The interpretation of these drawings is used to create a picture of the person's cognitive, emotional, and social functioning.