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Chapter 3 Basic features of clinical assessment, classification, and diagnosis
Clinical assessment
The collection and synthesis of information to reach a clinical judgment about people and their problems.
Without clinical assessment, high-quality research on the causes, correlates, and treatment of mental disorders would be essentially impossible, because clinical scientists cannot fully understand a phenomenon without first being able to measure it
An Outline of the Assessment Process
receive and clarify the referral question
plan data collection procedures
collect assessment data
process data and form conclusions
communicate assessment results
Referral question
The trigger that shapes the clinician’s choice of assessment instruments and the interpretation and communication of results.
Information used in a case study guide
Identifying data
Reason for appearance or referral, expectations for service.
Present and recent situation
Family constellation (family of origin)
Early recollections
Birth and development
Health and physical condition
Education and training
Work record
Recreation, interests
Sexual Development
Romantic relationships and family data
social support
turning points in life
History of abuse or other environmental influences
Collecting Assessment Data
can collect assessment data from four main sources: interviews, observations, tests, and historical records (case history data)
use multiple assessment channels to cross-validate information
Processing Data and Forming Conclusions
Processing assessment data is difficult also because we must somehow integrate information from diverse sources. In forming their conclusions, clinicians often must rely heavily on clinical judgment
Communicating Assessment Results
creation of an organized presentation of results called an assessment report. To be of greatest value, assessment reports must be both clearly written and clearly related to the goals that prompted the assessment in the first place.
A Brief History of the DSM
process became more formalized in 1952 when the first Diagnostic and Statistical Manual of Mental Disorders was published.
DSM-II provided a uniform terminology for describing and diagnosing abnormal behavior, but they offered no clear rules to guide mental health professionals’ diagnostic decisions.
in 1980 with the appearance of DSM-III, which included a set of (a) explicit diagnostic criteria, and (b) algorithms, or decision rules, for combining these criteria into a diagnosis
Among the most important changes introduced in DSM-5 was the new organization of its chapters.
Accurate diagnosis is important for several reasons
First, proper treatment decisions typically depend on knowing what is wrong with a client.
Second, research on the causes of psychological disorders requires that each of them can be accurately identified and differentiated from other disorders.
Third, accurate diagnosis allows clinicians to efficiently communicate with one another about disorders in a professional “shorthand”
Evaluation of the DSM.
Critics of the DSM have long questioned whether the all-or-none categorizations imposed by DSM criteria are the best way to understand and measure psychopathology
statistical evidence suggests that there is no clear boundary between being clinically depressed and not being clinically depressed
many critics argue that most diagnoses should be considered as extremes along one or more underlying dimensions rather than as discrete categories
ignores the context in which symptoms occur, thus providing no basis for understanding the meaning or function that a pattern of disordered behavior might have for different clients in different social circumstances
Psychodynamically oriented clinicians have criticized the DSM’s emphasis on observable symptoms.
For their part, biologically oriented clinicians have argued that the DSM’s emphasis on observable features of disorder fails to take into account the role of recent discoveries about the brain circuitry associated with specific disorders
Critics also have claimed that the DSM excludes certain potentially important conditions because every new version has been largely based on, and applied to, the symptoms of disorder seen in North American populations
Prediction
Those predictions might include forecasts about how the symptoms of a client’s disorder might change with or without treatment (that is, a prognosis), about future performance (descriptions of how someone will perform in a given job or situation), or about dangerousness (the likelihood that people will behave violently toward themselves or others).
A prognosis can also be influenced by assessment of such client factors as impulsivity and coping style, and repeated resistance to therapist suggestions.
Researchers who seek to improve the prediction of dangerousness are now focusing on combining assessment evidence from four domains:
(a) personality traits, such as anger or impulsiveness; (b) clinical factors, such as evidence of mental or personality disorders; (c) historical factors, especially a record of violence; and (d) contextual factors, such as the strength of social support from family and friends
Reliability
refers to the consistency with which it measures some target variable,
In clinical assessment, the consistency with which an instrument measures some target.
One way is to use repeated measurements.
measured in terms of internal consistency. This can be done by comparing results from two parts of a test, such as all the odd numbered items versus all the even-numbered items.
Interrater reliability tends to be higher when clinicians base their judgments on the same set of relatively clear criteria (such as the ones the DSM-5 provides for diagnosing panic disorder), or the same set of interpretive rules.
Validity
In clinical assessment, the degree to which an instrument measures what it is supposed to measure.
all major forms of validity in terms of one overarching concept, namely, construct validity
possess good construct validity when its results are systematically related to the construct or attribute that it is supposed to be measuring
The content validity of an assessment method is determined by how well it captures all the relevant dimensions of its target construct.
Criterion validity
reflects how strongly the results of an assessment method correlate with some important outcome, or criterion Form A) predictive validity because it is measured by evaluating how well the results of an assessment method forecast events such as violent behavior Form B) concurrent validity, reflects the degree to which the results of an assessment method are similar to those of other methods that are designed to measure the same construct.
How is Validity related to reliability
an assessment device cannot be valid without first being reliable. Still, the validity of an instrument is not guaranteed just because it is reliable.
the validity of an assessment instrument must always be viewed in relation to the purposes for which it is used
Standardization
The process of administering a test or other assessment method to samples of people that are large enough and representative enough to establish clinically useful norms for interpreting a client’s score on those assessments.
Bandwidth Versus Fidelity (or the breadth–depth)
The fact that in clinical assessment, the more detailed one’s exploration is, the fewer topics can be addressed, and the more topics are explored, the less detailed the exploration can be.
the more extensively they explore a client’s behavior, the less intensive each aspect of that exploration tends to become
The breadth of an assessment method is thus referred to as its bandwidth and the depth or detail of the information it yields is called its fidelity
Other Factors Affecting Assessment Choices
choices are also influenced by their theoretical orientation, their experience with various methods, the context in which they will conduct the assessment, and the cultural background of their clients or research participants
Clinical Intuition
The clear result is that clinical intuition does not usually lead to the most accurate judgments, and is all too often inferior to other methods of combining assessment information
like other humans’ judgments, are more prone to error when they rely too heavily on rules of thumb or mental shortcuts known as heuristics. One of these shortcuts, known as the availability heuristic, stems from the fact that experiences that are recent or remarkable are especially available to recall
anchoring bias in which—much as the rest of us form first impressions quickly—they let their view of a client’s disorder be influenced more strongly by the first few pieces of assessment information they receive than by any subsequent information
Numerous studies suggest that having larger amounts of assessment information tends to increase clinicians’ confidence in the inferences they make, but does not necessarily improve the accuracy of those inferences
Statistical prediction (also called actuarial prediction or mechanical prediction)
involves inferences based on probability data and formal procedures for combining information, all derived from research
the accuracy of the statistical approach equaled or surpassed that of the clinical approach
Statistical/mechanical prediction outperformed clinical prediction overall, regardless of the type of judges, the judges’ experience, the type of data being combined, or the design of the study
The superiority of statistical prediction is most evident in predicting violence and other rare events.
Practicing clinicians typically underutilize and undervalue actuarial prediction methods.
Clinical prediction
Drawing clinical inferences based primarily on intuition, informal observations, assumptions, and experience
Communicating Assessment Results
assessment reports should be clear, relevant to the goals of the assessment, and conveyed using language that will make them maximally useful to the consumers of the report.
Incremental validity
The ability of an assessment report to add something important to what is already known about a client.
Ethical Considerations in Assessment
clinicians must know the limitations of the assessments they perform, and they must be clear in advance about how those assessments are to be used.
interview
A conversation with a purpose or goal
Intake interviews
Procedures designed to establish the nature of clinical problems.
asked to describe the problem in terms of a DSM or ICD diagnosis (e.g., major depressive disorder).
Information gathered may help the clinician decide whether the client has come to the right place
a mental status examination
A planned sequence of questions designed to assess a client’s mental functioning in a number of important areas.
Problem-Referral Interviews
A procedure designed to answer a specific referral question.
Clinicians sometimes serve as diagnostic consultants to physicians, psychiatrists, courts, schools, employers, social service agencies, and other organizations
A procedure designed to answer a specific referral question: eg. Give me a profile of Mr. Q
Orientation Interviews
A procedure designed to acquaint clients with upcoming assessment, treatment, or research procedures
beneficial in at least two ways.
First, because the client is encouraged to ask questions and make comments, misconceptions that might impede treatment progress can be discussed and corrected.
Second, orientation interviews can help clients understand upcoming assessment and treatment procedures and what their role in these procedures will be
Debriefing Interviews
A procedure designed to provide clients with information and assess their understanding of a just-completed event.
debriefing interview can help alleviate clients’ anxiety about the assessment enterprise by explaining the procedures and protections involved in the transmission of privileged information and by providing a summary and interpretation of the assessment results
debriefings can help people who have experienced a significant event better understand it, ideally ensuring that potential gains are maximized and potential harms minimized.
Termination interview
A procedure designed to smoothly conclude a program of therapy or research
Termination interviews help make the transition from treatment to posttreatment as smooth and productive as possible
Crisis Interviews
A procedure designed to provide support, collect assessment data, and offer help to troubled clients, all in a very short time.
Ethnic and Cultural Issues in Clinical Interviews
Underutilization of Mental Health Care: Members of racial and ethnic minority groups generally receive less mental health care and lower-quality mental health care than does the general population. Reasons: Limits on access, Impact of beliefs and attitudes.
cultural differences in how symptoms are displayed can easily lead clinicians to misinterpret or misdiagnose them
Interview Structure
The most fundamental feature of clinical interviews is their structure: the degree to which the interviewer determines the content and course of the conversation.
Nondirective Interviews
Notice that the clinician hardly says a word, although there are things he could have done to nondirectively encourage the client to talk had it been necessary -The nondirective interviewer uses direct questions sparingly and relies instead on responses designed to help clients continue talking about their concerns.
Semistructured Interviews
Notice the nondirective features in this excerpt—the clinician’s responses conveyed an understanding of the client’s experience and encouraged further talk but did not dictate what the client talked about by requesting specific information. However, the interviewer also placed limits on the topic by asking a specific question. The more specific questions that interviewers ask, the more structure they impose on the interview.
Structured Interviews
the interviewer asks a series of specific questions phrased in a standardized fashion and presented in an established order.
When used to assign psychiatric diagnoses, structured interview protocols also include decision rules called algorithms that tell clinicians what specific combinations of symptoms are required for a given diagnosis, such as panic disorder or schizophrenia - EG. Diagnostic Interview Schedule for Children (DISC)
Advantages and Disadvantages of Structured Interviews
they provide a systematic way of assessing the variables that interviews are designed to explore. Although not as flexible, they are less prone to certain sources of error that can affect the reliability and validity of interview assessment data.
much of the disagreements between clinicians can come not from inconsistencies in client responses but from inconsistencies in the way clinicians collect, interpret, and use those responses
reduce variance in clinicians’ information gathering, recall, and judgment
DISADVANTAGES
Clinicians who depend too much on structured interviews risk becoming so “protocol bound” that they miss important information that the interview script did not explore.
their routinized nature can alienate clients
they depend heavily on clients’ memory, candor, and descriptive abilities
the unstructured interview remains by far the most common tool used by clinical psychologists on a day-to-day basis
Stages in the Interview
(stage 1) Interviews usually begin with efforts at making the client comfortable and ready to speak freely, --> Frame-setting: Establishing the norms and expectations associated with an interview, consultation, or therapy session
(Stage 2) continue into a central information gathering stage, --> Directive Techniques: --> Nondirective Techniques: Open-ended questions and encouraging remarks are used to prompt clients to speak while exerting as little influence as possible over what they say. --> Nonverbal Communication: look for inconsistencies between information transmitted through the verbal and nonverbal channels.
(Stage 3) and end with summary statements, client questions, and, if appropriate, plans for additional assessment sessions. --> the impending conclusion of the interview is signaled. --> Second, the client is praised for cooperativeness and reassured that the clinician recognized how stressful the interview was (emotional support). --> Third, the suggested plan for the final minutes invites the client to ask questions or make comments that may be important but had not yet been expressed
Four factors led to the decline of testing during the 60's and 70's
the discouraging results of research on the reliability and validity of many psychological tests.
test results can be vulnerable to systematic error, or bias. That concern focused especially on the possibility that standard tests of intelligence might discriminate unfairly against people in certain racial or ethnic groups.
the fear that testing might result in an invasion of respondents’ privacy.
worries that test results can too easily be misinterpreted and misused.
psychological testing has recovered some of its status and popularity
new and better tests have been designed to address some of the concerns we just mentioned.
A second reason is that many of today’s educational and health-care systems now routinely require psychological testing
What do tests measure?
tests can be grouped into three general categories based on whether they seek to measure: (a) intellectual or cognitive abilities; - most used (b) attitudes, interests, preferences, and values; or (c) personality characteristics. - most used
Some of these tests pose direct, specific questions (“Do you ever feel discouraged?”), whereas others ask for general reactions to less specific material (“Tell me what you see in this drawing”). Some have correct answers (“Is a chicken a mammal?); others ask for opinions or preferences.
Psychological test
A systematic procedure for observing and describing a person’s behavior in a standard situation.
Tests present a set of planned stimuli (factual questions, inkblots, or true–false questions) and ask the client to respond in some way. - The clinician then scores or interprets the client’s responses using reasonably objective, empirically derived scoring rules
psychological two most important features
Principles of objectivity and standardization --> tests are ideally designed to be objective measures of psychological characteristics --> The goal is to ensure that the differences among clients’ test scores reflect differences among the clients themselves, not differences among the clinicians who tested them. --> reduce or eliminate the impact of extraneous, or confounding, variables—such as scoring procedures or the tester’s personal characteristics—so that test results can be attributed to the characteristics of the client.
Tests differ from most other clinical assessment techniques in three ways:
A client’s test responses can be quantitatively compared with statistical norms
A test can be taken in private, without a clinician present, meaning that there might not be observational data to supplement test results.
Tests can be administered in groups as well as individually.
Tests of Psychopathology and Personality
Some of these tests are used for conducting research on the general characteristics of personality, others for diagnosing psychological disorders, and some for both purposes.
Personality
The pattern of behavioral and psychological characteristics by which a person can be compared and contrasted with others.
two major types of tests for measuring the dimensions and disordered aspects of personality:
Objective (or structured) personality tests present relatively clear, specific stimuli such as questions (“Have you ever wanted to run away from home?”) or statements (“I am never depressed”) to which the client responds with direct answers, choices, or ratings.
Projective (or unstructured) personality tests ask clients to respond to ambiguous stimuli (such as inkblots, drawings, or incomplete sentences) by describing and telling stories about what they see, or by completing sentences.
Objective Tests of Psychopathology
EG. The Minnesota Multiphasic Personality Inventory --> the world’s most widely used instrument for the assessment of clinical symptoms and personality in adults
members of various diagnostic groups showed statistically distinct patterns of responses. (EG. depressed people tended to respond in the same way to one particular set of items. Analyses of these patterns identified eight sets of items, called clinical scales, that were associated with certain disorders
clinicians must still be cautious when interpreting the profiles of people who identify with minority subcultures
The Personality Assessment Inventory
consists of 344 statements, which clients rate on a 1 to 4 scale to reflect the degree to which they agree with each.
Designed to assess a broad range of clinical symptoms, the test provides four validity scales (e.g., Inconsistency, Negative Impression) designed to detect problematic response styles
The Millon Clinical Multiaxial Inventory
At 195 items, it is shorter than either the MMPI or the PAI
Interpretation of the MCMI-IV requires considerable sophistication and knowledge related to psychopathology in general and personality disorders in particular. As a result, its interrater reliability tends to be somewhat lower than that associated with the MMPI scales.
The Personality Inventory for the DSM-5 (PID-5)
is a 220-item instrument developed by the DSM-5 Personality and Personality Disorders Workgroup.
It was intended to assess personality disorders as defined in the then-new DSM-5
Tests Measuring Specific Aspects of Psychopathology.
numerous tests that are aimed at assessing more specific aspects of disorder (eg. Beck depression Inventory, and the Fear Survey Schedule (FSS))
Projective Personality Tests
projective hypothesis states that each individual’s personality will determine, to a significant degree, how he or she interprets and responds to ambiguous, unstructured stimuli
Examples of Projective Tests
The Rorschach Inkblot Test: scientifically controversial, a set of 10 colored and black-and white inkblots. Most commonly used test from the 1930s-60s. Client is asked what the blot could be.
The Thematic Apperception Test: consists of a set of 31 cards, 30 show drawings of people, objects, and landscapes; one is blank. Asks the client to make up a story about it
Reliability and Validity of Psychological Tests
intelligence are among the most reliable and valid of all psychological tests.
the MMPI-2- RF, the NEO-PI-3, and other personality tests (except for the Myers–Briggs Type Indicator) show acceptable levels of reliability and validity for most of their intended clinical uses
Projective tests such as the Rorschach and the TAT generally are the least valid and reliable
what makes a test “good enough” to justify its use?
many widely used psychological tests are about as valid as many common medical tests.
Psychological Testing with Diverse Clients
culturally specialized versions of psychological tests are rare, so want to seek research evidence about how WAIS scores might be affected by cultural background.
Awareness of culture-specific effects have led to efforts by some test developers to create versions of standard assessments that will be reliable and valid for use with particular populations
The Ethical Use of Psychological Tests
Standards for Educational and Psychological Tests provide clear guidelines to help its members minimize the possibility of inappropriate use or interpretation of tests
these documents help ensure psychological tests are being developed, evaluated, administered, interpreted, and published with proper regard for scientific principles and the rights of clients, and thus that they make a positive contribution to society
New Roles and Goals for Psychological Tests
tests of personality and psychopathology do not necessarily have clinical utility
providing regular feedback to therapists regarding clients’ scores on these outcome measures improves therapeutic outcomes, probably because therapists can immediately adjust treatment procedures when they discover that their clients aren’t doing as well as they thought.
New trends in psychological testing
Tests that have survived decades of scrutiny will continue to be used (eg. Binet scales, MMPI). However, the “old standby” tests will not simply stand by; these tests will undergo periodic revisions, including renorming.
Tests that show unacceptably low levels of reliability, validity, and utility will see diminished use.
Testing will continue to expand and to improve the reliability and validity of instruments that will be used with ever more diverse client populations.
Computers, smartphone, tablets, and other mobile devices will play an increasingly important role in assessment.
Testing designed to aid in treatment planning and treatment outcome measurement will flourish.
Primary objectives of the HiTOP consortium are to
(a) integrate evidence generated by this research to date and (b) produce a system that reflects a synthesis of existing studies.
Limitations of Traditional Taxonomies
traditional systems consider all mental disorders to be categories, whereas the evidence to date suggests that psychopathology exists on a continuum with normal-range functioning; in fact, not a single mental disorder has been established as a discrete categorical entity
Second, traditional diagnoses generally show limited reliability, as can be expected when arbitrary categories are forced onto dimensional phenomena
Third, many existing diagnoses are quite heterogeneous and encompass multiple pathological processes
Fourth, co-occurrence among mental disorders, often referred to as comorbidity, is very common in both clinical and community samples and it suggests that some unitary conditions have been split into multiple diagnoses, which co-occur frequently as a result, indicating the need to redraw boundaries between disorders.
Fifth, many patients fall short of the criteria for any disorder, despite manifesting significant distress or impairment that indicates the need for care.
Psychoanalysis
theory that links personality characteristics and psychological disorders to unconscious conflicts stemming from early childhood relationships and to psychological defenses against the anxiety created by those conflicts.
id, superego, ego
id is the source of our most fundamental biological drives, especially sexual/sensual and aggressive ones.
superego contains both our conscience, which punishes us with guilt when we do things that are morally wrong,
ego ideal, which reflects how we would ideally like to be and which rewards us with pride when we do things that are morally right. Part of the personality that tries to mediate between the conflicting demands of the id and superego
Defense Mechanisms
Unconscious mental strategies designed to keep anxiety-provoking material from reaching consciousness.
People who habitually use denial, repression, projection, or other defense mechanisms may experience temporary protection from anxiety, but may distort reality in the process and, over time, jeopardize their interpersonal relationships.
Free Association
Saying whatever comes to mind, without censorship, to provide clues to unconscious memories, impulses and fantasies.
Psychoanalysis
A method of psychotherapy that seeks to help clients gain insight into, and work through, unconscious thoughts and emotions presumed to cause psychological problems.
an emphasis on: (a) searching for relationships between a person’s developmental history and current problems, (b) blockages or dissociations in self-awareness as causes of psychological problems, (c) talking as an approach to treatment, and (d) the importance of the therapeutic relationship.
Transference
A process in which a client’s typical relationship patterns and defense mechanisms appear in the therapy relationship
allows patients to see how old conflicts haunt their lives and helps them resolve these conflicts.
Countertransference
can impair the progress of therapy if therapists begin to distort the therapeutic interaction on the basis of their own conflicts and defenses.
Psychic Determinism
Freud believed that associations among memories, impressions, and experiences in a client’s mind are not random, but are determined by underlying unconscious processes. A core assumption of psychoanalysis that underlies most if not all psychoanalytic methods
Resistance
A process in which clients behave in ways that interfere with the psychoanalytic treatment process.
Interpretation, Working Through, and Insight
remarks, or interpretations, provide a way to point out how the past might be intruding on the present. Interpretations can be based on what a client says or does during therapy sessions, or on reports of the client’s experiences between sessions
may lead to insight if an interpretation is accurate and the client is ready to process it
Insight
A client’s conscious awareness of the underlying causes of psychological problems.
Working through
Fully exploring the implications of insights gained in psychoanalysis.
helps clients to develop a broader understanding of their problems, psychological makeup, and ways of relating to others.
the main goals of psychoanalytic treatment are to help clients:
(a) gain conscious and emotional insight into the underlying causes of their problems; (b) work through, or fully explore, the implications of those insights for everyday life; and (c) strengthen the ego’s control over the id and the superego and thereby bolster clients’ mastery over their sources of conflict.
psychoanalytic History and Case Formulation
(a) historical data such as family and developmental history (to identify information related to early conflicts or trauma); (b) mental status, level of distress, ego strengths and deficits, and “psychological mindedness” (to assess intellectual and emotional ability to engage in psychoanalytic treatment); and (c) defense mechanisms, themes, or patterns of attachment difficulties in interpersonal relationships
The Role of the Therapist in psychoanalysis
focus is always on the client, and the therapist remains purposely opaque, much like a blank wall, so that clients can be free to project onto the therapist the attributes and motives that are unconsciously associated with parents and other important people in their lives
latent content
the unconscious ideas, fantasies, and impulses that may appear in disguised form
Transference neurosis
The reenactment of the causes of the client’s problems within the therapy relationship.
Characteristics of alternatives to psychoanalysis
(a) deemphasize or reject the role of sexual and aggressive id impulses as the main drivers of personality development and focus on the ego and its adaptive functions; (b) emphasize the nature and role of our closest early relationships; and (c) highlight the healing aspects of the therapeutic relationship
psychodynamic psychotherapies
Variations on psychoanalytic treatment that departed significantly from the principles and methods of Freud’s original theories.
these therapies emphasize more positive aspects of personality, especially the role of the ego in motivating psychological growth, and not just resolving intrapsychic conflicts.
did not see early relationships as revolving mainly around sexuality
the therapeutic relationship is not just an arena for analyzing transference but as having healing properties in and of itself
Adler’s Individual Psychology
power behind the development of personality and disorder comes not from id impulses but from an innate desire to overcome infantile feelings of helplessness and to gain some control over the environment
striving for superiority- a drive for fulfillment as a person
striving is motivated by feelings of helplessness (inferiority) experienced in childhood.
focus more on the social and relational aspects of psychopathology
Jung’s Analytical Psychology
stressed the importance of the ego over the id and superego.
viewed unconscious as a source of innate drives for creativity and growth.
therapists focus less on the unconscious meaning of symptoms, and more on how clients create meaning as they construct their life stories
Ego Psychology
Behavior is determined by the ego, which can function to combat id impulses or referee conflicts between id and superego but also to promote learning and creativity.
more on working through current problems less on childhood
Object Relations Therapy
believe most problems stem from the nature of their earliest social relationships, especially their pattern of emotional attachment to their caregivers
early relationships act as prototypes for later ones
therapists take a much more active role in treatment
Relational Psychodynamic Psychotherapy
stress the idea that a client’s early relationships with caregivers serve as templates for later ones, however early relationships have an objective dimension (established by actual characteristics and events) and a subjective one (the way the relationships are perceived and remembered)
The Current Status of Psychodynamic Psychotherapy
psychodynamically oriented therapies are far more popular.
some forms of psychodynamic psychotherapy yield results that are comparable to those of therapies identified as empirically supported
becoming less ideological in practice.
Interpersonal Psychotherapy
A time-limited treatment that focuses on resolving the interpersonal problems that underlie psychological problems such as depression.
focused on the links between current or recent life events, difficulties in relationships, and symptoms of psychological disorder
Current Status of Interpersonal Psychotherapy
IPT has received strong research support for its effectiveness as a treatment of depression in a range of client populations, including adolescents and older adults
Humanistic Psychotherapy
emphasize conscious awareness rather than unconscious conflict.
assume that their clients’ lives can be understood only from the viewpoint of those clients.
view human beings not as instinct-driven creatures but as naturally good people who are able to make choices about their lives and determine their own destinies.
focus on amplifying clients’ strengths rather than just addressing their problems
see the therapeutic relationship as the primary vehicle by which treatment achieves its benefits.
Person-Centered Therapy
Rogers believed that people have an innate motive or drive toward growth, which he called the actualizing tendency
“if … then” proposition: If the correct circumstances are created by the therapist, then the client—driven by an innate potential for growth—will spontaneously improve.
Humanist - the Self and Conditions of Worth
As children grow, he said, they come to understand their likes and dislikes, their abilities, but these self-experiences do not develop in isolation they appear in the context of the child’s relationships with other people.
Things they say and do may be regarded by others in positive or negative ways
unconditional positive regard: parents communicate acceptance (if not approval) behavior and experiences.
conditions of worth: parents communicate disapproval or rejection of some of the child’s behaviors, feelings, and experiences risk creating the impression that their acceptance and love, and the child’s worth as a person, depends on the child’s thinking, feeling, and acting in ways that they approve
Incongruence
Humanist- conditions of worth force people to distort their real feelings or experiences and the more they do so, the more separation, or incongruence, there is between the real self and the ideal self
The Goals of Person-Centered Therapy
Treatment that focuses on creating a client–therapist relationship characterized by unconditional positive regard, empathy, and congruence that allows clients to become aware of their true thoughts and feelings and thus remove blockages to their personal growth.
do not set treatment goals; clients are free to select their own goals
providing an interpersonal relationship in which clients can feel accepted and free to be honest
Unconditional Positive Regard
In person-centered therapy, the therapist attitude that expresses caring for and acceptance of the client as a valued person.
makes it clear that the therapist cares about the client, accepts the client, and trusts the client’s ability to change.
The therapist’s willingness to listen
Congruence- In person-centered therapy, a consistency between the way therapists feel and the way they act toward clients.
Gestalt Therapy
An active form of humanistic treatment that seeks to create conditions in which clients can become more unified, more self aware, and more self-accepting.
a kind of humanistic treatment approach developed by Frederick S. (Fritz) and Laura Perls.
tries to reestablish clients’ stalled growth processes byhelping them become aware of feelings they have disowned but that are a genuine part of them
So instead of reflecting (as a Rogerian might) the client’s nostalgia for the past or worries about the future, a Gestalt therapist will point out the avoidance and insist that the client come back to the present moment
Attention to Nonverbal Behavior
Existential Approaches (Humanistic)
Otto Rank- people have a will to find meaning in their lives, and they try to help clients to do that by exploring with them what it means to be alive.
try to understand the client’s inner world, frames of reference, and flow of experiences. They do not try to formulate diagnoses or objective descriptions of their clients’ problems.
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