Psychology 365 Exam 1 Review

clinical assessment purpose

from referral source

most common reason for assessment

determine if diagnosis is possible

purpose of diagnosis

communicate what the individual is feeling, prognosis, course, treatment..

percent of clinical practice time devoted to intervention work

40%

normal amount of sessions for therapy

12

generally know if someone will have major therapeutic growth within…

3-6 sessions

dead person’s goals

goal that is not possible, centred on feelings, or other peoples emotions

hospital clinical psychology

for people experiencing concerns that lead to psychological disorders

community clinic clinical psychology

provincial government funded

residential clinic clinical psychology

working more specialized and private

child protection agencies clinical psychology

working with social workers, contacted by agencies to provide assessments

Prison clinical psychology

forensic psychologists, clinical training and employed by federal or provincial government to deliver intervention/ assessment

Private mental health practice

30% of clinical psychologists work in private practice

University clinical psychology

70% teaching, research, clinical director

Pros of Prescriptive authority

brain and behaviour are linked, could be as competent as other health care providers, more comprehensive services, remote or undeserved areas

cons of prescriptive authority

lead to greater prescribing

not focused solely on psychological intervention

what should psychologists know about medication?

classes, efficacy, starting and stopping procedure, side effects, current research

6 ways to stay healthy as a clinical psychologist

balance, priorities, consultation, time management, setting time to debrief, social support

scientist practitioner

PhD

balance of science and practice

competent in both producing research and providing services

clinical scientist

PhD

focus on development of research skills

less emphasis on clinical skills

practitioner scholar

PsyC

emphasis on practitioner

uses research but not producing necessarily

more in the US

Accreditation

programs and internships

by National (CPA or APA) or Provincial (OPQ) body

limited term

annual fee

Licensure

of individuals (degree, supervised practice, jurisprudence exam, EPPP)

continuing education

annual fee

Validity

does it capture what i think it is capturing

does the DSM 5 category capture it

Utility

is categorization useful

does the categorization help us understand the experience

categorical

either a member of the category or not

qualitative difference between members and non members

dimensional

members differ in extent to which they demonstrate characteristics

arranged on a continuum

purposes of a diagnostic classification system

concise description, common language, may contain information aetiology, comorbidity, prognosis, course, treatment, reimbursement of costs of services (insurance)

abnormality is defined by…

context / culture

a mental disorder is characterized by…

clinically significant disturbance in an individual's cognition, emotion regulation, or behaviour that reflects a dysfunction in the psychological, biological or developmental processes underlying mental functioning.

Bio-psycho-social model

biological vulnerabilty - exposure to stress - abuse of and disruption of protective factors

adverse childhood experiences

correlation between ACE = more disorder outcomes

DSM

psychodynamic in approach

post World War 2

4 systems in mental health field

influenced by Freud, Adler, Jung

1952

DSM-II

1968

more biological

psychopharmacology - brain involvement in mental illness

Freudian section

DSM-III

replace psychoanalytical diagnosis

list of symptoms

Robert Spitzer

Feigner

publication describing concept of diagnostic criteria

DSM-III/III-R

1980/1987

change in classification

sleep disorders

R = revised

DSM-IV/IV-TR

1994/ 2000

added global assessment of relational functional scale and a social occupational functioning assessment scale

better use of science

disorders for further study section

DSM-5

2013

began development in 1999

541 diagnostic categories

DSM-5-TR

2022

culturally and gender specific information

organized developmentally and chronologically

Alan Francis

Thinks we are pathologising normal human experience and including too many symptoms

Who said “ Because psychiatry is in the grips of a biomedical brain disease ideology about mental disorder, the perceived classification of normal conditions as disorders triggered the additional concern that a raft of new conditions would become targets of drug development and our already highly medicated society would become even more overmedicated “

Jerome Wakefield - not all treatment is medication

Who said “DSM-5 will turn temper tantrums into mental disorders, normal grief will become depression, the everyday forgetting characteristic of old age will become misdiagnosed, creating a huge false positive population of people, we will soon be mislabeled as psychiatrically sick “

Alan Francis - polarized but possibly some truth in what he says

differential diagnosis

diagnosis you have to rule out before ruling in the current disorder

ICD

WHO

42 languages

all health disorders

diagnostic criteria only

only used in Canada for population level

each disorder has a code for insurance companies in the US

challenges in diagnosis

keeping up with science

medicalization

inadequate diagnostic reliability

comorbidity

polythetic nature of disorders

pathologising normal experiences

psychological assessment decisions are:

subjective and subject to cognitive biases

Gathering data in psychological assessment

collateral information

emotional state

tone of voice

intonation

substance use

sleeping habits

body language

writing and speech

Assessment is systematic

contact client to set date

interview

testing

score assessment

write report

provide feedback

how many hours does an assessment typically take

20-40 hours

ASPPB

state, provincial, and territorial body that ensures licensure across states and Canada

understand, appreciate, acknowledge, and recognize how cultural context impacts individuals

Assessment Focused Services

assessment required for the referral

psycho-ed, custody, screening, return to work, forensic, psycho-diagnostic

provide information for referral source

can have far ranging services

Intervention Focused Services

assessment part of another service or used for treatment planning

first step in the intervention process

ongoing over time

provides information for clinician and client

Stand Alone

Screening - Diagnosis - Prognosis - Treatment Recommendations

Screening

people who are at risk

screening goes along with prevention

allows early identification

Diagnosis

do they meet criteria for…

what are the recommendations

formulate their experience

indicate symptoms

Prognosis

most likely course of how the diagnosis will continue

not set in stone

What predicts a better prognosis

social support, connection to resources, no comorbidity

Intervention Focused

inform treatment over time

use client information

diagnosis and cae formulation

prognosis

treatment planning

treatment monitoring

treatment evaluation

treatment monitoring

how treatment is going over time

shows psychologists what is effective

do not ask feeling based questions

throughout the course of treatment

treatment evaluation

at the end of treatment

evaluate how things went and how they could have been better

were services effective

base rates

frequency by which a problem occurs in the general population

low base rate means

the more rare the disorder

the more difficult it is to identify

the more error in diagnosis

less experience in psychologist in seeing that disorder

true positive

predicts diagnosis is present and it is

false negative

predicts there is no disorder but there is

false positive

predicts there is a disorder and there is not

true negative

predicts there is no diagnosis and there is no diagnosis

a psychological test

an evaluative device or procedure in which a sample of an examinees behaviour in a specified domain is obtained and subsequently evaluated and scored using a standardized process

Psychological testing yields…

score on a measure

requires standard administration/ scoring

can be conducted by a trained technician

Psychological Assessment

addresses a specific concern

multiple sources of data including standardized testing and review

requires integration and interpretation

qualities of a psychological test

standardization

reliability

validity

norms

testing practices in children

intelligence

symptom checklists

personality

usually multi-informant

testing practices in adults

symptom checklists

personality

cognitive functioning

usually single informant

ethical considerations in assessment

informed consent

awareness of limits and confidentiality

responsible for caring

more than x amount of people have mental disorders

450 million

mental disorders increase the risk for …

physical disorders

x amount of deaths annually are attributed to mental disorders

8 million

clinical psychology is…

a branch of psychology that focuses on developing assessment strategies and interventions to deal with these painful experiences that touch everyone’s lives

clinical psychology aims to …

reduce psychological distress and enhance the promotion of psychological well being

evidence based practice (EBP) model

requires the technician to synthesize information drawn from research and systematically collected data on the patient, the clinicians professional experience, and the patients preferences

emphasizes the importance of informing patients, based on the best available research evidence about viable options for assessment, prevention, or intervention

Critiques of EBP

group based data cannot be used when working with an individual

we cannot afford to wait for research to solve problems people have now

people are unique

there is no evidence on how to understand human problems

the idea that clinical psychology is primarily a healing art rather than a science based practice is problematic

the EBP model has been endorsed by

both the Canadian Psychological Association and the American Psychological Association as the basis for the professional practice of psychology

the objective of research in clinical psychology is

to produce knowledge that can be used to guide the development and application of psychological services

counselling is a generic term to describe

a range of mental health professions with various training and licensure requirements

clinical psychology have expanded their practice to address…

human problems outside the visual realm of mental health services by providing other services

clinical and counselling psychology promote …

the use of scientifically based interventions

historically school psychologists emphasized…

services related to specifically the learning of children and adolescents

psychiatrists are…

physicians who specialize in diagnosis, treatment and prevention of mental illness. 4 years of medical training.

psychiatric training deals extensively with..

physiological and biochemical systems and emphasizes biological functioning and abnormalities

emphasizes pyschopharmacological treatment over psychological treatment

Gerald Weissman

was the primary developer of the interpersonal treatment of depression

Isaac Marks

played a prominent role in the development of cognitive behavioural treatments for anxiety disorders

social workers focus on…

ways to improve the health and well being of individuals, families, groups, and communities

clinical social work faces increasing demands to provide

evidence based services

psychiatric nurses are responsible for

managing administrative matters in inpatient settings, providing psychoeducation and counselling and supervising ancillary services provided by others

Hippocrates emphasized

what is now known as a bio-psycho-social approach to understanding both physical and psychological disorders

bodily fluid theory

imbalances in the levels of blood, black bile, yellow bile, and phlegm are responsible for emotional disturbance

Plato emphasizes

the role of societal forces and psychological needs in the development and alleviation of mental disorders

Aristotle emphasized the

biological determinants of mental disorders

Biopsychosocial approach

theoretical framework that takes into account biological, psychological, and social influences on health and illness

Vincent De Paul proposed…

that mental and physical illness were caused by natural forces and that the extreme manifestations of mental disturbances such as the psychotic behaviour were not caused by witchcraft or satanic possession