PSYCH 305 Midterm 2

personality traits

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* the tendency to behave consistently in specific ways
* Behaviors, emotional reactions, ways of thinking, interpersonal style
* Should be relatively stable
* Consistency often seen across time, with variability across situations

objective personality tests

 tests scored using  scoring system based on population norms

clinical objective personality test

designed for people experiencing high levels of distress or pathology

non-clinical objective personality test

designed to assess personality in normal population

projective measures

tests based on responses to ambiguous stimuli; based on assumption that responses reveal info about personality structure 

self-report checklists

provide info about an individual’s experience in a specific domain (ex. Distress, mood, feared situations, etc); most often used in treatment monitoring, evaluation

limitations to measuring personality

* limits to self-knowledge
* self-presentation bias
* individual test strengths/weaknesses

MMPI validity scales

Cannot say (CNS), Variable inconsistency (VRIN), True response inconsistency (TRIN), Infrequency (F), Fake bad scale (FBS), Lie scale (L), Defensiveness (K)

Cannot say (CNS)- MMPI

unanswered items

variable inconsistency (VRIN)-MMPI

random/confused responding

True response inconsistency (TRIN)- MMPI

tendency to respond all true vs all false

infrequency (f)- MMPI

high levels of unfavorable self-presentation

fake bad scale (FBS)- MMPI

faking bad or malingering

lie scale (L)- MMPI

unrealistic positive self-presentation

defensiveness (K)- MMPI

unwillingness to disclose info

MMPI clinical scales

hypochondriasis, depression, hysteria, psychopathic deviate, masculinity-femininity, paranoia, psychasthenia, schizophrenia, hypomania, social introversion

Hs: hypochondriasis- MMPI

measures the tendency to be preoccupied with one’s health and to be unlikely to connect psychological problems to the experience of some physical symptoms

D: depression- MMPI

measures common cognitive, physical, and interpersonal symptoms of depression

Hy: hysteria- MMPI

measures the tendency to develop physical symptoms when stressed and to minimize the  extent of interpersonal problems

Pd: psychopathic deviate- MMPI

measures the tendency toward rebellious attitudes, conflict with authorities and family, and engagement in antisocial activities

Mf: masculinity-femininity- MMPI

measures gender-stereotyped interests, beliefs, and activities

Pa: paranoia- MMPI

measures interpersonal sensitivity, feelings of being mistreated, and, at the extreme, delusions of persecution

Pt: psychasthenia- MMPI

measures the tendency toward worry, apprehension, rumination, and fears of loss of control

Sc: schizophrenia- MMPI

measures the tendency to withdraw and experience social alienation, feel inferior, and at the extreme, experience delusions, hallucinations, and extreme disorganization

Ma: hypomania- MMPI

measures the tendency toward hyperarousal, excessive energy, low frustration tolerance, and agitation

si: social introversion- MMPI

measures introversion, lack of comfort in social contexts, and over-controlled style of coping

MMPI content scales

anxiety, fears, obsessiveness, depression, health concers, bizarre mentation, anger, cynicism, antisocial practices, type A behavior, low self-esteem, social discomfort, family problems, work interference, negative treatment indicators

Antisocial practices (asp)- MMPI

a measure of antisocial attitudes and a history of engaging in antisocial acts such as stealing

Type A behavior (tpa)- MMPI

a measure of the type A personality (ex. Characteristics of impatience, irritability, and being easily annoyed)

Low self-esteem (lse)- MMPI

a measure of general self-esteem

social discomfort (sod)- MMPI

a measure of social introversion

family problems (fam)- MMPI

a measure of reported family conflict and the tendency to have characteristics that increase the likelihood of current intereperesonal conflict

work interference (wrk)- MMPI

a measure of work-related impairmentsn

egative treatment indicators (trt)- MMPI

a measure of negative attitudes toward health care professionals and mental health treatments

strengths of MMPI

* Considerable research base
* Variety of scales
* Validity scales- good for testing when potential validity issues exist
* K-correction

weakness/ limitations of MMPI

* Length
* Reading level
* Under-representation of lower education and SES in standardization
* Some scales of low internal consistency
* Older versions: high intercorrelations among scales 

administration of MMPI

no right or wrong answers; go with your gut tells you

interpretation of MMPI

* Validity
* Code types: summary codes for two highest clinical elevations
* Other clinical and content scales 

PAI validity scales

inconsistency, infrequency, negative impression management, positive impression management

inconsistency- PAI

random responding

infrequency- PAI

highly unlikely symtoms

negative impression management- PAI

trying to make self look worse; over-reporting symtpoms

positive impression management- PAI

trying to make self look better; under-reporting symptoms

PAI clinical scales

somatic concerns, anxiety, anxiety related disorders, depression, mania

somatic concerns (SOM)- PAI

* measures a respondent’s physical concerns and complaints 

anxiety- PAI

measures a respondent’s general feelings of tension, worry, and nervousness

anxiety related disorders (ARD)- PAI

* measures more specific anxiety symptoms that relate to different categories of anxiety disorders

depression (dep)- PAI

* measures a respondent’s general feelings of worthlessness, sadness, and lethargy

mania (MAN)- PAI

* measures a respondent’s suspiciousness and concern about others harming them

paranoia (PAR)- PAI

measures a respndent’s suspiciousness and concern about others harming them

schizophrenia (SCZ)- PAI

measures a respondent’s unsual sensory experiences, bizarre thoughts, and social detachment

borderline features (BOR)- PAI

measures a respondents problem with identity, emotional instability, and problems wiht friendships

antisocial features (ANT)- PAI

measures a respondent’s level of cruel/criminal behavior and selfishness

alcohol problems (AKC)- PAI

measures a respondent’s problems with excessive drinking

drug problems (DRG)- PAI

measures a respondent’s problems with excessive recreational drug use

PAI interpersonal scales

* How does the person interact/feel in interpersonal relationships?
* Dominance; Warmth

PAI treatment-oriented scales

* Characteristics that may impact treatment engagement
* Aggression; Stress; Treatment Rejection; Suicidality; Non-Support

PAI strengths

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* Reading level
* Duration? ¢ High levels of content and discriminant validity (no overlapping items)
* High reliability
* Different types of scales

PAI limitations

* Lack of personality factors that may be of clinical interest
* Includes many diagnostic categories, but not all
* Duration?

goal of an interview

to both gather contextual information (a lot) and build/maintain rapport (the relationship)

unstructured interview

* Questions are not systematically asked in a specific order or way
* Greater flexibility in question type and order
* Greater opportunity for discussion, reflection
* Leads to variation in what is asked of the client and thus variation in reliability and validity in interviewing

(semi-) structured interviews

* Specific format and sequence for asking questions
* Format follows client responses to follow-up or not
* Most are diagnostic
* Semi vs. fully structured differ in opportunity for elaboration/exploration
* Thorough, but time consuming

open questions

Questions that allow client to elaborate; cannot be answered with a simple yes or no

closed questions

Can be answered with a single word

problem definition question

Questions that clarify a client statement

goal definition questions

help define where the client wants to ‘end up’

attending

paying attention to verbal and nonverbals

paraphrasing

rephrasing content of what is said

summarizing

tying together main ideas or themes to reinforce key points

reflection (of feeling)

identifying underlying emotion and stating it back to client

skills in interviewing: observing

* appearance
* grooming
* activity level
* attention span
* impulsivity
* affect
* emotional expression

internal skills

* ability to broach difficult topics
* Maintaining a balance between collecting information and maintaining rapport
* Knowing what information to collect vs. not
* Remaining non-judgemental

assessing risk

involves direct questions about the thoughts, plans, and intent to harm self or others

intra-counselling dimension

* Discussing REC differences between therapist and client
* Exploring reactions to difference
* Express lack of full understanding

intra-individual dimension

* Explore the intersections of identities within client
* Avoids “essentializing” or compartmentalizing

intra-REC dimensions

* Address issues arising between clients and people with shared REC identity
* May be similar or different to cultural group

inter-REC dimensions

* Broach experiences navigating difference between own & other groups
* Facilitate conversation about experience of racism, discrimination (over & covert)

REC

race, ethnicity, and culture

integrating assessment data

* consider info from all sources
* determine what is relevant and not
* identifying and explaining consistency vs contradiction

diagnosis

* considering whether client meets criteria for one or multiple disorders
* looking for disconfirming evidence
* looking for most parsimonious explanation
* if multiple disorders, how do they impact one another

case formulation/ conceptualization

* describing the patient in their life context and generating hypotheses about what is contributing to their current circumstances
* helps to inform treatment and progress

steps for developing a case formulation

1. develop a comprehensive problem list
2. Determine origin, precipitants, and consequence of each problem
3. Identify patterns or commonalities
4. Develop hypothesis to explain problems
5. Evaluate /refine hypothesis based on information gathered and patient’s feedback
6. Refine and revise as time goes on

providing feeedback

* ethical requirement
* ensures accuracy of factual info
* increases client engagement and benefit
* opportunity to talk about next steps, goals, etc.

therapeutic assessment

clients are active participants in all phases of assessment

* develop strong working alliance
* collaborative definition of goals of assessment
* explore results with client

steps of therapeutic assessment

1. initial session
2. standardized testing sessions
3. assessment intervention sessions
4. summary and discussion of findings
5. provide written feedback
6. follow-up sessions

standardized testing sessions

* baseed on client’s questions
* explain relevance to questions
* gather their experience

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assessment intervention sessions

* collaborative discussion about client’s experiences
* helps bring awareness to findings that may come through assessment

summary and discussion of findings

* level 1 findings: the way the client sees self
* level 2 findings: reframe or amplify client’s usual ways of seeing self
* level 3 findings: may conflict more starkly with view of self

provide written feedback

client-directed letter that helps to answer their own initial question that includes their input

follow-up sessions

Meet again in 2-3 months to talk about any questions or developments

psychotherapy

The informed and intentional application of clinical methods and interpersonal stances derived from established psychological principles for the purpose of assisting people to modify their behaviors, cognitions, emotions, and/or other personal characteristics in directions that the participants deem desirable

clinical practice guidelines

A summary of scientific research (dealing with the diagnosis, assessment, and/or treatment of a disorder) designed to provide guidance to clinicians providing services to patients with the disorder

clinical practice guidelines: the stepped-care model for depresison

1. recognition, assessment, initial management
2. treatment of sub-threshold to mild/moderate depression
3. treatment of persistent sub-threshold and mild to moderate symptoms, or moderate-severe depression
4. treatment of complex/severe depression

Recognition, Assessment, Initial Management

* • Be alert for symptoms, screen, refer if needed
* Send to emergency services if high risk

Treatment of Sub-Threshold to Mild/Moderate Depression

Psychoeducation, self-help, computerized CBT, related structured groups

Treatment of Persistent Sub-Threshold and Mild to Moderate Symptoms, or Moderate-Severe Depression

Anti-depressants, psychotherapy (CBT, IPT), other counselling/therapy or combinations thereof

Treatment of Complex/Severe Depression

Interdisciplinary care, combination of many psychosocial interventions, increased intensity/duration, ECT

THE ETHICS OF PSYCHOTHERAPY: INITIATING SERVICES

* informed consent
* Requires client understanding and appreciation of services being rendered
* For children, or other clients without decision-making abilities requires “assent”
* Refusing to initiate services, if needed

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individual psychotherapy

* One-on-one with a psychologist
* Supportive Counselling: Offering non-directive support
* Treatment: Goal and change focused
* Based on psychologist’s theoretical orientation
* Change through therapeutic relationship, specific interventions

group psychotherapy

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* Many clients and one or more clinicians ¢ Process: Utilize group dynamics to support one another and facilitate change
* Structured Groups: Prescribed content
* Psychoeducational: “Classroom” feel; more psychoeducational
* Treatment: Extensions of theoretical orientations and treatments