PSCI 150C Midterm Study guide

Clinical psychology

Integrates science theory and practice and uses these things to further goals, such as, understanding, predicting, and alleviating maladjustment, disability, and discomfort as well as to promote human adaptation, adjustment, and personal development.

focuses on the intellectual, emotional, biological, psychological, social, and behavioral aspects of human functioning across the life span, in varying cultures, and at all SES levels.

Goals of clinical psychology:

Integrate science and practice (clinical work), apply their integrated knowledge, alleviate suffering, and promote health.

Education and training in clinical psychology:

Must attain a PHD or PSYD from accredited program

More PsyDs are granted than PHDs

Can take 4-5 years

Clinical Internship, matching close to med school.

Accrue clinical hours

Can take 1 year

Often Postdoctoral fellowship

Clinical or research, depending on career goals.

Can take 1-2 years

All together 5-8 years.

Licensure (EPPP is a national exam, also state tests).

Etic:

emphasizes similarities between all people

Assumes some things are universal to human experience

Downplays culture-based differences

Examples: Universality of emotions, habituation response

Emic:

emphasizes culture-specific norms

Appreciate clients in the context of their own culture, considers behavior thoughts and feelings within the context of their culture.

Having an _____ perspective is important within the clinical field.

emic

Cultural competence:

Multicultural counseling and therapy can be defined as both a helping role and process that uses modalities and defines goals consistent with the life experiences and cultural values of clients, recognizes client identities to include individual, group, and universal dimensions, advocates the use of universal and culture-specific strategies and roles in the healing process, and balances the importance of individualism and collectivism in the assessment, diagnosis, and treatment of client and client systems. (D. W. Sue)

What makes a psychologist culturally competent? (3 things)

Awareness: of own assumptions, values, and biases

Knowledge: Understanding the worldview of the culturally different client

Skills: Developing appropriate intervention strategies and techniques

Cultural Formulation Interview:

- Cultural definition of the problem:

What brings you here today?

- Cultural perceptions of cause, context, and support

What do you think are the causes of your problem?

- Cultural factors affecting self-coping and past help seeking

What have you done to cope with your problem? Often, people look for help from many different sources, including different kinds of doctors, helpers, or healers.

- Cultural factors affecting current help-seeking

What kinds of help do you think would be most useful to you for your problem? Sometimes doctors and patients misunderstand each other because they come from different backgrounds.

Russel et al. study on the impact of ethnic matching on assessment:

findings: For minority patients, matched therapists reported higher levels of functioning in their patients than non matched therapists.

Therapist match did not matter for assessment of White-Americans

These findings suggest that cultural background does matter

Cabral & Smith meta-analysis on the impact of ethnic matching on treatment:

Do patients prefer therapists who match their backgrounds?Patients had a moderately strong preference to have a matched therapist, stronger among black and latino patients compared to white/asians.

Matched therapist perceived more positively?

Asian and black patients perceived more positively, not as important for white and lationo patients

Better outcomes?

Almost no benefit to having a matched therapist

Patients do prefer matched therapists, view them more positively, having one does not appear to help with treatment outcomes.

Therapist self-disclosure

Has to do with the therapist-client relationship

One of the key ways culture can have an impact on the treatment process is through its effect on this relationship

Differences in culture may impact someone's ability to experience and express empathy in a patient

One of the main things that matters to patients is if they feel understood by their therapists

They attempt to see if therapist truly does understand them from their POV. 2 ways they might do this is by

Making assumption based on the therapists outward appearance or items in their office

For things they cannot see they will sometimes ask a therapist to reveal things about themselves known as self-disclosure

Self-disclosure is also important in regarding to smooth facilitation of transference—> it is recommended that little to self-disclosure takes place so that creation of a blank canvas takes place

This is important bc if the client knows little they won;t be able to project ppl from their past onto the therapist

Intake interviews:

used to determine if the client is in the right place; or to figure out the most appropriate referral. If the client is in the right place then their goal is to figure out the best course of treatment.

Interviewing is like playing detective

Each interview type has different goals in mind

Diagnostic interviews:

designed to provide comprehensive mental health diagnosis

Interviewing is like playing detective

Each interview type has different goals in mind

Mental status exam:

used in medical settings to quickly evaluate how a client is functioning.

Interviewing is like playing detective

Each interview type has different goals in mind

Unstructured interview:

therapist engages in conversation where they have ideas of where they want to take the interview but there is no script to follow.

Guided conversation

Use mostly open-ended questions

Highly flexible

Semi-structured interview:

one that has guiding questions but the interviewer can go off. Guarantees certain questions will be asked but interviewers can follow up on things they find important.

Guiding questions in place but the interviewer can (and must) deviate

Balance between ensuring certain questions are asked and room for open-ended responding

EX: Diagnostic interviews

Structured interviews

Specific set of questions with specific wording and established order

Reliability -easier to replicate across multiple people

Can be quick to conduct

EX:

-Intake interviews

-Mental status exams

Rapport:

Positive, comfortable relationship between interviewer and client

How an interviewer is with clients

Having a positive comfy relationship between interviewer and client.

When a strong sense of rapport client feels the interviewer empathizes with them.

Interviewing skills:

- Quieting yourself: minimize excessive internal, self-directed thoughts that detract from listening

If they focus too much on their own thoughts they would not be focused on the client, comes with practice.

- Being self-aware

Know how you tend to affect others interpersonally, and how others tend to relate to you, recognizing power dynamic between interviewer and client.

- Develop positive working relationships, respectful and caring attitude is key.

-Listening—the primary task of the interviewer.

Verbal tracking

Repeating words and phrases back to the client to assure they have been heard.

Open-ended questions:

Allows spontaneous responses, elicits long answers that may or may not provide the necessary information

How have you been feeling lately?

Closed-ended questions:

Allows less elaboration and self-expression by the client, yields quick and precise answers

Are you married?

Interview Stages: The Opening

Establishing rapport is the most important first step of an interview.

• If clients don't trust or like you, they're less likely to report information.

• Some clients may not be there voluntarily.

• Appear warm and approachable

• Enlist clients as an ally - using "we" language can show clients we are working together as a team.

Frame setting:

explaining norms and expectations that surround an interview, consultation, or therapy session. Important for putting clients at ease and ensuring they consent for the process of the interview.

Begin interview with non-directive, open-ended questions: "So what brings you in today?"

Interview Stages: The Middle

(information gathering)

- Scanning and focusing: start with open ended questions, when a response needs more elaboration, ask a more directed question. When you've gotten your answer, zoom back out and ask more open ended questions.

• Use active listening, paraphrasing, & reflections.

• Avoid leading questions, be aware of patient's nonverbal communication (both from patient and therapist) & ask follow-ups if needed.

• Be aware of your own nonverbal communication

Closing the Interview:

- Frame setting - signal the end of the interview.

- Provide clients 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.

- Summarize & request feedback, outlining plan for treatment, and requesting feedback for the clients experience of the session.

The doorknob effect

Sometimes clients wait until the last minute to give you important info.

WHY: May not be ready to discuss problem, avoidant strategy.

May be letting down defenses, may finally feel comfortable with the therapist.

May not want the interview to end, must be acknowledged but talked more about in a subsequent session.

Standardization in testing:

All people taking test get same stimuli presented in same way

Responses should be quantitatively compared to statistical norms

Tests results are incorporated with interview data into a comprehensive assessment report. Ie: Testing data is often combined with other sorts of data to come to a full assumption/report.

Validity:

measures what it claims to measure

Content validity

has content appropriate for what is being measured

Discriminant validity

does not correlate with measures of different constructs

Convergent validity

correlates with other measures of the same construct

Incremental validity

increases predictive ability beyond that provided by an existing method of assessment

Reliability:

yields consistent, repeatable results

Test-retest reliability

yields similar results across multiple administrations at different times

Interrater Reliability

yields similar results across different administrators

Internal Reliability

consists of items that are consistent with one another

Clinical utility

improves delivery of services or client outcome

Hierarchical model:

Specific abilities exist, but are related to global, overall intelligence (merged of these two theories)

Carroll's three-stratum theory (ex. of a hierarchical theory)

includes narrow abilities which relate to broad abilities which then relate to general intelligence.

Cultural Fairness: Universal Nonverbal Intelligence Test -2 (UNIT-2)

Language-free test of intelligence
Requires no speaking or shared understanding of language between the person administering the test and the person taking it
Examiner presents instructions via hand gestures

- Clients age 5-21
- Normed on 1800 people matching US Census data
- Measures a more limited set of abilities than traditional tests
*Not well-established in the field

Why are there cultural issues in IQ testing?

- Disadvantaged
- Inappropriate content
- Stereotype threat

Aptitude:

capacity for a skill or knowledge

Example: IQ

Achievement:

proficiency in specific domains

Examples: SAT, ACT, GRE

Assessment Report

Information from testing is synthesized into an assessment report to communicate the results

Report should be written in a way that is easily understood by the referral sources

Always write a report with the possibility that the client will read it

How to have a good feedback session

• Clarify goals and roles up front

• Acknowledge the challenge of the assessment process

• Highlight both strengths and weaknesses

• Try to speak to the patient's primary concern (rather than the referring clinician's primary concern)

• Build hope - "bad news" is good to get if it means you can get better treatment, services, etc..

• Make it clear how the testing results indicate specific treatment recommendations

Feedback sessions

• Can be very valuable for patients

• Can be provided by assessor or referring clinician

• Many clinicians are uncomfortable with feedback sessions

• Worry how the patient will receive the information

• Worry that patients expect results that assessments cannot provide

• Difficulty translating assessment jargon into something understandable

Assessment

The collection and synthesis of information to reach a judgment

Multimethod assessment

• No measure of personality or behavior is perfect

• Best to use multiple methods:

Tests

Interviews

Observations

Historical records

Other sources

Convergent conclusions can be made with more confidence

What is Personality?

• Made up of characteristic patterns of thoughts, feelings, behaviors that make a person unique

• It arises within the individual and remains fairly consistent throughout life

• More psychological tests are designed to assess personality than other clinical target

Objective personality tests

• Unambiguous (not open to more than one interpretation) test items

• Offer clients limited range of responses

• Objectively scored

• Typically self-report questionnaires

• Typically a series of brief statements or questions to which clients respond in a true/false or likert-type scale format

Minnesota Multiphasic Personality Inventory (MMPI)

• Most popular and psychometrically sound objective personality test

• Used worldwide and translated into dozens of languages

567 self-descriptive sentences and client marks true/false

Clinical scales have a scale name and then a brief description

Ex: hysteria: vague medical reactions to stress, denial of conflict and anger, emotionality

MMPI-2-RF Validity Scales

Designed to measure test-taking attitudes

F-scale: Infrequency -- High F score suggest "faking bad" or true distress

L-scale: Lying -- endorsement of socially laudable but unusual traits ("faking good")

K-scale: Defensiveness -- more subtle scale to measure "faking good"

Variable response inconsistency scale (VRIN): responding to similar content inconsistently

Criticisms of MMPI

• Too Lengthy, requiring reading ability and prolonged attention

• Susceptible to "faking" by sophisticated clients who can outwit validity scales

• Emphasis on forms of psychopathology as factors that make up personality

Projective Tests of Personality

Based on the assumption that clients will “project” their personalities when presented with unstructured, ambiguous stimuli and an unrestricted opportunity to respond

• Tests give clients freedom to make sense of stimuli any way they choose

• Advocates claim they are less “fake-able”

Projective tests of personality strengths

Strengths: allow psychologist to assess unconscious aspects of personality

Strengths: no transparent: subjects cannot figure out how their responses will be interpreted

Projective tests of personality weaknesses

• Highly subjective in scoring and interpreting (lack of objectivity)

• Lack both validity and reliability

• Insufficient psychometrics

• Less systematic

NEO Personality inventory

• BIG 5: objective personality test

• No validity scales and does not help with clinical diagnosis

Neuroticism, Extraversion, Agreeableness, Openness, Conscientiousness

Rorschach

Created by Herman Rorschach in 1921

• 10 inkblots presented

• The idea is for the client to say what they see in each blot

• Tester records all responses verbatim and takes notes about response time, position of card, emotional responses

Scoring and interpretation is complex, popularity has generally declined

• Results often can't distinguish those who have a particular disorder from those who don't

• Little incremental validity, poor validity, and reliability. APA excluded courses in Rorschach from curriculum recommendations

Thematic Apperception Test

Henry Murray and Christiana Morgan published in 1943

31 cards: 30 show drawings of people, objects, and landscapes; 1 is blank

Usually 10 cards chosen by tester and administered

• Clients are asked to tell a story about each card, including what led up to the scene, what is happening now, and what is going to happen. Client is asked to draw on blank card and follow same procedures

• Analysis can focus on content and structure

• Reliability and validity are questionable

Sentence Completion Test

• The ambiguous stimuli are not inkblots or interpersonal scenes but beginnings of sentences

Rotter incomplete sentence blank (RISB) is more widely used

• Not often formally or empirically scored

• Reliability and validity are questionable

EX: I enjoy ________. It makes me furious _______. I feel very nervous_______.

Evidence-based practice

Psychological services that integrate the best available research with clinical judgment and

expertise in the context of patient characteristics, culture, and preferences.

Current and relevant research on effective treatment for a particular problem or disorder

Research and clinical expertise on what works for a particular client and how a treatment may need to be adjusted in the context of his/her unique characteristics, needs, and preferences