2300 merged

Psychology Week: Classification and Diagnosis

• Reasons for Classification and Diagnosis

  • Helps clarify and define problems.

  • Provides a basis for communication among researchers and clinicians.

  • Necessary for research.

  • Serves as the first step in deciding on treatment.

Assessment and Psychologists

• Development of psychological assessment tests mainly for military use in the US.

• Traditionally, assessments are conducted by psychologists.

• The majority of practicing psychologists have skills in conducting assessments; essential for non-academic positions.

Purpose of Psychological Assessment

• Main Goals

  • Classification/diagnosis

  • Description

  • Prediction

Classification

• Involves making a diagnosis.

• Critics' View: Tests may lack reliability and validity as diagnostic tools.

• Defenders' View: Tests combined with other clinical data enhance understanding.

Description

• Provides insights like:

  • Personality style

  • Psychological state at the time of assessment.

Prediction

• Evaluates potential therapy benefits for a client.

• Determines the best type of therapy.

• Assesses suicide risk and violence risk.

General Purpose of Assessment

• Central role should be to answer specific questions and aid decision-making.

• Evaluates an individual in a specific problem context.

• Data is contextualized, focusing on individual circumstances.

Contextual Example

• Two individuals with identical IQ scores (100):

  1. A 10-year-old struggling in school.

  2. A 63-year-old Chief of Surgery needing assessment post-accident.

• Context significantly affects interpretation and outcomes.

Requirements for Assessment Competence

• Must understand:

  • Descriptive statistics

  • Reliability and measurement error

  • Appropriate measure selection

  • Validity of tests for specific purposes

  • Normative test interpretation

Before Assessment

• Discuss purposes and processes with clients.

• Obtain informed consent.

• Educate clients about confidentiality.

• Establish rapport with clients.

Types of Psychological Tests

• Structured Interviews

  • Fully scripted and can be computer-administered.

• Semi-structured Interviews

  • More common: includes guidelines, questions, and decision trees.

Common Structured Interviews

• SCID (Structured Clinical Interview for DSM)

• SADS (Schedule of Affective Disorders and Schizophrenia)

• K-SADS (SADS for kids)

• DICA (Diagnostic Interview for Children and Adolescents)

Strengths of Structured Interviews

• Focused information collection with reduced irrelevant data.

• Increased reliability in diagnoses.

• Minimizes interviewer bias and ensures comprehensive information gathering.

Weaknesses of Structured Interviews

• Time-consuming.

• Can seem less personal.

• May review irrelevant problems.

• Could require costly materials.

Projective Tests

• Participants project their own structure and meaning onto ambiguous stimuli.

• Utilizes indirect methods of assessment.

• Broad interpretation potential employed in responses.

Concerns with Projective Tests

• Difficult to ensure reliability and validity in research.

• Normative scoring methods could influence individual interpretations.

Popular Projective Tests

• Rorschach Inkblot Test

• Thematic Apperception Test

• House-Tree-Person Test

Rorschach Inkblot Test

• Developed by Hermann Rorschach (1884-1922), combining art with science.

Concerns Regarding Rorschach Test

• Issues include lack of standardized procedures and scoring.

• Poor inter-rater reliability and insufficient norms.

Exner Scoring System for Rorschach

• John Exner developed this integrated system addressing various scoring methods.

• Enhances empirical support and interpretation measures.

Concerns and Criticisms Regarding Diagnosis

• Main criticisms include:

  • Categorical versus continuum classification.

  • DSM’s binary yes/no approach for classification.

DSM Overview

• The Diagnostic and Statistical Manual (DSM) is published by the American Psychiatric Association.

• First edition released in 1952, with improvements made in reliability and diagnostic criteria through newer versions.

Comorbidity in Diagnosis

• Definition: Co-occurrence of distinct disorders complicating treatment planning.

• Treatment of one disorder may exacerbate another, emphasizing importance of comprehensive medical history.

Examples

• Rarely someone with anxiety might develop symptoms from treatment meant for ADHD, creating further complications in evaluation.

Child Mental health issues in Ontario

• Reports show significant parental concern regarding child anxiety, affecting attendance in school.

• High rates of mental health problems among youth with many not receiving treatment due to various barriers.

Challenges in Accessing Mental Health Services

• Issues such as long wait times, service availability, stigma, and a lack of recognition of mental health symptoms complicate access for children.

Consent Issues with Minors

• Explores dilemmas when minors wish for help but parents refuse or vice versa.

Trauma in Childhood

• Studies focus on the recognition of trauma history's impact on mental health assessment and treatment.

Email and external resources indicate the need to differentiate between medical and developmental trauma when assessing children.

Psychology

Week uhh… 7 notes? The Halloween class

- Why we do classification & diagnosis

o Helps clarify/define problems

o Provides basis for communication for researchers and clinicians

o Necessary for research

o First steps for deciding treatment

- Assessment and psychologists

o Psychologists developed and administered tests to determine aptitudes and

abilities for the military in US

o Traditionally, assessment done by psychologist

o A majority of practicing psychologists conduct assessments

o Most non-academic jobs for psychologists include competence/skills in

assessment as an important requirement

- Purpose of psychological assessment

o Classification/diagnosis

o Description

o Prediction

o

- Classification

o Making a diagnosis

o Critics: tests are not reliable or valid diagnostic tools

o Defenders: test information used in conjunction with other clinical data

o Testing provides a time efficient means of developing a broader

understanding

- Description

o For instance:

▪ Personality style

▪ Psychological state at the time of assessment

- Dr. Latif really fucking loves reality tv “Love is Blind” — just in case you needed to

know. I didn’t.

- Prediction

o Whether a client will benefit from a type of therapy

o What kind of therapy is best

o Suicide risk

o Risk for violence

- Purpose of assessment

o Central role of assessment should be

▪ To answer specific questions

▪ To aid in making relevant decisions

o To evaluate an individual in a problem situation

o Data is contextualized

o Assessment is individually oriented but always consider the persons (sorry –

she went to the next slide before I was done :l )

- Example

o Two individuals present for assessment and both receive IQ scores of 100

o Person number 1 is a 10-year-old falling behind in school and having trouble

in class

o Person number 2 is 63-years-old Chief of Surgery who got into an accident

and needs to be assessed before returning to work

o Context is important

- Requirements for competence

o Descriptive statistics

o Reliability and measurement error

o How to select appropriate measures

o Validity of tests for specific purposes

o Interpretation of normative tests

o Administration (she continued before I could finish but said we didn’t need to

write everything down…)

- Before starting an assessment

o Discuss the purposes and processes of the assessment

o Obtain informed consent

o Educate the client about confidentiality

o Establish rapport with the client

Types of tests

- Structured interviews

o Completely laid out word for word could be administered via computer

- Semi-structured interviews

- More common. Includes guidelines, questions, decision trees, diagnostic criteria

- Common interviews:

o SCID: Structured Clinical Interview for DSM

o SADS: Schedule of Affective Disorders and Schizophrenia

o K-SADS: SADS for kids

o DICA: Diagnostic Interview for Children and Adolescents

o DIS: Diagnostic Interview

o DISC: Diagnostic Interview for Children

o ADIS: Anxiety Diagnosis Interview Schedule for DSM

o DIB: Diagnostic Interview for Borderlines

o SIS-D: Structured Interview of Sleep Disorders

o SUDDS: Substance Use Disorders Diagnostic Schedule

o Y-BOCS & CY-BOCS:

- Strengths

o Focused information: less irrelevant info

o Increasing reliability of diagnosis

o Minimizing effects of interviewer bias

o Ensuring complete and comprehensive information is gathered

o Can help clinicians with difficult differential diagnosis

o Can reassure clients that you are following standard procedures

- Weaknesses

o Can take a long time

o Can feel less personal

o Can spend time reviewing problems irrelevant to individual

o Possibly need costly materials

o Possibly more expensive for clients

- Projective tests

o Individuals must impose their own structure which is meaningful

o Stimulus material is instructed

o Indirect (disguised) method

o Freedom of response

o Interpretation is broad

- Projective psychometrics

o Extremely difficult to research (reliability and validity)

o Some thing normative descriptions would destroy holistic, individualized

nature

o In practice, many clinicians act as though methods do have implicit norms:

some scoring systems rate whether responses are popular, ordinary or

industrial

- Interpretative biases

o Illusory correlations between the content of test responses and personality

characteristics

o Me-too fallacy (“seems normal, is normal!”)

o Sick-sick fallacy (if you perceived someone as sick, you’ll perceive their

responses as such)

- Popular Projective Tests

o Rorschach ink blot test

o Thematic Apperception Test

o House-Tree-Person

- Rorschach Inkblot Test

o Hermann Rorschach (1884-1922)

o Talented art student who studied science

o Dream concerned him of relationship between perception and unconscious

- Rorschach: Validity and Reliability

o Lack of standardized role for administration and scoring

o Poor inter-rater reliability

o Lack of adequate norms

o Unknown or weak validity

- Rorschach: Exner Scoring System

o John Exner

o Integrated five scoring and interpretation systems

o Empirical support for new system

o Looks at content, location and determinants

o Involves complex comprehension and computations of tours of responses,

ratios of tips of responses. Interpretation is not based on singles scores or

responses

o Still used by psychoanalytic practitioners

Concerns and criticism about diagnosis

- specific criticisms

o Discrete entity vs. Continuum

- DSM historically categorical classification

o Yes-no approach to classification

o Normal and abnormal not taken into consideration

- DSM-V aimed to address this

- DSM classification

o Diagnostic and Statistical Manual (DSM) of the American Psychiatric

Association

o First DSM published in 1952

- Improvements in reliability

o Earlier editions of DSM (prior to DSM III)

▪ Were unreliable

▪ Many diagnostic disagreements

▪ Improvements provided to make diagnoses depended on what an

individual clinician might choose to ask about

o Newer editions of DSM

▪ more extensive descriptions

▪ More precise diagnostic criteria

▪ Increased use of standardized assessments

- DSM ClassificationSystem

o DSM III introduced extensively revised version that included multi-axis

classifications (each person is rated on five separate dimensions)

o DSM IV Dr Fances Allen Chauf

o DSM V introduced changes such as the elimination of multi-axis

classification

- Dr Frances argues about DSM V

o Diagnostic inflation

o Pharm industry will benefit most from

- Concerns and criticisms

o Loss of information about person

o Stigma

o Rosenhan study (1973)

▪ Can change the lens of observation

▪ Can also change other behaviours

- Classification controversies

o “With great power comes great responsibility” - Spider-Man’s Uncle Ben (this

was actually in the slides)

Disorders of Childhood

Lecture 8

PSYC-2300H

*If something was shown/discussed in class and did not appear on the slides it will be in italics and indicated

with a star bullet point as well as with a label to indicate the context it was mentioned (Ex. Note: blah blah).*

Comorbidity

Comorbidity

- Co-occurrence of different disorders

- Makes treatment planning more difficult

- When there is high ?

Comorbidity Example

- Does someone with anxiety and d have both syndromes separately?

Do they create a new symptom?

- Sometimes treating something (with medication) makes something else worse.

 Example: Treating ADHD with stimulants might make anxiety symptoms

worse (jittering).

 Note: Need to know a person's full medical history before giving a diagnosis

because everything is interrelated.

 Note: DSM added a diagnosis of Mixed anxiety-depressive disorder (MADD)

for those who don’t meet the diagnostic criteria for anxiety or depression but

still suffer from some symptoms.

Comorbidity: Why does it matter?

- Examples of symptoms of psychosis.

- Possible etiologies:

o Depression

o Anxiety

o Schizophrenia

 Video played in class example: False negative complicate COVID-19

 Note: Applications to mental illness diagnosis:

 Be a good consumer when it comes to personal health care.

 Make sure the professionals are asking the right questions.

Childhood Mental Health

Ontario Parents Report

- 1/2 report concerns about child’s anxiety

- 1/3 had a child miss school due to anxiety

- 1/4 missed work to care for a child with anxiety

Ontario Youth Report

- 62% report concerns about anxiety

o Only 3 in 10 (32%) spoke to a mental health professional about anxiety

- 1 in 5 children and youth will experience some mental health problem

o 5 of 6 will not receive treatment

Challenges Getting Services

- Long wait times

- Services not offering what a child needs

- Don't know where to go

- Don't offer services where they live

- Stigma

 Note the class discussion brainstormed more:

 Presents as somatic symptoms (feels physical to the kids, so adults don’t

recognize it as mental illness).

 The child may think it's normal (can't tell what is going on is abnormal).

 The child doesn’t want to be alienated.

 Parents do not want to put their child on meds.

 Double standard from parents:

 Blaming themselves - I must have messed up if my child has anxiety.

 Might not trust professionals from experience – denial/resistance.

 Note: Makes child mental illness complicated.

- Canadas youth suicide rate is the third highest in the industrialized world.

Consent Issues

- What if child wants help and parent refuses?

- What if a parent wants help and child refuses?

- Age of consent?

o Non in Canada with few exception's

o Can consent without parents under 18

o Age found to be arbitrary measure of maturity

- Informed consent

o Understand conditions

o Understand information's

- Prognosis

- Risks

- Benefits of accepting or refusing treatment

- Parent custody situations

 Note: You need consent from both parents if they share custody.

- Confidentially

 Note: Breaking confidentiality when necessary is allowed (harming self or

others) but give the child control over how (now or at the end of the session)

and who is told (call mom or wait for grandma to come get you and tell her).

- Medical records

 Note: Medical records have to be held for 10 years, and for children, it is 10

years after they turn 18 (Ex. If the child is seen at 6 the records must be held

until they are 28).

 Video played in class: Depression and Childhood Trauma: Leah’s Story

Trauma in Childhood

PTSD

- Use started with war veterans in the 1980s

- Opened up areas of study and treatment intervention

- But... different than trauma of children within caregiving systems

Children with Trauma History

- New diagnoses

- Diagnostic issues

- Areas for further research

 Note: Focusing on relationship (caregiving systems) trauma not war trauma

(differences discussed in later points).

National Traumatic Stress Network

- Assessment and treatment of tens of thousands of trauma exposed children across

the US

Children with Interpersonal Trauma History

- Note: The study looked at children with interpersonal trauma.

o Study by National Traumatic Stress Network

o 1 699 children received trauma treatment

- 78% were exposed to multiple and or prolonged interpersonal trauma

 Note: Within caregiving systems (consistent trauma)

 Example: Witnessing substance abuse, foster care, neglect.

- Less than 25% met criteria for PTSD

o Fewer than 10% were exposed to serious accidents of medical illness

 Note: Onetime events

 Example: House fire, school shooting, unexpected death, natural

disasters.

 Note: Why do we care?

 Note: If you're treating these children like people with PTSD you are

not treating the right treatment.

Study of Children with Interpersonal Trauma (cont.)

- At least 50% showed symptoms

- Affect regulation

- Attention and concentration

- Negative self-image

- Impulse control

- Aggression and risk taking

 Note: Don’t need to know everyone but understand what it looks like when a child is

struggling with interpersonal trauma.

Along with Abuse and Trauma

- Co-occurring types of victimization and aversive experience...

- General instability

- Community violence

- Trauma (of the specific event, PTSD nature)

What is complex trauma?

 Note: National Traumatic Stress Network discusses it as the follow:

o Children's exposure to multiple traumatic events

o Often invasive and interpersonal in nature

▪ Wide-ranging, long-term effects

o Events are severe and pervasive, such as abuse or profound neglect

o Usually occur in early life

o Can disrupt child’s development and formation of a sense of self

o Since these events often occur with a caregiver, they interfere with the

child's ability to form a secure attachment

Childhood Abuse Stats (Candain Red Cross)

- Interviewing adults

- Physical abuse in On

o 31% of males

o 21% of females

o Adult reporting on childhoods experience

- Neglect

o 2003 neglect was the most common form of child maltreatment reported to

social workers in CA

- Sexual abuse

o Study with Toronto street youth

▪ One-third of these youth had experienced severe psychical or sexual

abuse or both

Long Term Impacts

- Social development

- Psychological development

- Cognitive development

- Biological development

Sequela Associated with Complex Trauma

 Lau and colleagues study

o 3555 adolescents who had experienced psychical abuse

 Found:

o Poor psychical health

o Poor interpersonal relationships

o Increased impulsive risk-taking behavior

o Difficulties with cognitive processing

o Affection regulation aggressive cue interpretation

- ***Triad of cognitive disturbance, interpersonal disruptions, and oppositional

behavior. All cluster together***

Behavioral Associations with Maltreatment

- Shields and Cicchetti (1998) study

- Rogosch and Cicchetti (2005) study

o Aggression

o Problems with attetntion

o Dissociation

o Emotion dysregulation and lability

o Socially inappropriate behavior

o Behavioral dysregulation

o Faulty attributions associated with interpersonal conflict

Treatment Resistance

- Interpersonal trauma is associated with treatment resistance

- Lau and colleagues (2003) study

o Children with histories of interpersonal trauma were more likely to

prematurely terminate therapy and show externalizing behavior two years

after therapy ended

Why treatment resistance?

- As criteria for PTSD is not met...

- Significance of trauma exposure is ignored in treatment

- Things not addressed in treatment:

o Trauma related fear

o Reactivity

o Affective dysregulation

o Traumatic expectations

Diagnostics???

- Not great diagnostic criteria

- These children and adolescents tend to meet 3-8 different Axis 1 and Axis 2

disorders (look up)

- And... that's not helpful

Complex Trauma

- Proposed by Julian Ford, trauma expert

- Complex trauma involves prolonged or repeated exposure during critical

developmental windows or transitions (including adolescence) to intentional

interpersonal victimization that is inescapable and causes profound insecurity

- Complex PTSD was proposed but not included in the DSM-5

- Ford 2017 in Adolescent Psychiatry

Complex Trauma Propose Criteria

- Criterion A

o Traumatic victimization (physical, sexual) AND

o Attachment disruption (primary caregiver loss, separation, neglect, or

emotional abuse)

 Note: Noted as important to know.

- Criterion B

o Affective/psychological dysregulation

- Criterion C

o Avoidance

- Criterion D

o Self and relational dysregulation

DSM-5 (Letter to APA in 2009 by mental health professionals)

- Mental health experts urged DSM-5 to consider extensive research to extablish a set

of criteria for developmental trauma, as it is not captured by PTSD

- Some progress;

o Reactive Attachment Disorder

o Disinhibited Social Disengagement Disorder

o PTSD diagnosis under age 6

Therapy

Lecture 9

PSYC-2300H

*If something was shown/discussed in class and did not appear on the slides it will be in italics and indicated

with a star bullet point as well as with a label to indicate the context it was mentioned (Ex. Note: blah blah).*

Developmental Trauma Therapy

Trauma Informed Interventions

- Better outcomes with trauma-informed care.

- What does that mean?

o Intervention that targets trauma reactions and attachment.

 Note: How can you properly react to a traumatized child's defiant

behavior?

o Attachment focused interventions with caregivers.

- Areas of treatment focus:

o Attachment

o Self-regulation

 Note: What is the child's behavior trying to tell you? What does it tell us about the

trauma?

Key Messages for Trauma Recovery

- It is not happening right now. The trauma is over. It is in the past. You are here in the

present.

- You are safe. The adults here are responsible for your own safety and you are worthy

of care and protection.

- You are not inherently dangerous/toxic. What is inside you (thoughts, feelings,

impulses), cannot hurt you or others.

- You are good. Whatever you have experienced and whatever you have had to do to

survive, you are a good strong person who can contribute to your community.

- You have a future.

Creativity, Control, Empowerment

- Ask clients what they want and need

- Involve clients in the design of services

- Caregivers/supports - focus on collaboration and CHOICE rather than rule

enforcement

- Recognition of practices that are re-traumatizing

- Culture of power and control is minimized

Strengths-Based

- Strengths-based

- NOT punitive or pathology driven

- Function of behaviors as coping adaptions rather than intentionally provocative

- Fire alarm example

 Note: Traumatized kids have a broken fire alarm (Ford)

 Furthering: Interpreting things as bad to survive but they then apply

that to safe environments.

 Example: That kept you safe, makes you a survivor, a great strategy at

the time, you don’t need that strategy anymore.

 Video played in class example of therapies used in developmental

trauma: Developmental Trauma Disorder: Identifying Critical Moments and

Healing Complex Trauma

Cognitive Therapy: Beck and Ellis

Cognitive Therapy

- Ellis – Rational Emotive Therapy

- Beck – Cognitive Therapy

- Note: Video played in class as introduction: People Talk About Their First Therapy

Session

Rational Emotive Therapy: Example of Ration Thinking

- A-B-C theory of dysfunctional behavior

 Note: From before the midterm.

 Example of rational thinking:

o A = Fail a midterm examination

o B = It’s unfortunate that I failed – I did not study hard enough, and I must

make sure that I study harder for the final

o C = No consequences (emotional disturbance sequelae)

Rational Emotive Therapy: Example of Irrational Thinking

 Example of irrational thinking:

o A= Fail a midterm examination

o B = I’m stupid, I’ll never be able to pass this course, and I will fail this course

o C = Depression

Ellis’ List of Common Irrational Ideas

- I absolutely must have sincere love and approval almost all the time from all the

significant people in my life.

- I must be thoroughly competent, adequate and achieving in all respects or I must at

least have real competence or talent at something important otherwise I am

worthless

- People who harm me or who do a bad thing are uniformly bad or wicked individuals,

and I should severely blame, damn, and punish them for their sins and misdeeds

Ellis’ List of Common Irrational Ideas (Continued)

- When things do not go the way, I would like them to go, life is awful, terrible,

horrible, or catastrophic

- Unhappiness is caused by external events over which I have almost no control. I

also have little ability to control my feelings or rid myself of feelings of depression

and hostility.

 Note: All this stuff is not setting you up to feel good, and the thoughts are not

rational.

Rational Emotive Therapy

- Identify the patient's irrational beliefs

- Add “D” and “E” to A-B-C theory

 Note: “D”isputing the irrational beliefs.

- Teach patients to dispute the beliefs and substitute logical and rational beliefs

- “E”valuate the effects of disputing their irrational beliefs

Beck’s Theory

- Depressed people have a negative view of:

o Themselves

o The world

o The future

- Depressed people have negative schemas or frames of reference through which

they interpret all events and experiences

Depression and Negative Schemas

 Note: When depressed:

o Negative schemas:

▪ Always present

▪ Unconscious

▪ Become activated with stressful events

Example of a Thought log

Dysfunctional

thought

What type of

thought is it?

Evidence for? Evidence

against?

Alternative

thought

Black and white

thinking?

Disqualifying

the positive

“Should”

Blaming

Becks Cognitive Therapy

- Identify and changing maladaptive thoughts

- First sessions: Therapist explains cognitive theory of emotional disorders (negative

cognitions contribute to distress)

 Note: Term is psychoeducation, “This is the process: Are you willing to try?”

(prof wants us to know).

- Middle sessions: Client is taught to identify, evaluate and replace negative

automatic thoughts were more positive cognitions

- Therapist is a collaborator (fellow scientists in therapy)

- Final sessions: Solidify gains, focus on prevention of recurrence

Other Cognitive Therapy Elements

- Therapist as collaborator

o Therapist and client work together to test the logic and consistency of each

negative though

- Behavior component

o Behavioral coping strategies (problem solving skills and assertiveness

training)

Solidifying Gains and Prevention

- Solidifying gains: Broaden range of identified negative thoughts and strengthen

more positive cognitions

- Anticipate future stressful life events that might trigger a future depression and role

play more adaptive responses

 Note: What can you (the client) do to not go to square one?

Cognitive Behavioral Therapy: Efficacy/Effectiveness

- Identified as a well-established treatment for the treatment of unipolar depression

- As effective (and sometimes more effective than) alternate forms of treatments for

depression including antidepressant medication

 Note: Such as antidepressants.

 Note: CBT alone can alter the brain in positive ways.

- However (despite focus on prevention of relapse) 2/3 of patients who receive

cognitive therapy have another episode of depression within two years

CBT Effective for Which Type of Patient (New question)

- Outcome not predicted by level of intelligence

- Patient with lower levels of dysfunctional thinking benefit the most (paradoxically)

- Interpersonally avoidant patients do better in CBT (rather than interpersonal

psychotherapy)

- Patients with more obsessional styles do better in Interpersonal Psychotherapy

Effective for Which Disorders?

- Empirically supported treatment for

o Depression

o Generalized anxiety disorder

o Obsessive compulsive disorder

o Panic disorder

Behavioral Therapy: Classical Conditioning

Behavioral Therapy: Classical Conditioning

1. Systematic Desensitization

2. Exposure Therapy

3. Aversion Therapy

Systematic Desensitization: Components

- Developed by John Wolpe

- Relaxation paired with CS

 Note: Almost doing the opposite of what caused the fear.

- Anxiety hierarchy

 Example: Come up with a ladder of what's kind of scary (2 out of 10) to what

is really scary (10 out of 10).

- Relaxation training

- Desensitization

Example: Fear of Spiders

 Anxiety hierarchy example:

o Look at a picture of a cartoon spider

o Look at a picture of a real spider

o Loat at a video of a spider far away

o Look at a video of a spider near a person

o Go to pet store and look at a spider in a case

o Hold a spider

 Note: Done overtime.

 Will be on the exam: Create an anxiety hierarchy for ________.

Example: Fear of Public Speaking

 Anxiety hierarchy example:

o Practice in front of a mirror

o Practice in front of a friend

o Practice in front of a friend of a friend

o Practice in front of a small group

o Do the class presentation

 Note: If the fear cannot be directly faced (ex. Fear of flying) do it over VR.

Therapy

PSYC-2700

Lecture 11

*If something was shown/discussed in class and did not appear on the slides it will be in italics and indicated

with a star bullet point as well as with a label to indicate the context it was mentioned (Ex. Note: blah blah).*

Discussion: General Questions

Final Exam

 Cumulative with a focus on post midterm content, but be familiar with all the

content.

 Similar to midterm (multiple choice and short answer) but a bit longer.

 Heavier weighted on lecture (no nitty gritty facts from the book).

 Regarding the legal content as long as you know the slides (which have been

posted) you will be good for the exam.

Assignment

 Transcript can be a pdf.

 No need to use crazy technical terminology (if you do explain it).

Therapy

Factors That Make Therapy Successful

 Introduction video: A Panel Discussion: How Can White Therapists Be Allies to

People of Color?

Client Factors Influencing Therapy

- Client Outcome Expectations:

 Instilling hope can lead to better outcomes

▪ Renewed sense of mastery

 Two key components of hope (Snyder and colleagues):

▪ Agency (willingness to change)

▪ Pathways (specific ways for outcomes to become realized)

 Note: First therapy session should not feel like therapy (getting background,

getting to know client, planning for treatment [based on my experience we

should try...])

Client Factors-Way to Instill Confidence

- (1) Treatment rationale early on (sharing why therapy will help)

- (2) Increasing client's belief in skills of the therapist

- (3) Expressing confidence in client's ability to complete therapy

- (4) Sharing research (what we know about others who did this)

- (5) Revieing progress and comparing it with expectations

 Note: Check in every few sessions (what is working, how are they feeling,

telling them about the progress they made [not back to square one/speaking

only in facts not “sunshine and rainbows”]).

Client Factors Influencing Therapy

- Client Personality

o Avoidant attachment styles linked with negative outcomes

- Client Goals and motivation to change

o Motivation interviewing to overcome resistance to change

 Other ideas in class discussion: A client becomes too attached (one shouldn’t

come to therapy b/c they want the attachment not the therapy).

Therapist Factors Influencing Outcomes

- Personal qualities

 Note: Race, personality, gender.

- Experience, training, competence

o Collaboration

o Understanding

o Interpersonal effectiveness

o Cultural competencies

- Core competencies

o Ability to engage in relationships

o Ability to communicate

Client-Therapist Factors Influence Outcomes

- Working alliance

o Therapeutic alliance

o Build on initial rapport

o Establish trust

o Develop mutually agreed-upon goals

o Client commitment to therapy

Cultural Context

- Psychopathology is presented within the context and constraints of Western society

- What do we need to consider about culture?

Cultural Context

- Clinicians must respect the dignity and worth of each individual, regardless of

cultural background.

- Should members of minority groups be specifically recruited into the mental health

professionals?

First Nations in Canada

- Four percent of the Canadian population

- Higher levels of mental health problems reported

- Canadian Gov Truth and Reconciliation Commission Completed in 2015

o Statments from over 7 000 residential school survivors

o Calls for greater integration of indigenous perspectives into curricula at all

levels of schools.

 Video played in class: OBI Public Talks- Carol Hopkins: Promoting Mental

Wellness in Indigenous Communities

 Note: How does a situation it effects an Indigenous person vs a white person?

 Example: War across the world.