Pomerantz_5e_PPT5-merged
First published in 1953, with nine subsequent revisions
Applies to all specialties, but especially relevant to clinical psychologists
Divided into aspirational (general principles) and enforceable (ethical standards)
Models for ethical decision making, such as Celia Fisher's model
Psychologists' ethical beliefs based on surveys and studies
Confidentiality specifically mentioned in general principles and ethical standards
Tarasoff case and the duty to warn and protect
Challenges faced by clinical psychologists in interpreting and applying duty to warn
Dilemmas when the client is a child or adolescent and how much to reveal to parents
Informed consent is required during research, assessment, and therapy
Facilitates an educated decision-making process
Multiple relationships can be problematic
Ethical standard 3.05a defines sexual and nonsexual multiple relationships
Criteria for impropriety in multiple relationships: impairment in the psychologist and exploitation or harm to the client
Competence includes being a competent psychologist, boundaries of competence, and remaining competent
Personal problems and burnout can affect competence
Ethical considerations in test selection, test security, and test data
Ethical obligations in conducting research
Efficacy of psychotherapy and the ethical dilemma of participants who don't receive treatment
Managed care and the position of divided loyalty
Ethical issues related to technology, such as psychological tests on the internet and online therapy practices
Ethics in small communities and ways to overcome ethical issues
To gain knowledge about psychological disorders and establish a foundation for the field
Research on treatment outcomes to determine the effectiveness of therapies
Distinguishing between statistical significance and clinical significance
Research on assessment methods to evaluate and improve them
Research on diagnostic issues, such as validity, reliability, and relationships between disorders
Research on professional issues, including activities, beliefs, and practices
Research on teaching and training issues, such as training philosophies and specialized training
Clinical psychologists engage in research to gain knowledge about psychological disorders, evaluate treatment outcomes, improve assessment methods, explore diagnostic issues, examine professional issues, and address teaching and training concerns. Ethical considerations, such as confidentiality, informed consent, boundaries, and competence, are essential throughout the research process.
The experimental method is used in clinical psychology research.
The method involves observation of events, development of hypotheses, empirical testing of the hypotheses, and alteration of hypotheses based on results.
The development of hypotheses in the experimental method includes independent and dependent variables.
Randomized clinical trials (RCTs) are used to maximize internal validity.
RCTs are criticized for producing results that may not translate to the real world.
Quasi-experimental designs are used when constraints limit the testing of certain hypotheses.
Quasi-experimental designs are less scientifically sound than experimental designs.
Between-group designs involve an experimental group and a control group.
Within-group designs involve comparisons of participants in a single condition at various points in time.
Analogue designs involve an approximation of the target client or situation.
Analogue designs use participants whose characteristics resemble those of the target population, or ask participants to imagine themselves in a certain situation.
Correlational studies are conducted when neither an experiment nor a quasi-experiment is plausible.
Correlational studies examine the relationship between two or more variables.
Case studies involve a thorough, detailed observation and examination of a person or situation and individual behavior.
Case studies stimulate systematic research which converges on important findings.
Case studies are highly regarded by researchers who prefer an idiographic approach.
Case studies use some variation of an ABAB design.
Meta-analysis is a statistical method of combining results of separate studies to create a summation of findings.
Meta-analysis is a quantitative analysis in which the full results of previous studies each represent a small part of a larger pool of data.
The process of conducting a meta-analysis should incorporate five steps: formulating the research question, obtaining a representative study sample, obtaining information from individual studies, conducting appropriate analyses, and reaching conclusions and offering suggestions.
Cross-sectional designs are easier and more efficient.
Longitudinal designs require longer periods of time and provide valid approximations for changes that take place or evolve over time.
Technology is used for data collection in clinical psychology research, such as sending e-mail surveys and using actigraphs to measure sleep quality.
Amazon Mechanical Turk or Mturk is also used for data collection.
Technology is also used as a clinical intervention.
Abnormality can be defined by personal distress to the individual, deviance from cultural norms, statistical infrequency, and impaired social functioning.
The harmful dysfunction theory defines a disorder as a harmful dysfunction, combining value and scientific components based on social norms.
Harmful dysfunction refers to the failure of a mental mechanism to perform a natural function.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) defines mental disorder as a clinically significant disturbance in cognition, emotion regulation, and behavior.
The DSM indicates a dysfunction in mental functioning and distinguishes it from expectable reactions to common stressors.
The DSM reflects a medical model of psychopathology and is influenced by the culture and values of those defining disorders.
The DSM categorizes disorders with a list of specific symptoms.
The presence or absence of a diagnostic label strongly impacts the attention it receives from clinical psychologists.
The absence of a diagnosis means the absence of a label.
The label of a diagnosis can lead to stereotyping of individuals and can have an effect on the outcome of legal issues.
Discussions of abnormal behavior appear in ancient Chinese, Hebrew, Egyptian, Greek, and Roman texts.
Hippocrates' theories of abnormality emphasized natural causes and were a significant early step to current definitions.
Mental asylums were established in Europe and the U.S. in the 19th century, helping to categorize disorders.
There was an evolution of common terminology in the field of mental disorders.
Emil Kraepelin is considered the founding father of the current diagnostic system.
Kraepelin labeled specific categories, such as manic-depressive psychosis and dementia praecox.
In the late 1800s and early 1900s, the collection of statistical and census data was the primary purpose of diagnostic categories.
The Veterans Affairs developed its own early categorization system to facilitate diagnosis and treatment of soldiers returning from World War II, which had a significant influence on the creation of the first DSM.
DSM-I was published by the APA in 1952.
A revision was published as DSM-II in 1968.
Both editions were similar to each other but different from subsequent DSM editions.
DSM-I and DSM-II defined only three categories: psychoses, neuroses, and character disorders.
The definitions of disorders in these editions were not scientifically or empirically based.
Language reflected psychoanalytic approach to understanding people and their problems
Vague descriptions of clinical conditions described in prose
Specific symptoms or criteria not listed
Very limited generalizability or utility for clinicians
DSM-III (1980) relied on empirical data and used specific diagnostic criteria to define disorders
Psychoanalytic language replaced by terminology that reflected no single school of thought
Multiaxial assessment system introduced
Longer and more expansive than predecessors
Included many new disorders
DSM-III-R, DSM-IV, and DSM-IV-TR retained major changes introduced by DSM-III and introduced significant other changes
Published in 2013, the first substantial revision after 20 years
Led by David Kupfer and Darrel Regier
Researched over 12 years
Coordinated efforts with WHO
Steps included the creation of Task Force, work groups, scientific review committee, field trials, and a website to communicate progress to the public
Changes considered but not made include the use of biological markers as diagnostic tools, rating of disorders/symptoms on a scale, and a dimensional approach toward a disorder
Rejections of new disorders such as attenuated psychosis syndrome, mixed anxiety-depressive disorder, and internet gaming disorder
Title change to DSM-5
Dropped multiaxial assessment system
Premenstrual dysphoric disorder
Disruptive mood dysregulation disorder
Binge eating disorder
Mild neurocognitive disorder (mild NCD)
Somatic symptom disorder (SSD)
Hoarding disorder
Bereavement exclusion
Autism spectrum disorder
Attention-deficit/hyperactivity disorder: increased age of symptoms from 7 to 12, minimum number of symptoms in adults increased to 5
Bulimia nervosa: frequency of binge eating reduced to once/week
Anorexia nervosa: reduction of less than 85% of the body weight
Substance use disorder
Mental retardation renamed intellectual disability or intellectual development disorder
Learning disabilities in math, reading, and writing combined as specific learning disorder
Obsessive Compulsion Disorder removed from Anxiety Disorders to new category
Mood Disorders split into two: Depressive Disorders and Bipolar and related disorders
Many "work group" members quit midway
Leaders of mental health organizations boycotted DSM-5
Allen Frances was the most vocal critic, criticizing changes as unsafe and scientifically unsound, and arguing that DSM-5 will mislabel normal people, promote diagnostic inflation, and encourage inappropriate medication use
Specific criticisms by others include diagnostic overexpansion, transparency of the revision process, membership of the work groups, field trial problems, and price
Recent editions of DSM widely used by all mental health professions
Strengths include emphasis on empirical research, use of explicit diagnostic criteria, interclinician reliability, atheoretical language, and facilitated communication between researchers and clinicians
Criticisms include breadth of coverage, controversial cutoffs, cultural issues, gender bias, nonempirical influences, and limitations on objectivity
Categorical Approach
Dimensional Approach
Five-factor model of personality
Neuroticism
Extraversion
Openness to experience
Agreeableness
Conscientiousness
Interviewer should acquire general skills as foundation for conducting interviews
Requirements
Quieting themselves
Being self-aware
Developing positive working relationships with clients
Eye contact
Facilitates and communicates listening
Makes client feel heard
Requires interviewer to have cultural knowledge and sensitivity
Culture shapes connotations of body language
General rules for interviewer
Face the client
Appear attentive
Minimize restlessness
Display appropriate facial expressions
Skilled interviewers
Use pitch, tone, volume, and fluctuation
Attend closely to the vocal qualities of clients
Effective interviewers monitor the client's train of thought by
Repeating key words and phrases
Weaving clients' language into their own
Shifting topics smoothly
Inappropriate addressing can jeopardize the client's sense of comfort with interviewer
Mistakes
Using nicknames or shortening names
Omitting essential "middle" name
Addressing client by first name
Important decisions can be informed by behavioral observations of client
Observing behaviors allows psychologist to consider nonverbal components
Strong sense of rapport brings sense of connect with interviewer
To establish good rapport with clients
Make an effort to put the client at ease
Acknowledge unique, unusual situation of clinical interview
Enhance rapport by following client's lead
Directive questioning approach
Tends to be targeted toward specific pieces of information
Client responses are typically brief
Can sacrifice rapport in favor of informational data that clients may not otherwise choose to disclose
Nondirective questioning approach
Client may choose to spend time on some topics
Can provide crucial information that interviewers may not otherwise know to inquire about
Can fall short in terms of gathering specific information
Best strategy involves balance and versatility
Using only a directive approach could sacrifice rapport in favor of information
Using only a nondirective approach can facilitate rapport but fall short of gathering specific information
Open- and closed-ended questions
Clarification
Confrontation
Paraphrasing
Reflection of feeling
Summarizing
Depends on interview type, setting, client's problem, etc.
Provides initial conceptualization of client's problem
May consist of specific diagnosis
May involve recommendations
Documents the interview
More reliable than interviewer's memory
Could be a distraction to client
Distracts from noticing important client behaviors
Effect of taking notes highly dependent on situation
Recording interview requires client's written permission
Could hinder openness and willingness to disclose information
Client appreciates explanation of rationale for recording
Types
Traditional, psychoanalytic arrangement
Interviewer and client sitting face-to-face
Interviewer and client in chairs at an angle between 90° and 180°
Setting should facilitate fundamental goals of interview
Should steer clear of overtly personal items
Many assume that sessions are absolutely confidential
Some situations require psychologist to break confidentiality
Some assume that related others have access to interview records hence, disclose very little
Interviewers should explain policies regarding confidentiality
The form of an interview depends on the setting, client's presenting problem, and the issues the interview is intended to address.
There are several types of interviews, including intake interviews, diagnostic interviews, mental status exams, and crisis interviews.
Intake interviews are used to determine whether a client needs treatment and what form of treatment is needed.
These interviews involve detailed questioning about the client's presenting complaint.
Diagnostic interviews are used to assign DSM diagnoses to a client's problems.
They include questions that relate to the criteria of DSM disorders.
Structured interviews have advantages such as producing a diagnosis based explicitly on DSM criteria, being empirically sound, and being standardized.
However, they have disadvantages such as inhibiting rapport and the client's opportunity to elaborate or explain, not allowing for inquiries not related to DSM diagnostic categories, and requiring a more comprehensive list of questions.
In unstructured interviews, interviewers improvise and determine questions on the spot to seek relevant information.
The SCID is an example of a structured interview that asks about specific symptoms of disorders listed in the DSM.
The mental status exam is most often employed in medical settings and is intended for brief, flexible administration requiring no manual or other materials.
It captures the psychological and cognitive processes of an individual "right now."
The exam lacks standardization, with different questions within the same category.
Some main categories include appearance, behavior, mood, speech, orientation, and memory.
Crisis interviews assess problems demanding urgent attention, such as suicide, and provide immediate and effective intervention.
Key components of crisis interviews include quickly establishing rapport and expressing empathy.
Interviewers should be culturally competent and appreciate the cultural context.
There is variability among individuals within cultural groups.
Consideration of religion as a component of culture is important.
Open, respectful discussion of cultural variables can enhance rapport and increase the client's willingness to share information.
Interview questions can be used to inquire about the cultural backgrounds of clients.
There is no consensus regarding the definition of intelligence.
Classic theories of intelligence include Charles Spearman's theory of a singular intelligence and Louis Thurstone's theory of many intelligences.
More contemporary theories of intelligence include James Cattell's theory of fluid and crystallized intelligence and John Carroll's Three Stratum Theory of Intelligence.
The Wechsler intelligence tests, including the WAIS-IV, WISC-V, and WPPSI-IV, are widely used.
These tests assess intelligence in different age ranges.
The table provides information about the most recent editions, year published, and age ranges for the Wechsler intelligence tests and other related tests.
Neuropsychological tests, such as the Halstead-Reitan Neuropsychological Test Battery and the Bender Visual-Motor Gestalt Test, are used to assess cognitive functioning.
Cover entire life span
Vary as per demands of measuring intelligence at different ages
Separate tests, not variants of one another
Single full-scale intelligence score, four and five index score, and specific subtest scores
Administered one-on-one and face-to-face
Brief subtest with items of increasing difficulty levels
Core or supplemental subtests
Five categories of subtests of WISC and WPPSI
Share three with WAIS
Perceptual Reasoning Index has
Visual Spatial Index
Fluid Reasoning Index
Four categories of subtests of WAIS
Verbal Comprehension Index
Perceptual Reasoning Index
Working Memory Index
Processing Speed Index
Large sets of normative data
Scores reflect IQ
Backed by impressive psychometric data
Used for wide range of clinical applications
Limited connection between tests and day-to-day life
Complex or subjective scoring on some subtests
Similar to Wechsler tests
Administered face-to-face and one-on-one
Employs hierarchical model of intelligence
Yields singular measure of full-scale IQ, five factor scores, many specific subtest scores
Features same means and standard deviations
Psychometric data similarly strong
Covers entire life span as a single test
Includes normative data for specific relevant diagnoses
Features exactly five factors measured both verbally and nonverbally
Universal Nonverbal Intelligence Test-2 (UNIT-2)
Language free test
Administered one-on-one and face-to-face
No verbal instructions
Instructions via eight specific hand gestures
Appropriate for clients aged 5 to 21 years
Six subtests: Two tiers
Memory
Reasoning
Assesses limited range of abilities
Appropriate only for young clients
Limited psychometric data
Intelligence—cognitive capacity
Achievement—person’s accomplishments
Comparison of intelligence and achievement key factor in determining learning disabilities
Terminology changed in DSM-5
Achievement Tests
KeyMath achievement test
Gray Oral Reading achievement test
Woodcock Tests of Achievement (WJ-ACH)
Kaufman Test of Educational Achievement (KTEA)
Wechsler Individual Achievement Test (WIAT)
Wechsler Individual Achievement Test—Third Edition
For ages 4 to 50 years
Administered face-to-face and one-on-one
Measures achievements in four broad areas
Reading
Math
Oral language
Written language
Yields standard scores on same scale as intelligence tests
Linked to Wechsler IQ tests
Strong reliability and validity data supports WIAT-III
Measures cognitive functioning or impairment of the brain
Fixed-battery phase to flexible-battery phase
Full Neuropsychological Batteries
Halstead-Reitan Neuropsychological Battery (HRB)
Luria-Nebraska Neuropsychological Battery (LNNB)
NEPSY-II
Bender Visual-Motor Gestalt Test—Second Edition (Bender-Gestalt-II)
Rey-Osterrieth Complex Figure Test
Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)
Wechsler Memory Scale—Fourth Edition (WMS-IV)
Halstead-Reitan Neuropsychological Battery (HRB)
Battery of eight standardized neuropsychological tests
Suitable for ages 15 years and above
Alternate versions available for younger clients
Administered only as a whole battery
Primary purpose to identify people with brain damage
Helps in diagnosis and treatment of problems related to brain malfunction
Luria-Nebraska Neuropsychological Battery (LNNB)
Wide-ranging test of neuropsychological functioning like HRB
Consists of 12 scales
Emphasis on qualitative data in addition to quantitative data
NEPSY-II
Designed specifically for children between 3 and 16 years
Based on the general principles of Luria-Nebraska test
Includes 32 separate subtests across 6 different categories
Bender Visual-Motor Gestalt Test—Second Edition (Bender-Gestalt-II)
Most commonly used test
Straightforward copying task
Measures visuoconstructive abilities
Takes only 6 minutes to administer
Rey-Osterrieth Complex Figure Test
Brief pencil-and-paper drawing task comprising single complex figure
Involves use of colored pencils at various points in test
Examiner can trace client’s sequential approach to complex copying task
Includes a memory component
Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)
Focuses on a broader range of abilities than Bender-Gestalt or Rey-Osterrieth
Measures verbal skills, attention, and visual memory
Takes 20 to 30 minutes to complete
Includes 12 subtests in 5 categories
Wechsler Memory Scale—Fourth Edition (WMS-IV)
Often used to assess individuals between 16 and 90 years with suspected memory problems
Assesses
Visual and auditory memory across seven subtests
Immediate and delayed recall
First published in 1953, with nine subsequent revisions
Applies to all specialties, but especially relevant to clinical psychologists
Divided into aspirational (general principles) and enforceable (ethical standards)
Models for ethical decision making, such as Celia Fisher's model
Psychologists' ethical beliefs based on surveys and studies
Confidentiality specifically mentioned in general principles and ethical standards
Tarasoff case and the duty to warn and protect
Challenges faced by clinical psychologists in interpreting and applying duty to warn
Dilemmas when the client is a child or adolescent and how much to reveal to parents
Informed consent is required during research, assessment, and therapy
Facilitates an educated decision-making process
Multiple relationships can be problematic
Ethical standard 3.05a defines sexual and nonsexual multiple relationships
Criteria for impropriety in multiple relationships: impairment in the psychologist and exploitation or harm to the client
Competence includes being a competent psychologist, boundaries of competence, and remaining competent
Personal problems and burnout can affect competence
Ethical considerations in test selection, test security, and test data
Ethical obligations in conducting research
Efficacy of psychotherapy and the ethical dilemma of participants who don't receive treatment
Managed care and the position of divided loyalty
Ethical issues related to technology, such as psychological tests on the internet and online therapy practices
Ethics in small communities and ways to overcome ethical issues
To gain knowledge about psychological disorders and establish a foundation for the field
Research on treatment outcomes to determine the effectiveness of therapies
Distinguishing between statistical significance and clinical significance
Research on assessment methods to evaluate and improve them
Research on diagnostic issues, such as validity, reliability, and relationships between disorders
Research on professional issues, including activities, beliefs, and practices
Research on teaching and training issues, such as training philosophies and specialized training
Clinical psychologists engage in research to gain knowledge about psychological disorders, evaluate treatment outcomes, improve assessment methods, explore diagnostic issues, examine professional issues, and address teaching and training concerns. Ethical considerations, such as confidentiality, informed consent, boundaries, and competence, are essential throughout the research process.
The experimental method is used in clinical psychology research.
The method involves observation of events, development of hypotheses, empirical testing of the hypotheses, and alteration of hypotheses based on results.
The development of hypotheses in the experimental method includes independent and dependent variables.
Randomized clinical trials (RCTs) are used to maximize internal validity.
RCTs are criticized for producing results that may not translate to the real world.
Quasi-experimental designs are used when constraints limit the testing of certain hypotheses.
Quasi-experimental designs are less scientifically sound than experimental designs.
Between-group designs involve an experimental group and a control group.
Within-group designs involve comparisons of participants in a single condition at various points in time.
Analogue designs involve an approximation of the target client or situation.
Analogue designs use participants whose characteristics resemble those of the target population, or ask participants to imagine themselves in a certain situation.
Correlational studies are conducted when neither an experiment nor a quasi-experiment is plausible.
Correlational studies examine the relationship between two or more variables.
Case studies involve a thorough, detailed observation and examination of a person or situation and individual behavior.
Case studies stimulate systematic research which converges on important findings.
Case studies are highly regarded by researchers who prefer an idiographic approach.
Case studies use some variation of an ABAB design.
Meta-analysis is a statistical method of combining results of separate studies to create a summation of findings.
Meta-analysis is a quantitative analysis in which the full results of previous studies each represent a small part of a larger pool of data.
The process of conducting a meta-analysis should incorporate five steps: formulating the research question, obtaining a representative study sample, obtaining information from individual studies, conducting appropriate analyses, and reaching conclusions and offering suggestions.
Cross-sectional designs are easier and more efficient.
Longitudinal designs require longer periods of time and provide valid approximations for changes that take place or evolve over time.
Technology is used for data collection in clinical psychology research, such as sending e-mail surveys and using actigraphs to measure sleep quality.
Amazon Mechanical Turk or Mturk is also used for data collection.
Technology is also used as a clinical intervention.
Abnormality can be defined by personal distress to the individual, deviance from cultural norms, statistical infrequency, and impaired social functioning.
The harmful dysfunction theory defines a disorder as a harmful dysfunction, combining value and scientific components based on social norms.
Harmful dysfunction refers to the failure of a mental mechanism to perform a natural function.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) defines mental disorder as a clinically significant disturbance in cognition, emotion regulation, and behavior.
The DSM indicates a dysfunction in mental functioning and distinguishes it from expectable reactions to common stressors.
The DSM reflects a medical model of psychopathology and is influenced by the culture and values of those defining disorders.
The DSM categorizes disorders with a list of specific symptoms.
The presence or absence of a diagnostic label strongly impacts the attention it receives from clinical psychologists.
The absence of a diagnosis means the absence of a label.
The label of a diagnosis can lead to stereotyping of individuals and can have an effect on the outcome of legal issues.
Discussions of abnormal behavior appear in ancient Chinese, Hebrew, Egyptian, Greek, and Roman texts.
Hippocrates' theories of abnormality emphasized natural causes and were a significant early step to current definitions.
Mental asylums were established in Europe and the U.S. in the 19th century, helping to categorize disorders.
There was an evolution of common terminology in the field of mental disorders.
Emil Kraepelin is considered the founding father of the current diagnostic system.
Kraepelin labeled specific categories, such as manic-depressive psychosis and dementia praecox.
In the late 1800s and early 1900s, the collection of statistical and census data was the primary purpose of diagnostic categories.
The Veterans Affairs developed its own early categorization system to facilitate diagnosis and treatment of soldiers returning from World War II, which had a significant influence on the creation of the first DSM.
DSM-I was published by the APA in 1952.
A revision was published as DSM-II in 1968.
Both editions were similar to each other but different from subsequent DSM editions.
DSM-I and DSM-II defined only three categories: psychoses, neuroses, and character disorders.
The definitions of disorders in these editions were not scientifically or empirically based.
Language reflected psychoanalytic approach to understanding people and their problems
Vague descriptions of clinical conditions described in prose
Specific symptoms or criteria not listed
Very limited generalizability or utility for clinicians
DSM-III (1980) relied on empirical data and used specific diagnostic criteria to define disorders
Psychoanalytic language replaced by terminology that reflected no single school of thought
Multiaxial assessment system introduced
Longer and more expansive than predecessors
Included many new disorders
DSM-III-R, DSM-IV, and DSM-IV-TR retained major changes introduced by DSM-III and introduced significant other changes
Published in 2013, the first substantial revision after 20 years
Led by David Kupfer and Darrel Regier
Researched over 12 years
Coordinated efforts with WHO
Steps included the creation of Task Force, work groups, scientific review committee, field trials, and a website to communicate progress to the public
Changes considered but not made include the use of biological markers as diagnostic tools, rating of disorders/symptoms on a scale, and a dimensional approach toward a disorder
Rejections of new disorders such as attenuated psychosis syndrome, mixed anxiety-depressive disorder, and internet gaming disorder
Title change to DSM-5
Dropped multiaxial assessment system
Premenstrual dysphoric disorder
Disruptive mood dysregulation disorder
Binge eating disorder
Mild neurocognitive disorder (mild NCD)
Somatic symptom disorder (SSD)
Hoarding disorder
Bereavement exclusion
Autism spectrum disorder
Attention-deficit/hyperactivity disorder: increased age of symptoms from 7 to 12, minimum number of symptoms in adults increased to 5
Bulimia nervosa: frequency of binge eating reduced to once/week
Anorexia nervosa: reduction of less than 85% of the body weight
Substance use disorder
Mental retardation renamed intellectual disability or intellectual development disorder
Learning disabilities in math, reading, and writing combined as specific learning disorder
Obsessive Compulsion Disorder removed from Anxiety Disorders to new category
Mood Disorders split into two: Depressive Disorders and Bipolar and related disorders
Many "work group" members quit midway
Leaders of mental health organizations boycotted DSM-5
Allen Frances was the most vocal critic, criticizing changes as unsafe and scientifically unsound, and arguing that DSM-5 will mislabel normal people, promote diagnostic inflation, and encourage inappropriate medication use
Specific criticisms by others include diagnostic overexpansion, transparency of the revision process, membership of the work groups, field trial problems, and price
Recent editions of DSM widely used by all mental health professions
Strengths include emphasis on empirical research, use of explicit diagnostic criteria, interclinician reliability, atheoretical language, and facilitated communication between researchers and clinicians
Criticisms include breadth of coverage, controversial cutoffs, cultural issues, gender bias, nonempirical influences, and limitations on objectivity
Categorical Approach
Dimensional Approach
Five-factor model of personality
Neuroticism
Extraversion
Openness to experience
Agreeableness
Conscientiousness
Interviewer should acquire general skills as foundation for conducting interviews
Requirements
Quieting themselves
Being self-aware
Developing positive working relationships with clients
Eye contact
Facilitates and communicates listening
Makes client feel heard
Requires interviewer to have cultural knowledge and sensitivity
Culture shapes connotations of body language
General rules for interviewer
Face the client
Appear attentive
Minimize restlessness
Display appropriate facial expressions
Skilled interviewers
Use pitch, tone, volume, and fluctuation
Attend closely to the vocal qualities of clients
Effective interviewers monitor the client's train of thought by
Repeating key words and phrases
Weaving clients' language into their own
Shifting topics smoothly
Inappropriate addressing can jeopardize the client's sense of comfort with interviewer
Mistakes
Using nicknames or shortening names
Omitting essential "middle" name
Addressing client by first name
Important decisions can be informed by behavioral observations of client
Observing behaviors allows psychologist to consider nonverbal components
Strong sense of rapport brings sense of connect with interviewer
To establish good rapport with clients
Make an effort to put the client at ease
Acknowledge unique, unusual situation of clinical interview
Enhance rapport by following client's lead
Directive questioning approach
Tends to be targeted toward specific pieces of information
Client responses are typically brief
Can sacrifice rapport in favor of informational data that clients may not otherwise choose to disclose
Nondirective questioning approach
Client may choose to spend time on some topics
Can provide crucial information that interviewers may not otherwise know to inquire about
Can fall short in terms of gathering specific information
Best strategy involves balance and versatility
Using only a directive approach could sacrifice rapport in favor of information
Using only a nondirective approach can facilitate rapport but fall short of gathering specific information
Open- and closed-ended questions
Clarification
Confrontation
Paraphrasing
Reflection of feeling
Summarizing
Depends on interview type, setting, client's problem, etc.
Provides initial conceptualization of client's problem
May consist of specific diagnosis
May involve recommendations
Documents the interview
More reliable than interviewer's memory
Could be a distraction to client
Distracts from noticing important client behaviors
Effect of taking notes highly dependent on situation
Recording interview requires client's written permission
Could hinder openness and willingness to disclose information
Client appreciates explanation of rationale for recording
Types
Traditional, psychoanalytic arrangement
Interviewer and client sitting face-to-face
Interviewer and client in chairs at an angle between 90° and 180°
Setting should facilitate fundamental goals of interview
Should steer clear of overtly personal items
Many assume that sessions are absolutely confidential
Some situations require psychologist to break confidentiality
Some assume that related others have access to interview records hence, disclose very little
Interviewers should explain policies regarding confidentiality
The form of an interview depends on the setting, client's presenting problem, and the issues the interview is intended to address.
There are several types of interviews, including intake interviews, diagnostic interviews, mental status exams, and crisis interviews.
Intake interviews are used to determine whether a client needs treatment and what form of treatment is needed.
These interviews involve detailed questioning about the client's presenting complaint.
Diagnostic interviews are used to assign DSM diagnoses to a client's problems.
They include questions that relate to the criteria of DSM disorders.
Structured interviews have advantages such as producing a diagnosis based explicitly on DSM criteria, being empirically sound, and being standardized.
However, they have disadvantages such as inhibiting rapport and the client's opportunity to elaborate or explain, not allowing for inquiries not related to DSM diagnostic categories, and requiring a more comprehensive list of questions.
In unstructured interviews, interviewers improvise and determine questions on the spot to seek relevant information.
The SCID is an example of a structured interview that asks about specific symptoms of disorders listed in the DSM.
The mental status exam is most often employed in medical settings and is intended for brief, flexible administration requiring no manual or other materials.
It captures the psychological and cognitive processes of an individual "right now."
The exam lacks standardization, with different questions within the same category.
Some main categories include appearance, behavior, mood, speech, orientation, and memory.
Crisis interviews assess problems demanding urgent attention, such as suicide, and provide immediate and effective intervention.
Key components of crisis interviews include quickly establishing rapport and expressing empathy.
Interviewers should be culturally competent and appreciate the cultural context.
There is variability among individuals within cultural groups.
Consideration of religion as a component of culture is important.
Open, respectful discussion of cultural variables can enhance rapport and increase the client's willingness to share information.
Interview questions can be used to inquire about the cultural backgrounds of clients.
There is no consensus regarding the definition of intelligence.
Classic theories of intelligence include Charles Spearman's theory of a singular intelligence and Louis Thurstone's theory of many intelligences.
More contemporary theories of intelligence include James Cattell's theory of fluid and crystallized intelligence and John Carroll's Three Stratum Theory of Intelligence.
The Wechsler intelligence tests, including the WAIS-IV, WISC-V, and WPPSI-IV, are widely used.
These tests assess intelligence in different age ranges.
The table provides information about the most recent editions, year published, and age ranges for the Wechsler intelligence tests and other related tests.
Neuropsychological tests, such as the Halstead-Reitan Neuropsychological Test Battery and the Bender Visual-Motor Gestalt Test, are used to assess cognitive functioning.
Cover entire life span
Vary as per demands of measuring intelligence at different ages
Separate tests, not variants of one another
Single full-scale intelligence score, four and five index score, and specific subtest scores
Administered one-on-one and face-to-face
Brief subtest with items of increasing difficulty levels
Core or supplemental subtests
Five categories of subtests of WISC and WPPSI
Share three with WAIS
Perceptual Reasoning Index has
Visual Spatial Index
Fluid Reasoning Index
Four categories of subtests of WAIS
Verbal Comprehension Index
Perceptual Reasoning Index
Working Memory Index
Processing Speed Index
Large sets of normative data
Scores reflect IQ
Backed by impressive psychometric data
Used for wide range of clinical applications
Limited connection between tests and day-to-day life
Complex or subjective scoring on some subtests
Similar to Wechsler tests
Administered face-to-face and one-on-one
Employs hierarchical model of intelligence
Yields singular measure of full-scale IQ, five factor scores, many specific subtest scores
Features same means and standard deviations
Psychometric data similarly strong
Covers entire life span as a single test
Includes normative data for specific relevant diagnoses
Features exactly five factors measured both verbally and nonverbally
Universal Nonverbal Intelligence Test-2 (UNIT-2)
Language free test
Administered one-on-one and face-to-face
No verbal instructions
Instructions via eight specific hand gestures
Appropriate for clients aged 5 to 21 years
Six subtests: Two tiers
Memory
Reasoning
Assesses limited range of abilities
Appropriate only for young clients
Limited psychometric data
Intelligence—cognitive capacity
Achievement—person’s accomplishments
Comparison of intelligence and achievement key factor in determining learning disabilities
Terminology changed in DSM-5
Achievement Tests
KeyMath achievement test
Gray Oral Reading achievement test
Woodcock Tests of Achievement (WJ-ACH)
Kaufman Test of Educational Achievement (KTEA)
Wechsler Individual Achievement Test (WIAT)
Wechsler Individual Achievement Test—Third Edition
For ages 4 to 50 years
Administered face-to-face and one-on-one
Measures achievements in four broad areas
Reading
Math
Oral language
Written language
Yields standard scores on same scale as intelligence tests
Linked to Wechsler IQ tests
Strong reliability and validity data supports WIAT-III
Measures cognitive functioning or impairment of the brain
Fixed-battery phase to flexible-battery phase
Full Neuropsychological Batteries
Halstead-Reitan Neuropsychological Battery (HRB)
Luria-Nebraska Neuropsychological Battery (LNNB)
NEPSY-II
Bender Visual-Motor Gestalt Test—Second Edition (Bender-Gestalt-II)
Rey-Osterrieth Complex Figure Test
Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)
Wechsler Memory Scale—Fourth Edition (WMS-IV)
Halstead-Reitan Neuropsychological Battery (HRB)
Battery of eight standardized neuropsychological tests
Suitable for ages 15 years and above
Alternate versions available for younger clients
Administered only as a whole battery
Primary purpose to identify people with brain damage
Helps in diagnosis and treatment of problems related to brain malfunction
Luria-Nebraska Neuropsychological Battery (LNNB)
Wide-ranging test of neuropsychological functioning like HRB
Consists of 12 scales
Emphasis on qualitative data in addition to quantitative data
NEPSY-II
Designed specifically for children between 3 and 16 years
Based on the general principles of Luria-Nebraska test
Includes 32 separate subtests across 6 different categories
Bender Visual-Motor Gestalt Test—Second Edition (Bender-Gestalt-II)
Most commonly used test
Straightforward copying task
Measures visuoconstructive abilities
Takes only 6 minutes to administer
Rey-Osterrieth Complex Figure Test
Brief pencil-and-paper drawing task comprising single complex figure
Involves use of colored pencils at various points in test
Examiner can trace client’s sequential approach to complex copying task
Includes a memory component
Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)
Focuses on a broader range of abilities than Bender-Gestalt or Rey-Osterrieth
Measures verbal skills, attention, and visual memory
Takes 20 to 30 minutes to complete
Includes 12 subtests in 5 categories
Wechsler Memory Scale—Fourth Edition (WMS-IV)
Often used to assess individuals between 16 and 90 years with suspected memory problems
Assesses
Visual and auditory memory across seven subtests
Immediate and delayed recall
