Personality Psychology: Situation vs. Person Debate

The Person-Situation Debate

• The person-situation debate in personality psychology revolves around whether the person or the situation is more influential in determining a person's behavior.
• Personality trait psychologists believe that people have consistent personalities that guide their behaviors across situations.
• Situationists argue that people are not consistent enough from situation to situation to be characterized by broad personality traits.

Research Evidence

• Research evidence points to the influence of both person and situation on behavior.
• Behavior is best understood as the interaction between the person and the situation.

Traits and Situations

• Traits and situations interact to influence behavior.
• Different situations affect different people in different ways.
• Some situations allow the expression of personality, while others provoke a narrower range of behavior.

Self-Monitoring

• Self-monitoring is a theory that deals with the phenomena of expressive controls.
• High self-monitors display less consistency across situations in their behavior because they try to adapt more to the situation.
• Low self-monitors display more consistency in their behavior across situations because they are less likely to adapt to situations.

Self-Presentation Biases

• Emphasizing the positive: People are often motivated to present themselves in a favorable light.
• Malingering: Trying to look worse than one is.

Acculturative Stress

• Acculturative stress is the psychological impact of adaptation to a new culture.
• People who experience acculturative stress often find it tough and confusing to adjust to a new environment with different norms, values, social customs, politics, and education standards.

Minnesota Multiphasic Personality Inventory (MMPI)

• MMPI is a commonly taught and used personality inventory in clinical psychology.
• The original version was published in 1943 and had 550 items, while the second version has 567 items and the adolescent version has 478 items.

MMPI-2Validity Scales

• Cannot Say (?): Total number of unanswered items
• Lie Scale (L): A measure of self-presentation that is unrealistically positive
• Infrequency Scale (F): A measure of self-presentation that is very unfavorable – malingering or severe psychopathology
• Defensiveness Scale (K): Unwillingness to disclose personal information and problems

Symptom Checklist 90-Revised (SCL-90-R)

• SCL-90-R is a self-report psychometric instrument designed to evaluate a broad range of psychological problems and symptoms of psychopathology.
• It has 90 items and takes 12-15 minutes to administer, yielding nine scores along primary symptom dimensions and three scores among global distress indices.

Thematic Apperception Test (TAT)

• Developed by Murray in 1943, TAT is a projective psychological test.
• The test consists of 31 cards with pictures on them, and the participant tells a story about what they see in the picture.
• There is no consistently used scoring mechanism, and no clear norms or reliability data, making the TAT an unreliable test.

Integration and Clinical Decision Making

• Psychologists make optimal judgments about client problems, course of treatment, and future behavior while facing conflicting pressures to decrease diagnostic uncertainty, risks to patients, and costs.
• Clinical decision making involves deciding what information to gather, which tests to order, how to interpret and integrate this information to draw diagnostic conclusions, and which treatments to give.

Assessments

• All assessments are designed to address a question, and the psychologist determines the most appropriate type of assessment based on this question.
• As the assessment progresses, different tests or assessments may be added.
• A descriptive account of the client's level of functioning is important, including understanding the client in their social and interpersonal environment.
• Multiple informants, especially with children, are important to consider.
• Different assessments/tests provide conflicting results, which must be integrated and considered.

Case Formulation

• Case formulation aims to describe a person's presenting problems and use theory to make explanatory inferences about causes and maintaining factors that can inform interventions.
• Case formulation is a clear hypothesis that relates to how a problem developed and how it is maintained.
• It provides a framework for developing the most suitable treatment approach and is commonly used by clinical psychologists and psychiatrists.
• Key elements of case formulation include:
  • Description of presenting issues
  • Factors that act to create vulnerability or precipitate problems
  • Factors that maintain problems
  • Factors that help the person cope or act as resources
• Case formulation provides connections between various problems, guidance on treatment, and predicts patient functioning with and without treatment.

Components and Steps of Case Formulation

• Components of case formulation:
  • Description of problems and symptoms
  • Events or stressors that led to symptoms or problems
  • Predisposing life events/vulnerabilities
  • Hypothesized mechanism that links problems to current functioning
• Steps of case formulation:
  1. Develop a comprehensive problem list
  2. Determine the origin, precipitants, and consequences of problems
  3. Identify patterns among problems
  4. Develop working hypotheses to explain problems
  5. Evaluate and refine hypotheses
  6. In treatment, hypotheses should be reconsidered, re-evaluated, and revised

Threats to the Validity of Case Formulations

• Client factors:
  • Clients may try to under-pathologize themselves
  • Problems with retrospective recall
  • Clients may not accurately perceive or portray reality
• Clinician factors:
  • Self-serving attributional bias
  • Overuse of heuristics
  • Biases (gender, ethnic, socioeconomic, etc.)
  • Decision-making biases

Improving the Accuracy of Clinical Judgment

• Use directly relevant psychometrically sound tests
• Check for scoring errors
• Use normative data and base rate information
• Use DSM criteria when making a diagnosis
• Use decision trees or clinical guidelines
• Be systematic in unstructured interviews
• Be aware of relevant research
• Be aware of personal biases and preconceptions
• Search for alternative explanations for hypotheses
• Seek consultation
• Don't rely on memory, and don't rush to a conclusion

Important Concepts in Assessment Reports

• Important to remember the 'audience' of the report
• Privacy is important - avoiding stigmatizing labels, using multiple sources
• Exercise caution with computer-based interpretations (CBIs)
• Contents of a typical assessment report:
  • Identifying patient/client information
  • Reason for referral
  • Background information
  • Assessment methods
  • Interview data and behavioral observations
  • Test results and interpretation of test scores
  • Diagnostic impressions
  • Summary
  • Recommendations

Prevention Overview

• Prevention programs aim to decrease the risk of serious problems, including physical and mental health disorders.
• Community Psychology is a branch of psychology concerned with the reciprocal relationship between the community and the individual.

Poverty

• Approximately 1 billion children worldwide do not have adequate food, shelter, education, etc. (UNICEF, 2003).
• Around 17% of American children live at or below the poverty line.
• Many risk factors are associated with poverty, including increased violence, environmental pollutants, physical and mental health disorders.
• Prevention programs are designed to decrease poverty.

Approaches to Prevention

• Primary Prevention: Intervention before a disorder has developed to prevent its occurrence.
• Secondary Prevention: Intervention after the onset of the disorder (usually called treatment).
• Tertiary Prevention: With chronic disorders, the focus is on rehabilitation and long-term adaptation.
• Universal Preventive Interventions: Applied to the general population (e.g., vaccines, etc.).
• Selective Preventive Interventions: Targeted to individuals at high risk of developing a disorder.
• Indicative Preventive Interventions: Targeted to individuals at high risk and showing subclinical signs of the disorder.

Prevention – Central Concepts

• Risk reduction model: Identifying high-risk groups and developing intervention programs using research.
• Risk factors: Characteristics of the person or environment that increase the chance of developing a disorder.
• Protective factors: Characteristics of a high-risk person or environment that decrease the risk of developing the disorder.
• Importance of determining the outcome of a program:
  • Incidence rates: Number of new cases in a given year.
  • Number needed to treat: The number of people needed to treat to save one person from getting the disorder.
  • Meta-analysis: Comparing the outcome of several studies of a prevention program.
  • Efficacy and effectiveness.

Promoting Evidence-Based Parenting

• Home Visiting Programs: At-risk individuals (e.g., low-income teenage single mothers) are given several interventions on pregnancy, health care, parenting, etc.
• Triple P Positive Parenting: A multi-level system designed to target different at-risk parents.
  • Enhancing knowledge, skills, and confidence.
  • Promoting safe environments for children.
  • Promoting children's competence.
• Triple P is one of the most effective evidence-based parenting programs in the world, backed by over 30 years of ongoing research.

The Triple P

• Aims to prevent problems in the family, school, and community before they arise and to create family environments that encourage children to realize their potential.
• Draws on social learning, cognitive behavioral, and developmental theory, as well as research into risk factors associated with the development of social and behavioral problems in children.
• Equips parents with the skills and confidence they need to be self-sufficient and manage family issues without ongoing support.
• Delivered to parents of children up to 12 years, with Teen Triple P for parents of 12 to 16 year olds.
• Specialist programs include Stepping Stones, Family Transitions, Lifestyle, and Indigenous.

Promoting Evidence-Based Parenting (continued)

• Incredible Years: Designed for kids (3-8) with conduct problems – now a broader age group.
  • Group discussion, videotape examples, behavioral rehearsal.
  • Trains parents to praise positive behaviors, play effectively with kids, and set limits appropriately.

Shared Parenting

• Recognized as a viable post-separation parenting arrangement that is optimal for child development and well-being.
• Shared parenting goes wider than the time each parent spends with their children.
• Involves the child spending a significant proportion of their time with each parent.

Prevention of Violence

• Physical Abuse of Children: Meta-analysis indicates that home visit programs, behavioral parent training, and multimodal programs are effective in reducing abuse.
• Bullying and delinquency: Triple P and Incredible Years are effective in treating these problems.
• School-based programs on anger management and conflict resolution have mixed success.
• Each year, an estimated 200,000 young people aged 10–29 years are murdered, making homicide the fourth leading cause of death for this age group.
• Millions more sustain violence-related injuries that require emergency medical treatment, and countless others go on to develop mental health problems and adopt high-risk behaviors.

Psychological Assessment

• Theoretical orientation impacts the choice of assessment tools used by the clinician
• Generating and refining hypotheses about the client is crucial in psychological assessment
• Importance of being informed about human diversity, including:
  • Age
  • Gender
  • Sexual orientation
  • Culture
  • Religious beliefs
• Psychological assessment involves gathering and integrating multiple types of data from multiple sources and perspectives

Competencies in Psychological Assessment

• All clinical psychologists should be competent in conducting assessments
• Knowledge of:
  • Psychometric theory
  • Scientific, theoretical, empirical, and contextual bases of assessment
• Knowledge, skills, and techniques to assess:
  • Cognitive
  • Affective
  • Behavioral
  • Personality
• Ability to:
  • Assess intervention outcomes
  • Evaluate multiple roles that clients and psychologists function
• Understanding of the relation between assessment and intervention planning

Purposes of Psychological Assessment

• Two types of situations:
  • Assessment-focused services: providing information about a person's current or anticipated psychosocial deficits
  • Intervention-focused services: the first step in gathering information about appropriate treatment

Assessment-Focused vs. Intervention-Focused

• Assessment-focused services:
  • Provide information about a person's current or anticipated psychosocial deficits
  • Examples: child custody evaluations, neuropsychological assessments
• Intervention-focused services:
  • The first step in gathering information about appropriate treatment
  • Examples: intake evaluation at a clinic

Assessment in Clinical Psychology

• Definition and purpose:
  • Clinical assessment involves an evaluation of an individual's strengths and weaknesses, a conceptualization of the problem at hand, and some prescription for alleviating the problem
  • Leads to a better understanding of the client
• Ongoing process
• An iterative decision-making process
• Systematic data collection
• Information about the person's physical, social, and cultural environments

The Referral

• Referral by whom? (e.g. parent, friend, teacher, psychiatrist, judge)
• Referral question(s):
  • What aspect of a patient's behavior needs attention and clarification?
  • Example: Why is Jale disobedient?

Additional Assessment Types

• Screening:
  • A tool often developed to identify a disorder, condition, or characteristic
  • Examples: identifying mental health problems in adolescents
• Diagnosis/Case Formulation:
  • The development of an understanding of the basis/etiology of the problem that informs treatment
  • Knowing the diagnosis for a person helps clinicians communicate with other health professionals and search the scientific literature for information on associated features
• Prognosis/Prediction:
  • An assessment used to see whether a problem will worsen without treatment
  • The clinician's task is to use probabilistic information in a manner that takes into account the unique circumstances of the patient being assessed
  • Accuracy of prediction is a problem, and prediction errors are influenced by the base rate of a problem or diagnosis

Psychological Testing

• Psychological testing: a sample of a person's behavior scored in a standardized process
• Not the same as psychological assessment (which is often more multi-faceted and may not use tests per se)
• Standardization: consistency across clinicians in the procedure used to administer and score a test

Interviewing in Clinical Psychology

• Interviews are used to gather assessment data, develop a collaborative relationship with the client, and serve multiple purposes, including diagnosis, case formulation, problem definition, and goal setting.
• There are different types of interviews, varying in their degree of structure:
  • Unstructured interviews: the psychologist decides what questions to ask and follow up on as the interview unfolds.
  • Semi-structured interviews: allow for some flexibility in questioning and the order of questions.
  • Structured interviews: specify the precise ways questions should be posed and queries made, and define the types of responses necessary to score a particular symptom as present.

Structured Clinical Interview for DSM-5 (SCID-5)

• Used to characterize a study population in terms of current and previous psychiatric diagnoses.
• Helps researchers, practitioners, policy makers, and the general public who are interested in prevalence and incidence estimates of psychiatric disorders among certain populations.
• Also used to improve interviewing skills of students in the mental health professions, including psychiatry, psychology, social work, and psychiatric nursing.

Types of Interviews

• Structured diagnostic interviews:
  • Anxiety Disorders Interview Schedule (ADIS-IV): designed to cover in more depth DSM anxiety disorders and common co-morbid disorders.
  • Primary Care Evaluation of Mental Disorders (PRIME-MD): brief measure used in primary care to screen for mental disorders.
  • Patient Health Questionnaire (PHQ): a diagnostic tool for mental health disorders used by healthcare professionals that is quick and easy for patients to complete.

General Issues in Interviewing

• Attending skills:
  • Attention to body language (e.g., eye contact, leaning forward, head nods).
  • Absence of verbal activity.
  • Restating what the client said and checking if that was correct.
  • Rephrasing/clarifying.
  • Non-directional reflection of feeling.
  • Summarizing.
• Focus on the client:
  • Clinician does not self-disclose or convey personal struggles.
  • Respectful and non-judgmental.
  • Non-blaming stance.
  • Cultural sensitivity.
• Importance of defining the problem:
  • Clients are often vague about presenting problems.
  • Clinician must know what is normative behavior.
  • Questions about the frequency, duration, and intensity of the problem.
  • Questions about the meaning of the problem.
• Importance of defining the goals for treatment:
  • Clients often do not know what therapy can do.
  • Goals must be important to the client.
  • Goals must be expressed in terms of the ways people behave.
  • Goals must be small, simple, and achievable.
  • Goals must be in positive terms (e.g., "how would you know if therapy worked?").

Special Considerations in Interviewing

• Suicide assessment:
  • Importance of asking direct questions.
  • Specific thoughts about suicide.
  • Past attempts.
  • Plans for committing suicide.
  • Ever cut yourself intentionally?
  • Reasons for committing suicide.
  • Friendship or support system in place?
• Interviewing couples:
  • Importance of flexibility and interpersonal skills of the clinician.
  • Structuring and directing the interview.
• Interviewing families:
  • Similar challenges as with couples, but with the difficulty of establishing rapport with many individuals at once.
• Interviewing older adults:
  • Knowledge of life span issues without stereotyping.
  • Possible concerns with declining health, loss of autonomy, bereavement, and mortality.
  • Specific considerations for interviewing older adults, such as:
    • Ensuring good lighting and minimal distractions.
    • Speaking clearly and directly.
    • Using visual and tactile stimuli to enhance communication.
    • Maintaining a respectful and empathetic tone.

Evidence-Based Practice (EBP)

• Interdisciplinary approach to clinical practice that started in medicine as Evidence-Based Medicine (EBM) and spread to other fields
• Focuses on research findings derived from systematic collection of data through observation and experimentation
• Empirically Supported Treatments (ESTs) are clearly specified psychological treatments shown to be efficacious in controlled research with a delineated population

Ethics of Intervention

• Informed consent: Client must agree to services being given and know what works best for a given disorder
• Client should be informed of:
  • Confidentiality and limits of confidentiality
  • Financial arrangements
  • What to expect in therapy
  • Alternative treatments
• Therapist must monitor whether the treatment is working
• Treatment should be based on best-available evidence

Psychotherapy

• Defined by Norcross (1990) as the informed and intentional application of clinical methods and interpersonal stances derived from established psychological principles to modify behaviors, cognitions, emotions, and/or other personal characteristics
• Recognized by APA (2013) as an effective, evidence-based care
• Practiced by professionals from many disciplines (psychology, psychiatry, social work, nursing)

Short-Term Psychodynamic Therapy

• Based on psychoanalytic theories of Freud and recent theorists
• Focuses on:
  • Identification of themes and central conflicts
  • Defensive patterns in the person's life
  • Evoking emotions
  • Goal-setting
  • Termination of therapy
• Has strong evidence of effectiveness in depression, panic disorder, substance abuse, borderline PD, etc.

Interpersonal Therapy (IPT)

• Focuses on problems with communication and dysfunctional relationships
• Emphasizes understanding of current and past relationships
• Brief, usually 3-4 months
• Targets symptom resolution, improved interpersonal functioning, and increased social support
• Focuses on role transitions (becoming a parent, student to professional, etc.)
• Originally developed for depression, but applied to several populations including late life, different cultures, and several disorders (including eating disorders, anxiety, and substance abuse)

Process-Experiential Therapies

• Has roots in existential, humanistic, and client-centered approaches
• Emotionally Focused Therapy (EFT) is a short-term (8-20 sessions) structured psychotherapy approach
• Proposes that human emotions have an innately adaptive potential that, if activated, can help clients change problematic emotional states or unwanted self-experiences

Family Therapy

• A heterogeneous field with different schools and models that share principles and guiding assumptions
• Goals include improvement of family functioning, enhancement of mutual understanding and emotional support, development of coping skills and problem-solving strategies

Group Therapy

• Involves one or more psychologists leading a group of roughly five to 15 patients
• Targets specific problems, such as depression, obesity, panic disorder, social anxiety, chronic pain, or substance abuse
• Can also focus on improving social skills, helping people deal with a range of issues such as anger, shyness, loneliness, and low self-esteem