clinical psychology final sheet.docx

**.Chapter 8** ***Personality traits:*** consistent behaviors, attitudes emotions across time ***Objective personality tests:*** test taker responds to ambiguous stimuli and assessor determines some interpretation of the data. ***Clinical utility:*** do the tests add important and useful informat...

**.Chapter 8** ***Personality traits:*** consistent behaviors, attitudes emotions across time ***Objective personality tests:*** test taker responds to ambiguous stimuli and assessor determines some interpretation of the data. ***Clinical utility:*** do the tests add important and useful information. ***The dispositional approach to personality*** Tries to identify those psychological characteristics which remain relatively stable for a person over time and across situations. ***The person-situation debate in personality psychology*** Refers to the controversy concerning 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, opponents of the trait approach, argue that people are not consistent enough from situation to situation to be characterized by broad personality traits. Behavior= personality x interpretation of the situation. ***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 adapt less to situations. **Self-monitoring:** is a theory that deals with the phenomena of expressive controls. Defined as a personality trait that refers to an ability to regulate behavior to accommodate social situations. People concerned with their expressive self-presentation tend to closely monitor their audience to ensure appropriate or desired public appearances. Self-monitored try to understand how individuals and groups will perceive their actions. **Self-presentation biases** ***Emphasizing the positive:*** people are often motivated to present themselves in a favorable light (job applications). ***Malingering:*** trying to look worse than one is. Falsely or grossly exaggerated complaints with the goal of receiving a reward. ***Random responding:*** is a response set where individuals respond with little pattern or thought. Adds substantial error variance in analyses. ***Validity scales:*** portions of personality tests that are designed to catch these biases. **Validity Scale** Attempt to measure reliability of responses, for example with the goal of detecting defensiveness, careless or random responding. **Not:** projective tests may get around the self-presentation bias issue because the stimuli are ambiguous. **Culturally appropriate measures** The test user must ascertain the test and the test items do not systematically discriminate against one cultural group or another. **Tests can be biased in several ways** - May not be relevant to all cultural groups. - How tests are related may not be equal across groups - Cut-off scores may be different for different groups. - Different factors may exist for different groups. **Culturally appropriate measures** ***Acculturation:*** explains the process of cultural change and psychological change that results following meeting between cultures. The effect of acculturation can be seen at multiple levels in both interacting cultures. ***Acculturative stress:*** is the psychological impact of adaptation to a new culture. People who experience this is often consider it tough and confusing to adjust in the new environment with a wide range of strange things such as language, climate, custom and food. **MMPI-2 (*for adults)* and MMPI-A (*for adolescents)*:** most taught and used personality inventory in clinical psych. The first version used empirical criterion keying (items were chosen that discriminated groups) and the 2^nd^ version used content approach to test construction (developing items that designed to tap a construct rather than how groups responded). **Some MMPI-2 Validity Scales** ***Cannot say (?):*** total number of unanswered items. ***Lie scale (L):*** a measure of self-presentation that is very unfavorable. ***Defensiveness scale (K):*** unwilling to disclose personal information and problems. High K scores increase some other scores. **Validity Scales of the MMPI-2** ***The L scale:*** also referred as the "lie scale", this validity scale was developed to detect attempts by patients to present themselves in favorable light. ***The F Scale:*** this scale is used to detect attempts at "faking good" or "faking bad". ***The K Scale:*** sometimes referred to as the "defensive scale", this scale is a more effective less obvious way of detecting attempts to present oneself in the best possible way. ***TRIN Scale:*** the true response inconsistency scale was developed to detect patients who respond inconsistently. **VRIN Scale:** the variable response inconsistency scale is another method developed to detect inconsistent responses. ***The Fb Scale:*** high scores on this indicate that the respondent stopped paying attention and began answering questions randomly. **MMPI-2 NORMS, RELIABILITY AND VALIDITY** ***Norms:*** developed with large random sample selected form a diverse group in terms of ethnicity ***Reliability:*** good to mediocre depending on scale; test-retest validity is very good. ***Validity:*** enormous amount of data- interpretation is complicated with many clinical and content scales. **MCMI-III AND THE MACI** Focused on DSM diagnostic categories, but otherwise similar in design to the MMPI. ***MCMI:*** is psychological assessment tool intended to provide information on personality traits and psychopathology, including specific psychiatric disorders outlined in the DSM-5. It is intended for adults (18 and over) with at least a 5^th^ grade reading level who are currently seeking mental health services. ***MACI:*** developed specifically for use in clinical, residential, and correctional settings. It is useful primarily in the evaluation of troubled adolescents and may be used for diagnostic assistance in formulating treatment plans, and as an outcome measure. **Measures of Normal Personality Functioning** Used with the general population so no validity scales. ***CPI:*** has similar components as MMPI but unlike MMPI it was created to assess the everyday "folk-concepts" that ordinary people use to describe the behavior of the people around. ***NEO-PI-Revised:*** it keys the big 5 personality traits. ***Achenbach (child behavior checklist CBCL): ASEBA*** offers a comprehensive approach to assessing adaptive and maladaptive functioning. Parents report a series of problems in their children. Provides multi-informant assessment for ages1.5-90+. Is widely used in mental health services, schools, medical settings, child, and family services. ***SLC-90-R:*** the symptom checklist 90-revised is a relatively brief self-report psychometric instrument. It is designed to evaluate a broad range of psychological problems and symptoms of psychopathology. It is also used in measuring the progress and outcome of psychiatric and psychological treatments or for research purposes. Normed on individuals who are 13 years and older. ***Beck Depression Inventory (BDI-II):*** 21-question multiple-choice self-report inventory, one of the most widely used psychometric tests for measuring the severity of depression. It is designed for individuals aged 13 and over and is composed of items relating to symptoms of depression such as hopelessness and irritability, cognitions such as guilt or feelings of being punished, as well as physical symptoms such as fatigue, weight loss, and lack of interest in sex. **Projective Measures** Based on psychoanalytic idea that people project their negative attributes about themselves onto ambiguous external stimuli. However recent evidence indicates that the responses are about the person's experience and personality, not projection per se. ***Rorschach Inkblot Test:*** is a psychological test in which subjects' perceptions of inkblots are recorded and then analyzed using psychological interpretation, complex algorithms, or both. **Thematic Apperception Test (TAT)** Participant tells a story about what they see in the picture. No consistently used scoring mechanism, although the stories are supposed to yield data on needs, emotions, interpersonal relations, and conflicts within individual. Examiners typically focus their attention on one of three areas: the content of the stories that the subject tells; the feelings or tone of the stories; or the subject's behavior apart from responses. **Chapter 9** **Integration and Clinical Decision Making** ***Integrating assessment data*** Descriptive account of the client's level of functioning, importance of understanding client in his/her social and interpersonal environment. Often different assessments / tests provide conflicting results. ***Case formulation*** A clear hypothesis that relates to how a problem developed and how it is maintained. It offers a hypothesis about the cause and nature of the presenting problems and is considered an alternative approach to the more categorical approach of psychiatric diagnosis. Aims to describe a person's presenting problems and use theory to make explanatory inferences about causes and maintaining factors that can inform interventions. No just describe but explains how a person's problem has developed, and how it is maintained so that treatments can be based on influencing those factors. In clinical practice case formulations are used to communicate a hypothesis and provide a framework for developing the most suitable treatment approach. 1. A description of the presenting issues 2. The factors that act to create vulnerability or precipitate the problems developing. 3. Factors that may have been involved in the initial problem developing, but are helping to maintain the problems; and finally, 4. Factors that can help the person cope or act as resources. ***some benefits of a case formulation*** provides connection between various problems. provides guidance on the type of treatment. predicts the patient's functioning with and without treatment provides options if difficulties are encountered in treatment. indicates options, outside of psychological services. ***Components of case formulation*** Description of problems & symptoms Events or stressors that led to the symptoms or problems. Predisposing life events/ vulnerabilities A hypothesized mechanisms that links the problems to the person's current functioning ***Steps of a case formulation*** 1. Develop a comprehensive problem list. 2. Determine the origin, precipitants, and consequences of the problems. 3. Identify patterns among the problems. 4. Develop working hypotheses to explain the problems. 5. Evaluate and refine the hypotheses. 6. In treatment, the hypotheses should be reconsidered, re-evaluated, and revised. **Client factors** Clients may try and under-pathologize themselves. Problems clearly recalling a problem behavior or memories from their past (retrospective recall) Can't assume clients are accurately perceiving/portraying reality. **Clinician factors** ***Self-serving attributional bias:*** bias to make internal, stable, and global attributions for positive events (can seriously affect how clinicians evaluate their effectiveness) Overuse of heuristics (mental short cuts) Biases (gender, ethnic, socioeconomic) Several common decision-making biases **Improving the accuracy of clinical judgment** **Some Important strategies:** Use directly relevant psychometrically sound tests. Check for scoring errors. Use normative data and base rate information. Use *DSM* criteria when making diagnosis. Use decision trees or clinical guidelines. In unstructured interviews be as systematic as possible 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. **Contents of a typical assessment report** Identifying patient/client information Reason for referral Background information (including developmental history, educational & employment history, family & relationship history, medical history, etc.) Assessment methods (including tests administered) Interview data and behavioral observations. Test results (including interpretation of test scores) Diagnostic impressions Summary Recommendations **Purpose of giving feedback on an assessment report** Verify the general accuracy of the assessment results. Refine the interpretation of the results. Put the individual's symptoms in the context of his/her life history and current life circumstances. Provide some psychological relief for the individual by presenting an integrated picture. Provide concrete information about steps to address personal difficulties. Help the individual identify potentially stressful situations. Collaborate to design goals that build on personal strengths. **Chapter 10** ***Prevention programs:*** designed to decrease the risk of serious problems including physical and mental health disorders. ***Community psychology:*** branch of psychology concerned with the reciprocal relationship between the community and the individual. **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- focus on rehabilitation and a long-term adaptation ***Universal preventative interventions:*** applied to general population (vaccines) ***Selective preventive interventions:*** targeted to individuals at high risk of developing a disorder. ***Indicative preventive interventions:*** targeted to individuals at high risk and are showing subclinical signs of the disorder. **Prevention -- Central Concepts** ***Risk reduction model:*** identifying high risk groups and, using research, develops intervention programs. ***Risk factors:*** characteristics of the person or environment that increases chance of developing a disorder. ***Protective factors:*** characteristics of a high-risk person or environment that decreases risk of developing the disorder. **Importance of determining the outcome of program** ***Incidence rates:*** number of new cases each 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. ***Efficiency & effectiveness*** **Promoting evidence-based parenting** ***Home visiting programs:*** at-risk (low-income teenage single mothers) given several interventions on pregnancy, health care, parenting, etc. ***Triple P Positive Parenting:*** multi-level system designed to target different at-risk parents. - Enhancing knowledge, skills, confidence - Promoting safe environments for children - Promoting children's competence **The Triple P** Positive parenting programs are one of the most effective evidence-based parenting programs in the world. Triple P gives parents simple and practical strategies to help them confidently manage their children's behavior, prevent problems developing and build strong, healthy relationships. It 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. **Promoting evidence-based parenting** ***Incredible years:*** designed for kids (3-8) with conduct problems -- now a broader age group. Trains parents to praise positive behaviors, play effectively with lids, and set limits appropriately. ***Shared parenting:*** Shared parenting is widely recognized as beneficial for child development and well-being post-separation, with consensus among researchers, legal experts, and mental health practitioners. It involves children being raised with the love and guidance of both parents, although the exact time spent with each parent can vary and doesn\'t necessarily mean equal time. The term \"shared parenting\" is preferred over other similar terms like \"equal parenting\" or \"co-operative parenting.\" There is a strong recommendation for the legal and psycho-social systems to implement shared parenting presumptions promptly, with full support from professional bodies. **Prevention of Violence** ***Physical abuse of Children:*** meta-analysis indicated 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 successes. ***Violence prevention topics:*** child maltreatment, Inmate partner and sexual violence, elder maltreatment, Collective violence, youth violence, self-directed violence. ***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 successes. ***Olweus bullying Prevention Program:*** focus on changes in school and classroom, produced effective outcomes. ***Fast Track Program:*** focus on engaging the community with a high-risk population -- also noted success in terms of preventing conduct problems. Meta-analysis confirms the success of these programs in decreasing bullying and victimization. ***Anxiety (coping Koala):*** effective program -- identification of at-risk children and treating in group format of children and small number of sessions for parents. ***Coping cat*** is a CBT manualized and comprehensive treatment program for children from 7 to 13 years old with separation anxiety disorder, related anxiety disorders, and/or social phobia. **Prevention of internalizing disorders** The goals of the treatment are three-fold: - The child learns to recognize, experience, and cope with anxiety. - The child learns to reduce his/her level of anxiety. - The child learns to master developmentally appropriate, challenging, and difficult tasks. **Depression:** universal programs not particularly effective. Small effects for selective and indicated programs. **Two types of Universal Programs** ***Interactive:*** word on the development of interpersonal skills (more effective) ***Non-interactive:*** more information based. **Key features of efficacious programs** Universal programs more effective with active parent involvement Develop 1. Identification of social pressures, 2. Work on life skills, 3. Involve several levels of school, home community, 4. Very systematic. **Prevention of problems from trauma or loss** ***Critical incident stress debriefing:*** immediately following a traumatic event with counselors trained to help people process & discuss the experience (in groups) Outcome indicates not helpful and can be harmful (as different people process information differently). Similar findings for bereavement interventions. **Chapter 11** **\#\#\# Study Sheet for Final Exam: Chapter 11 -- Intervention: Overview** **\#\#\#\# Ethics of Intervention** 1\. \*\*Evidence-Based Practice (EBP)\*\* \- Interdisciplinary approach, introduced in 1992. \- Originated in medicine, spread to fields like psychology, social work, education. \- Empirically Supported Treatments (ESTs): Defined psychological treatments shown to be effective. 2\. \*\*Informed Consent\*\* \- Clients must agree to services. \- Adults consent for children; children must assent. \- Clients should be informed about: \- Confidentiality and its limits \- Financial arrangements \- Therapy expectations \- Alternative treatments \- Treatment effectiveness based on best evidence. \#\#\#\# Psychotherapy 1\. \*\*Definition\*\* \- Informed and intentional application of clinical methods to assist in modifying behaviors, cognitions, emotions, or personal characteristics. 2\. \*\*Effectiveness\*\* \- Recognized by APA in 2013 as effective. \- Practiced by professionals from various disciplines. \#\#\#\# Short-Term Psychodynamic Therapy 1\. \*\*Key Concepts\*\* \- Unconscious motivations, conflicts between Id and Ego, transference, and counter-transference. \- Intensive Short-Term Dynamic Psychotherapy (ISTDP) focuses on experiencing warded-off feelings. 2\. \*\*Therapy Versions\*\* \- Supportive-Expressive Therapy \- Time-limited Dynamic Therapy \#\#\#\# Supportive-Expressive Psychotherapy \- Two components: supportive techniques and expressive techniques. \- Focuses on interpersonal relationship issues and the role of drugs in problem behaviors. \#\#\#\# Time-Limited Psychotherapy \- Integrates classical and interpersonal psychoanalytic theory. \- Emphasizes analysis of transference. \#\#\#\# Interpersonal Therapy (IPT) 1\. \*\*Focus\*\* \- Problems with communication and dysfunctional relationships. \- Emphasis on role transitions and resolving interpersonal issues. 2\. \*\*Theory and Techniques\*\* \- Attachment Theory and Communication Theory. \- Techniques include role-playing, communication analysis, and use of interpersonal incidents. \#\#\#\# Process-Experiential Therapies 1\. \*\*Historical Background\*\* \- Rooted in existential, humanistic, and client-centered approaches. 2\. \*\*Emotionally Focused Therapy (EFT)\*\* \- Focus on emotion awareness, regulation, and transformation. \- Effective for depression, couple distress, and survivors of child abuse. \#\#\#\# Cognitive Behavioral Therapies (CBT) 1\. \*\*Behavior Therapy\*\* \- Focus on operant and classical conditioning. \- Key concepts include observation, imitation, and self-efficacy. 2\. \*\*Rational-Emotive Behavior Therapy (REBT)\*\* \- Founded by Albert Ellis. \- Focuses on identifying and disputing irrational beliefs. 3\. \*\*Cognitive Therapy (CT)\*\* \- Developed by Aaron T. Beck. \- Focuses on changing unhelpful or inaccurate thoughts. 4\. \*\*CBT Techniques\*\* \- Active role of therapist, use of research, didactic methods, and homework. \#\#\#\# General Points on Psychological Services \- Licensing ensures educational and experience guidelines. \- Typical visit duration ranges from 5-13 sessions; evidence-based treatments are usually 10-30 sessions. \#\#\#\# Additional Forms of Psychological Services 1\. \*\*Couple Therapy\*\* \- Focus on resolving relationship issues. \- Involves treating the relationship rather than individuals separately. 2\. \*\*Family Therapy\*\* \- Addresses problems within the context of family relationships. \- Focus on improving family functioning and mutual understanding. 3\. \*\*Group Therapy\*\* \- Involves therapy with multiple participants. \- Can target specific issues or general social skills improvement. This study sheet provides an overview of the key concepts and therapies discussed in Chapter 11 on intervention. Use this as a guide to review important points and prepare for your final exam.