Exam 1 Study Guide - Clinical Psychology PDF

Clinical Psychology Exam \#1, Chapters 1-7 These are SOME of the topics on your exam. Not all topics are listed as that would be me giving you all of the answers to your exam. I recommend reading your textbook and going over the lecture presentations, as well as really looking into these topics, t...

Clinical Psychology Exam \#1, Chapters 1-7 These are SOME of the topics on your exam. Not all topics are listed as that would be me giving you all of the answers to your exam. I recommend reading your textbook and going over the lecture presentations, as well as really looking into these topics, to prepare for your exam. Your exam will be 40 multiple choice questions and 10 true-or-false questions. - **What is clinical psychology?** - The psychological specialty that provides continuing and comprehensive mental and behavioral health care for individuals, couples, families, and groups; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth --- one that addresses a wide range of mental and behavioral health problems--- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities, and varied systems." -- American Psychological Association - What are the differences between clinical psychology and various professions? - Related mental health professions:  - Counseling Psychology: cannot diagnose, works with more general cases than clinical psychologists. Includes emotional, social, vocational, educational, health-related, developmental, and organizational concerns AKA everyday stressors and challenges, whereas clinical psychologists have a greater emphasis on pathology - School Psychology: School psychology combines psychology and education to support students' academic, social, and emotional development. - Social Work: Social workers contribute to the human services field by providing **holistic** solutions to the social, behavioral, economic or health problems faced by their clients. Psychologists focus their efforts specifically on helping their patients address potentially damaging mental health issues. - Psychiatry: Hold MD instead of pHd or PsyD. Able to prescribe medication. - Child, family, and geriatric psychology - Clinical neuropsychology: Psychologists focus more on emotions. Neuropsychologists focus on neurobehavioral disorders, cognitive processes, and brain disorders. Neuropsychology is driven more by research, and psychology homes in on the individual. - Forensic psychology - Health Psychology: Health psychologists tend to place most of their energies on improving the health of people, through diet, exercise, stress management techniques, etc. Clinical psychologists tend to exert their energies on helping clients and patients effectively manage their mental and physical conditions   - Different models/perspectives - Psychoanalytic/psychodynamic: 1\. Human behavior is determined by impulses, desires, motives, and conflicts that are often out of awareness. 2\. Psychological problems occur because clients unsuccessfully defend against, and unconsciously replay, internal conflicts experienced in childhood or later in relation to family, peers, and authority figures. 3\. Treatment is aimed at revealing and resolving conflicts and improving ego functioning so as to help clients recognize and change the ways they have behaved in the past. - Humanistic: 1\. Human nature is essentially positive; clients can be understood only by seeing the world from their point of view. 2\. Problems develop when people try to avoid experiencing emotions that are confusing or painful, thus causing them to become alienated from, and unaccepting of, their true selves. 3\. Therapists treat clients as responsible individuals who are experts on their own experiences and who must ultimately make decisions about their lives. 4\. The therapeutic relationship itself is seen as the primary vehicle through which therapy achieves its benefits. The goal is to keep the focus on the client's immediate, moment-to-moment experiences in a supportive atmosphere of honesty and acceptance - Behavioral: 1\. Human behavior is seen as learned through conditioning and observation of others. 2\. Psychological problems are learned behaviors that occur in specific situations or classes of situations. 3\. Behavior therapy focuses on changing environmental factors that had been maintaining learned maladaptive responses. 4\. Treatment methods are based on laboratory research on learning and stresses collection of data to evaluate treatment effectiveness - Cognitive/cognitive behavioral 1\. Behavior develops through learning which is accompanied by expectations, assumptions, beliefs and other kinds of cognitions. 2\. Individuals develop their own ways of understanding events, and those explanations affect how they feel and behave. 3\. Psychological problems develop when people's beliefs are dysfunctional and motivate correspondingly dysfunctional actions. 4\. Therapists engage clients in a rational examination of their beliefs, encouraging them to test their hypotheses, explore alternate beliefs, and practice applying new ways of thinking. - Social systems 1\. Human behavior develops in, and is maintained by, social networks that can support functional behavior but can also lead to psychological disorders. 2\. Treatment is aimed at altering dysfunctional social systems, not just influencing the behavior of an individual identified client. - Biological: 1\. Understanding disordered behavior requires attention to the biological factors and processes associated with it, including genetic, hormonal, neuroanatomical, and neurophysiological variables. 2\. Biopsychosocial explanations of psychopathology take biological, psychological, social, and cultural factors into account. 3\. According to the diathesis--stress model, biological, psychological, and sociocultural factors predispose people to disorder, but it takes stress to trigger it. - Clinical Assessment: - Always done at the first meeting - The collection and synthesis of information to reach a clinical judgment about people and their problems." Bernstein et al. - More formal and systematic  - Usually an outline (demographics, living situations, previous diagnoses, suicide assessment) - Always need to ask: "why are you here"? - Don 't focus just on "the moment"- history! - Required to understand client's problems, diagnose accurately, and treatment planning. - Not all intakes are clinical assessments! Some intakes just see if you are an appropriate fit for a program - - The Steps in a Clinical Assessment 1. Receive and Clarify Referral Question   - "What do I want to know?" and "How can I find it?" - Also go deeper! Follow-up questions - Sources: clients, school, parents, courts. Lots of different sources.  - First step in the goal of assessment.  - Many different types of referral questions, depending on the source of referral. - What are some different types of referral questions these professionals could ask you, a clinical psychologist? - Physicians - "What diagnosis does this client have? - Court  - Employer, government agency, or third party - School - "what is an appropriate educational setting for a child" - Parents - "Is my child suffering from depression"?   2. Planning data collection procedures - Quality of assessment instruments - Psychometric properties! - Practical considerations: time, context, usefulness - Ex: time; could only use one instrument - Child: what would be useful? Age appropriate tests 3. Collecting Assessment Data   - Four main sources to collect from:  - Interviews - 1 on 1 or others (adult needs HIPPA consent) - Observations - What do they look like? Are they always on time to each session? Are they fidgeting? - Judging in a way, but to receive more information. Benefits treatment - Can't make the same observations virtually than in person! - Tests - Different psychometric tests! - Normalcy or deviation - Historical records. - Report cards - Previous psychologist's notes - Can put a time of when things started - Cross validation of information and evaluating treatments. - Ex: client may say they aren't diagnosed with anything but record say they had a diagnosis of depression - Great with kids and adolescents, they aren't necessarily 'lying'. 4. Processing Data and Conclusions - What does the data mean?  - Integrate data from sources.  - What does this all mean? - Answer to the referral question. - "ex: your child needs assistance at school because they are having learning difficulties" 5. Communicating assessment results - Assessment report - Referral source - Sections of the assessment - Source of the information - History of behavioral health/ physical health - I.e thyroid issues associated with depression - Related to referral problem and treatment goals - Clinical interviews: - Intake interviews (not all intake interviews are clinical assessments!) - Establish the nature of someone's problems and assign DSM diagnosis - Take history - Mental Status Exam aka MSE (similar to physical exam): Looks at appearance, affect, mood, insight, judgement, etc. Lot less detailed than a clinical assessment - Problem referral interviews: Address specific referral questions - Example: client seems to struggle with substance abuse, do a specific substance use referral assessment - Orientation interviews: Prepare client for research or treatment - Has understanding of treatment, also if they are a good fit for a treatment module - Debriefing and termination interviews: End treatment and/or research - Crisis interviews: Support and guidance during and after a crisis. - Self harm assessment - Nondirective/Unstructured Interview - Asks open-ended questions designed to help clients continue talking about their concerns - Less prone to client and information that can affect the reliability and validity of interview assessment data - Semi structured interview - Organized set of topics gives interviewer flexibility in wording questions, interpreting answers, and guiding decisions about what to address next - Structured interview - A structured interview in psychology could be a clinical assessment like the \"Structured Clinical Interview for DSM-5 (SCID)\" where a clinician asks a set series of predetermined questions in a specific order to diagnose a mental health disorder, ensuring consistent evaluation across patients by using standardized criteria to assess symptoms and behaviors - Standardized questions: - Every interviewee is asked the same questions in the same order, allowing for reliable comparison between individuals.  - Specific criteria: - Questions are designed to assess specific symptoms or behaviors related to a particular mental health diagnosis.  - Rating scales: - Responses are often scored using a standardized rating scale to quantify the severity of symptoms - Series of specific questions phrased in a standardized fashion and presented in an established order. Allow for reliability and validity - They eliminate open-ended questions and can thwart conversation. - Client/information variance: differences in the ways clinicians answer questions or make observations - Structured interviews are more reliable than unstructured ones - Interview stages +-----------------------+-----------------------+-----------------------+ | Beginning | Middle | Closing | +=======================+=======================+=======================+ | - Opening -- | - Information-gathe | - Reinforce client | | Establish | ring | cooperation | | rapport, make | using | | | client feel | nondirective and | - Discuss plans for | | comfortable | directive | further contact | | | techniques | | | - Establish norms | | | | and expectations | - Pay attention to | | | (frame-setting, | client's | | | mandated reporter | nonverbal | | | clause) | communication | | | | | | | | - Paraphrase aka | | | | use reflections | | | | (restating | | | | client's content | | | | while | | | | highlighting | | | | client's | | | | feelings)  | | | | | | | | | | | | | | | | - Helps client to | | | | understand what | | | | they are saying, | | | | because sometimes | | | | we think without | | | | speaking as well | | | | as we if we are | | | | understanding | | | | what our client | | | | is saying | | +-----------------------+-----------------------+-----------------------+ - Psychological tests and personality tests: - Objectivity - Tests should give similar results - AKA different scores should not be result of clinicians but result of differences among clients.  - Standardization - Same set of materials  - Same ways to evaluate - Same scoring criteria - Tests of intellectual functioning  - Aptitude and achievement tests  - Tests of attitudes, interests, preferences, and values  - Tests of psychopathology  - Tests of personality  - The Stanford-Binet Scales -  The Stanford--Binet Intelligence Scales is an individually administered intelligence test that was revised from the original Binet--Simon Scale by Alfred Binet and Théodore Simon. It is in its fifth edition, which was released in 2003. - It is a cognitive-ability and [[intelligence]](https://en.wikipedia.org/wiki/Intelligence) test that is used to diagnose developmental or intellectual deficiencies in young [[children]](https://en.wikipedia.org/wiki/Children), in contrast to the [[Wechsler Adult Intelligence Scale]](https://en.wikipedia.org/wiki/Wechsler_Adult_Intelligence_Scale) (WAIS). The test measures five weighted factors and consists of both verbal and nonverbal subtests. The five factors being tested are knowledge, quantitative reasoning, visual-spatial processing, [[working memory]](https://en.wikipedia.org/wiki/Working_memory), and fluid reasoning. - The Wechsler Intelligence Scales  - The Wechsler Adult Intelligence Scale (WAIS) is an [[IQ test]](https://en.wikipedia.org/wiki/IQ_test) designed to measure [[intelligence]](https://en.wikipedia.org/wiki/Intelligence) and [[cognitive ability]](https://en.wikipedia.org/wiki/Cognitive_ability) in adults and older adolescents - WAIS, WISC, or SB provide a general measure of intellectual functioning (g or Full-Scale IQ) and a multifaceted description of a person's cognitive strengths and weaknesses. Results can indicate ADD, learning disorders, impulsivity, brain damage. - Most commonly used test - WISC -- Ages 5 to 17 (children) - WAIS -- Ages 17 and up (adults) - Differences between Stanford-Binet and Weschler - The major difference between the Stanford-Binet and Wechsler\'s intelligence tests lies in Wechsler\'s inclusion of both verbal and nonverbal items for a comprehensive measure of intelligence, contrasting with the Stanford-Binet\'s focus on verbal ability and a single intelligence score - The Stanford-Binet is used to assess children\'s cognitive abilities and potential, while the WAIS is used to measure intelligence in adults and older adolescents. - The Stanford-Binet doesn\'t include items that measure specific skills, while the WAIS provides a profile of strengths and weaknesses - MHC: no access to these tests! Or interpretation - So, you must refer clients out - Clinical Psychologists: access - Aptitude test: measures potential - Measure a person\'s potential to develop a culturally valued ability or to succeed in a certain area. They can help determine which career a student might be best suited for. For example, a business might use aptitude tests to assess how well an applicant will fit into the company culture. - These tests measure a candidate\'s various abilities, including mental agility, numerical reasoning, and verbal reasoning. They are often used in recruitment to assess a candidate\'s suitability for a role. - SAT: SAT, the Scholastic Aptitude Test, measures an innate ability, rather than knowledge acquired through schooling; how well you will do in college, potentially (that's a hunk of bull but anyways) - Any reasoning tests - Abstract reasoning tests: These tests measure a candidate\'s ability to understand abstract concepts and patterns. They often use non-verbal questions that show visual images, shapes, and concepts that may be related. Candidates may be asked to manipulate shapes or patterns to identify the next part of a series or to find the odd one out.  - Situational judgment tests: these tests evaluate how a candidate responds in a work setting. They present a scenario based on a typical work situation and ask the candidate to assess the best response or to judge if a given response was appropriate.  - Spatial reasoning tests: also known as spatial awareness tests, these tests assess a candidate\'s ability to analyze unique shapes and how their mind processes still images.  - Deductive reasoning tests: these tests evaluate a candidate\'s ability to think logically and methodically to deduce the correct conclusion from given premises. They are often used to select applicants for jobs in engineering and IT.  - Diagrammatic reasoning tests: these tests evaluate a candidate\'s problem-solving, abstract reasoning, and critical thinking abilities. They typically assess how well a candidate can find shared patterns across diagrams and shapes.  - Achievement test: measures knowledge and skills - Measure a person\'s knowledge and skills that have already been learned. They can help determine if a student is ready to pass a grade level or if they have the knowledge to receive a diploma or certificate. - ACT: tests if you are ready for college, do you have the skills?  - Woodcock-Johnson - The Woodcock-Johnson IV Tests of Cognitive Abilities --Fourth Edition (WJ-IV COG; Schrank, McGrew, & Mather, 2014) is an individually-administered, norm-referenced instrument that measures general intellectual ability (g) and specific cognitive abilities in persons age 2 to 90+ years old. - The Woodcock-Johnson IV Tests of Achievement (WJ IV ACH) is an achievement test that assesses academic skills, such as reading, writing, and mathematics. It can be used to identify strengths and weaknesses in a student\'s academic abilities, and is often used for special education purposes. - Strong Interest Inventory (SII) - The Strong Interest Inventory (SII) is a career assessment tool that helps people identify their interests and work preferences. It\'s used to help people make decisions about their education and career, and can be used for a variety of purposes, including: Choosing a college major, Career development, Employee engagement, and Workforce reintegration - Study of Values (how we 'think')  - General Life Orientation: The Life Orientation Test (LOT) is a standard psychological instrument that assesses one's dispositional level of optimism (are you an optimist or pessimist), providing meaningful insight into possible interventions, such as those ose to address harmful thought patterns. This makes the instrument a useful tool for any practitioner's toolkit. - Objective Tests - Group of tests in questionnaire form - Particular response to structured set of instructions (true/false, yes/no, etc.) - Projective Tests - Based off psychodynamic theory  - Responses reflect psychological needs, drives, and motives  - Scoring is based on examiner's subjective impression and level of skill - Minnesota Multiphasic Personality Inventory (MMPI-2-RF) - Personality Assessment Inventory (PAI) - Millon Clinical Multiaxial Inventory (MCMI-IV) - Eysenck Personality Questionnaire (EPQ-R) - NEO-PI-3 - California Psychological Inventory (CPI)  - Myers-Briggs Type Indicator (MBTI) - Less likely given as a first option due to a lack of objectivity, they only test what is going on with the client internally, hard to score. Also rather dated. - Rorschach Inkblot Test  - Set of inkblots (10) that are shown one by one and asks for the participant to explain what each of them look like/could be  - Gives inside look at how participant perceives their environment/world  - No correct answers, however, some features of inkblot do have ideal responses  - High intellectual functioning is measures by a response that integrates several features of blot  - Examiners grade these exams based on response and how much of the image they described (the whole image, half of it, or a particular detail).  - Good for people with schizophrenic and any psychopathic tendencies - Thematic Apperception Test (TAT)  - Consists of pictures (12) that are open to interpretations - Used in research on motivation and personality and used to assess attitudes towards others  - We're likely to project our needs in responses, even if unaware or reluctant  - In terms of assessing attitudes towards others, its mostly for parents, lovers, and spouses (interpersonal skill) - Interpretations should be a individual telling you a story about the picture, including what is happening in the picture, what led up to the event and what will happen in future  - Projective Tests for Children  - Bender Gestalt Test  - Various techniques such as role-playing, reflections, insight, interpretations: - Build a strong therapeutic relationship in a safe, collaborative, and supportive atmosphere.  - Foster insight by promoting self-examination and self-knowledge. - Provide new information by countering misconceptions, explain how problems can arise, be maintained, and alleviated; assign reading material or other resources. - Assign homework by reminding clients of important points from therapy sessions and encouraging them to practice newly learned behaviors at home. - Reinforces what is discussed in therapy - Develop faith, hope, and expectation for change. - A common psychodynamic technique for promoting insight is interpreting a client's behavior to help the client draw new and more informed conclusions about them. - The "why" to what is happening - When a therapist makes comments designed to prompt clients to examine their thoughts and actions to reach more informed conclusions about them, they are using a technique called interpretations. - What is psychotherapy, why do people go to psychotherapy: Treatment techniques administered by trained mental health professionals within a professional relationship to help clients overcome psychological problems. Why do people go to therapy? - Various reasons (no reason that is correct or incorrect) - Most common: individual's coping strategies are no longer working/helping to deal with problems - Individual recognizes that their life is unmanageable and they're in need of some help - A life stressor (death, pregnancies, divorce, marriage, school, etc.) - Just to talk it out - A referral from another source (doctor, school, employer, friend) - Completely outside and unbiased source (you become that 'safe space') - Treatment planning - Inpatient: client is living at that program - Psychiatric units/hospitals (less than 30 days, severe cases) - Short staffed and lack resources, which is why the stay is short - Residential programs   - Places were one lives, but different tiers, depending on independence - Prisons - Clinicians are usually working on a treatment team - Outpatient  - Intensive outpatient programs (IOP) - Therapy all day long, but you do get to go home   - Continuous drug testing - Offices, schools, and other community locations.  - Ideally, create a sense of privacy and comfort - Remote virtual - Treatment conducted remotely using digital technology - Special ethical issues arise. - Individual therapy - 1 on 1. Clinician and client - Group Therapy  - Lead by group facilitator/ clinical supervisor - Can be effective for many disorders - Best when there is a strong therapeutic alliance and group cohesion - Should not be confrontational interactions and should not be independent.  - Group dynamic, not hyper independent - Big rule: you are not allowed to talk to people outside of the group (breaking group dynamic by having a relationship) - Support groups are different. Facilitated by non-clinician. Less structured and longer time frame - Couples Therapy - Most forms, especially behavioral couples therapy and emotion-focused couples therapy, are effective. - Benefits may not be long-lasting. - Individuals clients are not your client. It's the **relationship** - Family Therapy - Behavioral versions are especially effective in the short-term. - Benefits tend to diminish over time. - Effective to improve communication patterns and problematic behavior in the identified client.  - Notice how each person is playing a part of the problem (heavily focused on intersectionality) - Research on benefits of treatment Ethical Guidelines - There are 5 general principles - 10 ethical standards Main ethical concerns for therapists: - Confidentiality: therapists cannot ethically share information about their clients with anyone except in cases involving suicidal or homicidal intent or abuse of a child or elderly, incapacitated person - Competence: Clinicians are professionally responsible, meaning that they practice only within their areas of expertise. They maintain high standards of scientific and professional knowledge. Clinicians will not engage in assessment or therapeutic practices unless they have had the appropriate education, training and/or supervised experience need for those practices - Informal Consent: therapist is obligated to tell clients about the limits of confidentiality, about potential outcomes of treatment, and about anything else that might affect the clients' willingness to enter therapy. - Conflict of interest: therapists are obligated to maintain therapeutic boundaries which establishes for the client a set of expectations about the roles and interaction patterns that will occur within the therapeutic relationship. A conflict of interest would occur if the therapist's personal interest compete with the best interests of the client. What are the goals of therapy - Build a strong therapeutic relationship in a safe, collaborative, and supportive atmosphere - Foster insight by promoting self-examination and self-knowledge - Provide new information by countering misconceptions, explain how problems can arise, be maintained, and alleviated: assign reading material or other resources - Assign homework by reminding clients of important points from therapy sessions and encouraging them to practice newly learned behaviors at home - Develop faith, hope, and expectation for change Psychotherapy approaches: - Psychodynamic: emphasized exploration of unconscious conflicts and other psychological forces that underline behavior disorders - Humanistic: emphasizes use of the client therapist relationship to create conditions in which clients recognize and act on genuine feelings and reach their full growth potential - Behavioral: emphasizes techniques derived from learning theory to identify and alter specific behaviors associated with psychological disorders - Cognitive and cognitive-behavioral: emphasizes developmental of cognitive skills, especially for identifying unhelpful thinking, evaluating and modifying beliefs, learning to observe even painful thoughts and experiences without criticizing our reactions to them, and changing problematic behaviors, regulating emotions, and referring to others in new way - Social systems: emphasizes the influence of social and cultural forces operating in clients' lives, including experiences of poverty or discrimination. Often conducted in group or family formats Naturalistic observation assessments: - Observation by participant observers - Self-observation (self-monitoring) - Unobtrusive and corroborating measures Controlled observation assessments: - Performance tests - Role playing and staged events - Physiological measures - Virtual reality assessment - Behavioral avoidance test (BATS): a diagnostic tool that measures fear and avoidance behavior. It's used to assess changes in symptoms for obsessive compulsive disorder (OCD) and to measure avoidance in phobias Three unconscious forces shapes personality: - ID: the psychological force that produces instinctual needs, drives, and impulses - Ego: psychological force that employs reason and perates in accordance with the reality principle - Superego: represents a person's values and beliefs Ego defense mechanisms: - Strategies developed by the ego to control unacceptable ID impluses and to avoid or reduce the anxiety they arouse Defense Mechanisms: - Repression: person avoids anxiety by simply not allowing painful or dangerous thoughts to become conscious. - Example: an executive desire to run amok and attack their boss and colleagues at a board meeting is denied access to their awareness - Denial: person simply refuses to acknowledge the existence of an external source of anxiety - Example: you are not prepared for tomorrow's final exam, but you tell yourself that it's not actually an important exam and that there's no good reason not to go to a movie tonight - Projection: personal attributes their own unacceptable impulses, motives, or desires to other individuals - Example: the executive who represented their destructive desires may project their anger onto their boss and claim that it is the boss who is hostile - Rationalization: person creates a socially acceptable reason for an action that reflects unacceptable motives - Example: a student explains away poor grades by citing the importance of the "total experience" of going to college and claiming that too much emphasis on grades would interfere with a well-rounded education - Displacement: person displaces hostility away from a dangerous object and onto a safer substitute - Example: after a perfect parking spot is taken by a person who cuts in front of your car, you release your pent-up anger by starting an argument with your roommate - Intellectualization: person represents emotional reactions in favor of overly logical responses to a problem - Example: a woman who has been beaten and raped gives a detached, methodical description of the effects that such attacks may have on victims - Regression: person retreats from an upsetting conflict to an early developmental stage in which no one is expected to behave maturely or responsibly - Example: a child who cannot cope with the anger they feel toward a rejecting mother regresses to infantile behavior, soiling their clothes and no longer taking care of basic needs Classical conditioning: when two events repeatedly occur close together in time, they become fused in a person's mind. Before long, the person response in the same way to both events Modeling: individuals learn responses simply by observing others and repeating their behavior Operant conditioning: the consequences of a behavior impact the likelihood of that behavior Reinforcers: positive outcomes that increase the likelihood of a behavior Punishment: negative outcomes that decrease the chances of a behavior Self-actualization: a concept regarding the process by which an individual reaches his or her full potential. Existential therapies do not believe that experimental methods can adequately test the effectiveness of their treatments: as a result, little controlled research has been conducted. Carl rogers developed client-centered therapy, a warm supportive approach to treatment that was at odds with the dominant psychodynamic approaches of the time Psychoanalysis: refers to either the theory or the treatment of abnormal mental functioning that emphasizes unconscious psychological forces as the cause of psychopathology Applied science: the use of methods and findings of scientific psychology to solve practical problems of human and animal behavior and experience - Methods for studying psychological treatments