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FAU / Psychology / PSY 4343 / What is the concept of demonology?

What is the concept of demonology?

What is the concept of demonology?

Description

School: Florida Atlantic University
Department: Psychology
Course: CLINICAL PSYCHOLOGY
Professor: Larry miller
Term: Spring 2018
Tags: Psychology, clinicalpsychology, and clinical
Cost: 50
Name: Clinical Psychology Mid Term Study Guide
Description: This is a detailed study guide for Dr. Miller's Clinical psychology midterm.
Uploaded: 02/24/2018
34 Pages 179 Views 49 Unlocks
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CLINICAL PSYCHOLOGY MIDTERM STUDY GUIDE


What is demonology?



EXAM DATE: 03/01/2018

What are some of the landmark events in the history of clinical  psychology? What is its  

relationship to medical psychiatry and academic psychology?  HISTORY

∙ Demonology: Mental illness was viewed in terms of “demonology” or the  belief that demons take over the mind.

∙ Astrology: The studyof the positions and relationships of the sun, moon,  stars.

∙ Somatogenesis: Abnormality is caused by biological disorder or illness. ∙ Psychogenesis: The psychological cause to which a mental illness or  behavioral disturbance may be attributed (as distinct from a physical cause) ∙ In the age of science, concepts of human behavior have typically followed the technological paradigms of the time period.


What is astrology?



Don't forget about the age old question of In what way does faith ringgold’s god bless america differ from jasper johns’s flag?

o EX: Hydraulic model: Brain/Mind is a steam engine; Electric model:  Brain/ Mind is a circuit, etc.)

RELATIONSHIP TO MEDICAL PSYCHIATRY AND ACADEMIC PSYCHOLOGY At first, psychology and psychiatry developed separately.

∙ Psychiatry= medical specialty devoted to treating mental disorders. ∙ Psychology= academic subject devoted to studying the law of behavior ∙ First half of 20th century, psychiatry was dominated by psychoanalysis, a  distinctly “psychological” form of treatment. If you want to learn more check out What is pre-columbian era?

Who were William Tuke, Philipe Pinel, Eli Todd, and Lightner Witmer, and  what did  

they do?

William Tuke

∙ Established the York Retreat in 1796, in response to horrible conditions of  asylums in England.


What is psychiatry?



∙ York Retreat:

o Introduced the idea of moral therapy: religious (Quaker) orientation,  daily prayer, soft restraints when need

o Medical treatment began in 1847

o Inspired the opening of retreat style facilities in Europe and the United  States. If you want to learn more check out What is a segmentary lineage?

Phillipe Pinel

∙ Advocated for the humane treatment of the mentally ill. ∙ PRECEDING (meaning BEFORE) Freud, Pinel pioneered the use of case  history and talking therapy as methods for studying and treating mental  patients.

∙ Instituted reforms at several hospitals; mostly known for the reforms at The  Saltpetriere.

Eli Todd  

∙ Successful and respected physician at Hartford, CT

∙ 1791- opened a clinic for smallpox inoculation.

∙ 1824- established the Retreat

o Following Pinel, emphasized the humane treatment of mentally ill. ∙ Pioneered the democratic treatment model: giving patients a say in their  own treatment. We also discuss several other topics like What is physicalism?

∙ Was extremely against the evils of alcohol  

Lightner Witmer (The FATHER OF CLINICAL PSYCHOLOGY) ∙ Studied with famous European and American psychologist, and was steeped  in the scientific tradition.

∙ Sought to make psychology a scientifically-informed clinical field. ∙ 1896- Opened the first psychological clinic at the University of  Pennsylvania to treat children with learning disabilities.

∙ 1907- Began a journal, The Psychological Clinic, and coined the term  clinical psychology 

∙ Believed clinical psychology to have a collaborative relationship with allied  fields (medicine, social work, education); BUT to exist as a distinct,  autonomous profession, anticipating clinical psychology’s status today.

∙ Some where cristales of psychology separating itself professionally from  medicine  We also discuss several other topics like Who were the sadducees?

o Cf. Cummings

How did psychologists’ participation in the two world wars influence the  field of clinical  

psychology?

WORLD WAR I (1914-1918

∙ First technological war: death on a massive scale and need for smarted  soldiers and officers.

∙ Psychologist (with their training in quantitative psychometrics) distinguished  themselves as experts in mental testing, especially intellectual and ability tests applied to military personnel.

o Many tests still in use today.

∙ 1920’s & 1930’s: clinical psychology largely remained an assessment field,  only a few sporadic practitioners treating patients.  If you want to learn more check out Name one of edward bellamy's popular novels.

o Psychotherapy continued to be dominated by psychoanalytically  trained psychiatrists.

WORLD WAR II (1939- 1945)

∙ More cases emerging of “shell shock” and “combat fatigue” in military  personnel.

∙ Many psychiatrists were conscripted into military medical service, leaving a  gap in menatla health treatment providers for soldiers.

∙ While continuing their primary role as “mental testers”, more psychologists  were recruited to provide therapeutic services.

∙ While predominantly following the psychodynamic model, psychologist  contributed to the innovation of effective short-term treatment  modalities that could be applied in military settings.

What are the scientist-practitioner and practitioner-scholar models of  clinical psychiatry?

Scientist-Practitioner Model

∙ Also called Boulder Model, is a training model for graduate school programs  that aspires to train applied psychologists with a foundation of research and  scientific practice.

Practitioner-Scholar Model

∙ Focused on the practical application of scholarly knowledge.

∙ More emphasis on the delivery of services in practice and less emphasis on  research productivity.

What were the major developments in clinical psychology from the second  half of the  

20th Century to the present?

Developments in Later 20th Century

∙ 1940’s-1960’s – Empowered by their military experience,  

∙ more psychologists became involved in psychotherapy, although they were  still outnumbered (and in some cases, fiercely resisted) by psychiatrists.  ∙ 1949 – Boulder Conference affirmed the necessity of both research and  practice for the training of PhD psychologists, establishing the scientist practitioner model of clinical psychology.

∙ 1973 – Vail Conference recognized the growing schism between academic  and clinical psychology. Sought to establish Psychology as a distinct practice  profession with the introduction of the PsyD degree, informed by the  practitioner informed by science model.

∙ 1960’s -1970’s – Insurance companies began authorizing  

∙ benefits for evaluation and treatment by psychologists.  

∙ Emergence of other practice professions in the psychotherapy field, e.g.  social workers, mental health counselors, etc.

∙ Also, a time of virtually unregulated expansion of psychotherapy and  counselor professions, along with untested, bizarre, and in some cases,  harmful “treatments,”  

∙ threatening to alienate psychotherapy from mainstream healthcare. ∙ 1980’s – With continuing advancement in psychopharmacology, the field of  psychiatry rebranded itself as a rigorously empirical medical profession,  seeking to consolidate their monopoly on prescribing privileges and  distinguishing themselves as the “real” doctors with the publication of DSM-III in 1980.  

∙ Meanwhile, mental health consumers still wanted talk therapy, and clinical  psychology grew to about 50% of all doctoral degrees awarded. ∙ Psychology also expanded into the areas of neuropsychology, health  psychology, and military psychology.

∙ 1990’s-2000’s – Proliferation of master’s-level clinicians competing with  psychologists, at the same time as managed care insurance programs began  to sharply limit the scale of mental health services.

∙ Coming full circle, psychologists began to lobby for prescribing privileges,  first achieved in the military setting because of a need for practitioners (cf.  WWII).

∙ Also, development of new and innovative models of mental health care  delivery, in addition to traditional, office-based practice: neuropsychology,  forensic psychology, police psychology, business consulting, media, etc.

In most states, including Florida, what are the major independently  licensed mental  

health professions, and how do they differ? What types of general or  unique services  

does each provide?

Getting Licensed

∙ Licenses issued by each state’s Department of Professional Regulation. ∙ Some states may or may not have reciprocity.

∙ Licensure usually reissued biannually, after fulfilling certain requirements. ∙ License required to:

o Practice independently (without supervision).

o Receive third-party reimbursement (insurance,government contract,  etc.).

o Present credibility in professional services.

∙ 3 primary license-eligible clinical psychology degrees: o PhD – Academic orientation, usually requires experimental research  dissertation.

o PsyD – Practice orientation, often requires clinical case study  dissertation.

o EdD – Practice orientation, geared toward educational concerns. o In practice, the professional activities of these three degree holders  differ little, except insofar as the psychologists’ interests are unique to  them.

Licensed Mental Health Profession

∙ License-eligible Masters-level degrees:

o LCSW: Licensed Clinical Social Worker – 2-year degree plus 1-year  supervision for licensure. Can do most forms of psychotherapy.

o LMHC: Licensed Mental Health Counselor – 2-year degree plus 1- year supervision for licensure. Can do most forms of psychotherapy. o LMFT: Licensed Marriage and Family Threrapist – 2-year degree  plus 1-year supervision for licensure. Can do most forms of  

psychotherapy, but tend to specialize in marriage, family, and child  issues.

∙ Other professions who may provide mental health services: o Psychologist: Mental health profession who evaluates and studies  behavior and mental processes. Can be a researcher (who makes  abstract studies of mental disorders and their treatments) or can be  licensed to see and treat patients in a therapeutic setting.

o Psychiatrists – Medical doctors whose residency was in psychiatry.  May practice psychotherapy, but now almost exclusively focus on  psychopharmacology.

o Psychiatric Nurses – Usually require Masters-level nursing degree  plus mental health training. Can do many forms of psychotherapy and  may have limited prescribing privileges.

o CAP : Certified Addictions Professional – Not an independent licensed  pracitioner, but certified to provide clinical services usually restricted  to an addictions treatment setting and supervised by a licensed  clinician.

What are some recommendations for undergraduate Psychology majors  who are  

preparing for graduate study?

Undergraduate Recommendations for Graduate Study

∙ Decide what you want to do: which degree and program is most suitable  for your goals and professional interests?

∙ Take the right courses: depends on availability, but cover the basic  sciences and liberal arts, and don’t overload on psych courses.

∙ Get to know your professors: you’re going to need letters of  recommendation, so don’t be a “brilliant ghost.” Make yourself stand out (in a good way) from the hundreds of other students each professor may teach  each year.

∙ Get research, practice & publication experience: preferably all three.  Demonstrate your commitment to the field by getting involved in  departmental and extracurricular activities.

∙ Get good grades: to graduate school search committees, size (of GPA) does  matter (a lot).

∙ Get high GRE scores: this is more important for some programs than  others, but prepare well

∙ Join professional associations as a student (e.g. APA, FPA, etc.) ∙

What are the steps one takes to become a clinical psychologist? Graduate School (Doctoral Program)

∙ First two years are mainly coursework.

∙ Then, gradual move into more clinical training and/or research, depending on  the program (PhD,PsyD) for the next two years or so.

∙ The final year of the program usually involves a predoctoral internship. Awarded Degree, next is LICENSURE

∙ Next, you need to study for and take your state licensing exam. ∙ Many states and programs require a post-doctoral internship to provide a  year of post-doctoral supervision (or may be in another setting). ∙ Licensing exam usually consists two parts: (1) substantive section, and  (2) state laws and rules

∙ In some states, if you have a non-clinical doctoral degree in psychology, you  may be able to sit for the licensing exam after getting a certain number of  hours of clinical supervision, but this is becoming less common.

∙ Once you are licensed, you must renew it every biennium (2 years) by taking  a certain number of state-approved continuing education (CE) credits through a variety of sources.

Board Certification (NOT Required)

∙ The American Board of Professional Psychology offers board certification in 13 specialty areas,including clinical psychology, forensic psychology, health  psychology, neuropsychology, organizational psychology, rehabilitation  psychology, and others.

∙ Eligibility for board certification usually requires (1) documentation of  experience in the specialty; (2) a work sample; (3) a written exam; and (4) an oral exam.

What is the role of research in the practice of clinical psychology? Research in Clinical Psychology

∙ Research in the mental health fields burgeoned following the free-wheeling,  “anything goes” practices of the 1970’s.

∙ Scientist-practitioner model should put psychologists in an advantageous  position to evaluate the validity of a wide range of claims about theory and  practice.  

∙ Even if you don’t conduct research, training in the scientific method should  equip you with adequate b.s.-detection skills.

∙ Psychological research employs two main methodologies: o Case study approach: ideographic: “thick” description: multiple  detailed observations on a small number of subjects: good for  

generating hypotheses.

o Experimental approach: nomothetic: “thin” description: study  limited number of variables on a large pool of subjects: good for  testing hypotheses.

∙ Treatment efficacy: how does this intervention compare overall to other  interventions for the same condition in similar subjects?

∙ Treatment effectiveness: how well does this intervention work for this  particular patient?

∙ Empirical research has in fact established the efficacy and effectiveness of  many kinds of psychotherapies for mental disorders and problems in living,  with success rate equaling or exceeding that of many standard medical  procedures used for physical disorders.

∙ Move in medical practice to evidence-based treatment.

∙ Move in mental health field to manualized therapy: pros and cons. ∙ Publication in clinical psychology: peer-reviewed journals vs. popular press;  case studies, empirical research, assessment and treatment guide

What are some of the important principles of daily practice in clinical  psychology?

Career Activities

∙ Clinical practice: tremendous diversity.

o Assessment.

o Treatment.

∙ Areas of specialization: adults, children, trauma victims, organizational  consulting, LGBTQ issues,  

∙ etc.

∙ Most practicing psychologists are both generalists and specialists. ∙ Forensic psychology.

o Assessment.

o Testimony.

o Areas of specialization within this field.

∙ Teaching, research & publication: usually associated with academic  psychologists at universities. Some clinical psychologists are full-time faculty  members, most teach as adjuncts because of their clinical time  commitments.

∙ Private practice, institutional setting, or both.

What are the rules, restrictions, and limits on psychologist-patient  confidentiality?

Confidentiality

∙ Mental health practitioners have always sought to maintain the highest  standards of confidentiality.

∙ 1996 – Health Insurance Portability and Accountability Act (HIPAA):  applied standards to all medical and clinical practices.

∙ 1996 – Jaffee v. Raymond: U.S. Supreme Court ruling created  psychotherapist-patient privilege, on a par with lawyer-client privilege. ∙ Fiduciary relationship: who is the patient or client?

∙ Mandated or third-party referrals, e.g. pre-employment screening, FFDE,  forensic evaluations, etc.

Exceptions to Confidentiality

∙ Mandated or third-party referrals, e.g. pre-employment screening, FFDE,  forensic evaluations, etc.

∙ Danger to self or others: discretionary decision by psychologist: no duty-to protect law in Florida (cf. Tarasoff case).

∙ Mandated reporting of child, elder, or disabled abuse in every state: must  report reasonable suspicion.

What are some of the clinical-professional boundary relationships that  psychologists  

must be on guard for?

Clinical-Profesisonal Boundaries

∙ Dual Relationship- the participation in more than one role with the same  client.

o Should ALWAYS avoid entering into a dual relationship with a client. ∙ Boundary Violations: BIOTP standard.

∙ Professional Boundary Violation= any interaction not in the best clinical interest of the patient because it:

o Compromises the psychologist’s effectiveness.

o Coerces or exploits the patient in any way.

∙ Most violations involve sexual or financial transactions.

What types of competencies must clinical psychologists have in order to  practice  

effectively?

Competencies in Clinical Psychology

∙ Professional competence: education, training, experience, learning  orientation (or style).

∙ Cultural competence: skill in dealing with diverse types of people.

What is the role of diagnosis in clinical psychology? What is the  relationship between  

diagnosis and treatment?

Role of Diagnosis  

∙ Observation.

∙ Classification.

∙ Correlation.

∙ Causation.

∙ Explanation.

∙ Control.

∙ To be useful, a diagnosis must be:  

∙ Reliable.

∙ Valid.

∙ Diagnoses may be:

∙ Categorical.

∙ Dimensional.

Even though we are now two years into DSM-5, many organizations still  use the diagnostic model of the previous DSMs. What are the five axes of  DSM-III through DSM-IV-TR?

5 Axes of DSM-III through DSM-IV-TR

∙ Axis I: Is a clinical syndrome (cognitive, anxiety, mood disorders [16  syndromes]) present?

∙ Axis II: Is a Personality Disorder or Mental Retardation present. ∙ Axis III: Is a General Medical Condition (diabetes, hypertension or  arthritis etc.) also present.

∙ Axis IV: Are Psychosocial or Environmental Problems (school or housing  issue) also present?

∙ Axis V: What is the Global Assessment of the person’s functioning.

What are the main differences between the new DSM-5 and the previous  DSMs?

DSM-5 Major Changes

∙ Arabic, not Roman numerals.

∙ No more axes.

∙ No GAF.

∙ New diagnoses, revised diagnostic criteria, and category shuffling. ∙ Inclusion of diverse organic brain syndromes.

∙ Coordination with ICD-10.

What is the difference between a delusion and a hallucination. Delusion

∙ A false belief or thought

Hallucination

∙ A false or irrational perception

o Your senses (usually sight and auditory) are involved

What is the meaning of a sign, symptom, syndrome, and disorder? Sign

∙ Objective, observable feature, characteristic or behavior of a patient. o EX: Limping

Symptom

∙ Subjective experience reported by the patient.

o “My leg really hurts.”

Syndrome

∙ Set of regular occurring signs and symptoms with a common etiology and  predictable course.

Disorder

∙ Syndrome that causes significant distress the the patient or others.

What are the different types of clinical interview format, and what are the  uses of each? How can they be integrated?

Clinical Interview Formats

∙ Directive vs. nondirective interview.

∙ Structured vs. un(less)structured interview.

∙ Continuum, not dichotomy.

∙ May be different interview styles for different patients &/or different  phases of the interview.

∙ Time constraints: single encounter or continued sessions. ∙ Standardization, balance, flexibility.

∙ Adversarial interviews.

What are the types of active listening techniques that are useful in clinical interviewing.

Active Listening Skills

∙ Emotion labeling.

∙ Paraphrasing.

∙ Reflecting/mirroring

∙ Minimal encouragers.

∙ Silence.

∙ “I” messages.

∙ Open-ended questions.

∙ Real crises: mix, match & combine tactics.

∙ Listing in for feelings.

∙ Observing body language

o Eye contact: engaged= not detached, not threatening.

o Body activity: posture, movement, behavioral echoing.

o Nonverbal behavior allows important information to be obtained and  contributes to enhanced rapport.

What are the essential components of a competent, ethical clinical  interview?

Ethical Clinical Interview Components

∙ Presenting problem: why are you here?

∙ History of the problem: how did things get this way?

∙ History of the person: medical, family, development, education,  employment, legal, military, religious, cultural.

∙ Signs, symptoms, and syndromes.

∙ Mental status exam: screening for cognitive, emotional, and behavioral  status.

∙ General appearance: Is the client put together or desheveled?  ∙ Mood: Happy? Sad? Angry?

∙ Interpersonal engagement, relatedness, rapport: Are they contributing  any insight or thoughts to the session?

∙ Motor activity: immobile to agitated.

∙ Orientation x3: time, place, person.

o Are they aware of where they are, who they are, and the time period  they are in?

∙ Perception: distortion, hallucination.

∙ Cognition: concrete, confused, delusional.

∙ Attention and concentration.

∙ Memory: many types.

∙ Speech:

o Aphasic: Lack of speech

o Tangential:  

o Circumstantial:

o Pressured:

o Slow:

∙ Intelligence: general estimate or specific tests.

∙ Reality orientation: insight, judgment.

∙ MMSE.

What are the issues surrounding confidentiality and informed consent? Confidentiality

∙ Part of ethical guide lines and means that information between patient and a  therapist cannot be shared with anyone.

o Psychologist may disclose private information in order to protect the  client or the public from harm.

o Psychologists are required to report ongoing domestic violence, abuse  or neglect of children, the elderly, or people with disabilities.

o May release information if court ordered.

Informed Concent

∙ Permission granted in the knowledge of the possible consequences, typically  the which is given to a patient by a doctor for treatment with full knowledge  of the possible risks and benefits.

What are some of the similarities and differences between an interview for individual patient treatment and an interview in a mandated referral or  litigation setting?

Interview for Treatment

∙ Almost always a positive relationship between client and therapist. ∙ The client is usually there by choice.  

∙ The therapist is there to help the client.

Interview in a Mandated Referral or Litigation

∙ Usually court-ordered to be used in an upcoming case.

∙ Client is forced to undergo the interview (not by choice)

∙ Clinician is there to obtain information and possibily to assess competencies  of client.

∙ Not a very positive relationship between clinician and client.

What are some features of a crisis interview?

Crisis Interview Featurs

∙ Main contexts.

o Suicidal patient.

o Hostage-barricade scenario.

o Crime or disaster victim.

∙ Assess for:

o Suicidal/homicidal intent or plan.

o General mood & cognition.

o Level of self-control.

∙ Crisis interview is really a combination of interview & intervention:  may rely heavily on active listening techniques.

What are some of the dimensions and characteristics of intelligence? Types of Intelligence

∙ Verbal vs. visuospatial.

∙ Fluid vs. crystallized.

∙ Academic vs. practical.

∙ Multiple intelligences.

o Howard Gardner coined the theory of multiple intelligence: Logical,  spatial, body, musical, interpersonal.

What are the main differences between the WAIS and WAIS-R and the  subsequent  

WAIS-III and WAIS-IV?

WAIS

∙ Included non-verbal (know as performance scales) as well as verbal items  for all test takers.

∙ Six verbal subtests:

o Information, Comprehension, Arithmetic, Digit Span, Similarities, and  Vocabulary.

∙ Five performance subtests.

o Picture Arrangement, Picture Comprehension, Picture Completion,  Block Design, Object Assembly, and Digit Symbol

WAIS-R

∙ Administration changes

∙ Iterm and scoring changes.

∙ Same 11 subtests.

WAIS-III

∙ Updated the norms.

∙ Extended the age range.

∙ 3 new subtests added

∙ New four factor clinical model

∙ Decreased reliance on time performance.

∙ Extensive testing of reliability and validity.

∙ Enhanced fluid reasoning measurement.

WAIS-IV

∙ Revision to Goal

o Improve psychometric properties

o Provided theoretical foundation for the measurement of intelligence. ∙ Improvement to the measurement of fluid reasoning, processing speed, and  working memory.

∙ Improved reliability and validity.

∙ Changes to subtests  

On the WAIS-IV, what do the VCI, PRI, WMI, and PSI measure? What are  their component subtests?

WAIS-IV  

∙ Verbal Comprehension Index

o Similarities

o Vocabulary

o Information.

o Comprehension

∙ Perceptual Reasoning Index

o Block Desing

o Matrix Reasong

o Visual Puzzles (Picture completion)

∙ Working Memory

o Digit Span

o Arithmetic.

o Letter-Number Sequencing

∙ Processing Speed

o Symbol Search

o Coding

How does one go about administering, scoring, and interpreting the  Wechsler IQ scales?

Administering  

∙ Wechsler IQ tests are individually administered,  

∙ face-to-face tests: labor-intensive.

∙ Subtests are administered in a standardized order,  

∙ with standardized instructions, based on the manual. 

Scoring

∙ Individual subscale scores are added within categories.

∙ Raw scores are converted to subscale scores by  

∙ using age-normed tables.

∙ Hand scored or computer scored

Interpreting

∙ Subscale scores may be expressed as:

o IQ scores.

o Percentiles.

o Descriptors.

∙ IQ scores fall along a normal curve, with x=100 and a SD=15.

Be able to identify the IQ score ranges that belong with the descriptors:  Very Superior,  

Superior, High-Average, Average, Low-Average, Borderline, and Impaired  (Mental  

Retardation).  

IQ Range (“deviation IQ”) IQ Classification

∙ 130 and above Very superior

∙ 120-129 Superior

∙ 110-119 High average

∙ 90-109 Average

∙ 80-89 Low average

∙ 70-79 Borderline

∙ 69 and below Extremely low (Mental retardation maybe?)

What is the Flynn Effect?

The Flynn Effect

∙ Refers to the gradual improvement in intelligence scores over the last several decades.

What are the main difference between objective and projective personality tests?

PROJECTIVE Personality Test

∙ Typically based on psychodynamic models of the mind: influence of  unconscious forces on conscious behavior.

∙ Utilize ambiguous stimuli onto which the subject will project his  unconscious wishes, fears, and fantasies.

∙ Idiographic vs. nomothetic approach.

∙ Rich data, but verifiable?

o Since the information they are providing is very subjective, it is difficult to validate.

∙ Face-to-face administration: labor-intensive in  

∙ administration and interpretation.

∙ Based on PROJECTIVE HYPOTHESIS:

o When people attempt to understand an ambiguous or vague stimulus,  their interpretation of that stimulus reflects their needs, feelings,  experiences, prior Conditioning, and thought processes.

∙ Ambiguous stimuli that have been used include:

o Ink blots (Rorschach)

o Ambiguous pictures (Themantic Apperception Test)

o Sentence stems

OBJECTIVE Personality Test

∙ Nomothetic approach.

∙ Unambiguous questions: T-F, multiple-choice, rating scales.

∙ Paper-and-pencil, not face-to-face.

∙ Group administration possible.

∙ Computers: may not even need a human to administer and score the test. ∙ Validated against known groups: how much does current subject  resemble these groups?

∙ Examples of Objectiver Personality Tests

o Minnesota Multiphasic Personality Inventory (most widely used objective personality test) 

What are the main features of the administration, scoring, and  interpretation of the Rorschach and TAT?

Rorschach Test

∙ Developed by Hermann Rorschach in 1921.

∙ 10 ink blots, 5 B&W, 5 color.  

∙ Free-association phase.

∙ Inquiry phase.

∙ Subjective interpretation.

∙ 1980’s – John Exner develops the Comprehensive Rorschach System. o Standard administration, scoring, and interpretation of the inkblots.  o Retains basic psychodynamic orientation.

o Addresses reliability issue, but not validity issue.

∙ Comprehensive Rorschach System: Exner criteria.

o Location: whole, parts, details.

o Determinants: form, color, shading.

o Form quality: identifiable, obscure, conventional, idiosyncratic,  distorted.

o Popular: frequently identified or unusual responses.

o Content: objects, animals, body parts, static or active.

Thematic Apperception Test

∙ TAT developed in 1935 by Henry Murray and Christina Morgan. ∙ Based on Murray’s psychological needs theory. 

o Primary Needs: basic needs that are based on biological demands (a  y gen, food, water).

o Secondary Needs: Psychological needs, such as the need for  nurturing, independence, and achievement. These needs are essential  for psychological well-being.

∙ 31 cards: usually only use about 10 in any given test session. ∙ Interpretation based on clinician’s judgment.

∙ Formal scoring systems have been developed, but are rarely used.

What are the validity scales and the clinical content scales of the MMPI-2  and what do  

they measure? How are the scales combined to yield a useful personality  profile of a  

particular patient?

MMPI Validity Scales

∙ L = Lie scale: inconsistency of responding.

∙ F = Frequency: “fake-bad” responding.

∙ K = Correction: “fake-good” responding.  

∙ Other validity scales.

MMPI Clinical Content Scales

∙ Hypochondriasis: concern with bodily symptoms.

∙ Depression: Depressive symptoms.

∙ Hysteria: Awareness of problems and vulnerabilities.

∙ Psychopathic Deviate: Conflict, struggle, anger, respect for societies rules. ∙ Masculinity/Femininity: stereotypical masculine or feminine interests/  behaviors.

∙ Paranoia: Level of trust, suspiciousness, sensitivity.

∙ Psychasthenia: Worry, anxiety, tension, doubts, obsessiveness. ∙ Schizophrenia: Odd thinking and social alienation.

∙ Hypomania: Level of excitability

∙ Social Introversion: People orientation.

What are the main features of the other personality tests we discussed in  class?

What are some of the types of patients who might be referred for a  neuropsychological  

assessment?

Million Clinical Multiaxial Inventory-III (MCMI-III)

∙ 2nd most used objective personality test

∙ Designed to assess DSM-IV-TR personality disorders and clinical  symptomatology (axis II)

∙ Adolescent version also exists

∙ 175 true/false items take 25 minutes

∙ Has six different major scales

o Clinical Personality Pattern Scale

o Severe Personality Pathology Scales

o Clinical Syndrome Scales

o Modifying Indices

o Validity Index

California Psychological Inventory

∙ Developed for sue with relatively well-adjusted individuals.

∙ Assesses individual’s strengths and positive personality attributes. ∙ MMPI was the basis for CPI’s development.

∙ Takes 45-60 minutes to complete.

∙ Pencil and paper or computer based.

∙ Brief form used for organizational training and evaluation.

∙ CPI 260 specifically developed for managerial assessment and leadership  training.

5 Factor Personality Inventory

∙ Openness: Curious, original, intellectual, creative, and open to new ideas. ∙ Conscientiousness: Organized, systematic, punctual, achievement  oriented, and dependable.

∙ Extraversion: Outgoing, talkative, sociable, and enjoys being in social  situations.

∙ Agreeableness: Affable, tolerant, sensitive, trusting, kind and warm. ∙ Neuroticism: Anxious, irritable, temperamental, and moody.

What are some of the types of patients who might be referred for a  neuropsychological assessment?

Patients Referred for a Neuropsychological Assessment

∙ Older age: dementia, stroke, etc.

∙ Younger age: ADHD, LD (Learning disability), etc.

∙ Any age: PCS (psychological counseling services), clinical & forensic. ∙

What are the main features of the neuropsychological tests we discussed  in class?

Neuropsychological Assessment: COMPONENTS

∙ Record review: integrate many sources.

∙ Clinical interview.

∙ Collateral interviews: may be especially important.

∙ Behavioral observations.

∙ Neuropsychological test findings.

∙ Conclusions & diagnosis.

∙ Recommendations.

What are the advantages and limitations of using fixed vs. flexible  neuropsychological  

test batteries. How do many neuropsychologists integrate these two types of testing?

Fixed Battery Approach 

∙ Provides a comprehensive assessment overview; focus is on the outcomes of  the testing

o Matrix approach.

o Standardized

∙ Problem:  

o Time and cost

o Individual deficits may hinder performance.

o Collection of unimportant information.

o Relies on availability of quality norms.

o Hard to measure reliability because it takes to long to implement. ∙ Advantage:

o Systematic.

o Comprhensive.

o Objective interpretation.

o Easy to be trained in.

o Easy to replicate.

o More acceptable in a legal setting.

Flexible Battery Approach 

∙ Examiner chooses test instruments on the basis of the patient’s history and  presenting symptoms, and on the basis of the outcome of any prior testing  that may have been done.

o Can also be called “patient-centered testing”

∙ Looks at qualitative as well as quantitative data.

∙ Problem:  

o Norming  

o Overlapping  

o Score conversion

o Replication

o Need extensive training

o Susceptible to bias.

∙ Advantage:  

o Patient-tailored approach.

o Can focus more on the relevant domains.

o Emphasis is on the process rather than the outcome.

CLINICAL PSYCHOLOGY MIDTERM STUDY GUIDE

EXAM DATE: 03/01/2018

What are some of the landmark events in the history of clinical  psychology? What is its  

relationship to medical psychiatry and academic psychology?  HISTORY

∙ Demonology: Mental illness was viewed in terms of “demonology” or the  belief that demons take over the mind.

∙ Astrology: The studyof the positions and relationships of the sun, moon,  stars.

∙ Somatogenesis: Abnormality is caused by biological disorder or illness. ∙ Psychogenesis: The psychological cause to which a mental illness or  behavioral disturbance may be attributed (as distinct from a physical cause) ∙ In the age of science, concepts of human behavior have typically followed the technological paradigms of the time period.

o EX: Hydraulic model: Brain/Mind is a steam engine; Electric model:  Brain/ Mind is a circuit, etc.)

RELATIONSHIP TO MEDICAL PSYCHIATRY AND ACADEMIC PSYCHOLOGY At first, psychology and psychiatry developed separately.

∙ Psychiatry= medical specialty devoted to treating mental disorders. ∙ Psychology= academic subject devoted to studying the law of behavior ∙ First half of 20th century, psychiatry was dominated by psychoanalysis, a  distinctly “psychological” form of treatment.

Who were William Tuke, Philipe Pinel, Eli Todd, and Lightner Witmer, and  what did  

they do?

William Tuke

∙ Established the York Retreat in 1796, in response to horrible conditions of  asylums in England.

∙ York Retreat:

o Introduced the idea of moral therapy: religious (Quaker) orientation,  daily prayer, soft restraints when need

o Medical treatment began in 1847

o Inspired the opening of retreat style facilities in Europe and the United  States.

Phillipe Pinel

∙ Advocated for the humane treatment of the mentally ill. ∙ PRECEDING (meaning BEFORE) Freud, Pinel pioneered the use of case  history and talking therapy as methods for studying and treating mental  patients.

∙ Instituted reforms at several hospitals; mostly known for the reforms at The  Saltpetriere.

Eli Todd  

∙ Successful and respected physician at Hartford, CT

∙ 1791- opened a clinic for smallpox inoculation.

∙ 1824- established the Retreat

o Following Pinel, emphasized the humane treatment of mentally ill. ∙ Pioneered the democratic treatment model: giving patients a say in their  own treatment.

∙ Was extremely against the evils of alcohol  

Lightner Witmer (The FATHER OF CLINICAL PSYCHOLOGY) ∙ Studied with famous European and American psychologist, and was steeped  in the scientific tradition.

∙ Sought to make psychology a scientifically-informed clinical field. ∙ 1896- Opened the first psychological clinic at the University of  Pennsylvania to treat children with learning disabilities.

∙ 1907- Began a journal, The Psychological Clinic, and coined the term  clinical psychology 

∙ Believed clinical psychology to have a collaborative relationship with allied  fields (medicine, social work, education); BUT to exist as a distinct,  autonomous profession, anticipating clinical psychology’s status today.

∙ Some where cristales of psychology separating itself professionally from  medicine  

o Cf. Cummings

How did psychologists’ participation in the two world wars influence the  field of clinical  

psychology?

WORLD WAR I (1914-1918

∙ First technological war: death on a massive scale and need for smarted  soldiers and officers.

∙ Psychologist (with their training in quantitative psychometrics) distinguished  themselves as experts in mental testing, especially intellectual and ability tests applied to military personnel.

o Many tests still in use today.

∙ 1920’s & 1930’s: clinical psychology largely remained an assessment field,  only a few sporadic practitioners treating patients.  

o Psychotherapy continued to be dominated by psychoanalytically  trained psychiatrists.

WORLD WAR II (1939- 1945)

∙ More cases emerging of “shell shock” and “combat fatigue” in military  personnel.

∙ Many psychiatrists were conscripted into military medical service, leaving a  gap in menatla health treatment providers for soldiers.

∙ While continuing their primary role as “mental testers”, more psychologists  were recruited to provide therapeutic services.

∙ While predominantly following the psychodynamic model, psychologist  contributed to the innovation of effective short-term treatment  modalities that could be applied in military settings.

What are the scientist-practitioner and practitioner-scholar models of  clinical psychiatry?

Scientist-Practitioner Model

∙ Also called Boulder Model, is a training model for graduate school programs  that aspires to train applied psychologists with a foundation of research and  scientific practice.

Practitioner-Scholar Model

∙ Focused on the practical application of scholarly knowledge.

∙ More emphasis on the delivery of services in practice and less emphasis on  research productivity.

What were the major developments in clinical psychology from the second  half of the  

20th Century to the present?

Developments in Later 20th Century

∙ 1940’s-1960’s – Empowered by their military experience,  

∙ more psychologists became involved in psychotherapy, although they were  still outnumbered (and in some cases, fiercely resisted) by psychiatrists.  ∙ 1949 – Boulder Conference affirmed the necessity of both research and  practice for the training of PhD psychologists, establishing the scientist practitioner model of clinical psychology.

∙ 1973 – Vail Conference recognized the growing schism between academic  and clinical psychology. Sought to establish Psychology as a distinct practice  profession with the introduction of the PsyD degree, informed by the  practitioner informed by science model.

∙ 1960’s -1970’s – Insurance companies began authorizing  

∙ benefits for evaluation and treatment by psychologists.  

∙ Emergence of other practice professions in the psychotherapy field, e.g.  social workers, mental health counselors, etc.

∙ Also, a time of virtually unregulated expansion of psychotherapy and  counselor professions, along with untested, bizarre, and in some cases,  harmful “treatments,”  

∙ threatening to alienate psychotherapy from mainstream healthcare. ∙ 1980’s – With continuing advancement in psychopharmacology, the field of  psychiatry rebranded itself as a rigorously empirical medical profession,  seeking to consolidate their monopoly on prescribing privileges and  distinguishing themselves as the “real” doctors with the publication of DSM-III in 1980.  

∙ Meanwhile, mental health consumers still wanted talk therapy, and clinical  psychology grew to about 50% of all doctoral degrees awarded. ∙ Psychology also expanded into the areas of neuropsychology, health  psychology, and military psychology.

∙ 1990’s-2000’s – Proliferation of master’s-level clinicians competing with  psychologists, at the same time as managed care insurance programs began  to sharply limit the scale of mental health services.

∙ Coming full circle, psychologists began to lobby for prescribing privileges,  first achieved in the military setting because of a need for practitioners (cf.  WWII).

∙ Also, development of new and innovative models of mental health care  delivery, in addition to traditional, office-based practice: neuropsychology,  forensic psychology, police psychology, business consulting, media, etc.

In most states, including Florida, what are the major independently  licensed mental  

health professions, and how do they differ? What types of general or  unique services  

does each provide?

Getting Licensed

∙ Licenses issued by each state’s Department of Professional Regulation. ∙ Some states may or may not have reciprocity.

∙ Licensure usually reissued biannually, after fulfilling certain requirements. ∙ License required to:

o Practice independently (without supervision).

o Receive third-party reimbursement (insurance,government contract,  etc.).

o Present credibility in professional services.

∙ 3 primary license-eligible clinical psychology degrees: o PhD – Academic orientation, usually requires experimental research  dissertation.

o PsyD – Practice orientation, often requires clinical case study  dissertation.

o EdD – Practice orientation, geared toward educational concerns. o In practice, the professional activities of these three degree holders  differ little, except insofar as the psychologists’ interests are unique to  them.

Licensed Mental Health Profession

∙ License-eligible Masters-level degrees:

o LCSW: Licensed Clinical Social Worker – 2-year degree plus 1-year  supervision for licensure. Can do most forms of psychotherapy.

o LMHC: Licensed Mental Health Counselor – 2-year degree plus 1- year supervision for licensure. Can do most forms of psychotherapy. o LMFT: Licensed Marriage and Family Threrapist – 2-year degree  plus 1-year supervision for licensure. Can do most forms of  

psychotherapy, but tend to specialize in marriage, family, and child  issues.

∙ Other professions who may provide mental health services: o Psychologist: Mental health profession who evaluates and studies  behavior and mental processes. Can be a researcher (who makes  abstract studies of mental disorders and their treatments) or can be  licensed to see and treat patients in a therapeutic setting.

o Psychiatrists – Medical doctors whose residency was in psychiatry.  May practice psychotherapy, but now almost exclusively focus on  psychopharmacology.

o Psychiatric Nurses – Usually require Masters-level nursing degree  plus mental health training. Can do many forms of psychotherapy and  may have limited prescribing privileges.

o CAP : Certified Addictions Professional – Not an independent licensed  pracitioner, but certified to provide clinical services usually restricted  to an addictions treatment setting and supervised by a licensed  clinician.

What are some recommendations for undergraduate Psychology majors  who are  

preparing for graduate study?

Undergraduate Recommendations for Graduate Study

∙ Decide what you want to do: which degree and program is most suitable  for your goals and professional interests?

∙ Take the right courses: depends on availability, but cover the basic  sciences and liberal arts, and don’t overload on psych courses.

∙ Get to know your professors: you’re going to need letters of  recommendation, so don’t be a “brilliant ghost.” Make yourself stand out (in a good way) from the hundreds of other students each professor may teach  each year.

∙ Get research, practice & publication experience: preferably all three.  Demonstrate your commitment to the field by getting involved in  departmental and extracurricular activities.

∙ Get good grades: to graduate school search committees, size (of GPA) does  matter (a lot).

∙ Get high GRE scores: this is more important for some programs than  others, but prepare well

∙ Join professional associations as a student (e.g. APA, FPA, etc.) ∙

What are the steps one takes to become a clinical psychologist? Graduate School (Doctoral Program)

∙ First two years are mainly coursework.

∙ Then, gradual move into more clinical training and/or research, depending on  the program (PhD,PsyD) for the next two years or so.

∙ The final year of the program usually involves a predoctoral internship. Awarded Degree, next is LICENSURE

∙ Next, you need to study for and take your state licensing exam. ∙ Many states and programs require a post-doctoral internship to provide a  year of post-doctoral supervision (or may be in another setting). ∙ Licensing exam usually consists two parts: (1) substantive section, and  (2) state laws and rules

∙ In some states, if you have a non-clinical doctoral degree in psychology, you  may be able to sit for the licensing exam after getting a certain number of  hours of clinical supervision, but this is becoming less common.

∙ Once you are licensed, you must renew it every biennium (2 years) by taking  a certain number of state-approved continuing education (CE) credits through a variety of sources.

Board Certification (NOT Required)

∙ The American Board of Professional Psychology offers board certification in 13 specialty areas,including clinical psychology, forensic psychology, health  psychology, neuropsychology, organizational psychology, rehabilitation  psychology, and others.

∙ Eligibility for board certification usually requires (1) documentation of  experience in the specialty; (2) a work sample; (3) a written exam; and (4) an oral exam.

What is the role of research in the practice of clinical psychology? Research in Clinical Psychology

∙ Research in the mental health fields burgeoned following the free-wheeling,  “anything goes” practices of the 1970’s.

∙ Scientist-practitioner model should put psychologists in an advantageous  position to evaluate the validity of a wide range of claims about theory and  practice.  

∙ Even if you don’t conduct research, training in the scientific method should  equip you with adequate b.s.-detection skills.

∙ Psychological research employs two main methodologies: o Case study approach: ideographic: “thick” description: multiple  detailed observations on a small number of subjects: good for  

generating hypotheses.

o Experimental approach: nomothetic: “thin” description: study  limited number of variables on a large pool of subjects: good for  testing hypotheses.

∙ Treatment efficacy: how does this intervention compare overall to other  interventions for the same condition in similar subjects?

∙ Treatment effectiveness: how well does this intervention work for this  particular patient?

∙ Empirical research has in fact established the efficacy and effectiveness of  many kinds of psychotherapies for mental disorders and problems in living,  with success rate equaling or exceeding that of many standard medical  procedures used for physical disorders.

∙ Move in medical practice to evidence-based treatment.

∙ Move in mental health field to manualized therapy: pros and cons. ∙ Publication in clinical psychology: peer-reviewed journals vs. popular press;  case studies, empirical research, assessment and treatment guide

What are some of the important principles of daily practice in clinical  psychology?

Career Activities

∙ Clinical practice: tremendous diversity.

o Assessment.

o Treatment.

∙ Areas of specialization: adults, children, trauma victims, organizational  consulting, LGBTQ issues,  

∙ etc.

∙ Most practicing psychologists are both generalists and specialists. ∙ Forensic psychology.

o Assessment.

o Testimony.

o Areas of specialization within this field.

∙ Teaching, research & publication: usually associated with academic  psychologists at universities. Some clinical psychologists are full-time faculty  members, most teach as adjuncts because of their clinical time  commitments.

∙ Private practice, institutional setting, or both.

What are the rules, restrictions, and limits on psychologist-patient  confidentiality?

Confidentiality

∙ Mental health practitioners have always sought to maintain the highest  standards of confidentiality.

∙ 1996 – Health Insurance Portability and Accountability Act (HIPAA):  applied standards to all medical and clinical practices.

∙ 1996 – Jaffee v. Raymond: U.S. Supreme Court ruling created  psychotherapist-patient privilege, on a par with lawyer-client privilege. ∙ Fiduciary relationship: who is the patient or client?

∙ Mandated or third-party referrals, e.g. pre-employment screening, FFDE,  forensic evaluations, etc.

Exceptions to Confidentiality

∙ Mandated or third-party referrals, e.g. pre-employment screening, FFDE,  forensic evaluations, etc.

∙ Danger to self or others: discretionary decision by psychologist: no duty-to protect law in Florida (cf. Tarasoff case).

∙ Mandated reporting of child, elder, or disabled abuse in every state: must  report reasonable suspicion.

What are some of the clinical-professional boundary relationships that  psychologists  

must be on guard for?

Clinical-Profesisonal Boundaries

∙ Dual Relationship- the participation in more than one role with the same  client.

o Should ALWAYS avoid entering into a dual relationship with a client. ∙ Boundary Violations: BIOTP standard.

∙ Professional Boundary Violation= any interaction not in the best clinical interest of the patient because it:

o Compromises the psychologist’s effectiveness.

o Coerces or exploits the patient in any way.

∙ Most violations involve sexual or financial transactions.

What types of competencies must clinical psychologists have in order to  practice  

effectively?

Competencies in Clinical Psychology

∙ Professional competence: education, training, experience, learning  orientation (or style).

∙ Cultural competence: skill in dealing with diverse types of people.

What is the role of diagnosis in clinical psychology? What is the  relationship between  

diagnosis and treatment?

Role of Diagnosis  

∙ Observation.

∙ Classification.

∙ Correlation.

∙ Causation.

∙ Explanation.

∙ Control.

∙ To be useful, a diagnosis must be:  

∙ Reliable.

∙ Valid.

∙ Diagnoses may be:

∙ Categorical.

∙ Dimensional.

Even though we are now two years into DSM-5, many organizations still  use the diagnostic model of the previous DSMs. What are the five axes of  DSM-III through DSM-IV-TR?

5 Axes of DSM-III through DSM-IV-TR

∙ Axis I: Is a clinical syndrome (cognitive, anxiety, mood disorders [16  syndromes]) present?

∙ Axis II: Is a Personality Disorder or Mental Retardation present. ∙ Axis III: Is a General Medical Condition (diabetes, hypertension or  arthritis etc.) also present.

∙ Axis IV: Are Psychosocial or Environmental Problems (school or housing  issue) also present?

∙ Axis V: What is the Global Assessment of the person’s functioning.

What are the main differences between the new DSM-5 and the previous  DSMs?

DSM-5 Major Changes

∙ Arabic, not Roman numerals.

∙ No more axes.

∙ No GAF.

∙ New diagnoses, revised diagnostic criteria, and category shuffling. ∙ Inclusion of diverse organic brain syndromes.

∙ Coordination with ICD-10.

What is the difference between a delusion and a hallucination. Delusion

∙ A false belief or thought

Hallucination

∙ A false or irrational perception

o Your senses (usually sight and auditory) are involved

What is the meaning of a sign, symptom, syndrome, and disorder? Sign

∙ Objective, observable feature, characteristic or behavior of a patient. o EX: Limping

Symptom

∙ Subjective experience reported by the patient.

o “My leg really hurts.”

Syndrome

∙ Set of regular occurring signs and symptoms with a common etiology and  predictable course.

Disorder

∙ Syndrome that causes significant distress the the patient or others.

What are the different types of clinical interview format, and what are the  uses of each? How can they be integrated?

Clinical Interview Formats

∙ Directive vs. nondirective interview.

∙ Structured vs. un(less)structured interview.

∙ Continuum, not dichotomy.

∙ May be different interview styles for different patients &/or different  phases of the interview.

∙ Time constraints: single encounter or continued sessions. ∙ Standardization, balance, flexibility.

∙ Adversarial interviews.

What are the types of active listening techniques that are useful in clinical interviewing.

Active Listening Skills

∙ Emotion labeling.

∙ Paraphrasing.

∙ Reflecting/mirroring

∙ Minimal encouragers.

∙ Silence.

∙ “I” messages.

∙ Open-ended questions.

∙ Real crises: mix, match & combine tactics.

∙ Listing in for feelings.

∙ Observing body language

o Eye contact: engaged= not detached, not threatening.

o Body activity: posture, movement, behavioral echoing.

o Nonverbal behavior allows important information to be obtained and  contributes to enhanced rapport.

What are the essential components of a competent, ethical clinical  interview?

Ethical Clinical Interview Components

∙ Presenting problem: why are you here?

∙ History of the problem: how did things get this way?

∙ History of the person: medical, family, development, education,  employment, legal, military, religious, cultural.

∙ Signs, symptoms, and syndromes.

∙ Mental status exam: screening for cognitive, emotional, and behavioral  status.

∙ General appearance: Is the client put together or desheveled?  ∙ Mood: Happy? Sad? Angry?

∙ Interpersonal engagement, relatedness, rapport: Are they contributing  any insight or thoughts to the session?

∙ Motor activity: immobile to agitated.

∙ Orientation x3: time, place, person.

o Are they aware of where they are, who they are, and the time period  they are in?

∙ Perception: distortion, hallucination.

∙ Cognition: concrete, confused, delusional.

∙ Attention and concentration.

∙ Memory: many types.

∙ Speech:

o Aphasic: Lack of speech

o Tangential:  

o Circumstantial:

o Pressured:

o Slow:

∙ Intelligence: general estimate or specific tests.

∙ Reality orientation: insight, judgment.

∙ MMSE.

What are the issues surrounding confidentiality and informed consent? Confidentiality

∙ Part of ethical guide lines and means that information between patient and a  therapist cannot be shared with anyone.

o Psychologist may disclose private information in order to protect the  client or the public from harm.

o Psychologists are required to report ongoing domestic violence, abuse  or neglect of children, the elderly, or people with disabilities.

o May release information if court ordered.

Informed Concent

∙ Permission granted in the knowledge of the possible consequences, typically  the which is given to a patient by a doctor for treatment with full knowledge  of the possible risks and benefits.

What are some of the similarities and differences between an interview for individual patient treatment and an interview in a mandated referral or  litigation setting?

Interview for Treatment

∙ Almost always a positive relationship between client and therapist. ∙ The client is usually there by choice.  

∙ The therapist is there to help the client.

Interview in a Mandated Referral or Litigation

∙ Usually court-ordered to be used in an upcoming case.

∙ Client is forced to undergo the interview (not by choice)

∙ Clinician is there to obtain information and possibily to assess competencies  of client.

∙ Not a very positive relationship between clinician and client.

What are some features of a crisis interview?

Crisis Interview Featurs

∙ Main contexts.

o Suicidal patient.

o Hostage-barricade scenario.

o Crime or disaster victim.

∙ Assess for:

o Suicidal/homicidal intent or plan.

o General mood & cognition.

o Level of self-control.

∙ Crisis interview is really a combination of interview & intervention:  may rely heavily on active listening techniques.

What are some of the dimensions and characteristics of intelligence? Types of Intelligence

∙ Verbal vs. visuospatial.

∙ Fluid vs. crystallized.

∙ Academic vs. practical.

∙ Multiple intelligences.

o Howard Gardner coined the theory of multiple intelligence: Logical,  spatial, body, musical, interpersonal.

What are the main differences between the WAIS and WAIS-R and the  subsequent  

WAIS-III and WAIS-IV?

WAIS

∙ Included non-verbal (know as performance scales) as well as verbal items  for all test takers.

∙ Six verbal subtests:

o Information, Comprehension, Arithmetic, Digit Span, Similarities, and  Vocabulary.

∙ Five performance subtests.

o Picture Arrangement, Picture Comprehension, Picture Completion,  Block Design, Object Assembly, and Digit Symbol

WAIS-R

∙ Administration changes

∙ Iterm and scoring changes.

∙ Same 11 subtests.

WAIS-III

∙ Updated the norms.

∙ Extended the age range.

∙ 3 new subtests added

∙ New four factor clinical model

∙ Decreased reliance on time performance.

∙ Extensive testing of reliability and validity.

∙ Enhanced fluid reasoning measurement.

WAIS-IV

∙ Revision to Goal

o Improve psychometric properties

o Provided theoretical foundation for the measurement of intelligence. ∙ Improvement to the measurement of fluid reasoning, processing speed, and  working memory.

∙ Improved reliability and validity.

∙ Changes to subtests  

On the WAIS-IV, what do the VCI, PRI, WMI, and PSI measure? What are  their component subtests?

WAIS-IV  

∙ Verbal Comprehension Index

o Similarities

o Vocabulary

o Information.

o Comprehension

∙ Perceptual Reasoning Index

o Block Desing

o Matrix Reasong

o Visual Puzzles (Picture completion)

∙ Working Memory

o Digit Span

o Arithmetic.

o Letter-Number Sequencing

∙ Processing Speed

o Symbol Search

o Coding

How does one go about administering, scoring, and interpreting the  Wechsler IQ scales?

Administering  

∙ Wechsler IQ tests are individually administered,  

∙ face-to-face tests: labor-intensive.

∙ Subtests are administered in a standardized order,  

∙ with standardized instructions, based on the manual. 

Scoring

∙ Individual subscale scores are added within categories.

∙ Raw scores are converted to subscale scores by  

∙ using age-normed tables.

∙ Hand scored or computer scored

Interpreting

∙ Subscale scores may be expressed as:

o IQ scores.

o Percentiles.

o Descriptors.

∙ IQ scores fall along a normal curve, with x=100 and a SD=15.

Be able to identify the IQ score ranges that belong with the descriptors:  Very Superior,  

Superior, High-Average, Average, Low-Average, Borderline, and Impaired  (Mental  

Retardation).  

IQ Range (“deviation IQ”) IQ Classification

∙ 130 and above Very superior

∙ 120-129 Superior

∙ 110-119 High average

∙ 90-109 Average

∙ 80-89 Low average

∙ 70-79 Borderline

∙ 69 and below Extremely low (Mental retardation maybe?)

What is the Flynn Effect?

The Flynn Effect

∙ Refers to the gradual improvement in intelligence scores over the last several decades.

What are the main difference between objective and projective personality tests?

PROJECTIVE Personality Test

∙ Typically based on psychodynamic models of the mind: influence of  unconscious forces on conscious behavior.

∙ Utilize ambiguous stimuli onto which the subject will project his  unconscious wishes, fears, and fantasies.

∙ Idiographic vs. nomothetic approach.

∙ Rich data, but verifiable?

o Since the information they are providing is very subjective, it is difficult to validate.

∙ Face-to-face administration: labor-intensive in  

∙ administration and interpretation.

∙ Based on PROJECTIVE HYPOTHESIS:

o When people attempt to understand an ambiguous or vague stimulus,  their interpretation of that stimulus reflects their needs, feelings,  experiences, prior Conditioning, and thought processes.

∙ Ambiguous stimuli that have been used include:

o Ink blots (Rorschach)

o Ambiguous pictures (Themantic Apperception Test)

o Sentence stems

OBJECTIVE Personality Test

∙ Nomothetic approach.

∙ Unambiguous questions: T-F, multiple-choice, rating scales.

∙ Paper-and-pencil, not face-to-face.

∙ Group administration possible.

∙ Computers: may not even need a human to administer and score the test. ∙ Validated against known groups: how much does current subject  resemble these groups?

∙ Examples of Objectiver Personality Tests

o Minnesota Multiphasic Personality Inventory (most widely used objective personality test) 

What are the main features of the administration, scoring, and  interpretation of the Rorschach and TAT?

Rorschach Test

∙ Developed by Hermann Rorschach in 1921.

∙ 10 ink blots, 5 B&W, 5 color.  

∙ Free-association phase.

∙ Inquiry phase.

∙ Subjective interpretation.

∙ 1980’s – John Exner develops the Comprehensive Rorschach System. o Standard administration, scoring, and interpretation of the inkblots.  o Retains basic psychodynamic orientation.

o Addresses reliability issue, but not validity issue.

∙ Comprehensive Rorschach System: Exner criteria.

o Location: whole, parts, details.

o Determinants: form, color, shading.

o Form quality: identifiable, obscure, conventional, idiosyncratic,  distorted.

o Popular: frequently identified or unusual responses.

o Content: objects, animals, body parts, static or active.

Thematic Apperception Test

∙ TAT developed in 1935 by Henry Murray and Christina Morgan. ∙ Based on Murray’s psychological needs theory. 

o Primary Needs: basic needs that are based on biological demands (a  y gen, food, water).

o Secondary Needs: Psychological needs, such as the need for  nurturing, independence, and achievement. These needs are essential  for psychological well-being.

∙ 31 cards: usually only use about 10 in any given test session. ∙ Interpretation based on clinician’s judgment.

∙ Formal scoring systems have been developed, but are rarely used.

What are the validity scales and the clinical content scales of the MMPI-2  and what do  

they measure? How are the scales combined to yield a useful personality  profile of a  

particular patient?

MMPI Validity Scales

∙ L = Lie scale: inconsistency of responding.

∙ F = Frequency: “fake-bad” responding.

∙ K = Correction: “fake-good” responding.  

∙ Other validity scales.

MMPI Clinical Content Scales

∙ Hypochondriasis: concern with bodily symptoms.

∙ Depression: Depressive symptoms.

∙ Hysteria: Awareness of problems and vulnerabilities.

∙ Psychopathic Deviate: Conflict, struggle, anger, respect for societies rules. ∙ Masculinity/Femininity: stereotypical masculine or feminine interests/  behaviors.

∙ Paranoia: Level of trust, suspiciousness, sensitivity.

∙ Psychasthenia: Worry, anxiety, tension, doubts, obsessiveness. ∙ Schizophrenia: Odd thinking and social alienation.

∙ Hypomania: Level of excitability

∙ Social Introversion: People orientation.

What are the main features of the other personality tests we discussed in  class?

What are some of the types of patients who might be referred for a  neuropsychological  

assessment?

Million Clinical Multiaxial Inventory-III (MCMI-III)

∙ 2nd most used objective personality test

∙ Designed to assess DSM-IV-TR personality disorders and clinical  symptomatology (axis II)

∙ Adolescent version also exists

∙ 175 true/false items take 25 minutes

∙ Has six different major scales

o Clinical Personality Pattern Scale

o Severe Personality Pathology Scales

o Clinical Syndrome Scales

o Modifying Indices

o Validity Index

California Psychological Inventory

∙ Developed for sue with relatively well-adjusted individuals.

∙ Assesses individual’s strengths and positive personality attributes. ∙ MMPI was the basis for CPI’s development.

∙ Takes 45-60 minutes to complete.

∙ Pencil and paper or computer based.

∙ Brief form used for organizational training and evaluation.

∙ CPI 260 specifically developed for managerial assessment and leadership  training.

5 Factor Personality Inventory

∙ Openness: Curious, original, intellectual, creative, and open to new ideas. ∙ Conscientiousness: Organized, systematic, punctual, achievement  oriented, and dependable.

∙ Extraversion: Outgoing, talkative, sociable, and enjoys being in social  situations.

∙ Agreeableness: Affable, tolerant, sensitive, trusting, kind and warm. ∙ Neuroticism: Anxious, irritable, temperamental, and moody.

What are some of the types of patients who might be referred for a  neuropsychological assessment?

Patients Referred for a Neuropsychological Assessment

∙ Older age: dementia, stroke, etc.

∙ Younger age: ADHD, LD (Learning disability), etc.

∙ Any age: PCS (psychological counseling services), clinical & forensic. ∙

What are the main features of the neuropsychological tests we discussed  in class?

Neuropsychological Assessment: COMPONENTS

∙ Record review: integrate many sources.

∙ Clinical interview.

∙ Collateral interviews: may be especially important.

∙ Behavioral observations.

∙ Neuropsychological test findings.

∙ Conclusions & diagnosis.

∙ Recommendations.

What are the advantages and limitations of using fixed vs. flexible  neuropsychological  

test batteries. How do many neuropsychologists integrate these two types of testing?

Fixed Battery Approach 

∙ Provides a comprehensive assessment overview; focus is on the outcomes of  the testing

o Matrix approach.

o Standardized

∙ Problem:  

o Time and cost

o Individual deficits may hinder performance.

o Collection of unimportant information.

o Relies on availability of quality norms.

o Hard to measure reliability because it takes to long to implement. ∙ Advantage:

o Systematic.

o Comprhensive.

o Objective interpretation.

o Easy to be trained in.

o Easy to replicate.

o More acceptable in a legal setting.

Flexible Battery Approach 

∙ Examiner chooses test instruments on the basis of the patient’s history and  presenting symptoms, and on the basis of the outcome of any prior testing  that may have been done.

o Can also be called “patient-centered testing”

∙ Looks at qualitative as well as quantitative data.

∙ Problem:  

o Norming  

o Overlapping  

o Score conversion

o Replication

o Need extensive training

o Susceptible to bias.

∙ Advantage:  

o Patient-tailored approach.

o Can focus more on the relevant domains.

o Emphasis is on the process rather than the outcome.

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