PSY-0071 Midterm Study Guide
PSY-0071 Midterm Study Guide PSY 0071
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This 4 page Study Guide was uploaded by Amy Bu on Monday March 7, 2016. The Study Guide belongs to PSY 0071 at Tufts University taught by Dr. Alexander Queen in Winter 2016. Since its upload, it has received 59 views. For similar materials see Clinical Psychology in Psychlogy at Tufts University.
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Date Created: 03/07/16
PSY 71 Midterm Study Guide Know the differences in education and scope of practice for the four primary mental health professionals discussed in class: 1. Psychiatrists: physicians (MD), specialize in treating mental illnesses. Requires medical school degree and 4 years of residency, typically takes a biomedical view of mental illness. 2. Psychologists: doctorates (PhD, PsyD, EdD), 1 year of clinical internship, 1-2 years of postdoctoral supervised experience, and an EPPP exam to practice. Perform research, therapy, testing, but do not prescribe medication. 3. Clinical Social Workers: social workers who specialize in mental health treatment. Masters (2 years) in social work, 2 years supervised experience. Usually take a social justice approach, develop patient strengths. 4. Psychiatric Nurse Practitioners: nurse practitioners who specialize in psychological disorders. Masters in Nursing (MSN) degree or doctorate. Can prescribe medication in most states in the US with physician supervision. Know the differences between the Boulder and Vail models of clinical psychology training: 1. Boulder: Scientist-Practitioner Model, has predominated for many decades. Learn to do research, but also apply research to practice (e.g. PhD programs). Trained in both research and clinical work. (Programs tend to be smaller and more competitive). 2. Vail: Practitioner-Scholar Model. Students should be informed in research, but may not need the rigorous research training to DO the research. Focuses instead on clinical practice (e.g. PsyD). Less statistics and research training, more practical and clinical training. Clinical / Counseling / School Psychologists: 1. Clinical: trained in psychology departments. Work in hospitals, clinics, universities, and private practice; typically treat more severe populations. Use more psychodynamic therapy and Cognitive Behavioral Therapy. 2. Counseling: trained in education departments or schools. Typically work in university counseling clinics or private practices, with “healthier” or less severe populations (e.g. dealing with relationships, job transitions). Use more humanistic approaches. 3. School: intersection between psychology and special education. Work in K-12 educational environments, with kids with learning disabilities or emotional/behavioral problems. Know the changes from DSM-IV to DSM-5 we discussed in class: 1. Updated in 2013, uses a non-axial system, has increased emphasis on cultural factors (e.g. social anxiety may be defined differently in EastAsian countries). 2. Autism Spectrum Disorders have been lumped together (e.g.Asperger’s no longer exists), clarification as to “with/without intellectual impairment”. 3. Social Communication Disorder as a new diagnosis. 4. OCD and PTSD are now separated. 5. “Gender identity disorder” renamed “Gender Dysphoria”. 6. Removed the bereavement exclusion for Major Depressive Disorder. Know the DSM-5 criteria for the disorders we discussed in class, pay particular attention to: schizophrenia-spectrum disorders, bipolar disorder, and neurodevelopmental disorders: * SEE CHEAT SHEET! * 1. Schizophrenia Spectrum: Schizophrenia, Schizophreniform, Schizoaffective Disorder. 2. Bipolar Disorders: Bipolar I, Bipolar II, Cyclothymic Disorder. 3. Neurodevelopmental: Intellectual Disability,Autism Spectrum Disorder (ASD),Attention Deficit / Hyperactivity Disorder (ADHD). Know the history of the therapeutic relationship (including Freud’s and Rogers’theories) as well as research into the effect of the therapeutic relationship on treatment outcomes (HINT: pay attention to the graph I showed you in class!): Also called therapeutic alliance / working alliance / rapport. 30% of treatment outcome is attributable to relationship! 1. Freud: founder of psychoanalysis (earliest form of psychotherapy), which aimed to “make the unconscious conscious”. Believed in transference (transferring emotions to the therapist, e.g. thinking of them in the role of a father / romantic partner, etc) and countertransference (therapist transferring emotions to the patient). 2. Rogers: believed in humanistic psychology, that the relationship itself was curative, and that it is both necessary and sufficient. Psychopathology is the result of incongruence between perceived self and actual experience. Incongruence is result of conditions of worth (as opposed to unconditional worth). Founded client-centered therapy. Understand and be able to apply the Transtheoretical Model: What: Pre-contemplation (haven’t thought about change), Contemplation (thinking about action within next 6 months), Preparation (about to take action next month), Action (making changes), Maintenance (persisted change behaviors). The stage the client is at informs how to proceed with treatment. 6 Necessary Conditions for Change: 1. Must be some relationship or psychological contact 2. Client is in a state of incongruence 3. Therapist is in a state of congruence (genuineness) 4. Unconditional positive regard 5. Empathic understanding 6. Therapist’s unconditional positive regard / empathic understanding is felt by the client. Know the principles and techniques of motivational interviewing: Goals: increase client’s intrinsic motivation to change, elicit change talk from the client (likely to lead to actual change). Principles: 1. Express Empathy (show warmth/caring, support self-esteem), 2. Develop Discrepancy (evoke patient’s own reasons for/against change), 3. Roll with Resistance (resistance is predictor of poor outcomes), 4. Support Self Efficacy (question/reflect to help patient believe they can change). Techniques: 1. Open-ended questions, 2. Affirmations that express empathy and understanding, 3. Reflective listening, 4. Summaries. (OARS)! Other techniques: ask permission, explore importance/confidence, readiness to change, paradoxical statements Know the difference between unstructured and structured clinical interviews, including research about diagnostic reliability and patient attitudes: Structured: SCID, research version (comprehensive, current & lifetime diagnoses) / clinician version (most common diagnoses, current only). Set list of close-ended questions, little/no room for variability or improvisation of other questions. Semi-structured: like structured, use SCID, but has room for impromptu questions to ask about more relevant issues that come up. Unstructured: clinician’s judgment only, no set list of questions. Diagnostic accuracy: Structured and semi-structured are best. Patients like them better than clinicians think! Given a clinical scenario, be able to recognize diagnostic clues from a patient’s history: Legal history (whether they have gotten in trouble with the law), Medical history (their health status, previous diagnoses, medication), Family history (family members’previous diagnoses, potential genetic risk factors), Social history (relationships with others). Understand the components of a mental status exam: Purpose: gather information about client’s present state of mind, often informal. Appearance: age, weight, dress, hygiene Attitude/Behavior: ability to establish rapport, body movements, eye contact Cognition: orientation (person, place, time), alertness, attention/concentration, memory problems Speech: clarity and understandability, speed, whether there are unusual speech/phrases Thought Process/Content: organization, speed of thoughts, whether there are delusions. Mood (how they feel most days) Affect (emotions in a moment, range/intensity/appropriateness) Perception: visual and/or auditory hallucinations, whether depersonalized Insight: recognition of mental illness, compliance. Know the risk factors for suicide discussed in your readings and in class: Age: females = 45-54, males = 75+. Gender: women make more attempts (2-3 times), but men are 4x as likely to succeed. Race/Ethnicity: suicide rates highest for Whites (according to reports/statistics). Marital Status: widowed/divorced have highest risk, then single, last is married. PreviousAttempts: highest risk in 6mo-2yrs after an attempt. Life Stress: e.g. breakup, death of loved one, failure at work/school, lack of social support. Personality: hopelessness is better predictor of suicide than intensity of depression. Mental Illness: 90-95% of those who complete suicide has diagnosable DSM disorder. Depression: risk greatest within 3 months after symptoms improve. Understand the 3 main types of questions to ask when conducting a suicide assessment: 1. Intent: does patient desire/intend to harm self or others? 2. Plan: does patient have a specific plan to harm self or others? 3. Means: does patient have ability to carry out the plan? Know about involuntary hospitalization procedures we discussed in class: Voluntary: willingly admitted to hospital. Involuntary: “Section 12”, unwillingly admitted due to likelihood of serious harm due to mental illness. May be initiated by: 1. physicians, 2. psychologists, 3. clinical social workers, 4. psychiatric nurse practitioners, 5. police officers (last resort). Can be held up to 72 hours, unless facility/court believes person still at extreme risk. Limited number of restrained hours. Duty to Warn: can break confidentiality if client in imminent danger to identified person. Must do one or more of: 1. warn intended victim, 2. notify local police, 3. initiate hospitalization. Know about safety planning procedures and times you can break client confidentiality: Safety Plan: prioritized written list of coping strategies and support sources to use during or preceding a suicidal crisis, has 5 steps. 1. Recognize warning signs of suicidal crisis (e.g. situations, thoughts, mood, behavior). 2. Identify internal coping strategies (things to do alone, e.g. listen to calm music, take a hot shower, go for a walk, eat good food). 3. Use social contacts to distract self (does not entail telling them about suicidality, e.g. calling a friend to chat, going to an event, doing an activity with someone). 4. Contacting others to help resolve crisis (telling them about suicidality and asking for help, e.g. to accompany to hospital, call hotline for you, talk to you to calm you down). 5. Contacting professionals/agencies (mental health-related, or the police at last resort. e.g. emergency mental health hotlines, walk-in emergency care).
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