Clinical Psychology Week 2 Class Notes
Clinical Psychology Week 2 Class Notes PSY BEH 150C
Popular in Clinical Pychology
Popular in Psychology And Social Behavior
This 6 page Class Notes was uploaded by Rebecca Sumrow on Tuesday October 4, 2016. The Class Notes belongs to PSY BEH 150C at University of California - Irvine taught by J. RINEHART in Fall 2016. Since its upload, it has received 2 views. For similar materials see Clinical Pychology in Psychology And Social Behavior at University of California - Irvine.
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Date Created: 10/04/16
Clinical Psychology – 10/4/16 Class Notes Clinical Assessment • Who sends you to a clinical psych? School, employer, court, self. o Why in school: behavior assessment, learning disability, IQ. o Plan data collection: pick a measure. o Processor CLINICAL ASSESSMENT • First you decide what you want to know and then choose the assessment that may help you answer the question. o Ask why you are here. o Ask what you think about that. o How does that make you feel? o As a clinical, asking what is the diagnosis? What is their intellectual functioning? Do they have a learning disability? What am I trying to learn? Assessment • IQ tests are usually in a school setting to gifted placement or to see if there is a variation between intelligence and performance. Referral Source • Who sends you to a clinical psych? School, employer, court, self. o Why in school: behavior assessment, learning disability, IQ. o Plan data collection: pick a measure. o Processor Referral Question • If the referral is through the court, the client may be incompetent. • They may want to be competent and they may not want to be. Choosing Assessment Tool • Psychometric properties of measure means high validity and reliability. • Client characteristics: What are their language needs? What is their competency level? Can they read? Are you presenting written content at an appropriate level? • Clinical competence: Are you as the clinical sufficiently trained in the subject of this therapy? Are you trained in giving, assessing and interpreting the data? Collecting Assessment Data • A clinician may want to combine the following methods of gathering information: o Interview. o Observations both verbal and non verbal, behavioral and emotional. Speech and appearance. • Gathering information and data from multiple sources helps to validate the data by sheading light on any inconsistencies or errors. Sometimes clients lie, sometimes they are unaware of the truth. Clinical Psychology – 10/4/16 Class Notes Clinical Assessment Processing Data & Forming Conclusions • Individual scores don’t show much in regards to trends or assessments. But amassing data allows comparison against outside data and groups to assess norms. • You should always clarify where information comes from by noting it in the assessment: “Client states that…” • Though social workers and MFTs can administer some tests, more comprehensive testing must be given and interpreted by PhDs or PsyDs. Communicating Assessment Results • Always proceed as if the client will be reading their assessment. Maintain the following: o No derogatory language o Remain neutral o Maintain a clinical and professional tone o Leave out personal opinion and only include assessment results or clinically appropriate assessments. DSM History • There was no DSM prior to the original. • The DMS was created after WWII: lots of people were assessed for placement in the military. • Precursor to the ASVAB. • Lots of vets needed mental health support after the war. DSM-I • The angle of assessment and interpretation was the psychodynamic ideology of disorders. • “psychosis” DSM-II • Still heavily based in Psychodynamic principles. Leading into DSM-III • Many psychologists felt that the field in general was drifting from the scientific principles of psychology and instead moving to focus on more therapeutic methods which should be based in empirical evidence but they felt that weren’t anymore. Leading into DSM-III • Major theme of previous DSM was Neurosis but this DSM was set to remove references to it. • The DMS is heavily influenced by politics and not by data. The process off selecting disorders is not based on evidence but instead a voting system and a panel system. • Admittance to the DSM was mostly based on contents of the ICD, experience and politics. Clinical Psychology – 10/4/16 Class Notes Clinical Assessment DSM-III • There was a shift from the theoretical structure to the medical model. In this model, culture isn’t and couldn’t be considered. • There was criticism in the community that the DSM was relying too much on data but supporters cited the needs for data to provide evidence that what is being reported is truly the experience of the client. • Due to the departure from theoretical stance, the DSM was heavily filled with descriptions of psychopathology instead of why people are experiencing these symptoms. Axis System • Axis 1: clinical disorders like depression, anxiety, bipolar disorder, substance abuse. • Axis 2: personality disorders developmental/intellectual disability like Narcissistic personality disorder, OCPD, borderline personality disorder. • Axis 3: medical conditions like cancer diagnosis, recovery from surgery. • Axis 4: psychosocial factors like present struggles from loss of job, divorce, death, new marriage. • GAF means Global assessment of functioning: scoring 100 is rare. 60-70 is average. A zero score would be only due to a catastrophic and profound communication disability like catatonia. Influence of Managed Care • Due to the requirement of the use of diagnostic criteria to bill and categorize, this reinforces the use of the DSM. • Once blue cross was sued for not allowing payment of psychologists, it is required that all psychologists be billed and paid in the same manner as MDs. Influence of Managed Care • Before PTSD, vets were labeled with diagnosis like shell shock, and battle fatigue. DSM-III-R • There was a slight increase in number of diagnosis from 265 to 292. • The APA to add a diagnosis added sleep disorders, which is an example of a political decision. DSM-IV • The APA added a task force. DSM-IV-TR • The TR only means test revision. • The additions were: prevalence, onset, cultural information, age groups and it was released in more languages. Clinical Psychology – 10/4/16 Class Notes Clinical Assessment 50 Years of DSM • Criticisms: o With each release, they added more diagnoses. o There were diagnosis or information added without strong evidence that the addition was appropriate or useful. DSM-5 • People feared the release of the DSM 5 because they feared the changes would be overwhelming. • The multi-axil system was removed but it has such historical significance and cultural significance in psychology that it is still referenced today. • Changes that were notable is that substance abuse and substance dependence became one disorder that now falls on a continuum. • The addition of more categories reduced the use of NOS (not otherwise specified) for symptoms or symptom clusters that don’t neatly fit within a diagnosis or specific criteria. • If too many people fall into NOS, that is an indicator that the validity of the tests and scales is not strong. • The addition of Binge eating disorder absorbed a lot of eating disorder outliers. Criticisms of the DSM • Pharmaceutical companies have strong connections to the decision makers on the panel creating the DSM which is concerning regarding their interest in diagnosis, criteria and treatment models. • Of the people who have financial ties to the pharmaceutical companies, more often than not they are psychiatrists. • A concerning phenomena is that as a medication is released, the prevalence and popularization of the associated diagnosis spikes. Example is the 90’s and Prozac. • Some cultures and their traditions may manifest as pathologies and thus they are over-treated when they shouldn’t be. • Women tend to be more diagnosed than men, this is concerning because the DSM may not be normalizing pathology across genders. Alternative Diagnostic Approaches • The DSM5 is a categorical diagnostic tool. You either have or do not have a diagnosis, which isn’t necessarily indicative of the range of manifestations of symptoms. • Diagnostic ability with checklists increases reliability but can compromise validity. • The major focus of this release of DSM is diagnosis and the use as a diagnostic tool. Treatment Planning • When someone is “non specific” they can benefit from a variety of treatments in a overlapping fashion. • With the variability of symptoms and diagnosis, comorbidity is significant and common, this can convolute individual treatment plans. Clinical Psychology – 10/4/16 Class Notes Clinical Assessment • In order to assess progress. Therapists should be administering continual assessments to weigh the effectiveness of their treatment plan. • At times, self-assessment is a treatment alone. If someone is suffering from an eating disorder, being cognizant of his or her patterns and behaviors can cause them to self adjust. Prediction • Assessment can provide a prognosis on the effectiveness of treatment with the disorder that is being treated across the population. Prediction • Prediction is oftentimes used by parole boards to predict how likely someone is to reoffend. • We must be aware of type 1 and 2 errors, particularly when freedoms and liberties are being decided via the use of prediction. • Clinicians have a low base rate in predicting behavior. • Clinical judgment (an educated guess) is subject to the same cognitive biases as any other opinion. o Availability heuristic: tend to make judgments based on what info is most available during the decision making process. o Illusory correlation: seeing relationships when there is none. o Confirmation bias: tend to things they already know. o Hindsight bias: after the fact saying “I knew that would happen.” Reliability • A measure has high inter-rater reliability when: o The same or similar scores are found when independent raters complete the same assessment. • A measure has high internal consistency when: o Different parts of instrument are similar to one another. Reliability • A measure has high test-retest reliability when: • The same or similar scores are found when assessment is completed multiple times. Validity • Content validity: How well does it capture what it intends to? • Predictive validity: does the SAT test predict college performance? • Incremental validity: If a 20 questions assessment performs as well as a 50 question assessment the 20 question assessment has higher incremental validity. • Instruments must have reliability and validity to have good psychometric properties. Standardization • Used across large populations.. • Tests must be normalized across age and cultural populations. Clinical Psychology – 10/4/16 Class Notes Clinical Assessment • Cognitive tests are normalized across age. Bandwidth-Fidelity • The goal is to provide a balance between breadth and depth of assessments. • If the breath is to vast it may miss detail. • If the depth is to vast it may cause validity issues by causing fatigue in the client due to too many assessments taken. Assessment Report • It must clearly communicate the findings. • It must be goal oriented in that it addresses the reason someone came in, in the first place. • It is considered useful if it provides new information. • Ethical regulation states that the individual item answers cannot be given as the tests are copywrited and training is needed to decipher the results. Sample Assessment Report • Include demographic information like name, age, date of the testing. Provide information regarding therapy like therapists name. Also include the background info provided on the client, appearance and in-session behavior of client. The presenting problem and any relevant historical info should be included. • When composing the assessment, be careful to use sensitive language and be clinical as well as general in term. • Keep the results of the assessment comprehensive but succinct.
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