PSYC 3230 Cyterski
PSYC 3230 Cyterski 3230.0
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This 12 page Class Notes was uploaded by Samantha Snyder on Friday September 4, 2015. The Class Notes belongs to 3230.0 at University of Georgia taught by Cyterski in Fall 2015. Since its upload, it has received 76 views. For similar materials see Abnormal Psychology in Psychlogy at University of Georgia.
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Date Created: 09/04/15
262 FamilySocial Treatments 1 Group therapy 0 Therapist amp group of clients with similar problems 0 Participants develop insights build social skills strengthen selfworth 0 Research often just as helpful as individual therapy 0 Selfhelp or mutual help groups same concept no therapist 2 Familycouples therapy Family therapy 0 19505 0 Therapist meets with a family identi es problem behaviors helps family change its ways 0 Family is one unit under treatment 0 Structural family therapy therapist helps members recognize and change harmful patterns of communication 0 Not extremelyconsistently proven to be especially helpful Couples therapy 0 Therapist two people in longterm relationship 0 Focuses on structure and communication patterns teaching problem solving and communication skills 0 Divorce rate in US Europe Canada close to 50 0 May follow principles of any major orientation 0 Sociocultural approach Integrative Couple Therapy asks couples to accept some behaviors as understandable result of basic differences that cannot be changed amp to embrace the relationship regardless o No one type has been proven superior or even especially effective o 14 of treated couples eventually divorce 3 Community Mental Health Treatment 0 Allows individuals to get treatment in nearby familiar social surroundings day programs or residential services 0 Seems to be especially valuable in treatment of severe disorders 0 Try to focus on prevention i Primary efforts to improve community attitudes and policies total prevention ii Secondary identifying and treating disorders in early stages before they get too serious iii Tertiary provide effective treatment asap so moderatesevere disorders don39t become longterm problems 263 How do Multicultural Theorists Explain Abnormal Functioning Culture quotset of values attitudes beliefs history and behaviors shared by a group of people amp communicated thru generationsquot MulticulturalCulturally Diverse Perspective seeks to understand how race culture ethnicity gender etc affect the behavior and thoughts of people of different racesculturesgenders does not imply inferiority Ethnic and Social minority groups are the most studied in the US Prejudice and discrimination is also taken into account as they may contribute to abnormal patterns of tension unhappiness low selfesteem and escape 264 Multicultural Treatments 0 Research ethnicracial minority groups less improvement from clinical treatment less use of mental health services stop therapy sooner that majority groups 0 Two features can increase effectiveness 1 Greater sensitivity to cultural issues 2 Inclusion of cultural morals and models esp w kids amp teens Culture sensitive therapies developed to address unique issues gender sensitive therapies follow the same principles 0 Typically include these elements 1 Special instruction of therapists 2 Therapist39s awareness of client39s cultural values 3 Therapist39s awareness of stress prejudices amp stereotypes client faces 4 Therapist39s awareness of hardships faced by immigrant kids 5 Help clients recognize impact of their own culture and dominant culture on their selfviews and behaviors 6 Identifyingexpressing suppressed anger amp pain 7 Achieving bicultural balance 8 Raising selfesteem 265 Assessing the Sociocultural Model Treatments sometimes succeed where other traditional approaches have failed 0 Findings are dif cult to interpret usually identi es relationships but not always causation Unable to predict abnormality in speci c individuals why some people but notaH Due to limitations most ppl use sociocultural model in conjunction with other approaches 0 Sociocultural factors may create a favorable climate for disorders to develop but biological andor psychological factors must be present too Chapter 3 Clinical Assessment Diagnosis and Treatment 31 Clinical Assessment How and Why does the Client Behave Abnormally ldiographic data speci c details and background of an individual s problem Assessment collecting of relevant information in an effort to reach a conclusion 0 Clinical assessment used to determine how and why a person is behaving abnormally and how to help them also allows for progress evaluation Must be standardized amp have clear reliability and validity 0 Three categories 1 Clinical Interviews 2 Tests 3 Observations 0 311 Characteristics of Assessment Tools Standardize setting up whenever a technique is Reliability of assessment measures a good tool will always yield the same results in the same situation 0 when the same test given some time apart has a high correlation between results 0 When different Judges independently agree on how to scoreinterpret test results Validity with which a test measures what it is supposed to measure 0 Face validity when results appear to be valid because they seem reasonable 0 tool s ability to predict future characteristics or behavior Elementary school kids example likelihood of smoking in HS retest in HS 0 degree to which the measures gathered from one tool agree with measures gathered from other assessment techniques Measuring depression with two different test types do they both conclude the presence of depression 312 Clinical Interviews Facetoface encounter Conducting the Interview Often rst contact between client and clinician Used to collect detailed information about the person s problems and feelings lifestyles and relationships amp other views and expectations for therapy 0 Clinical interviewers often focus on the topics they give the most importance to psychodynamic vs behavioral vs cognitive clinicians Structured vs Unstructured 0 open ended questions allows interviewer to follow cHenFsleads Often appeal to psychodynamic and humanistic clinicians More likely to be unreliable people respond differently to different interviewers gender warm vs cold age race religion etc 0 prepared questions sometimes uses standard set of questions designed for all interviews Sometimes include a set of questionsobservations that systematically evaluate the client s sensorium awareness time and place orientation attention span memory mood judgement and insight thought process and content and appearance 0 quotmental version of yearly physicalquot Video from class 0 Very simple and broad subjective judgements Allows clinicians to cover same topics in all interviews and compare responses increases the reliability of an assessment Often appeal to behavioral and cognitive clinicians o having a set list of questions to ask but not all questions will apply to every person and some will require different followup questions What are the Limitations of Clinical Interviews 0 Can be very helpful can also lack validity or accuracy clients may intentionally mislead a clinician avoid certain topics make the situation seem better may be unable to give an accurate report of feelings for various reasons 0 Mistakes in judgement on interviewer s part relying too heavily on rst impressions interviewer biases all can skew info in a clinical interview 313 Clinical Tests Tests used to gather information about a few aspects of a person s life from which broader conclusions can be drawn 1 Projective Tests Projective Tests Require clients to interpret vague stimuli ink blotsambiguous pictures or follow open ended directions draw a person Idea is that vaguegeneral instructions will allow people to project aspects of their personality into the task 0 Used primarily by psychodynamic clinicians Common examples 0 Rorschach test Rorschach Psychodynamic Inkblot Test 1921 Symmetric but accidental patterns of inkblots o Thematic Apperception Test TAT Pictorial projective test 30 black and white pictures of individuals in vague situations asked to make up a dramatic story about each card Idea is that people taking test will always identify with one of the characters on each card 0 SentenceCompletion tests 19205 Good springboard for discussion 0 DrawaPerson tests DAP Clinicians often ask clients commonly children to draw pictures of human gures and talk about them Evaluations based on details shapes solidity of pencil like location of drawing on paper sizefeatures of gures comments made during the task Merits of Projective tests 0 Most common used until 19505 0 Now largely used for gaining supplementary information 0 Do not consistently show reliabilityvalidity o Tests like TAT contain racialethnic biases 2 0 Personality inventories asks clients questions about their behavior beliefs and feelings 0 Indicate which of a long list of statements apply to them 0 Two adult versions and one adolescent versions available 0 500 selfstatements answered true false or cannot say 0 Made up of 10 clinical scales scores above 70 between 0120 are considered deviant 0 Better than projective tests do not take much time to administer or score scored objectively standardized comparable greater testretest reliability more valid 0 Still have cultural limitations 0 Should be used in combination with interviews and other assessment tools 3 Response Inventories Ask respondents to provide detailed information about themselves focus on one speci c area of functioning at a time social skills emotion etc o Affective inventories measure severity of emotions anxiety depression anger Beck Depression Inventory most popular 0 Social Skills Inventories used mostly by behavioral and family social clinicians asks ppl to indicate how they would react in a variety of social situations 0 Cognitive Inventories reveal typical thoughts surprisingly not often used by cognitive therapists of response inventories and frequency of use have increased in the past 30 years 0 Major limitations only a few are considered reasonably valid and reliable 4 Psychological Tests detects valid changes in breathing perspiration heart rate while answering questions then compared to client answering yes to control questions 0 Hard to tell difference between emotions nervousness being upset actually lying etc 0 Many require expensive equipment can be inaccurate and unreliable lab equipment is often elaborate and maybe intimidating falsely exciting a person s nervous system 5 Neurological and Neuropsychological Tests 0 Head injury brain tumorsmalfunctions alcoholism infections etc can cause problems with personality and behavior 0 designed to measure brain structure and activity 0 EEG records brain waves 0 Neuroimagingbrain scanning CAT scan Xrays the brains structure taken at different angles PET scan computer produced motion picture of chemical activity MRI uses magnetic property of certain brain atoms to create a detailed picture of the structure 0 fMRI detailed pictures of neuron activity pics of functioning brain sometimes unable to detect subtle abnormalities 0 measure cognitive perceptual and motor performances 0 Brain damage will likely affect visual perception memory visual motor coordination so tests focus on those things Many Components 6 Intelligence Tests 0 Intelligence is an inferred quality so it must be measured indirectly o Binet 1905 IQ test Among most carefully produced tests Well standardized very reliable pretty high validity Low motivation and high anxiety can affect scores may contain cultural biases 000 314 Clinical Observations Naturalistic and Analog Observations Naturalistic observations usually take place in homes schools or institutions 0 Focus on parentchild siblingchild teacherchild interactions and fearful aggressive or disruptive behavior 0 Observations are often made by participant observers key people in the person s life then reported to a clinician Analog observations observations aided by equipment like video cameras two way mirrors etc 0 Married couples resolving an argument parentchild interaction speechanxious ppl giving a speech 0 Clinical observations are not always reliable 0 Various clinicians observing the same person to assess different aspects of behavior and reach different conclusions 0 To reduce careful training of observers and use of checklists 0 May not be totally valid Overload not being able to see or record all important behaviors or events Observer drift a steady decline in accuracy as a result of fatigue or gradual unintentional change in the standards used for observations over a long period of time Observer bias Client reactivity behavior may be altered by the very presence of an observer Lacks crosssituational validity observations in one setting cannot always be applied to other settings children who are aggressive at school but not at home SelfMonitoring Client carefully observe themselves and report the frequency of certain behaviors thoughts amp feelings as the occur over time 0 Helpful for infrequentlyhyperfrequently occurring behaviors 0 Can be the only way to observe and measure private thoughtsperceptions o Validity can be a problem falsify records unintentionally change behaviors 32 Diagnosis Does the Client s Syndrome Match a Known Disorder 0 Clinical picture combination of information from interviews tests and observations 0 Diagnosis the determination of if a person s psychological problems comprise a particular disorder 321 Classi cation Systems Syndrome cluster of symptoms 0 Classi cation System list of categories or disorders with descriptions of symptoms and guidelines for assigning individuals to the categories 0 First modern system developed by Emil Kraepelin in 1883 eventually formed the guidelines for the Diagnostic and Statistical Manual of Mental Disorders DSM written by the American Psychiatric Association 0 Other countries use International Classi cation of Diseases ICD World Health Organization 0 Currently fth edition DSM5 322 DSM5 Lists 400 disorders criteria for diagnosing sometimesrelated symptoms background info and research ndings Clinicians are required to provide categorical and dimensional information as part of a diagnosis 0 Categorical information indicated by client s symptoms 0 Dimensional information how severe the client s symptoms are how dysfunctional heshe is 0 First edition to seek categorical AND dimensional information as part of diagnoses Categorical Information Clinicians must rst decide if client has one of the hundreds of disorders 0 Most commonly diagnosed anxiety and depression 0 Some people receive only one diagnoses but many people receive multiple diagnoses Dimensional Information DSM5 has various rating scales to judge how much a client s symptoms impair them Additional Information Clinicians often include relevant medical conditions and special psychological problems ex breakup losing job etc 323 Is DSM5 an Effective Classi cation System DSM5 is most reliable version thus far meaning any clinician who uses it is likely to make the same diagnosis for one patient as another 0 Some argue the framers of DSM5 didn t run enough eld studies to test reliability and that DSM5 retained much of the same problems regardless Same with problems of validity 324 Call for Change DSM5 was produced after a decade of work nally a new version was approved in 2012 0 Several categories added changed and removed list of major changed on pg 87 325 Can Diagnosis and Labeling Cause Harm 0 Sometimes even with trustworthy methods of diagnosis clinicians car arrive at the wrong conclusion 0 Studies show clinicians sometimes pay too much attention to info from the beginning of the assessment process amp certain sources 0 Biases can also alter diagnosis genderageracereligionsocioeconomic status etc 0 Aside from misdiagnosis just classifying people can cause them to view a diagnosis as a quotselffulfilling prophecyquot 0 Society attaches a stigma to mentally ill people hard to get a job date etc 0 Come clinicians want to do away with diagnoses completely others say no we just need to increase awareness that diagnoses are critical to understanding and treating people in distress 33 Treatment How Might the Client be Helped 331 Treatment Decisions 0 To arrive at a treatment plan combining idiographic data broad information about the nature and treatment of a disorder and current research under their theoretical orientations Growing movement called Empirically Supported or EvidenceBased Treatment meant to help clinicians become familiar with and apply new research ndings 0 Task forces formed to identify which therapies have received quotclear research supportquot propose corresponding treatment options and spread info to clinicians 0 Critics argue too simplistic biased misleading 332 The Effectiveness of Treatment 0 400 forms of therapy are currently practiced in the clinical eld 0 How do you de ne success of a treatment How do you measure improvement 0 Biggest problem in determining the effectiveness of treatment variety and complexity of treatments currently in use 0 People differ in problems personal styles motivations o Therapists differ in skill experience orientation and personality 0 Therapies differ in theory format and setting 0 Proper research procedures address some of those problems using random assignment control groups etc 0 Even well designed studies have limitations on the conclusions that can be drawn 0 Therapy Outcome Studies measure the effects of various treatments 0 Typically ask 1 of 3 questions 1 Is therapy in general effective 2 Are particulartherapies generally effective 3 Are particulartherapies effective for particular problems ls Therapy Generally Effective Studies show that therapy is generally more helpful that placebos or no treatment at all 0 510 of patients seem to get worse due to therapy symptoms become more intense may develop new ones meme manage 1 treated untreated A person perigee Plumber el peeple l l l l l l 1 l a l 1 l i ll l 1 l 2 l 1 l 1 l 39hr 939 file improvement utela ndine imie revemenl Are Particular Therapies Generally Effective Uniformity Myth false belief that al therapies are equivalent despite difference is the therapist s training experience theoretical operations and personalities Alternative approaches study effectiveness of a particular kind of therapy separate from other types most studies like this show that particular kinds of therapy ARE more effective than noneplacebos but when compared no form of therapy is superior to another Rapprochement Movement tries to identify a set of common strategies that may run through the work of all effective therapists basically effective therapists practice more similarly to each other than they preach Are Particular Therapies more Effective for Particular Problems People with different disorders may respond differently to various forms of treatment Paul Gordon most appropriate question regarding the effectiveness of treatments quot What speci c treatment by Whom is most effective for this individual with that speci c problem and under Which set of circumstancesquot There ARE differences in effectiveness of different treatments for different disorders 0 Ex Behavior therapies are best for phobias but drug therapy is best for schizophrenia 0 Some respond better to combined approaches becoming more common for patients to see two therapists a psychopharmacologist medication prescription and a psychologist for therapy 0 Knowledge of which therapies work better for certain disorders and how therapies work together is extremely helpful to therapists More and more clinicians use batteries of assessment tools
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