Clinical Psychology 6 Flashcards
Priority 3
What are some negative stereotypes of elderly clients and what does research say about them?
stereotypes: physical and mental impairment, irritability, resistance to change
research: intellectual stability, active involvement in community, respond to therapy more slowly than, but nearly as effectively as younger adults
What are the percentages of overall population and MH services use among the aged?
- US population: 11%
- outpatient clinic population: 2%
- community MHC population: 4%
- inpatient population: 28%
What are some of the foci of therapy with older clients?
- identity transitions
- involvement in satisfying activities and relationships
- treatment of depression
Describe Reminiscence Therapy.
- facilitates acceptance of successes and shortcomings in life
- stresses resolution of past conflicts, creation of future goals
- commonly group setting
- effective Tx for depression among elderly
Describe Cass’ six stage model of homosexual identity development.
- identity awareness, consciousness of being different
- identity comparison, acting heterosexual but feeling homosexual
- identity tolerance, realization of homosexuality
- identity acceptance, exploration of gay community
- identity pride, becoming active in gay community
- synthesis, full acceptance of self & others
Describe Troiden’s four age-based stages of homosexual identity development.
- sensitization, pre-pubescent awareness of homosexual feelings without understanding
- identity confusion (self-recognition), awareness of one’s homosexuality, age ~17 (males) or ~18 (females)
- identity assumption, coming out, age ~19-21 (males) or ~21-23 (females)
- identity commitment, adoption of homosexual lifestyle, age ~21-24 (males) or ~22-23 (females)
Describe some advantages of the term “sexual prejudice” over “homophobia” and “heterosexism.”
- homophobia implies a pathological fear, rather than a socially reinforced prejudice
- heterosexism is limited to biases against non-heterosexuals, but sexual prejudice addresses bias based on sexuality in any form
Describe the distal and proximal factors affecting mental health outcomes among LGBT clients, according to Meyer’s Minority Stress Model.
- distal factors: external, objective events and conditions, such as discrimination and violence
- proximal factors: internal, subjective appraisals of or responses to events and conditions, such as expectations of rejection, concealment of sexual orientation, and internalized homophobia
Discuss Eysenck’s research on psychotherapy outcomes.
His 1952 19-study comparative analysis indicated that 2/3 or neurotic patients recovered within two years, whether or not they received psychotherapy. Thirty years later (1985), he indicated that behavior therapy was superior to placebo or no treatment.
Discuss the results of Smith, Glass & Miller’s meta-analysis of psychotherapy outcomes.
- 475 studies, 2500 patients, 78 treatment types, average of 16 sessions
- psychotherapy is better on average than no treatment (d = .85)
- average client better off than 80% of controls
- 66% of clients improve (34% of controls improve)
- more recent research indicates that effect size is as large as 1SD
List nine client variables that have been studied as predictors of psychotherapy outcome.
- intelligence: generally positively related
- openness/nondefensiveness: generally positively related
- understanding of goals: generally positively related
- personality characteristics: ego strength, suggestibility, anxiety tolerance are generally positively related
- expectations: moderate expectations generally more successful than those with very high or very low expectations
- motivation: early motivation appears unrelated, but motivation during therapy appears positively related
- SES: negative relationship appears to be function of tendency for low SES patients to be referred to less-experienced treaters
- gender: appears not to be related, although more women than men seek psychotherapy
- age: appears not to be related
List nine therapist variables that have been studied as predictors of psychotherapy outcome.
- competence: little studied, but appears to be positively related
- expectations: some evidence that outcomes are enhanced when client expectations are effectively addressed early in treatment
- emotional well-being: there is a clear, but modest positive relationship with therapy outcome
- professional background & experience: paraprofessionals are as effective as those with advanced degrees, but clients view education level and an important factor; also experience is more important with challenging patients, complex treatments, and early assessment of outcome- ethnicity: not a factor in outcome, but may affect early termination/drop-out
The following appear to have little to no effect on outcome: - age
- gender
- orientation
- self-disclosure
List three treatment variables that have been studied as predictors of psychotherapy outcome.
- therapeutic alliance: accounts for more than any other factor, including treatment type
- treatment type: no consistent relationship, although some studies have found behavioral interventions to be more effective for specific disorders
- duration/dosage: relationship is ambiguous, but generally time-limited treatments are favored over longer ones; some research finds a linear improvement up to about 26 sessions
Discuss treatment outcome research on children and adolescents.
- little done overall
- outcomes appear to be similar to those with adults
- some evidence that teen girls respond best
- overall effect size of d = .71, 76% are better than no treatment
- most studies do not reflect clinical practice (1% meet Tx representativeness criteria)
- low rate of self-referral (13%), high recruitment through others (77%)
Describe the three stages of Howard’s Phase Model of Psychotherapy Readiness.
- remoralization: focus on and improvement in client’s feelings of hopelessness and desperation
- remediation: focus on symptom relief; typically between sessions 5 and 15 (able to do this because of regaining hope in remoralization)- rehabilitation: gradual improvement in life functioning, e.g., work, relationships, etc.
Name the 10 clinical scales of the MMPI-2.
- Hypochondriasis (Hs) [somatocentrism]
- Depression (D)
- Hysteria (Hy) [physical problems with functional origin, conversion reactivity]
- Psychopathic Deviate (Pd) [psychopathy]
- Masculinity-Femininity (Mf)
- Paranoia (Pa)
- Psychasthenia (Pt) [neuroticism]
- Schizophrenia (Sc)
- Hypomania (Ma)
- Social Introversion (Si) [intro-/extroversion]
Name the five validity scales of the MMPI-2.
- ? or “Cannot Say”: # unanswered/both-answered items; >30 uninterpretable; >10 interpret with caution; may indicate reading diff, overcaution, indecisiveness, paranoia, rebelliousness, intellectualization
- L or “Lie”: high scores = unwillingness to admit minor shortcomings, bias toward favorable presentation, lack of self-insight; low scores = independence, bluntness, negative self-view
- F or “Infrequency”: high scores (T=70-90) = psychopathy, malingering, eccentricity; >90 invalidate test; low scores = social conformity, lack of pathology
- K or “Correction”: aka “defensiveness”, better indicator than L of positive bias; high scores = unwillingness to reveal problems/conflicts, desire to “fake good,” associated with poor Tx prognosis; low scores = poor self-image, frankness, self-criticism, poor self-defense; non-defensive, but high-education can score high (60-70)
- TRIN, VRIN, Back Side (F[B]): item consistency scores
