Dx Variation in Clinical Psych Flashcards
Scope of Clinical Psychology
#1. Scope of adjustment and suffering
Activity: think of different populations and where they may be on a normal distribution.
Looking at a normal distribution there is a point in which psychologists decided what classifies as a disorder or not. (A line vertical on the right side of a normal distribution).
Scope of Clinical Psychology #2 Spectrum of public health interventions.
Activity: Choose one spectrum or disorder and apply the activity to it
What is promotion?
What is Prevention and three types?
What is treatment and 2 categories?
What is maintenance and it’s two categories?
What is the difference between promotion and universal prevention?
Promotion Section
Includes targets/society as a whole- general population
Health Promotion: enhance good things (not treat pathology)
Ex: quilting focused on positive (not pathology)
Prevention Section
Before someone has diagnosable condition (intervention)
Goal: prevent a disorder or to lower the risk for the development of a disorder.
Prevention types (Universal, Selective, Indicated)
Universal: everyone in the population has access to (if everyone at OSU has access to tutoring)
Selective: targets group of people who may have risk factors for developing problem, chosen on basis of being part of a group known to be at risk. Ex: OSU prevents drop out by reaching out to nontraditional students, transfer students. Or implementing workshops for children whose parents are divorcing. Sometimes selective is known as “At Risk:
Indicated Prevention: person selected because they have early signs of the problem.
Aimed toward high-risk individuals: people with risk factors that make them highly vulnerable for development of a disorder, but are not recognized as clinical cases (currently/yet).
Minimal/subthreshold symptoms (don‘t meet the diagnostic levels), markers of possible development of mental, emotional or behavioral disorder or biological predisposition for the disorder.
E.g. interventions for children with early (subthreshold level) symptoms of depression or other disorders
Treatment Section
Case Identification:
Early recognition of disorders who may need a service. Link people to services/ treatment which require..
In order for this to occur, need valid assessments.
To have valid assessments, need instruments (like interviews) and valid procedures and processes. (e.g., human or computerized interviewers; self-assessment)
Valid classification systems.
We also need effective referral processes. (Sometimes known as chain of care). Parent concerned kid has ADHD, parent takes them in, therapist diagnosis them, but then says there no care in Corvallis… this would be missing link in chain of care.
Standard Treatment for Known Disorders:
Early recognition of diseases/disorders and referral to standard treatment
Interventions with individuals with diagnosed diseases/disorders
Maintenance Section
Compliance with long term treatment (Goal: reduction in relapse and reoccurrence, , health and well-being maintenance, long-term treatment)
After Care (including rehabilitation)
Aim of treatment and maintenance?
Aims at these two levels: to treat the disorder; to decrease the seriousness of the symptoms; to alleviate the consequences of the disorder (also worsening, invalidity, secondary problems etc.)
Ecological Perspective
In clinical psych –> we remove person from their environment to room and treat them there. Don’t necessarily see family, peer relations…
Racism, sexism etc. is imbedded and directly impacts person
Ecological Quote
“Part of the extension of the work you will do is, yes, focused on our young leaders and our young people, but understanding we also then have to be clear about the needs of their parents and their grandparents and their teachers and their communities because none of us just live in a silo. Everything is in context.
My mother used to — she would give us a hard time sometimes, and she would say to us, ‘I don’t know what’s wrong with you young people. You think you just fell out of a coconut tree?’ You exist in the context of all in which you live and what came before you.”
Classification and Diagnosis in Clinical Psychology:
Purposes
Positive Consequences
Negative Consequences
Human Variation
Classification and diagnosis in clinical Psychology.
Think about: purpose of diagnostic system, positive consequences, negative consequences, and human variation.
Structure of DSM
What is a mental disorder?
Signs and symptoms
Diagnostic criteria (symptoms, duration, distress and impairment, exclusions)
Structure of DSM
What is a mental disorder
A mental disorder involves significant disturbances in cognition, emotion, or behavior due to underlying dysfunction, causing distress or impairment in daily life. Normal stress responses and socially deviant behavior or societal conflicts, aren’t considered disorders unless linked to individual dysfunction (listed above).
Signs (what clinician sees, or others) “
Symptoms: what client reports
Diagnostic criteria:
Types of Exclusions: substance use, culturally approved responses, better explained by medical condition
Reading: Case Formulation
provides a framework to begin organizing answers to questions
Psychotherapy case formulation is a process for developing a hypothesis about, and a plan to address, the causes, precipitants, and maintaining influences of a person’s psychological, interpersonal, and behavioral problems in the context of that individual’s culture and environment.
. It explains why the individual has problems.
symptoms and problems questions include: What are
her main problems, and how are they interrelated? Is she still grieving
the loss of her son? Are there problems that if successfully treated would
also solve others? What triggers her symptoms? Why did she scratch her
husband’s car instead of seeking better solutions?
Diagnostic questions include: What is Rochelle’s diagnosis? Does she
have major depression or another mood disorder? Does she have an anxiety
disorder or a personality disorder? Does she meet criteria for more than
one diagnosis? If so, which diagnosis should be the primary focus in therapy?
What are her psychosocial stressors? What is her overall level of functioning?
Questions surrounding possible explanations of her behavior include:
What is her self-concept? How does she view others? What are her wishes
and fears? What are her primary coping strategies? How well integrated
is her personality? How strong is her sense of identity? What automatic
thoughts does she have? What factors influence her mood regulation?
What are her goals and why is she not able to achieve them? How is her
environment, both interpersonal and physical, affecting her behavior?
How are her current and past family dynamics influencing her current
functioning? Is diabetes contributing to her mood? What role are finances
playing? What are her strengths? What is her risk for suicide? How are cultural factors and social role expectations affecting her behavior?
Questions focusing on treatment planning include: Are there evidencebased treatments or treatment processes that can help Rochelle? Does she
need behavioral therapy? Cognitive–behavioral? Psychodynamic? Supportive? Some other modality? How long does she need to be in treatment?
What short-term and long-term goals would be most helpful? Which problem or problems should we start with? Will she be able to form a therapeutic
alliance with me? How motivated is she? Above all, will she or can she come
for treatment?
Reading: Chapter 1 Chat GPT Quick Summary
In psychotherapy, determining what to do in a session is complex and uncertain. While therapists may not always know the best immediate action, having a structured plan increases the likelihood of helping the client. A case formulation is essential for guiding treatment. It is developed using information from theory, evidence, and expert practice, and involves creating a hypothesis about the causes and factors maintaining a client’s issues. This process informs treatment planning, integrates various client factors (e.g., symptoms, environment, cultural influences), and evolves as new information emerges and progress is monitored.
A case formulation focuses on understanding a client’s overall psychological issues, while an event formulation explains specific in-session events, ideally aligning with and either confirming or disconfirming the broader case formulation. Prototype formulations, on the other hand, are theoretical models of specific disorders (e.g., depression or anxiety) that provide a general framework for understanding the disorder, which can then be customized into an idiographic case formulation for the individual client. These formulations guide treatment and enhance understanding of the client’s experiences.
Case formulation is essential in psychotherapy for four key reasons: it guides treatment by helping therapists stay on track, increases treatment efficiency by creating a structured plan, tailors treatment to the client’s specific circumstances, and enhances therapist empathy by promoting deeper understanding. Formulation provides a holistic framework that integrates biological, psychological, and social factors. Historically, it has evolved from medical traditions that emphasized observation and reasoning, and is influenced by modern psychological theories and models, including the classification of psychopathology and structured approaches to case formulation.
The dimensionalist perspective views psychopathology on a continuum, contrasting with the traditional categorical model. While the categorical approach is more practical for clinical decision-making (e.g., diagnosing or choosing treatment), it can be limiting when clients don’t fully meet diagnostic criteria. The dimensionalist view suggests that psychopathology varies by degree, offering a more nuanced understanding, especially for subclinical conditions. Both approaches have merits, and therapists can benefit from applying either model depending on the context, blending dimensional insights with categorical diagnoses for more tailored treatment planning.
The DSM-5 incorporates both categorical and dimensional approaches to psychopathology. The categorical model aids clinical decision-making but can be restrictive when clients don’t fit clear diagnoses. The dimensional model offers a continuum-based view, providing a more nuanced understanding, especially for subclinical conditions. Therapists can benefit from using both approaches to create more tailored treatment plans.
