Exam 1 Flashcards
All clinical assessments share a primary goal of aiding the understanding of…
the person’s current level of psychosocial functioning
What is clinical psychology?
a broad approach to human problems consisting of areas such assessment, diagnosis and treatment with regard to numerous populations (children, adults, families, etc.)
What is assessment/diagnosis?
evaluating the psychological functioning of an individual, couple, family or group (diagnostic assessment, psychological testing)
What is prevention?
developing, implementing, and evaluating mental health prevention programs (ex. bullying, risky drinking)
What is intervention?
providing psychotherapy using a variety of theoretical orientations (ex. CBT, DBT, interpersonal)
What is consultation?
providing info and recommendations on how to best assess, understand, an/or treat individuals or groups
What is teaching and supervision?
providing info to help others understand the field of psychology (ex. teaching undergraduate/graduate courses, providing clinical supervision to graduate/health care professionals)
What is administration?
- contribute to the overall running of various departments and institutions (committees)
- act in management positions (department head, dean, CEO)
What does research involve?
- apply for research grants
- conduct research studies (ex. human functioning, psychopathology)
- publish the results of research studies
- read research publications
What does the training of a clinical psychologist include?
- academic preparation (undergrad degree - 4 yrs, master degree with master’s thesis and practicum training - 2 yrs, doctoral degree with doctoral dissertation and internship - 4/5 yrs, postdoctoral fellowship which is optional - 1 to 3 years)
What is the difference between clinical psych and psychiatry?
- clinical psych
- graduate degree (PhD)
- clinician
- trained in psych principles
- doesn’t prescribe medications (w a few exceptions)
- training in research methods - psychiatry
- medical degree (MD)
- physician
- trained in medical principles
- prescribe medications
- no formal training in research methods (but can do a research fellowship)
What is counselling psychology?
- often trained in departments of education rather than dep. psych
- focus on well-adjusted ind. (traditionally but some overlap)
- focus on ind. dealing with normal challenges in life, not necessarily psychopathology
- typically less focus on research
- commonly employed in educational settings, like uni counselling clinics
What is school psychology?
- employed primarily by school boards
- promote intellectual, social, emotional growth of school aged children
- services related to learning among children and adolescents (ex. assessment of intellect/emotion/behaviour, evaluation of learning disabilities, consult w teachers/parents on how to optimize students’ learning potential)
What is social work?
- Ontario needs a undergrad or master’s degree in social work
- focus on social determinants and consequences of mental health and illness
- takes comprehensive approach to client, coordinating social and community services, medical services, vocational and employment activities
- activities include: program planning, therapy, advocacy
- employed by public agencies and work on multidisciplinary teams
What is psychiatric nursing?
- registered nurse who has specialized training in mental health
- activities include medical management of inpatients, implementing therapeutic recommendations, discharge planning, supportive therapy
What are biological theories?
abnormal behaviour is caused by something going wrong in the brain/body, something wrong with the way transmitters work (an imbalance)
What are some mental illnesses that would fall into “biological theories” category?
- biologically based depression (serotonin)
- schizophrenia (dopamine)
- biopolar
- ptsd
What are some treatments that go under biological theories?
- medication (SSRIs; block reuptake so NT stay in synapse longer, used to target certain NTs)
- lobotomy (believe certain part of brain was the problem and if u removed it u would fix it)
- electroconvulsive shock therapy (inpatient’s for mood and anxiety when they haven’t responded to other things, also for active suicidality when other things haven’t worked)
What are supernatural theories?
abnormal behaviour is caused by the devil, demons, evil spirits or punishment by the gods
What are some treatments used for supernatural theories?
- exorcisms
- humours (bloodletting)
- trepidation
- witch hunts
What are psychological theories?
abnormal behaviour is caused by traumatic experiences (e.g.
stress/bereavement)
What are some treatments used for psychological theories?
- cbt
- exposure therapy
- behavioural focused treatments
- treatments around how did the disorder originate and how is it maintained
Describe asylums.
- early as 12th century
- mentally ill confined in one place
- deplorable conditions and just places of maintenance
- seen as places of seperation
- viewed more as places of incarceration
- included things like bloodletting and trepidation
What were the reason behind asylums?
- not to rehabilitate the people but to keep the public safe from them
- viewed psych disorders aas medical conditions that were untreatable and people would have to deal with them for the rest of their life
When was the Madhouses Act?
1774
How were people admitted prior to the Madhouses Act?
anyone could be sent here before their will
What was the Madhouses Act?
- meant to determine general living conditions in asylums
- the # of people
- people had to be admitted by doctor (but patient didn’t have to agree)
- enviornment became a bit more standardized but still inadequate
What was the first asylum?
St. Mary’s (Bethlehem, 1547, seen more as a circus as people could pay to go see the patients)
What was moral treatment?
- movement toward a more humane treatment of mentally ill
- incorporated a psych view of mental illness (moved away from bio)
- believed recovery was possible
Who is Phillipe Pinel?
- biggest name associated with moral treatment
- humane treatment in France (1792)
- fought against idea of asylums
- believed it was important for people in asylums to live better (jobs, social, freedom) and for them to become places of rehabilitation
Who is Benjamin Rush?
- moral treatment in NA (1792)
- first person to coin term “moral treatment”
- same like Phillipe but focus on rehabilitation
Who is Dorothy Dix?
- advocated for construction of mental hospitals
- her work led to 32 mental health hospitals being built
When did classification came into effect?
- 19th century
- physicians began to describe symptoms and classify them into certain disorders
- more was known on how the brain functioned
What were Griesinger’s ideas?
- any mental condition must have a physical cause and can be described in terms of brain pathology
- one of the first to try to classify what he saw
What were Kraeplin’s ideas?
- convinced all mental disorders were due to biological factors
- credited with delevoping the first classifcation system
- called groups of symptoms that frequently co-occur “syndromes”
- this term still used in DSM today
Clinical psych was almost exclusively an ______ based discipline until the middle of the ____ century.
assessment, 20th
The influence of the _____ world view (late 1700s) was evident in the application of scientific principles to understanding normal and abnormal behaviour.
enlightenment
Who is Wilhelm Wundt?
- established first psychology research lab
- focused on perception and sensation
- bio focused
What were Francis Galton’s ideas?
- studied individual differences among people, particularly differences in motor skills and reaction times which he believed were related to differences in intelligence
Who coined the term “nature vs. nurture?
Francis Galton
What were James McKeen Cattell’s ideas?
focused on the associated between reaction time and intelligence
Who coined the term “mental tests?
James McKeen Cattell
What did Alfred Binet and Theordore Simon do?
- developed a strategy to measure mental skills that could show info that identified children of limited intelligence
- (gathered data of children and established norms)
- adminstered the tests to each child and compare them to each other to see what the cognitive functioning of each were compared to each other
Why did Alfred Binet and Theodore Simon create their test?
- French school system where they wanted all children to be in school
- they wanted to identify the children who would not thrive under the regular school system and needed more help
- there wasn’t a way to determine this before
Who is Lewis Terman?
- came up with a modified version of Binet and Simon’s test in the U.S. called the “Stanford Binet intelligence test”
What was the first widely available scientifically-based test of human intelligence?
Stanford Binet
What 2 procedures/tests did the U.S. government create when it entered WWI to screen the mental fitness of recruits? Explain them.
- Army Alpha Test: measure of verbal abilities that could be administered in group format
- Army Beta Test: measure of non-verbal abilities (people who couldn’t read or understand english could do this one)
When did Clinical Psychology become an officially recognized discipline by the APA?
1919
What are projective personality tests?
- presumed an individual’s interpretation of a situation is determined by personality characteristics
- different from strictly a behaviourism approach
- people have different personality characteristics that changes how they interpret things
- the development of these tests proceeded w/o attention to norms, standardization, reliability and validity
What is are some examples of projective personality tests?
Rorschach inkblot test, house-tree-person test, thematic apperception test
What are some controversies/criticisms around the inkblot test?
- it used psychometric properties
- scoring system took so long
What is a thematic apperception test?
- projective personality test
- present a person one picture of an ambiguous situation and ask them to complete the story
- also had a scoring system
What is the MMPI (Minnesota Multiphasic Personality Inventory)?
- objective personality test
- easily admistered test that could effectively screen for psychological disturbances
- development and interpretation of this test relied on test development criteria
- effort went into creating the test
- can be given across a community
by Hathaway
What is the difference between a Projective Personality Test and an Objective Personality Test?
- Projective: person projects their personality onto test (ambiguous stimuli)
- Objective: have norms, standardization, administered the same bw people
What are the principles of behavioural assessments?
- focused on easily defined and observable behaviours and the environemental determinants of behaviour
- focued on gathering clinical data
- first time assessment is for informing treatment, purpose is gathering info to inform treatment
- Ex. a child with attention deficits involve classroom observations (how many times they get out of their seat) and then decide on a treatment
Who is Walter Mischel?
- challenged personality assessment by claiming a person’s past experience and environmental context is more informative than personality in predicting feelings, thoughts and behaviours
- Example where an environment that more involved rather than someone’s personality: church, library
Who is credited with development of psychoanalysis and modern history of psychotherapy?
Freud
Who are some other advocates of psychoanalytic approaches?
Carl Jung, Alfred Adler, Anna Freud
Who focused on “neurosis” and said it is the symptoms associated with neurosis or psychosis?
Freud
also focused on defense mechanisms - transference
What is the assumption and goal of psychoanalytic approaches?
Assumption: most psychopathology stems from unconscious processes
Goal: develop an awareness of the unconscious and gain insight into the origin of problems
Who is Lightner Witmer?
- credited as the first person to coin the term “clinical psychology”
- established the first clinic offering psych services and university training in clinical psych
Who started behaviour therapy?
John Watson and Mary Cover Jones
What was Watson’s main study?
Little Albert: how phobias can be conditioned in people and taught us about generalization in phobias (everything fluffy white animal was categorized as scary)
What was Mary Cover Jones’ main experiment?
how exposure can be used to treat phobias (repetition of showing the rat without the loud noise shows the child there is nothing to be scared of)
Why did the demand for psychotherapy (or clinical psych) grow dramatically?
bc of WWII, need from the vets
Humanist therapy began in the 40s with who?
Carl Rogers
Cognitive therapy began in the 60s and 70s with what 3 psychologists?
Albert Ellis, Don Meichenbaum and Aaron Beck
What does humanist theory entail?
focus on self actualizing, focus should be on the individual rather than applying a technique to everyone
What 3 models guide the training of clinical psychologists?
- scientist-practitioner model
- practitioner-scholar model
- clinical scientist model
What was the Boulder Conference?
- trying to join the fields of clinical practice and science
- there was a big gap bw these 2 prior
What is the scientist-practitioner moder?
- aka the “boulder model”; most clinical psych programs endorse this model
- attempt to connect science and practice
- still variability among programs regarding the balance of science and practice in training
What is the guiding philosophy in the scientist-practitioner model?
clinical psychologists should be able to produce research and use empirical evidence to guide their clinical services
What is the practitioner-scholar model?
- aka “ the vail model”
- more clinical, pushing for more clinical practice
- doctor of psychology programs (PsyD)
- education/part of program; search for empirical research but don’t conduct their own
What is the guiding philosophy in the practitioner-scholar model?
clinical psychologists should be research consumers who are informed by science in their services, but don’t need the skills to conduct research
What are some critiques of the practitioner-scholar model?
- are they good consumers of literature?
- do they use empirically supported techniques?
What is the difference between a PhD and a PsyD?
PhD: - more science, offered by unis, more competitive, smaller class sizes, more financial support, offered throughout canada
PsyD: - more practice, offered by unis or professional schools, less competitive, larger class sizes, less financial support, fairly limited across canada
What does McFall’s manifesto for a science of clinical psychology state?
- clinical psych must be scientific to be legitimate
- primary objective in a clinical program must be to produce the most competent clinical scientist possible
Under McFall’s manifesto, psychological services should not be administered unless…
- exact nature of service is described clearly
- claimed benefits of the service must be described clearly AND scientifically validated
- negative side effects that outweigh benefits must be empirically investigated
What is the Clinical Scientist Model?
- more science
- People need to be trained as scientists first and practitioners second
- concerned clinical psych isn’t grounded enough in science
What is the grounding philosophy in the Clinical Scientist Model?
clinical psychologists should be equipped to contribute to the knowledge base of psych and related disciplines
In Ontario, what is required to be a registered psychologist (to get ur license)?
- phD
- 1 year supervised practice
- ethics/jurisprudence exam
- EPPP exam
- oral exam
What does, “accountability to the public” mean?
- clinical psych is a regulated profession
- must be licensed to provide services in the jurisdiction u practice in for protection of public
What does, “accountability to stakeholders” mean?
- must justify the time and expense of assessment and therapy
- lead to the Empirically Supported Assessment and Empirically Supported Treatment movements
- assessments should have clinical utility
- assessments should be used for service evaluation
- treatments should be time-limited and supported by research
What does “proliferation of research” mean?
- increasing pressure for health care practices to be both effective and cost-effective lead to the development of empirical criteria to determine whether an intervention is efficacious in the treatment of a given disorder
- many organizations such as insurance companies will only fund ESTs delivered by a registered psychologist
- criteria showing there has been good studies showing that the given treatment is better than getting no treatment at all
What are some criticisms of empirically supported treatments?
- some theories look good in studies and theories but might not generalize to actual treatments
- assumes people don’t have comorbidity
- everything is based on group means
- depends on funding (need money to do big studies)
What are some pros of telephone-based assessment/treatments?
- people who don’t feel comfortable in person, location and costs (e.g. for parking at a hospital)
- helpful for stigma (people thought they could be more honest because they couldn’t go looking for facial expressions they perceive to be negative)
What are some pros of web-based assessment/treatment?
- homework people do on their own
- reduces costs
What are some examples where VR therapy could be used?
- exposure therapy for phobias (where it isn’t easy to represent the fear, e.g. planes and social anxiety (e.g. looks like they’re giving a presentation)
- some evidence it works for PTSD
What is the Canadian Code of Ethics?
- ethical principles to guide all members of the CPA, regardless of role (ex. teacher, researcher)
- published by Canadian Psych Association
- newest edition includes tech enhanced treatments
- there is a “rule book” that if u break it u can go to a hearing and see if the claims meet it
What is the “aspirational code” in the Canadian Code of Ethics?
there are some standards that aren’t necessarily standards that they must follow, but that they should consider some pro bono financial options, guidelines of things they should consider in their practice
What are the 4 ethical principles (of the Canadian Code of Ethics)?
- respect for the dignity of the person
- responsible caring
- integrity in relationships
- responsibility to society
What is the structure of the Canadian Code of Ethics?
- each principle is followed by a list of specific ethical standards
- principles are arranged in hierarchical order (If ethical principles conflict, the highest ethical principle should be given priority)
- There often isn’t a “right or wrong choice” when ethical issues arise, but it’s reasoning
“Clear and imminent danger to the safety of any person is of greatest importance.” Explain and give an example.
- this is a break to the “dignity of the person” , also bc it deals with confidentiality which falls under the same principle
- Ex. if they are a threat to themselves or others, clear and imminent threat to a child but this is why we tell people we may have to breach confidentiality but we try to make it collaborative (ex. Try to make the call together to children’s aid rather than going over their head)
- Brings up the issue of what is “clear and imminent danger”
What are 3 examples that fall under “respect for the dignity of the person” and give an example of an issue that would break it?
- general respect: using proper language, abstaining from all levels of a sexual relationship
- Confidentiality: don’t relay info that is collected during being a clinical psych unless consent is given, ex. Break if they want info to be sent to another doctor to continue treatment
- Non-discrimination: not including anyone from treatment, or from research (unless you have a rational, i.e. a study on men)
What are 3 examples that fall under “responsible caring” and give an example of an issue that would break it?
- general caring: avoid doing harm to people
- competence and self knowledge: conduct only activities that you’re competent in (ex. State the pop. that you know like adults or children) or state what area you’re most competent in, know areas of competence, keeping up to date on info, seek help if you have your own issues that are substantially affecting performance
- minimize harm: being aware of the power dynamic and not abusing power, giving ample notice when discontinuing practice
What are 3 examples that fall under “integrity in relationships” and give an example of an issue that would break it?
- accuracy: explain your qualifications and experience, only taking credit for what you’ve actually done
- straightforwardness: being honest to people so they can make competent decisions, in research using lay terms that will make sense to the patient
- avoidance of conflict of interest: not able to get into business with someone you’re giving treatment to, can’t say I’ll give u treatment if u do something for me, like a renovation.
What are 3 examples that fall under “responsibility to society” and give an example of an issue that would break it?
- development of knowledge: keep informed of developments in field and using them
- beneficial activities: continuing education, providing some kind of community/pro bono treatments like workshops
- respect for society: ex. Lack of clinical psych in indigenous, remote areas so be aware of their culture before treating
The code of ethics has no intention to regulate a psychologist’s activities outside of this context, unless the behaviour…
- it undermines public trust in discipline
- calls into question the psych’s ability to carry out responsibilities appropriately
ex. Every year you have to get your license and state any charges or complaints filed against you
What is evidence based practice?
- basing clinical services on research evidence from scientific studies
- What is research saying is beneficial and effective in different areas. Depending on the issue, what should be your first line of action. This is what psych focuses on.
What is eminence based practice?
- basing clinical services on tradition and authority, accepting recommendations simply because they come from an expert
- based more on tradition, authority, accepting treatment bc it comes from an expert but don’t know if there’s been research into it
What is the Golden Mean Fallacy?
(an error in reasoning)
- assume that the most valid conclusion to reach is a compromise of two competing positions
- ex. If we know CBT is effective in depression and also intertherapy, the golden mean would say if we know they’re both effective then maybe if we combine them they’re be more effective. But there are guidelines against this. Sometimes the treatments can cancel each other it.
What is Appeal to Ignorance?
(error in reasoning)
- arguing that, because there is no evidence to prove a position wrong, the position must be correct
- assuming what the best treatment is, but if there is no evidence against it or with it, we assume it’s right based on the theory of the disorder
What is correlation?
- the variables are associated with each other
- how strongly they are connected
What is Third Variable Problem?
- association between two variables may be due to a third confounding variable
(a third variable that actually explains the relationship)
What is causation?
- one variable directly or indirectly influences the level of a second variable
What is Moderation?
- one variable influences the direction or size of the relation between two other variables
- ex. Media and body image is evident in both males and females but more prominent in females so gender is a moderation here (is a stronger correlation for females)
What is Mediation?
- the influence of one variable on a second variable is due, in whole or part, to the influence of a third variable
- what is the mechanism that maintains the relationship between the 2 variables
What is internal validity?
- The extent to which the interpretations drawn from the results of a study can be justified, and alternative interpretations can be reasonably ruled out
- the more tightly controlled research is the higher the chance to have internal validity
- if it’s a controlled research design, in a lab with specific treatment guidelines this leads to higher internal validity
What is external validity?
the extent to which the interpretations drawn from the results of a study can be generalized beyond the narrow boundaries of the specific study in question
(generalized on a bigger scope)
What are efficacy studies?
studies that try to reduce threats to INTERnAL validity
- tightly controlled experimental designs)
What are effectiveness studies?
studies that try to reduce threats to EXTERNAL validity
- treatment effects in “real world” context
Should you demonstrate efficacy or effectiveness first?
efficacy
What is a case study?
- detailed clinical description of a single subject
- Not an experimental study so you can’t make a hypothesis or make general conclusions
- make primary connections bw events, behaviours, symptoms
What is a single case design?
examine whether treatment results in the expected behaviour change
What are the 2 types of single case design?
- AB design: A represents the level of symptoms prior to the intervention (baseline) and B is the level of symptoms after the intervention
- ABA reversal design: similar to AB but intervention is withdrawn after a few weeks but data is still collected. typically not used today bc maybe unethical to remove treatment from people who benefit from it
What is a correlational desgin?
- examine relationships bw variables w/o manipulating any
- provides useful preliminary info but limited bc it cannot determine causal relationships
- seeing how variables interact
What is the most used study design?
correlational design (cheaper)
What is a quasi-experimental design?
- involves a variable being manipulated by researcher but not random assignment
- may not be ethical to randomly assign
- usually comparing 2 previously established groups of participants
Why is a quasi-experiment not a full experiment?
bc it doesn’t involve random assignment
What is an experimental design?
- involves random assignment to conditions and experimental manipulation
- allows for causal statements
Which study design provides the best protection against threats to internal validity?
experimental design
What is a randomized controlled trial (in an experimental design)?
- random assignment of individuals into one or more treatment conditions
What is a meta-analysis?
- quantitative lit review
- set of statistical procedures for summarizing results
- combines results of prior research using metric called an effect size
- “participants” are research studies, not individuals
What is epidemiological research?
- study of the frequency and distribution of a disorder in the pop.
involves prevalence and incidence (new cases)
cross-sectional (time course of research study)
assessment conducted at one point in time
longitudinal (time course of research study)
assessment conducted at several points in time over an extended period with same individuals
follow-up (time course of research study)
assessment conducted at several points in time with same individuals to examine impact of an intervention
What are the ways “abnormality” is defined?
- social norms/cultural relativism
- unusualness/statistical deviation
- discomfort
- mental illness
- maladaptiveness
- harmful dysfunction/dyscontrol
(boundaries are arbitrary, depends on definition you use)
What is the DSM definition of Mental Disorder?
- clinically significant behaviour/psychological syndrome that occurs in an individual
- associated with distress or disability or with a significantly increased risk of suffering death/pain/disability/important loss of freedom
- not merely an expectable/culturally sanctioned response to a particular event
- need to meet criteria of significantly distressed/impairment
What does harmful dysfunction mean?
the behaviours associated with a mental disorder are dysfunctional and this causes harm to the ind. or others
What does dyscontrol mean?
the resulting impairment (of harm dysfunction?) must be involuntary or at least not readily controlled
- ex. If someone murders someone, for legal reasons, they can’t say oh it was my ASPD
Is the DSM categorical or dimensional?
categorical (but can rate things on “low, med or high”)
What is a disadvantage of categorical approach?
issues with comorbidity
What is a disadvantage of dimensional approach?
harder to get a diagnosis, harder to communicate what’s going on w person
On the DSM-IV multiaxial system, why are personality disorders separate from clinical?
originally thought these were more outstanding things, start early and are long lasting, not necessarily responsive to treatments and that clinical are more responsive to treatments and “episodes”
Describe Axis III - general medical conditions.
- may be directly etiological to the development/worsening of symptoms
- mental disorder may be psych response to GMC
- GMC may not be directly related to mental disorder but have prognostic or treatment implications
- EX. parkinson’s may lead someone to be more likely to have depression
Describe some examples of Axis IV - psychosocial and environmental problems
- problems with primary support group (ex. divorce)
- educational/employment/housing problems
- economic problems
- problems with access to health care services
- problems related to crime/interaction with legal system
What are the 2 domains that the Global Assessment of Functioning measures degree of impairment.
- symptom severity
- functional impairment (psych, social, occupational functioning)
- if severity and functional level disagree, use lower score
What is comorbidity?
person recieves diagnoses for 2 or more disorders at a specific point in time
- often is the norm
- 40% of people at a certain point who have one diagnosis often meet another
- 57% of people with a mood disorder often have another
What is the impact of comorbidity?
- more severe impairment
- more likely to have a chronic history of mental health problems
- more physical problems
- more health care service utilization
(may need to adapt treatments if they conflict with each other)
What are Criteria Sets for Further Study in the appendix in DSM?
- not official diagnoses yet, but being considered for future inclusion
- other people do research to see if they should be included
- have diagnostic characteristics
