Exam One Flashcards
What does the clinical psych definition FOCUS ON?
INTEGRATION of science and practice, the APPLICATION of this integrated knowledge across diverse human pop., and the PURPOSE of alleviating human suffering and promoting health.
Personal Reqs. to be Clinical Psychologist
More to do with attitudes and character than with training and credentialing. MOST DISTINGUISHING FACTOR: clinical attitude/clinical approach (tendency to combine knowledge from research on human behavior and mental processes with efforts at individual assessment in order to understand and help a particular person.
Legal, Education, and Ethical Reqs
degree + state/national licence. (full license = independent)
Education
PhD. Psychopathology, assessment, and intervention strategies, clinical research.
Experience
one to two year internships
testing of competence
licensing board exam. Examination for Professional Practice in Psych (EPPP) ; reciprocity = other states with same license
mental health literacy
accurate understanding of psych disorders and their treatments
Counseling psych diff
most similar; developmental transitions
school psych diff
scientist-practitioner model too, but more training in ed and child dev., interventions on kids, families, and school
social work
administration, pub policy, research, and comm organizing ; social/situational, not intrapersonal/interpersonal
six activities of clin. psych
assessment, treatment, research, teaching (inc. supervision), consultation, and administration
three categories of assessment
tests, interviews, observations
reasons for emphasis in research
critically evaluate research to see what is most affective; academia must often supervise/evaluate research projects conducted by students; research training valuable for administrators in evaluating effectiveness of agency’s programs; research helps evaluate own clinical work
case oriented vs program/administration oriented
case = focus on particular cinet/organizational prob; program = focus on aspects of organizational function/structure that are causing trouble
Dr. David Shakow
most influential in clin.psych development; clinical training program.
recommendations in the Shakow report (three)
a cln psych should be trained first as a psych; clin training as rigorous as for nonclinical areas of psych; prep of the clin psych should be broad and directed toward assessment, research, and therapy
greatest impact of shakow report
prescribed that special mix of scientific + professional prep that has typified most clin training programs ever since. SCIENTIST-PROFESSIONAL MODEL ; first major conference = Boulder model
vail conference
PsyD; masters = professional psych. .
salt lake city conference
in grad programs seeking accreditation, grad students must be trained in a core of psych knowledge that should include research design and mthods, stats, ethics, assessment, history and systems of psych, biosociocog bases of behavior, and individual differences
academy of psych clinical science (APCS)
richard mcfall; empirical focus (APS)
clinical scientist model
APCS approach; heavy emphasis on scientific research (university setting)
scientist practioner model
boulder model; equal research and practice. common in traditional PhD programs and some prof. schools
practitioner scholar model
Vail model; human services, less emphasis on scientific training (prof schools/PsyD)
Psych clinical science accreditation system PCSAS
developed to provide a sharper focus on research training in clinical psych doctoral programs
certification vs licensure
cert = restrict use of title psychologist … licensure = more restrictive; define practice of psych
state boards of psych two functions
determine standards for admission and administering procedures for the selection/examination of candidates AND regulate prof. practice and conducting disciplinary proceedings involving alleged violators of prof. standards
managed care
method of allocating health services to a group of ppl in order to provide the most appropriate care while still containing the overall cost of these services – employee assistance programs (EAPs), health maintenance organizations HMOs, preferred provider PPOs, integrated deliveryIDs, and independent practice IPAs.
insurance panels
list of professionals who have been approved to provide services for reimbursement ii
parity
status of being equal (pay or status)
Lightner Witmer
first clinical psychologist and started first psych clinic ; diagnosed Charles with visual verbal amnesia (reading disorder)
5 aspects of Witmer’s new clinic
1) most of clients were children ; 2) his recommendations for helping clients were preceded by diagnostic assessment; 3) did not work alone but in a team approach collaborating on cases; 4) emphasized prevention of future probs through early diagnosis 5) clinical built on principles being discovered in scientific psych as a whole
Lightner Witmer
first clinical psychologist and started first psych clinic ; diagnosed Charles with visual verbal amnesia (reading disorder) – emprical tradition
psychometric tradition
measuring people’s physical and mental abiltilies (came from astronomy, anatomy, and biology), phrenology,
measuring individual differences in 1900s
1) Galton-Cattell sensorimotor tests (assessing inherited, relatively fixed mental STRUCTURES) 2) Binet - (mental FUNCTIONS)
Clinical tradition
mental illness could be helped not hidden
trephining
boring of holes in the skull to provide evil spirits with an exit.
landmarks of clinical tradition in clinical psych
classified psych disorders “dissociations”, used case studies ; introduced european psychogy and psychiatry to US (Principles of Psych) ; psychoanalysis
why was it difficult to find clinical training
university programs were often dominated by faculty skeptical of psychotherapy AND psychiatrists were reluctant to admit psychologist into psychoanalytic training institutes
psychodynamic approach
human behavior deried from constant struggle between desire to satisfy instincts and need to respect rules and realities ; goal = INSIGHT ;
humanistic approach
people = creative, growthful beings who realize their fullest potential ; disorders = avoidance of true self (PHENOMENOLOGICAL or EXPERIENTIAL THERAPIES) ; people/individual based honesty and acceptance.
psychodynamic approach
human behavior deried from constant struggle between desire to satisfy instincts and need to respect rules and realities ; goal = INSIGHT ; Therapist = “archaeologist”
humanistic approach
people = creative, growthful beings who realize their fullest potential ; disorders = avoidance of true self (PHENOMENOLOGICAL or EXPERIENTIAL THERAPIES) ; people/individual based honesty and acceptance. therapist = “mirror”
behavioral approach
behavior learned thru conditioning and observation; psych probs = learned and specific to situations ; behavior therapy = changing variables that maintain situation-specific learned maladaptive responses ; derived from empirical research and stresses collection of data to evaluate treatment effectiveness. therapist = “coach”
cognitive approach
behavior = learned connections but from how individuals CONSTRUE or THINK about the event; individuals have their own belief systems; psych problems = when peoples beliefs contribute to the things they most fear ; therapists offer alternate beliefs ; (ABC) therapist = “scientist” (identify, challenge, and replace habitual maladaptve thoughts)
group, family, marital, and related systems and approaches
human bheavior developed in social contexts; roles, beliefs, behaviors, and feedback mechanisms; therapists focus on patterns of interaction and exchange that have significance for individuals in the system ; “social planner” help group members make changes in roles, intergroup relations, and communcation patterns
diathesis
presence of some kind of biological defect (biochemical or anatomical problem in brain), the autonomic nervous system, or the endocrine system. set of defects inherited but also trauma.
diathesis-stress view of schizo
biolical, psycho, and environmental causes. a) vulnerability of schizo is mainly biological; b) diff people have differing degrees of vulnerability; c) vulnerability transmitted partly thru genetics and partly through neurodevelopmental abnormalities associated with birth/prenatal; d) psych components such as exposure to poor environments and failure to develop coping skills = when schizo appears and how severe
assessment
the collection and synthesis of info to reach a judgment.
DSM general history
DSM1 and 2 = uniform terminology for describing and diagnosing abnormal behavior, but no clear rules to guide diagnostic decisions. DSM3 = set of crtera for diagnostic label; mainly to specific symptoms and symptom durations (not causes) DSM3R = multiaxial diagnoses, clinicals describe along diff dimensions or axes (full picture of factors) DMS4 and DSM4TR reliabilty. DSM5 = categories
Predicting dangerousness
base rate (freq. with which dangerous acts is usually very low); clinicians = level of risk rather than will/wont.
True positive
if clinician predicts dangerousness and the person does behave dangerously
true negative
clinical predicts no danger and person does not behave dangerously
false positive
clinician predicts danger, no danger occurs
false negative
clinician predicts no danger but danger occurs
clinical intuition
clinicans have special inferential abilities
illusory correlations
draw false inferences from assessment data
anchoring bias
establish views of a client more on the basis of the first few pieces of assssment info than on any subsequent info ; also let assessment info coming from certain sources outweigh others
confirmation bias
tendency to interpret new info in line with existing beliefs
clinical vs statistical prediction
stat prediction = inferences based on probability data and formal procedures for combining info (derived from research); clincal = inferences based on practioner’s training, assumptions, and professional experiences; sta is superior
psychometric properties of assessment instruments
clinical judgments depend on the soudess of the measures used to help make those judgements (asssessment instruments)
reliability
consistency in measurement or to agreement among diff judges or raters – test-retest / internal consistency / interrater reliability (compare to other diagnoses)
validity
degree to which it measures what it is supposed to measure ;; content validity/ predictive validity [both CRITERION validity = how strongly an ass. result correlates with important criteria) (predict events) when two agree = concurrent validity. ; Construct validity = systematically related to the construct it is supposed to be measuring.
standardization
designers of the test have given it to a large, representative sample of persons and analyzed the score. average score is in a population. variance of scores on individual items or subtests.
bandwidth fidelity
greater bandwidth associated with lower fidelity in broadcasting; the more they explore a clients behavior, the less intensive each aspect of that exploration becomes (and vice versa) ; breadth of assessment device = bandwidth/depth or exhaustiveness of the device = fidelity
bandwidth fidelity
greater bandwidth associated with lower fidelity in broadcasting; the more they explore a clients behavior, the less intensive each aspect of that exploration becomes (and vice versa) ; breadth of assessment device = bandwidth/depth or exhaustiveness of the device = fidelity
intake interviews
establish the nature of the problem. asked for a classification or assessment of the problem in the form of a DSM diagnosis, also develop broader descriptions of clients and the environmental context in which their behavior occurs
problem referral interviews
client referred in order to answer a specific question; the referral question determines the type of assessment conducted
orientation interviews
to make new experiences less mysterious and more comfortable, conduct special interviews to acquaint the client with the assessment, treatment, or research procedures to come. beneficial in at least two ways: (client encouraged to ask questions/make comments AND understand upcoming assessment/treatment procedures)
debriefing interviews
to provide clients with info and assess their understanding of that info after an event
termination interviews
when time to end a clinical relationship, many loose ends tied up.
crisis interviews
attempt to provid support, collect data, and provide help in a very short time
underutilization
minorities receie less mental health care and lower quality mental health care
what interviewers do when faced with possible cultural issues
educate themselvs about more common cultural variations/interview behaviors; recognize own limitations; cultural sensitivity
structured interviews
asks a series of specific questions phrased in a standardized fashion and presented in an established order
adv of structured interviews
systematic way to assess variables that interviews designed to explore. not flexible, but less prone to error. help reduce variance.
disadv of structured interviews
protocol bound, miss important info that the interview script did not explore. bandidth versus fidelity! routinized nature can alienate clients. depend on memory, candor, and descriptive abilities of respondents.
malingering
clients motivated to appear mentally distrubed
impression management and why it is important to detect these
desire to present onself in a particular light to a mental health profession- can undermine the validity of interview data
impression management and why it is important to detect these
desire to present onself in a particular light to a mental health profession- can undermine the validity of interview data
observational assessment: approaches
NATURALISTIC OBSERVATION (natural context); CONTROLLED (sets up situation to observe behavior); PARTICIPANT (observer = participant, record notes called an ethnography); SELF observaton
demand characteristics
social cues that suggest what actions are or are not appropriate and expected
reliability of observational assessment
extent of observational assssments reliable.
task complexity
reducing tast complexity increases interrater reliability
rater training
structured training to define variables and keep accountable of structure
relationship between task complexity + rater training
more complex + structured rater training
test
systematic procedure for observing and describing a person’s behavior in a standard situation. present a set of planned stimuli and ask the client to respond in some way.
analytic/rational approach
what are the qualities i want to measure and how do i define these qualities? analyzing the content of a domain and matching questions that he or she believes (or that a theory says) – appears sensible but may or may not work
empirical approach
instead of deciding ahead of time what test conent should be used, the tester lets the content choose itslef. – work but may or may not be sensible
sequention approach
combines analytic and empirical. groups of correlated items = scales, relatively pure measures of certain dimensions of personality, mental ability, or the like.
response set/style/bias
tendency for soe clients to respond in particular ways to most items, regardless of what the items are.
social desirability bias
clients respond to test items in ways that are most socially acceptable, whethor or not those responses reflect their true feelings/impulses
acquiescent response style
agree with all questions
binet scales general characteristics
age graded. IQ = mental age / chronological age. :: fluid reasonsing, knowledge, quant reasoning, visual spatial processing, and working memory.
binet scales population
testing of children
binet scales general reliability findings
very high internal consistency. high levels of reliability.
wechler scales general characterisitcs
IQ compares the points earned by the client to those earne by persons of equal age in the standardization sample
wechsler scales population
designed for adults but now have for children and preschol.
wechsler scales reliability
strong. test retest great.
IQ definition
avg intelligence for age, taken as 100
objective vs projective personality tests
obj = present clear, specific stimulu such as questions or statements, respond with direct answers, choices, or ratings.. proj = ask clients to respond to ambiguous or unstructured stimuli.
MMPI characteristics
assessment of clinical symptoms and personaity. true/false/cannot say.
content scales vs validity scales
content = provide insights of specific symptoms. validity scales = measure reliability of attitudes
purpose of validity scales
to help detect various test taking attitudes or response distortions.
psychometric strength
measuring the mind
NEOPI and CPI additional examples of objective tests
NEOPI = measure neuroticism, extraversion, and openness, now agreeableness and conscientiousness. (adult personality) CPI = developed for assessing normal personality. true/false, but C{I are grouped into more diverse and positivly oriented scales, including sociability, self acceptance, responsibility, dominance, self control, etc.
rorschach (description + how it is analyzed)
set of ten colored and bw inkblots – tester records all responses verbatim, then goes back through them and conducts and inquiry of the characteristics of blot.
TAT description + how analyzed
31 cards, make up a story about it (what led up to the scene, what is now happening, and what is going to happen) focus on content and structure
general conclusions about reliability and validity of projective tests
test retest varies. mixed.
psych testing vs medical testing
psych tests are more reliable (shockingly) ; both evolve with research
WWII
psychoanalysts (influx of psychiatrists); awareness of the talking cure. Returning veterans = PTSD; need for professionals, VA traineeships, increased OhD psych training. STAMP OF APPROVAL OF BEING PSYCHOTHERAPISTS
Boulder Conference
first conference after WW2. Goal: consensus on content of training for clinical psych. Result: “scientist-practitioner model”. both research + practice. PhD required.
Chicago conference
goal: explore need for specifically professional training models. sets tone for professional psych training.
vail conference
goal: articulate professional training. PsyD! “scholar practitioner”
Gainsville Conference
reaffirm boulder. research informs practice and vice versa. APCS “the clinical scientist model”.
Indiana conference
advance clinical scientist. emphasis on science in research + clinical applications
Salt lake city conference
concerns about “free standing” programs. APA accreditation depends on affiliation w/ university ad training.
current models from least research focus to most
scholar-practitioner, scientist practitioner, clinical scientist
The schism
1988 = split in field. 2 GROUPS: APA and APS. could be a member of both or neither.
split between research vs practice
research: inidividual case study. clinicians are poorly trained. clinicians are uniformed in their work. VS clinicians: group research study. research oversimplifies clinical work. research fials to address real world issues. research writing inaccessible. research stats are not applicable.
current issues in clinical psych:
managed care, prescription privaleges, EVTs, ESTs, and EBTs.
research vs practice
scientist focus: interest in knowledge for its own sake, academic freedom is important. VS professional focus: interest in knowledge that can be applied
what can case studies NOT do?
provide definitive “proof” and is NOT same as well-controlled confirmation
what CAN case studies do?
1) cast doubt on general theory, 2) provide new directions to subs. research 3) provide opp. for new applications 4) sometimes > scientifically acceptable info 5) permit investigation of rare phenomena 6) put “meat” on theoretical skeleton
biopsychosocial approach
3 elements (bio psycho social); each element influences the other; all human probs; dysfunction @ 1 level = dysregulation dysfunction @ another.
History of PP Movement
1195: APA formally endorses PP
Where has PP passed?
GUAM (branches of armed forces); NEW MEXICO (first state); LOUISISANA; ILLINOIS; IOWA, IDAHO (have pops. w/ low accessibility to psychiatrists and MDs)
factors contributing to PP movement
OVERDEPENDENCE on psychotherapy, OVERSUPPLY of psychotherapists/inadequate training = phd school influx; rise of MANAGED CARE; dominance of SYNDROMAL CLASSIFICATION and diagnoses; MEDICAL AND DRUG COMPANIES interests
PROS of PP
SOLVES OVER RELIANCE PROBLEM on psychotherapy; PAY more; MASTERS LEVEL exclusion; MANAGED CARE attraction; TREATMENT RANGE wider
CONS of PP
not improve EFFECTIVENESS; medications are SEDUCTIVE; MEDICATION + PSYCHOTHERAPY not always best; patient ATTRIBUTIONS (drug help vs self change); LESS THERAPY, more prescription; EXPERTISE in both bio and psych interventions; MARKET SHARE/VALUE not increased; PROFESSIONAL ID; RISKS (legal and treatment); FRACTURING w/in and outside field
managed care
prepaid comp. health plans that reward maintenance and prevention of illness. system to manage/dispense healthcare (vs traditional fee for service model)
why did MC evolve?
to contain growing health care expenditures
early attempts of MC
limited stays, copayments, exclusions, Employee ass. programs, utilization reviews
utilization reviews
depends on managed care company* managed care company reviews/monitors care to approved insurance.
common triggers of utilization reviews
care exceeds 6-8 mo.; client seeing more than one psycho.; provider caring for 2+ members of family; evidence based practices not being followed
HMOs
employer contracts w/ HMO to provide all health services for employees. set fee per year. healhcare providers under HMO contract
PPOs
providers must e approved by MC company; providers get referrals in exchange for lower level reimbursement from co. ; utilization review
CHALLENGES of MC
1) consumer confusion (how much/who/what?) 2) compromised services 3) exclusion of some patients 4) time/effort joining (paperwork/approval); 5) time/effort justifying treatments; 6) psych may sell their services; 7) may not offest med costs 8) large business taking over care
psychotherapy vs medication
cost effective, time frame for MC, Psycotherapy ADV: + success, better relapse prevention; less side effects
clinical assessment
diagnosis (classification), description (observe/udnerstand); prediction (what can be expected)
Benefits of diagnosis
1) Provides a nomenclature (reduces confusion, standard for prof. communication, time saving); 2) organizes research/knowledge 3) describes sim/diff between groups of individuals; 4) helps predict (outcome/prognosis) 5) insurance
DSM5
no llonger multiaxial!!! psychosocial/environment = V-Codes; Global functionsing (WHODAS = world health org. disability ass. schedule)
critiques of DSM5
1) cant contail all info; 2) stereotypes; 3) emphasizes weakness; 4) ignores enviro/emphasizes individual responsibility; 5) inhibits creative thinking 6) artificial
probs of DSM5 practice
not all criteria are explicit, multiple axes cumbersome, too many categories, cultural biases, ignores relationship between client/clinician
hikikomori
japan: withdrawal. refusal to leave home.
culture bound syndromes
a recurrent, locality sepcific pattern of aberrant behavior and troubling experience. seen as illness indigenously, most have local names, seldome equivalence w/ DSM.
4 domains- how culture affects
definiton of problem; perception of cause, context, support; self-coping and past help seeking; current help seeking
cultural considerations
cultural IDENTITY; distress CONCEPTUALIZATION (how do they understand whats going on?); psychosocial enviro/FUNCTIONING/vulnerability and resilience; client/clinican RELATIONSHIP
assessing culture in DSM5
in text (diff in presentation); cultural formulation interview; glossary: cultural concepts of distress
cross cultural assumptions
universalist approach (western medical framework) vs relativistic approach (qualitative/descriptive framework–per culture)
importance of culture
demographics, globalization (beyond US), scientific accuracy, ethical obligation
ICD10 importance
international classification of diseases and related health probs
NIMH RdoC Project
research domain criteria
testing vs assessment
ASS: person focused, sohpisticated integration, never focused on single score/data point; TESTING: standardized, interpretation with normative data, assess aspect of indiv. knowledge, personality, skill
ADV and DISADV of self monitoring
ADV: for clients = ease; for ptobs = range, most appropriate for some behaviors; DISADV: reactivity = +/- ; required funcitoning
Initial interview process KEY ASPECTS
Establish rapport; role induction (what to expect); Stem affect (relieve/hope); Assess future sessions (plan)
Common forms of interviews
INTAKE (establish nature of prob); ORIENTATION (acquaint to clinical/treatment process); MENTAL STATUS EXAMINATION (assess appearance, manner, orientation, thought process, mood/affect); CRISIS (time pressure, assess, provide support); STRUCTURED CLINICAL (set sub. questions to determine diagnosis)
forms of questions
open ended, facilitative, clarifying, confronting, direct
Assumptions of IQ
ACCURATE, STABLE, EQUAL OPPORTUNITY to learn; UNIVERSAL
Flynn effect
progressive IQ test score increases over the years
cross cultural ability testing assumptions
shared values and meaning (right = intelligent); shared modes of knowing (w/in individual), shared conventions of communication (undoc. childs hesitance to answer freely)
personality testing
emotional state, motivational, interpersonal characteristics, attiudinal outlook
personality testing challenges
faking, ambiguity of behaviors, situation (influence of situation)
MMPI2
empirically derived, T/F items, clinical scales + validity scales, adults (objective measure)
MMPI2 adv
variety uses, objectively based (epirical approach/items discriminate ppl with issues); validity scales (test taking attitude)
MMPI2 disadv
reliability imperfect, normative samples, subscale intercorrelations, overconfidence in objectivity, time of admin.
projective tests basic assum[ptions
behavioral reflection of personality, ambiguous stimuli reveal tru nature, responses = intrapsychic wishes/needs
Rorscach inkblot test scoring
location, determinants, content, popularity
Draw a person test
drawing before writing, early primitive personality layer. DISADV: ability counfound, psychometrics do not support it. rough screening tool.
online testing
personal growth/development, diagnositc/treatment, cog. ability/certificaiton
benefits of online test
accessiblity, anonymous, candid resposes, test presentation, scoring acccuracy
disadv of online test
lack of control, detection of serious issues, individ. differences and performance, more negative affect, professiona;l/ethical issues(confidentiality, feedback, crises)
