final exam Flashcards
**Multiculturalism as a fourth force
Powerful force
Enhances existing model
Infuses awarenes/sensitivity
Applied to various cultural backgrounds
recent efforts to emphasize issues of diversity and culture
Adding divisons (highlight cultural competance)
APA ethics code changes (principle E, standards 3.01, etc. & APA qualification requires adressing diverse backgorunds
DSM (Cultural formulation interview, outline, cultural-bound syndromes/concepts of distess)
What is cultural competance?
–Counselor’s awareness, knowledge, and skills needed to function effectively in a pluralistic democratic society (Inclusivity, respect poeples cultures/beliefs, all coexist)
–Effective advocacy of new theories, practices, policies, and organizational structures that are more responsive to all groups
etic vs emic
etic - emphasizes our simalarities (early days)
emic - recognizes cultural-specific norms, considers clients’ thoughts/behavior in context of their culture
Tripartate Model of Personal Identity
individual - unique, nonshared experience (our DNA)
group - like other people (gender, ethnicity, race, sexual orientation
universal - like all other people (self-awareness, homo sapiens, ability to use symbols, common life experiences)
level of similarities at these 3 levels
cultural adaptation
Adapt treatment for different groups
Allocentric (community) guided imagery scripts instead of idiocentric (individual) scripts
cultural self awareness
- Begins with learning about own culture
- Not only basic facts, but values, assumptions, and biases
- Unique and idiosyncratic views (individuals perspective reflects their personal experiences & values, challenges existing norms)
Knowledge of diverse cultures
–acknowledge cultural differences with clients
–have knowledge of their cultural group (knowing history not just values)
–Appreciate the heterogeneity inherent in every culture, avoid sterotyping
acculturation
person/groups adopt and adapt to the cultural traits, values, customs, and behaviors of a different cultural group. modify orginal culture and incorporate new ideas. result of migreation, colonization, globalization.
acculturation strategies
when individuals from the same culture undergo acculturation
their experiences, attitudes, levels of adaptation to the new culture can vary + contribute to the development of heterogeneity within the culture
Heterogeneity within cultures stems from differences in acculturation
Acculturation strategies (john berry)
Assimilation – abandon old culture for new
Separation –reject new culture, retain old
Integration – retain new and old
Marginalization – reject new and old (lack of belonging, discriminated against, inability to maintain their cultural identity while being denied acceptance by the dominant culture.)
a sim
narrow vs broad definitions of culture
Narrow - typically point to ethnicity and
race as the defining characteristics
vs – much broader range of variables, includingsocioeconomic status, gender, geography/region, age, sexual orientation, religion/spirituality, disability status,
immigrant/refugee status, and political affiliation,
“any group that shares a theme or issues”
subcultures
based on specific work settings, living communities, or other variables may represent enough of an influence on the life experiences of clients to justify tailoring the treatment to best fit them (i.e. prison culture)
graduate programs should…
–explicitly state a commitment to diversity
–active effort to retain a diverse faculty
–ensure students aware of their own cultural values/bias and others they work with
–evaluate students on their cultural competence on a regular basis
microagressions
subtle, everyday actions, behaviors, or verbal comments that communicate derogatory or negative messages to individuals based on their membership in a marginalized or minority group. These actions are often unintentional unconsciously done, but they can still have harmful effects on the recipients.
(example; asking male client if they have a girlfriend)
What Constitutes a
Culture?
-Narrow vs broad definitions
-Numerous cultural variables
-Interactions in many ways
-Shapes life experience of client
difficulties MEASURING the outcome of culture-based efforts
- How to meausre it reliabily (consistently)
- How to set baseline for cultural competance beofre trainaing
- How to make a causal connection between efforts and outcomes
Educational Alternatives
Assessment of all courses for infusion of culture- centered approach in curriculum
Regular evaluation of students on cultural competence
GENERAL PRINCIPLES
Aspirational (describe an ideal level of ethical functioning or how psychologists should strive to conduct themselves)
broad, guiding, cant get in troube for
Ethical standards
ENFORCEABLE, very specific, descriptive, CAN get in trouble for
ethical principles
Beneficence/Nonmaleficence
act in the best interest of others, psychologists strive to benefit those with whom they work and do no harm (nonmaleficence)
ethical principles
Fidelity and Responsibility
Psychologists establish relationships of trust with those with whom they work. They are aware of their professional/scientific responsibilities to society/specific communities in which they work
Fidelity - loyal, honest, and trustworthy in their relationships with patients or clients. maintaing boundaires and trust
Responsibility – refers to the duty or obligation of healthcare professionals to fulfill their professional roles and duties effectively
ethical principles
integrity
Psychologists seek to promote accuracy, honesty, and truthfulness in the science, teaching, and practice of psychology
having a strong moral compass and consistently acting in accordance with one’s values, even when faced with challenges or temptations. being transparent, trustworthy, responsiblliy for actions
ethical principles
Justice
Psychologists recognize that fairness and justice entitle all persons to access and benefit from the contributions of psychology and to equal quality in the processes, procedures, and services being conducted by psychologists
fairness, equity, and the distribution of resources or benefits. all clients entitled to treatment
ethical principles
Respect for People’s Rights and Dignity
Psychologists respect the dignity and worth of all people, and the rights of individuals to privacy, confidentiality, and self-determination.
privacy and maintaining the confidentiality of their personal information, clients’ autonomy to make decsions, being culturally sensitive and not discriminating for race, sexual orientation, etc.
confidentiality
characteristic most closely associated with the ethical practice of clinical psychology, mentioned among the general principles
multiple relationships
Refers to situations where a professional engages with a client or patient in roles or contexts beyond the therapeutic relationship.
what makes it unethical?
–if the impairment in the psychologist is compromised (can’t perform their duties effectively)
–Exploitation or Harm to the client
boundaries of competence
Psychologists provide services, teach, and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study, or professional experience.
responsibility to provide care and services within the scope of their expertise and training, and to recognize and address their own limitations.
informed consent
in any professional activity conducted by psychologists, informed consent is an essential process. ensures the client is knowledgeable about the activities in which they may participate, it affords individuals the opportunity to refuse to consent if they so choose
informed consent
in any professional activity conducted by psychologists, informed consent is an essential process. ensures the client is knowledgeable about the activities in which they may participate, it affords individuals the opportunity to refuse to consent if they so choose
continuing education
regulations of many state licensing boards. says to be eligible to renew their licenses, psychologists in many states must attend lectures, participate in workshops, complete readings, or demonstrate in some other way that they are sharpening their professional skills and keeping their knowledge of the field current.
Ethics in Clinical Assessment
Test selection
Test security – prevent the questions, items, and other stimuli included in psychological tests
from entering the public domain
Test data
Ethics in Clinical Research
Ethical obligations ( minimize harm to participants, plagiarism, and avoid fabrication of data)
Efficacy of psychotherapy Participants who don’t receive treatment, all should be informed before of chance of placebo
Contemporary Ethical
Issues
ethics in small communities (military bases, small colleges/towns)
tech and ethics- online therapy and online psych tests
**divided loyalities **
Personal problems - Burnout
-causes: repetition, not leaving it at work, taking on too much with one client, personal problems
-effects: providing poor treatment, not making good connections
-actions: take appropirate action, self care
assesment
Clinical Psychologists use assessment more than any other (social workers, psychiatrists, prof. counselors) Employ a wide range of methods: intelligence and personality tests, neuropsychological tests
Assessment is closely and uniquely associated
with the identity of clinical psychology
validity vs reliability
Validity -measures what it claims to measure
Reliability -consistent, repeatable results
Clinical unity
Clinical unity recognizes that individuals seeking healthcare often have complex needs that extend beyond a single medical condition. It involves bringing together various healthcare professionals, such as physicians, nurses, psychologists, social workers, and other specialists, to collaborate and provide integrated care.
emphasizes the integration of medical, behavioral, and social care to provide holistic and patient-centered services.
general skills
The interviewer should acquire general skills as a foundation for conducting interviews
-quieting yourself : Turning off internal thoughts/questions to focus fully on client
-being self-aware: knowing how you affect people interpersonally & how they relate to you
-developing positive working relationships with clients. : genuine respect, empathy, cultural sensitivity, attentive listening
the interviewer: specific behaviors
Eye Contact
–facilitates and communicates listening
-makes client feel heard
-requires interviewer to have cultural knowledge and sensitivity
the interviewer: specific behaviors
body language
-culture shapes connotations of body language
General rules for interviewer
-face the client
-appear attentive
-minimize restlessness
-display appropriate facial expressions
the interviewer: specific behaviors
vocal qualitites
-skilled interviewers
-use pitch, tone, volume, and fluctuation
-attend closely to the vocal qualities of clients
the interviewer: specific behaviors
verbal tracking
effective interviews monitor the client’s train of thought by..
-repeating key words/phrases
-weaving clients language into their own
-shifting topics smoothly
the interviewer: specific behaviors
reffering to client by correct name
-inappropriate addressing can jeopardize the clients’ sense of comfort
Mistakes -
using nicknames/shortening name
addressing clients by first name and emitting essential ‘middle’ name (calling mary-beth mary)
the interviewer: specific behaviors
observing client behavior
-allows psychologist to consider nonverbal components
-important decisions can be informed by behavioral observations of client
rapport
refers to a positive, comfortable relationship between interviewer and client.
Strong sense of rapport brings sense of connect with interviewer
To establish good rapport with clients
* Make an effort to put the client at ease
* Acknowledge unique, unusual situation of clinical interview
* Enhance rapport by following client’s lead
Technique: Directive Versus Nondirective Styles
Technique: Directive Versus Nondirective Styles
Directive questioning approach
- Tends to be targeted toward specific pieces of information
- Client responses are typically brief
- Provides crucial data that clients may not otherwise choose to discuss
- Can sacrifice rapport in favor of information
Technique: Directive Versus Nondirective Styles
non directive questioning approach
- Client may choose to spend time on some topics
- Can provide crucial information that interviewers may not otherwise know to
inquire about - Can fall short in terms of gathering specific information
which is better; nondirective or directive
Best strategy involves balance and versatility
* Using only a directive approach could sacrifice rapport in favor of information
* Using only a nondirective approach can facilitate rapport but fall short of gathering specific information
Technique: Specific Interviewer Responses
- Open- and closed-ended questions
- Clarification
- Confrontation
- Paraphrasing
- Reflection of feeling
- Summarizing
open vs close ended questions
Open-ended question – “What more can you tell me about the eating problems you mentioned on the phone?” may take the interview in a different direction than a
Closed-ended question, such as, “How many times per week do you binge and purge?”
such as, “How many times per week do you binge and purge?”
Technique: Specific Interviewer Responses
clarification
purpose of this question is to make sure the interviewer has an accurate understanding of the client’s comments. Clarification questions not only enhance the interviewer’s ability to “get it,” they also communicate to the client that the interviewer is actively listening and processing what the client says. Sometimes, it’s better to wait than to immediately demand clarification
Technique: Specific Interviewer Responses
confrontation
Interviewers use confrontation when they notice discrepancies or inconsistencies in a client’s comments. Confrontations can be similar to clarifications, but they focus on apparently contradictory information provided by clients
Technique: Specific Interviewer Responses
paraphrasing
used simply to assure clients that they are being accurately heard. restate the content of clients’ comments, using similar language.
“I only binge when I’m alone,” → “so You only binge when no one else is around?”
Technique: Specific Interviewer Responses
reflection of feeling
echoes the client’s emotions .“I only binge when I’m alone” was delivered with a tone and body language that communicated shame—her hand covering her face, her voice quivering, and her eyes looking downward—the interviewer might respond with a statement such as “You don’t want anyone to see you bingeing—do you feel embarrassed about it?” Unlike paraphrasing, reflecting a client’s feelings often involves an inference by the interviewer about the emotions underlying the client’s words.
Technique: Specific Interviewer Responses
summarizing
usually involves tying together various topics that may have been discussed, connecting statements that may have been made at different points, and identifying themes that have recurred during
the interview. Like many of the other responses described in this section, summarizing lets clients know that they have been understood but in a more comprehensive, integrative way than, say, paraphrasing single statements.
conclusion made by clinical interviewer
The conclusion can take a number of different forms, depending on the type of interview, the client’s problem, the setting, or other factors. * Depends on interview type, setting, client’s problem, etc. * Provides initial conceptualization of client’s problem * May consist of specific diagnosis * May involve recommendations
form of interview depends on
- Setting
- Client’s presenting problem
- Issues the interview is intended to address
types of interviews
types of interviews
types of interviews
Diagnostic Interview
Purpose is to diagnose
-goal is to assign DSM diagnoses to client’s problems
-Include questions that relate to criteria of DSM
disorders
types of interviews
intake interview
determines whether to “intake” the client to the setting where the interview is taking place. -Whether client needs treatment
What form of treatment is needed
Diagnostic Interviews
unstructured vs structred
Structured interview is a predetermined, planned sequence of questions that an interviewer asks a client. Constructed for particular purposes, usually diagnostic.
-highly reliable {but rigid} , Structured interviews produce a diagnosis based explicitly on DSM criteria
Unstructured interview, in contrast, involves no predetermined or planned questions. In unstructured interviews, interviewers improvise
-Determine questions on the spot to seek relevant information
Diagnostic Interview
Advantages/dis of structured interview
ADVANTAGES +
* Produces diagnosis based explicitly on DSM criteria
* Empirically sound
* Standardized, and typically uncomplicated
DISADVANTAGES -
Rigidity inhibits rapport and client’s opportunity to elaborate or explain
* Does not allow for inquiries not related to DSM diagnostic categories
* Requires a more comprehensive list of questions, which lengthens the interview
diagnostic interview
Advantages/dis of unstructured interview
scid/semistructred interview
- List of questions that ask about specific symptoms of disorders listed in DSM
- Most SCID questions designed to elicit yes/no answers
- Modular
mental status exam
- Employed in medical settings
- Intended for brief, flexible administration requiring no manual or other materials
- Captures psychological and cognitive processes of an individual “right now”
may be administered differently by various health professionals (Psychiatrists, clinical psychologists) brief and flexible, because its lack of standardization questions may diffe
categories of mental status exam
- Appearance
- Behavior/psychomotor activity
- Attitude toward interviewer
- Affect and mood
- Speech and thought
- Perceptual disturbances
- Orientation to person, place, and time
- Memory and intelligence
- Reliability, judgment, and insight
types of interviews
crisis interview
*Assesses problems demanding urgent attention
like suicide, etc.
*Provides immediate and effective intervention
*Key components * Quickly establishing rapport * Expressing empathy
Cultural Components of interviewing
Appreciating the Cultural Context
* Interviewer should be culturally competent
* Variability among individuals within cultural groups
* Consideration of religion as a component of culture
Acknowledging Cultural Differences
*Open, respectful discussion of cultural variables * Can enhance rapport * Increase client’s willingness to share information
(where were you born, who do you consider family, how to you identify yourself culturally)
Classic Theories of Intelligence
Charles Spearman: Intelligence Is One Thing
- A singular characteristic—“g” for general intelligence
- Based on research that measured
- Academic abilities * Sensory-discrimination tasks * Primary finding—single factor underlying strong correlation
between wide range of abilities
Classic Theories of Intelligence
Louis Thurstone: Intelligence Is Many
Things
- Multiple factor analysis
Numerous distinct abilities - Verbal comprehension
- Numerical ability
- Spatial reasoning
- Memory
Theories of Intelligence that fall between
James Cattell
- Fluid intelligence – the ability to reason when faced with novel problems
- Crystallized intelligence – the body of knowledge one has accumulated as a result of life experiences.
More Contemporary Theories of Intelligence
John Carroll’s Three Stratum Theory of Intelligence
- A single “g” at the top
- Eight broad factors beneath “g” * More than 60 highly specific abilities beneath these broad factors
intelligence testing
3 Wechsler Intelligence Tests
- Wechsler Adult Intelligence Scale 4th (WAIS-IV)
- Wechsler Intelligence Scale for Children 5th (WISC-V)
- Wechsler Preschool and Primary Scale of Intelligence 4th (WPPSI-IV)
Tests - Cover entire life span
- Vary as per demands of measuring intelligence at different ages
- Separate tests, not variants of one another
- one on one, face to face
Four categories of subtests of WAIS
- Verbal Comprehension Index
- Perceptual Reasoning Index
- Working Memory Index
- Processing Speed Index
Wechsler Intelligence Tests
- Large sets of normative data
- Scores reflect IQ
- Analysis of each subtest score
- Very familiar to most clinical psychologists
- Some subtests may be culturally loaded or biased
- Limited connection between tests and day-to-day life
- Complex or subjective scoring on some subtests
intelligence testing
Stanford-Binet Intelligence Scales—Fifth Edition
- Similar to Wechsler tests * Administered face-to-face and one-on-one
- Employs hierarchical model of intelligence
- Yields singular measure of full-scale IQ, five factor scores, many specific subtest scores
- Features same means and standard deviations
- Psychometric data similarly strong
Differences with Wechsler tests and Stanford-Binet
Stanford Binet
* Covers entire life span as a single test
* Includes normative data for specific relevant diagnoses
* Features exactly five factors measured both verbally and nonverbally
Five features of SB5 tests:
- Fluid Reasoning ; ability to solve novel problems
- Knowledge ; general info accumulated over time via personal experiences
- Quantitative Reasoning ; ability to solve numerical problems
- Visual-Spatial Processing ; ability to analyze visually presented information (object permance, detecting patterns, etc.)
- Working Memory ; the ability to hold and transform information in short-term memory
Additional Tests of Intelligence: Addressing Cultural Fairness
Universal Nonverbal Intelligence Test-2 (UNIT-2)
- Language free test * Administered one-on-one and face-to-face
- No verbal instructions * Instructions via eight specific hand gestures * Appropriate for clients aged 5 to 21 years
Achievement vs Intelligence tests
*Intelligence—cognitive capacity
*Achievement—person’s accomplishments *Comparison of intelligence and achievement
key factor in determining learning
disabilities *Terminology changed in DSM-5
Neuropsychological Testing
- Specialized area of assessment within clinical psychology * Measures cognitive functioning or impairment of the brain * Fixed-battery phase to flexible-battery phase
Full Neuropsychological Batteries
Halstead-Reitan Neuropsychological Battery (HRB)
*Battery of eight standardized neuropsychological tests
*Suitable for ages 15 years and above
*Alternate versions available for younger clients *Primary purpose to identify people with brain damage
*Helps in diagnosis and treatment of problems related to brain malfunction
Full Neuropsychological Batteries
- NEPSY-II
- Designed specifically for children between 3 and 16 years * Based on the general principles of Luria-Nebraska test * Includes 32 separate subtests across 6 different categories
Brief Neuropsychological Measures
Rey-Osterrieth Complex Figure Test
- Brief pencil-and-paper drawing task comprising single complex figure * Involves use of colored pencils at various points in test * Examiner can trace client’s sequential approach to complex copying task * Includes a memory component
Brief Neuropsychological Measures
Repeatable Battery for the
Assessment of Neuropsychological
Status (RBANS)
- Focuses on a broader range of abilities than Bender-Gestalt or Rey- Osterrieth * Measures verbal skills, attention, and visual memory * Takes 20 to 30 minutes to complete
- Includes 12 subtests in 5 categories
brief neurological measures
Wechsler Memory Scale—Fourth Edition (WMS-IV)
Often used to assess individuals between
16 and 90 years with suspected memory problems *Assesses *Visual and auditory memory across seven subtests *Immediate and delayed recall
Working Memory Index
a measure of the capacity to store, transform, and recall incoming information and data in short-term memory
processing speed
a measure of the ability to process simple or rote information rapidly and accurately
They feature large, carefully collected sets of normative data. That is, the manual for each Wechsler test includes norms collected from about 2,000 people. These normative groups closely match recent U.S. Census data in terms of gender, age, race/ethnicity, and geographic region, among other variables
MMPI is objective
Multimethod Assessment
Personality best assessed using multiple methods
Each method offers unique perspective but often converge on similar conclusions
* Integration of multiple methods proves most informative
Evidence-Based
Assessment
select only those methods that have strong psychometrics {reliability, validity, and clinical utility}
* Sufficient normative data
* Sensitivity to issues of diversity
* Targeted toward a particular diagnosis/problem
Criteria to distinguish methods from those lacking evidence
Quantitative expression of strengths and weaknesses
* Subjective decision making
* Challenge of integrating “what works” empirically
with clinical judgment and client needs
overpathologizing
viewing as abnormal of which is culturally normal. clinical psychologist must appreciate the meaning of a behavior, thought, or feeling within the context of the client’s culture, which may differ
from the context of the psychologist’s own culture.
Cultural malpractice
A personality assessment conducted without
knowledge or sensitivity to cultural specifics can be a dangerous thing;
has been labeled “cultural malpractice”
Objective personality tests
- Unambiguous test items with limited range of responses
- Objectively scored
- Paper and pencil questionnaires
- Series of direct, brief statements or questions and either true/false or multiple-choice response options
Minnesota Multiphasic Personality Inventory-2 (MMPI-2)
- Most popular and psychometrically sound objective
personality test - Used in many countries and cultures
- simple test format
- appropriate only for adults
Projective personality tests
*stimuli up for interpretation
open-ended range of client responses
Not as “fake-able” as objective tests
Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A)
1992
designed for clients aged 14 to 18 years
Objective Personality Tests
Personality Assessment Inventory (PAI)
contains 344 items, each of which offers
4 responses: totally false, slightly true, mainly true, and very true.
Includes multiple validity scales
* 11 clinical scales, some matching the MMPI
* Specific diagnoses or problems
* Direct correspondence to some DSM disorders
appropriate for clients 18 to 89 years old (child version is PAI-A)
Objective Personality Tests
Millon Clinical Multiaxial Inventory-IV
- Created in 1977 by Theodore Millon
- Current version, MCMI-IV, published in 2015
- self-report, pencil-and-paper, true/false format
- Emphasis on personality disorders unlike MMPI-2 and PAI
- Used in medical situations where personality is seen to influence physical health
- Clinical scales for other forms of personality
pathology
- Clinical scales for other forms of personality
- Modifier indices to assess clients’ test-taking attitude
Objective Personality Tests
NEO Personality Inventory-3
- Personality measure that assesses normal personality characteristics
- Big Five or five-factor model of personality
- Neuroticism
- Extraversion
- Openness
- Agreeableness
- Conscientiousness
objective personality
Beck Depression Inventory-II: BDI-II Site
- Self-report test to assess depressive symptoms in adults and adolescents
- 21-item test listed in order of increasing severity
- Total score reflects client’s overall level of depression
Created by Aaron Beck in 1960s - Briefer tests with focus on one characteristic, like
depression, anxiety, or eating disorders
limited scope but is re
Projective Personality Tests
Rorschach Inkblot Method
Created by Hermann Rorschach in 1921
Test process
* Response phase
* Inquiry phase
* Weak reliability and validity data
* Scoring and interpretation guidelines are complex, not always followed closely
* Results often cannot distinguish those who have a particular disorder from those who don’t
Projective Personality Tests
Thematic Apperception Test (TAT)
Published by Henry Murray and Christiana Morgan
in 1935
* Uses series of cards each featuring an ambiguous stimulus
like Rorschach test * Features interpersonal scenes rather than inkblots
projective - Sentence Completion Tests
Rotter Incomplete Sentences Blank (RISB)
Includes 40 written sentence “stems” followed by blank space
* Formal scoring system, but highly dependent on
psychologist’s clinical judgment
Personalities revealed by endings added and sentences created
Behavioral Assessment
challenges assumptions of
traditional techniques
Offers fundamentally different approach to assessment * Client behaviors not signs of deep-seated, underlying
issues or problems
* Client behaviors are the problems
Methods of Behavioral Assessment
- Analogue observation
- Documentation
- Traditional assessment methods
- Terminology
Behavioral observation—naturalistic observation - Identifies and defines target behavior * Systematic observation
