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Abnormal Behavior > Lecture 2 - Assessment and Diagnosis > Flashcards

Lecture 2 - Assessment and Diagnosis Flashcards

1
Q

the First Session

A
  • Therapist: “What brings you here today?”
  • Patient: “I’m _____ … I have _____”
  • Therapist: “Tell me more …”
  • A story begins …
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2
Q

Objectives of the First Session

A
  • Listen: Attentive, Therapeutic, Empathy
  • Validate
  • Observe
  • Orient to the therapeutic process
  • match? or referral?
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3
Q

how the Scientific Method is involved in the First Session

A

the Clinical Psychologist is a Scientist:

  • theory
  • hypothesis
  • data collection
  • evidence in support of or disproving the hypothesis
  • reformulating the hypothesis
  • empirically supported interventions
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4
Q

psychological assessment

A
  • a procedure
  • use of psychological tests, observation, and interviews
  • develop a summary of the client’s symptoms and problems
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5
Q

psychological diagnosis

A
  • a general “summary classification”
  • use of a diagnostic manual, e.g. DSM-5
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6
Q

types of assessment

A
  • Clinical Psychologists are the only professionals comprehensively trained in Psychological Assessment
  • Some Clinical Psychologists are primarily assessors
  • Psychological assessment includes Neuropsychological Assessment (a subspeciality of Clinical Psychology) and Psychodiagnostic Assessment
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7
Q

Step 1 of assessment

A

Identify and characterize the presenting problem:

  • situational or pervasive?
  • duration?
  • prior attempts to help or treat?
  • how does problem impact social roles?
  • does problem match any DSM disorder criteria?
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8
Q

Step 2 of assessment

A

Comprehensive assessment may incorporate the following:

  • a general physical examination
  • a neurological examination
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9
Q

Neuropsychological assessment

A

Objective: assess cognitive domains

  • attention, memory, executive function, language, visuospatial ability, intelligence
  • as a clue to the extent and location of brain damage (e.g. Dementia)
  • as a way of characterizing the level of cognitive functioning (e.g. Learning Disabilities)
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10
Q

Psychodiagnostic assessment

A

Objective: to assess an individual’s psychological presentation

  • three procedures commonly used in psychodiagnostic assessments include: assessment interviews (structured or unstructured), clinical observation of behavior, and psychological tests
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11
Q

assessment interviews

A

clinician obtains information about the client’s situation, personality, and behavior

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12
Q

structured interviews

A

restrict freedom to explore but increase reliability

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13
Q

unstructured interviews

A

allow for more exploration but decrease reliability

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14
Q

clinical observation of behavior

A
  • ideally in a natural environment, such as a child’s behavior in a classroom or at home
  • often in a clinic or hospital where the client seeks help
  • rating scales can augment clinical observations of behavior and can increase reliability and validity (e.g. w/ ADHD)
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15
Q

the two general categories of psychological tests for use in clinical practice are …

A

… intelligence tests and personality tests

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16
Q

most commonly used intelligence tests

A
  • the WISC-IV and the Stanford-Binet (for children)
  • the WAIS-IV (for 16 y.o and older)
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17
Q

personality tests include …

A

… projective and objective personality tests

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18
Q

in projective personality tests …

A

… unstructured stimuli are presented to a subject and the subject projects meaning or structure onto the stimuli

  • these projections are believed to be unconscious processes
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19
Q

projective personality tests include:

A
  • the Rorschach Inkblot Test
  • the Thematic Apperception Test
  • the Sentence Completion Test
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20
Q

Rorschach Inkblot Test

A

see many dif. inkblots, can code what you see

  • not used alone to give comprehensive interpretation, part of more comprehensive assessment
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21
Q

Thematic Apperception Test

A

shown a picture, asked “What do you see? Can you tell a story w/ a beginning, middle, or end?”

  • story you tell says something specific about your own story
22
Q

advantages of projective tests

A
  • comprehensive
  • potential advancement of psychodynamic, psychoanalytic conceptualization
23
Q

disadvantages of projective tests

A
  • length of time to administer and interpret
  • subjectivity
  • advanced skill/training necessary to interpret/score
  • debates over reliability and validity
24
Q

objective personality tests

A
  • typically structured questionnaires, self-report or rating scales
  • include the MMPI and MMPI-2 (Minnesota Multiphasic Personality Inventory)
25
Q

MMPI and MMPI-2 (Minnesota Multiphasic Personality Inventory)

A
  • the most widely used personality test for clinical and forensic assessment
  • subject’s response is compared to norms and clinical samples
  • the MMPI includes ten clinical scales measuring psychopathology and a few validity scales measuring honesty, straightforwardness
26
Q

advantages of objective tests

A
  • cost-effective, reliable, objective
  • computer scoring
27
Q

disadvantages of objective tests

A
  • too mechanistic, reduces complexity
  • self-report biases, distortions
28
Q

Integration of Assessment Data

A
  • assessment data from various sources must be integrated into a coherent working model
  • a definitive picture may emerge or sometimes, there are discrepancies that necessitate further assessment
29
Q

Components of an assessment report

A
  • Referral Question
  • Background Information (including family history, psychosocial history, medical history, and psychological history)
  • Behavioral Observations
  • Tests Administered
  • Test Results
  • Summary and Diagnostic Impressions
  • Recommendations
30
Q

ethical issues in assessment include:

A
  • Potential cultural bias
  • Theoretical orientation of the clinician
  • Underemphasis on the external situation
  • Insufficient validation
  • Inaccurate data or premature evaluation
31
Q

classifying abnormal behavior

A

classification involves the attempt to delineate meaningful sub varieties of maladaptive behavior

32
Q

benefits of classification

A
  • Introduction of order
  • Enables communication
  • Enables statistical research
  • Insurance reimbursement
33
Q

three basic approaches to classification models are:

A
  • the categorical approach
  • the dimensional approach
  • the diagnostic approach
34
Q

categorical approach

A

a patient is healthy or disordered, but there is no overlap

35
Q

dimensional approach

A

the patient may fall along a range from superior functioning to absolutely impaired functioning

36
Q

formal diagnositic classifcaiton of mental disorders

A
  • the Diagnostic and Statistical Manual of Mental Disorders (DSM)
  • the International Classification of Disease (ICD)
37
Q

example: DSM-IV TR Diagnosis

A

Axis I: Major Depressive Disorder; Alcohol Dependence Disorder; Generalized Anxiety Disorder

Axis II: Borderline Personality Disorder

Axis III: Anemia

Axis IV: Recent Arrest, falling grades, conflicts w/ parents

Axis V: GAF = 70

38
Q

DSM (pre-DSM-5) had 5 axes:

A

Axis I: Clinical syndromes or other conditions that may be the focus of clinical attention

Axis II: Personality disorders, mental retardation

  • Axis III: General medical conditions
  • Axis IV: Psychosocial and environmental problems
  • Axis V: Global assessment of functioning
39
Q

DSM criticisms

A
  • The Pathology Assumption
  • Reduces Complexity
  • Presentations that do not fit (e.g. Complex/Developmental Trauma)
  • May promote selective bias in evidence in
    patient and therapist
40
Q

Non-pathological models

A
  • healing
  • learned
  • survival

(e.g. Internal Family Systems, IFS)

41
Q

Conviction of Psychotherapy

A

the belief that people w/ psychological problems can change-can learn more adaptive ways of perceiving, evaluating, and behaving is the conviction underlying all psychotherapy

  • an effective psychotherapist assists clients w/ changing dysfunctional emotion, cognitive and behavior patterns and replacing them w/ new, functional ones
42
Q

Why seek therapy?

A
  • current stressors
  • historical issues/problems
  • referrals by others - reluctant clients
  • personal growth
43
Q

professional therapists

A
  • Religious Counselors
  • Psychologists - PhD
  • Clinical or Counseling, PsyD
  • Psychiatrists - MD
  • Clinical Social Workers - LICSW
  • Psychiatric Nurse Practitioners - NP
44
Q

the therapeutic relationship is a …

A

… working alliance

  • Collaborative relationship
  • Agreement on goals and takes
  • Affective bond
  • Clear communication
  • Pt./Client’s motivation, expectation of receiving
    help
45
Q

Success of therapy based in …

A

… therapeutic alliance, not in how advanced degree is/years of training

46
Q

Estimating therapy gains

A
  • Therapist impression
  • Client report
  • Family/friend report (as people grow in therapy, some of their old friend may not be friends w/ them anymore, b/c they became friends with the old them)
  • Pre-treatment vs. post-treatment scores
  • Measures of change in overt behaviors
  • Insight does not automatically guarantee change!
47
Q

Objectifying and quantifying change: Would change occur anyway?

A
  • Most researchers agree that psychotherapy is more effective than no treatment even though some psychological states may resolve w/o treatment
  • Often times, time itself heals a lot of things (e.g., therapy can’t heal bereavement)
48
Q

Can therapy be harmful?

A
  • People may deteriorate in treatment
  • Boundary violations often play a role (all info given is in pt.’s interest, it is all therapy)
49
Q

What approaches should be used?

A
  • current emphasis on evidence based or empirically supported approaches
  • however, it is a challenge to control all variables in therapy
50
Q

treatment approaches

A

psychosocial approaches

  • behavior - exposure, aversion, modeling, token economics
  • cognitive and cognitive behavioral therapy (Rational Emotive-Ellis and Beck’s Cognitive Therapy)
  • Humanistic - experimential (client-centered therapy by Carl Rogers, motivational interviewing, Gestalt)
  • psychodynamic/psychoanalytic

couple and family therapy

eclecticism and integration

biological approaches

  • psychopharmacology
  • electroconvulsive therapy (ECT)
  • neurosurgery
  • deep brain stimulation

Abnormal Behavior (8 decks)

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