CLINICAL PSYCHOLOGY
MODULE
(Midterm)
PREPARED BY:
MS. DONNA P. SOMBREA, MPSY
PSYCHOLOGY DEPARTMENT, ADAMSON UNIVERSITY
Disclaimer:
This module was outlined from the textbooks and other references (see bibliography section).
Not originally written by the assigned instructor.
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ABOUT THE INSTRUCTOR
Ms. Donna P. Sombrea is a full time instructor in Adamson University since August 2018,
and work as a part time Behavior Therapist at ABA Learning Difference Behavioral
Therapy Center. She gained her Bachelor’s Degree in Psychology at Adamson
University and completed her Master’s Degree in Clinical Psychology at the Ateneo
de Davao University. Ms. Donna supervised student organization, Adamson University
Psychological Society (AUPS), for SY 2018-2019 and SY 2019-2020. She is a community
oriented individual. She is an advocate of LGBT and HIV, and worked with different
non-profit religious organizations as active volunteer and facilitator.
Affiliations:
Adamson University Psychological Society (AUPS)
Adviser
SY2018-2019- Present
AdU Association of Campus Student Adviser (ACSA)
Secretary
SY2018-2019 -Present
AdU- ICES Vincentian Center for Social Responsibility (VCSR)
Volunteer Facilitator
January 2019-Present
AdU- ICES Student-Alumni Volunteers for Empowerment
Volunteer Alumni
January 2020- Present
AdU Office for Vincentian Identity and Mission
Missionary
January 2019-Present
The Loveyourself, Inc
Advocate/ Volunteer/ HIV Counselor (on process)
November 2018- Present
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Table of Contents
A. Disclaimer
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2
B.
C.
D.
E.
F.
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3
4
5
6
About the Instructor
Table of Contents
Course overview
Module Course Outline
MODULE 3: CLINICAL ASSESSMENT
1. Assessment Interview
2. Assessment of Intelligence
3. Personality Assessment
4. Behavioral Assessment
5. Clinical Judgement
G. MODULE 4: How are Psychological Disorders Treated?
 Medication and Intervention
 Useful treatments
 Simple CBT treatment programme
 Ethics
H. References
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Course overview
Course Title:
CLINICAL PSYCHOLOGY
Course Code:
PY 414
Pre-Requisite:
ABNORMAL PSYCHOLOGY
Pre-Requisite to:
PRACTICUM 1
Credit Units:
3
Course Description
A course designed to help students identify clinical problems or issues dealing
with maladjustment. It discusses behavior problems and studies the importance
of the use of psychometric and projective tests in assessment process. This allows
student understand the purpose of understanding, preventing, and relieving
psychologically-based distress or dysfunction and promote subjective well-being
and personal development. It also discusses the clinical psychologist’s
involvement in the treatment and management of psychiatric patients as a
health team member.
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MODULE COURSE OUTLINE
MODULE 1: INTRODUCTION TO CLINICAL PSYCHOLOGY


What is Clinical Psychology?
Historical Overview
MODULE 2: TENDS AND ISSUES INTO PSYCHOLOGICAL DISORDER



Classification
Diagnosis
Research
MODULE 3: CLINICAL ASSESSMENT
6. Assessment Interview
7. Assessment of Intelligence
8. Personality Assessment
9. Behavioral Assessment
10. Clinical Judgement
MODULE 4: How are Psychological Disorders Treated?




Medication and Intervention
Useful treatments
Simple CBT treatment programme
Ethics
MODULE 5: Psychological Disorder: Brief Etiology, Assessment, and Treatment
 Childhood Disorders
 Schizophrenia
 Mood Disorders
 Generalized Anxiety Disorder
 Specific Phobia
 Panic Disorder and Social Anxiety Disorder
 Substance Use Disorder
 Eating Disorder
 Personality Disorders
MODULE 6: Specialization in Clinical Psychology
 Community Psychology
 Health Psychology
 Neuropsychology
 Forensic Psychology
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MODULE 3: CLINICAL ASSESSMENT
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A. Course Title: Clinical Assessment
B. Learning Objectives:
Student will be able to understand the utility of assessment tools and its process, this
includes:
1. Clinical Interview
2. Assessment of Intelligence
3. Personality Assessment
4. Behavioral Assessment
5. Clinical Judgement
C. Duration and Platform:
1. Week 1-3
2. 1 hour Discussion (Synchronous Discussion via google meet)
3. 2 hours Recorded Lecture and other Activities (Asynchronous via Blackboard
LMS)
D. Assessment:
1. Online Quiz
E. Topic Outline:
Assessment in Clinical Psychology
Psychological assessment as an area of emphasis has seen its ups and downs. During the 1960s
and 1970s, there seemed to be a decline in interest in psychological assessment (Abeles, 1990).
Therapy was the more glamorous enterprise, and assessment almost seemed somehow “unfair”
to clients. It appeared that clinical psychology’s historical commitment to assessment was
waning. The prevailing attitude about assessment was “Let the technicians do it!”
1980’s- students began to show an interest in specialization
– Forensic psychology (the application of psychology to legal issues)
– Intrigued by pediatric psychology, geriatrics, or even neuropsychology.
Evidenced based approach to clinical assessment
• Evidenced based assessment uses theory and knowledge about psychological problems
to help in the selection of assessment methods and measures, as well as to guide the
actual process of assessment itself.
– Overcomes past assessment practices: “one-test-fits-all” test selection approach.
“one-test-fits-all” test selection approach, the use of poorly validated measures, unreliable test
interpretation, and the use of tests with limited evidence for treatment utility (Hunsley & Mash,
2007).\
In other words, clinical psychologists must be properly trained to know about the assessment
process itself, about the conditions to be evaluated, and about the psychometric properties of
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assessment methods and measures that are available to address the specific assessment situation
at hand.
Clinical assessment
• involves an evaluation of individual’s or family’s strengths and weaknesses, a
conceptualization of the problem at hand (as well as possible etiological factors), and
some prescription for alleviating the problem
• All of these lead us to a better understanding if the client
• It is not something that is done once and then is forever finished
Assessment is not something that is done once and then is forever finished. In many cases, it is
an ongoing process—even an everyday process, as in psychotherapy. Whether the clinician is
making decisions or solving problems, clinical assessment is the means to the end. Intuitively,
we all understand the purpose of diagnosis or assessment. Before physicians can prescribe a
treatment, they must first understand the nature of the illness.
The referral
• The assessment process begins with a referral. The question posed about the patient by
the referral source. Someone—a parent, a teacher, a psychiatrist, a judge, or perhaps a
psychologist—poses a question about the patient.
– “Why is X disobedient?”
– “Why can’t Y learn to read like the other children?”
– “Why can’t A learn to read like the other children?”
– “Is the patient’s impoverished behavioral repertoire a function of poor learning
opportunities, or does this constriction represent an effort to avoid close
relationships with other people who might be threatening?”
It is important that they take pains to understand precisely what the question is or what the
referral source is seeking.-- Clinician decide if the questions unanswerable: “Is the client
capable of murder?” unless there is more information about the situation. Thus, rephrased.
Most parents do not have the psychometric background to understand what an IQ estimate means
and are quite likely to misinterpret it. Thus, before accepting the referral in an instance of this
kind, the clinical psychologist would be well advised to discuss matters with the parents.
•
•
Clinicians thus begin with the referral question
Clinician’s theoretical commitments can affect influence information
– Psychodynamic clinician: ask about early childhood experiences
In other cases, the information obtained may be similar, but clinicians will make different
inferences from it. For example, to a psychodynamic clinician frequent headaches may suggest
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the presence of underlying hostility but merely evidence of job stress to a behavioral clinician.
For some clinicians, case-history data are important because they aid in helping the client
develop an anxiety hierarchy; for others, they are a way of confirming hypotheses about the
client’s needs and expectations.
Assessment, then, is not a completely standardized set of procedures. All clients are not given the
same tests or asked the same questions. The purpose of assessment is not to discover the “true
psychic essence” of the client, but to describe that client in a way that is useful to the referral
source—a way that will lead to the solution of a problem.
I. ASSESSMENT INTERVIEW
Assessment interview
– tool/ chief technique
– clinical decision making, understanding, and prediction
General Characteristics of Interviews
An interaction
-Almost all professions count interviewing as a chief technique for gathering
data and making decisions.
-From fact finding to emotional release to cross-examination
-Used to elicit data, information, beliefs, or attitudes in the most skilled fashion
possible
Interviews versus test
-Most purposeful and organized but sometimes less formalized or standardized
than psychological tests.
-Flexible
-Threats to the reliability and validity of interview data (except structured
diagnostic interviews)
The Art of
Interviewing
-Freedom to exercise one’s skills and resourcefulness
-skill of interviewer
But for all this, we must not lose sight of the fact that the clinical utility of the interview can be
no greater than the skill and sensitivity of the clinician who uses it.
A good interview is one that is carefully planned, deliberately and skillfully executed, and goaloriented throughout. As with any activity that is engaged in frequently, people sometimes take
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SEMISTRUCTURED
FULLY STRUCTURED
interviewing for granted or believe that it involves no special skills; they can easily overestimate
their understanding of the interview process.
Interviewers are not using the interchange to achieve either personal satisfaction or enhanced
prestige. They are using it to elicit data, information, beliefs, or attitudes in the most skilled
fashion possible.
Interviewing Essentials and Techniques
Physical Arrangements
-Can be conducted anywhere that two people can meet and
interact
-Consider privacy and protection from interruptions (phone
rings during the session/noise)
Note-Taking and Recording
-help clinician recall
-danger in taking verbatim notes is that this practice may
prevent clinician from attending fully to the essence of the
patient’s verbalizations.
-excessive note-taking tends to prevent the clinician from
observing the patient (subtle changes of expression or body
position
-Audio or video recording- shall have consents
P.A- nothing is more damaging to the continuity of an interview than a phone that rings
relentlessly, an administrative assistant’s query, or an imperative knock on the door
Types of interview
SEMISTRUCTURED
•
•
•
intensive training for the clinician on the interview before they can be applied in a
reliable and valid manner (feasible for smaller studies)
High acceptance in daily clinical routine
Allow reformulation of questions and additional inquiries about a given answer
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•
Interviewer based (incorporate diagnostician’s clinical judgement into the coding
of the information given by the patient)
FULLY STRUCTURED
•
•
•
•
Trained paraprofessional (epidemiological studies)
Diagnostician is not allowed to alter the working of questions and cannot make
further inquiries about the answer
Respondent based (not in clinical judgement)
WHO- Composite International Diagnostic Interview (CIDI) and Children’s
Interview for Psychiatric Syndrome (ChIPS)
Both types of interview have a determined order and wording of questions, and a specific
procedure of coding
Sample fully structured- clinical interviews
 Anxiety Disorders Interview Schedule (ADIS-C/P)
o DSM-IV (age 6-18)
 Child and Adolescent Psychiatric Assessment (CAPA)
o DSM- IV, ICD-10. (Age: 9-18)
 Children’s Interview for Psychiatric Syndromes (ChIPS).
o DSM-IV (age 6-18)
 Diagnostic Interview for Children and Adolescents- Revised.
(DSM- IV, ICD-10) (age: 60-90)
 Diagnostic Interview Schedule for Children (DISC- IV).
o DSM-IV, ICD-10 (age: 70-120)
 Diagnostisches Interview bei psychischen Storugen im Kindes- und Judendalter (KinderDIPS).
o DSM- IV (DSM 5- research version available) (age: 60-90)
 Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present
and Lifetime version (K-SADS-PL)
o DSM-IV (DSM 5 currently under examination) (age:35-75)
 Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID)
o DSM-IV, ICD 10 (age: 30)
CLINICAL INTERVIEWS FOR PRESCHOOL CHILDREN
1. Berkeley Puppet Interview (BPI) (age: 4-8)
Symptomatology in clinically relevant domains
2. Dominic- Interactive- (age: 6-11) DSM-IV
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3. Pictorial Instrument for Children and Adolescents (PICA-III-R). (Age: 6-16)
DSM-III-R
UNSTRUCTURED INTERVIEW
• An interview in which the clinician asks any questions that come to mind in any order
**Interview with children: Parents and the Child.
Parents are asked some relevant questions from their observation on their children, in which
children cannot answer themselves (e.g. sleep walking)
Rapport
•
•
Most essential ingredient of a good interview is a relationship between the clinician and
the patient
When patients realize that the clinician is trying to understand their problems in order to
help them, then a broad range of interviewer behavior becomes possible.
– Relationship founded on respect, mutual confidence, trust, and a certain degree of
permissiveness.
– Common mistake “There, there, don’t worry. I know exactly what you’re feeling”
Probing, confrontation, and interviewer assertiveness may be acceptable once rapport has been
established. If the patient’s accepts the clinician’s ultimate goal of helping, a state of mutual
liking is not necessary. The patient will recognize that the clinician is not seeking personal
satisfaction in the interview
Communication
• Language that the patient can understand
• The use of questions (open-ended, facilitative, clarifying, confronting, and direct
questions.
• Silence
• Listening (understanding and acceptance)
• Gratification of self (sometimes clinician is professionally insecure and inexperiencedpatient’s problems, experiences, or conversation reminds clinicians of their own value,
attitude, and adjustments)
• The impact of clinician (e.g. grooming)
• Clinician’s values and background
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VARIETIES OF INTERVIEWS
•
•
•
INTAKE- ADMISSION INTERVIEW
• An interview conducted for the purpose of
• determining why the patient has come to an agency (e.g., clinic, hospital)
• determining whether the agency can meet the patient’s needs and
expectations
• Informing the patient about the agency’s policies and procedures
CASE-HISTORY INTERVIEW
• An interview conducted for the purpose of gaining a thorough understanding of
the patient’s background and the historical/ developmental context in which a
problem emerged
• Informants
• Knowledgeable adults in the patient’s life that can provide additional
information about the patient
• Covers both childhood and adulthood, and it includes educational, sexual,
medical, parental-environmental, religious, and psychopathological matters.
• Informants: Knowledgeable adults in the patient’s life that can provide additional
information about the patient
MENTAL STATUS EXAMINATION INTERVIEW
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•
•
•
An interview conducted to evaluate the patient for the presence of cognitive,
emotional, or behavioral problems.
• The clinician assesses the patient in a number of areas, including (but not limited
to) general presentation, quality of speech, thought content, memory, and
judgement.
CRISIS INTERVIEW
• An interview conducted for the purpose of
• Defusing or problem solving through the crisis at hand
• Encouraging the individual to enter into a therapeutic relationship at the
agency or elsewhere so that a longer-term solution can be worked out.
• Such interviewing requires training, sensitivity, and judgment
• Purpose of the crisis interview is to meet problems as they occur and to provide
an immediate resource
• Deflect the potential for disaster and to encourage person to enter into a
relationship with the clinic or make a referral so that a longer term solution can be
worked out
• Such interviewing requires training, sensitivity, and judgment
DIAGNOSTIC INTERVIEW
• An interview conducted for the purpose of arriving at a DSM-V diagnostic
formulation
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Samples reports:
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CRISIS INTERVIEW
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Reliability and Validity of Interviews
• Reliability
– Inter-rater reliability
• The level of agreement between at least two raters who have evaluated the
same patient independently
• Kappa Coefficient = the statistical index of inter-rater reliability
– Test-retest reliability
• The consistency of interview scores over time
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Suggestions for Improving Reliability and Validity
– Whenever possible, use a structured interview
– If one does not exist for your purpose, consider developing one
– Develop good interviewing skills
– Be aware of the patient’s motives and expectancies
– Be aware of your own expectations, biases, and cultural values
The Art and Science of Interviewing
•
•
Becoming a skilled interviewer requires practice
Becoming a skilled interviewer requires good self-awareness
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II. ASSESSMENT OF INTELLIGENCE
Historical background
o Many students came from “uneducated” families or families that did not speak English.
As a result, the failure rate in schools shot up dramatically.
o To preserve resources, there was pressure to identify those most likely to succeed in
school. Second, psychological scientists believed, and ultimately demonstrated, that
mental abilities could be measured. Although early attempts focused primarily on
measures of sensory acuity and reaction time (e.g., Francis Galton, James McKeen
Cattell), the groundwork was laid.
o Stephen Gould’s (1981) popular book The Mismeasure of Man was a scathing critique of
the intelligence testing movement and of the “reification” of the notion of intelligence.
o This rather heated debate resurfaced in the 1990s with the publication of The Bell Curve
(Herrnstein & Murray, 1994). In this book, Herrnstein and Murray reviewed the concept
of intelligence, recounted the history of intelligence testing, responded to many of the
critiques offered by Gould (1981), and delved into public policy issues such as poverty,
crime, welfare, and affirmative action.
Alfred Binet:
- Binet’s original purpose was to develop an objective method of identifying those truly
lacking in academic ability (as opposed to those with behavior problems).
- Institutions such as schools, industries, military forces, and governments were, by their
nature, interested in individual differences (e.g., levels of intelligence) that might affect
performance in those settings; therefore, intelligence testing prospered.
Types of Reliability
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



However, by the end of the 1960s, everyone from psychologists to consumer advocates
seemed to be attacking the validity of these tests. Basically, the argument was that such tests
discriminate through the inclusion of unfair items.
A result of a lengthy civil rights suit (Larry P. v. Wilson Riles) begun in 1971, the California
State Board of Education in 1975 imposed a moratorium on the use of intelligence tests to
assess disabilities in African Americans.
Stigmatizating programs for cognitively impaired individuals
Some African Americans contemplated a court challenge of the ruling, claiming it assumed
that African Americans would do poorly on the tests. Still others argued that IQ testing is not
a social evil but the principal means by which we can right the wrongs imposed upon
minorities by a devastating environment.
Concepts


So what should intelligence tests measure? In one sense, intelligence tests are
achievement tests because they measure what one has learned (Sternberg et al., 2005).
There is no universally accepted definition of intelligence (Wasserman & Tulsky, 2005).
Intelligence is a very general mental capability that, among other things, involves the
ability to reason, plan, solve problems, think abstractly, comprehend complex ideas, learn
quickly and learn from experience. It is not merely book learning, a narrow academic
skill, or test-taking smarts. Rather, it reflects a broader and deeper capability for
comprehending our surroundings—“catching on,” “making sense” of things, or “figuring
out” what to do (Arvey et al., 1994)
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•
Defining intelligence: three classes
– Emphasis on adjustment to environment
• Adaptability in new situations
• Capacity to deal with a range of situations
– Emphasis on the ability to learn
• Educability
– Emphasis on abstract thinking
• Ability to use symbols and concepts
• Verbal and numerical symbols
Theories of Intelligence
•
Factor analysis
– Spearman’s approach
• g (general intelligence) represents elements common to intelligence tests
• s (specific intelligence) for unique factors of a given test
• Intelligence is broad-based and generalized
– Thurstone’s approach
• Group factor concept (rather than just g factor)
• Primary mental abilities
• Numerical facility
• Word fluency
• Verbal comprehension
• Perceptual speed
• Spatial visualization
• Reasoning
• Associative memory
A number of individuals took issue with Spearman’s contentions, including E. L. Thorndike
and L. L. Thurstone. For example, Thurstone (1938) presented evidence (based on a factor
analysis of over 50 separate tests that had been administered to 240 participants) for a series
of “group” factors rather than the almighty g factor.
•
Cattell’s Theory
– Centrality of g
– 17 primary ability concepts
– Fluid ability: genetically based intellectual capacity
– Crystallized ability: capacities attributed to culture-based learning
– Hierarchical model of intelligence
Cattell’s approach might be described as a hierarchical model of intelligence
Such factors represent what psychologists refer to as fluid intelligence and crystallized
intelligence. Fluid intelligence refers to the ability to reason and think flexibly.
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Crystallized intelligence refers to the accumulation of knowledge, facts, and skills that
are acquired throughout life.
•
Guilford’s Classification
– Structure of intellect (SOI) model as a guide
– Intelligence is three-dimensional
• Operations
– Cognition, memory, divergent and convergent production,
evaluation
• Contents
– Areas of information in which operations are performed: figural,
symbolic, semantic, and behavioral
• Products
– When a particular mental operation is applied to a specific type of
content, there are six possible products: units, classes, systems,
relations, transformations, and implications
Guilford reasoned that the components of intelligence could be organized into three dimensions:
operations, contents, and products.
The operations are cognition, memory, divergent production (constructing logical alternatives),
convergent production (constructing logic-tight arguments), and evaluation.
The content dimension involves the areas of information in which the operations are performed:
figural, symbolic, semantic, and behavioral.
Finally, when a particular mental operation is applied to a specific type of content, there are six
possible products: units, classes, systems, relations, transformations, and implications.
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If we contemplate all possible combinations, we arrive at 120 separate intellectual abilities.
Perhaps the most widely held reservation about Guilford’s approach is that it is a taxonomy or
classification rather than a theory.
•
Gardner’s multiple intelligences
– Problem solving skills
– 8 formal groupings
• linguistic
• musical,
• logical-mathematical
• spatial
• bodily-kinesthetic
• naturalistic
• interpersonal
• intrapersonal
– Major criticism: “Intelligences” vs. “talents”
Major criticism of Gardner’s theory is that some of his proposed “intelligences” may be better
conceptualized as “talents” than as forms of intelligence (Neisser et al., 1996). Nevertheless,
Gardner’s views have attracted a great deal of attention from psychologists and educators alike
and emphasize areas of potential and ability that are not tapped by traditional psychological tests.
A number of levels of processing have been studied, including speed of processing, speed in
making choices in response to stimuli, and speed with which individuals can extract various
aspects of language from their long-term memory. But many problems and questions remain. Is
there a central processing mechanism for information? How do the processing elements change
as the person develops? Are there general problem-solving skills or merely skills specific to
certain ability areas? Perhaps time will tell.
•
Sternberg’s triarchic theory
– Component
• Analytical thinking
– Experiential
• Creative thinking
– Contextual
• “Street Smarts”
This approach deemphasizes speed and accuracy of performance. Instead, the emphasis is on
planning responses and monitoring them.
The componential aspect refers to analytical thinking; high scores would characterize the person
who is a good test-taker.
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The experiential aspect relates to creative thinking and characterizes the person who can take
separate elements of experience and combine them insightfully. Finally, the contextual aspect is
seen in the person who is “street smart”—one who is practical, knows how to play the game, and
can successfully manipulate the environment.
IQ
•
Ratio IQ
– Mental age (MA): index of mental performance
• Determined using a Binet test
– Chronological age (CA): actual age in years
– IQ = MA/CA * 100
– Merely a score; not an equal-interval measure
• We cannot be sure that an IQ of 100 is really twice as much as an IQ of 50
– Limitations for older adults
• MA is consistent, but CA increases; can appear that IQ decreases as we
age when it really doesn’t
We have also accepted Thurstone’s group factors. We seem to want to identify and quantify how
much intelligence the person has, yet we cannot escape the belief that intelligence is somehow
patterned—that two people may have the same overall IQ score and still differ in specific
abilities.
In measuring intelligence, we cannot be sure that we are dealing with equal-interval
measurement. We cannot be sure that an IQ of 100 is really twice as much as an IQ of 50 or that
our scale has an absolute zero point.
We cannot add and subtract IQs. All we can do is state that a person with an IQ of 100 is brighter
than a person with an IQ of 50. All of this should serve to remind us that IQs and MAs are
merely scores.
•
•
Deviation IQ
– Adjusts for chronological age (CA) limitations
– Assumption is made that intelligence is normally distributed throughout the
population
– Comparison to CA group
– Same score will mean the same thing for people with different CAs
Heritability
– Behavioral genetics: evaluates both genetic and environmental influences
• Studies of heritability using dizygotic twins, monozygotic twins, and
siblings
– Environmental influencers
• Raised together/separated
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Behavioral genetics is a research specialty in which both genetic and environmental influences
on the development of behavior are evaluated.
Proteins are produced and regulated by genetic codes, and proteins interact with physiological
intermediaries (hormones, neurotransmitters, structural properties of the nervous system) to
produce behavior (Plomin, DeFries, & McClearn, 2008).
The genetic makeup of an individual, referred to as the genotype, is fixed at birth. A person’s
genotype is passed down from the biological parents. The phenotype refers to observable
characteristics of an individual, and a person’s phenotype can change. Intelligence and even
mental disorders are phenotypic characteristics that may change over time. The phenotype is a
product of the genotype and the environment.
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Some is probably due to genetics. To find out how much, we equate environmental conditions
such as soil, water, and sun- light (indicated by different shadings of the ground). This reflects
the fact that environmental conditions in B are equal for all the trees so that any environmental
sources of variance have been eliminated. The remaining variance in B is entirely produced by
genetic factors. Therefore, the heritability of height for A is the variance in B (the variation
attributable to genetic factors) divided by the variance in A (the total variation in the population).
•
Stability
– Youth instability
• Test-retest intervals
• Environmental influence greater at younger ages
– Flynn effect
• From 1972 on, Americans’ IQ scores have on average increased 3 points
each decade
• Explanation? People getting smarter, more exposed to cognitive tasks
found on IQ tests
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Age and IQ Stability
•
1.
2.
3.
4.
5.
•
Stanford-Binet Scales
– Like the 1986 version, the SB-5 is based on a hierarchical model of intelligence.
Specifically, the Stanford-Binet Fifth Edition (SB-5) assesses five general
cognitive factors, and each factor is tapped by both verbal and non-verbal subtest
activities (Roid & Pomplun, 2005):
Fluid reasoning involves the ability to solve new problems and is measured by the
following subtests;
Quantitative reasoning involves the ability to solve numerical and word problems as well
as to understand fundamental number concepts;
Visual-spatial processing involves the ability to see relationships among objects, to
recognize spatial orientation, and to conduct pattern analysis;
Working memory involves the ability to process and hold both verbal and non-verbal
information and then to interpret it;
Knowledge involves the ability to absorb general information that is accumulated over
time through experience at home, school, work, or the environment in general.
Wechsler Scales
– Deviation IQ based
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– Designed for adults
– Performance scale and
Verbal scale
• Each made up of subtests
• Each subtest gets an IQ score
• Full Scale IQ
•
Wechsler Adult Intelligence Scales (WAIS-IV)
– Published in 2008 (ages 16-90)
– Scoring system
• Index scores: Verbal Comprehension, Perceptual Reasoning, Working
Memory, Processing Speed
• Full Scale IQ Score
– 15 subtests
– Reversal items
• Allows the examiner to determine the examinee’s ability level without
having to administer items markedly below that ability level
WAIS-IV Subtests
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•
Intelligence Scale for Children (WISC-IV)
– Ages 6-16
– 4 major indices
• Verbal comprehension
• Perceptual reasoning
• Working memory
• Processing speed
Organization of the WISC-IV
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Clinical Usage
•
•
•
Estimation of general intelligence
Prediction of academic success
Appraisal of style
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III. PERSONALITY ASSESSMENT
Many academics argue that testing in general—and projective testing in particular—is not valid.
Others advise that textbooks such as this one should drastically reduce the coverage of
personality assessment. There is only one thing wrong with the foregoing claims and advice:
They do not reflect the real world of clinical practice. In fact, psychological assessment
continues to be a high-profile activity of both today’s practicing clinicians and clinical
researchers (Butcher, 2010)
We not only describe some of the more popular objective and projective personality measures
but we critically evaluate their psychometric properties and clinical utility as well. Another
related issue concerns accountability (Wood, Garb, Lilienfeld, & Nezworski, 2002).
Objective Testing
•
Objective Personality Measures
– Fixed set of responses
• True/false
• Yes/No
• Dimensional scaling
Assessment Procedures
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Objective Testing
Objective tests of personality or self-report inventories have had a central role in the
development of clinical psychology (Butcher, 2010).
•
Advantages
– Economical
– Large group testing
– Computer scoring & interpretation
– Single dimension or trait can be targeted
– Straightforward
– Objective & reliable
•
Disadvantages
– Questions may be uncharacteristic of respondent
– Underlying reason for behavior not evident
– Mixed behaviors, unrepresentative
– Distorted or lost information
– Purposeful incorrect answering
– Misinterpretation
Some inventories contain a mixture of items dealing with behaviors, cognitions (i.e., thoughts
and beliefs), and emotions (i.e., feelings). Yet inventories often provide a single overall score,
which may reflect various combinations of these behaviors, Cognition, and emotions.
Other difficulties involve the transparent meaning of some inventories’ questions, which can
obviously facilitate faking on the part of some patients.
Some tests tend to depend heavily on the patient’s self-knowledge.
•
Content validation
– What to assess?
– Assess major manifestations of condition/trait of interest
– Requires
• Definition of variables
• Consulting experts
• Judges for assessment of relevance
• Psychometric analysis
Content was determined by surveying the psychiatric literature to identify the major
manifestations of “neuroses” and “psychoses.”
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Content Validation. The most straightforward approach to measurement is for clinicians to
decide what it is they wish to assess and then to simply ask the patient for that information.
Content was determined by surveying the psychiatric literature to identify the major
manifestations of “neuroses” and “psychoses.”
Neurosis is a mild mental disorder NOT arising from organic diseases – instead, it can occur
from stress, depression or anxiety. Psychosis is a major personality disorder characterized by
mental and emotional disruptions. It is much more severe than neurosis – often impairing and
debilitating the affected individual.
Neurotic disorders involve symptoms of stress without a radical loss of touch with reality.
Examples of neurosis and neurotic disorders include major depressive disorder, anxiety
disorders, and obsessive disorders. Neurotic persons over-appreciate real or potential issues
happening in their lives, causing mental distress.
Psychotic disorders involve delusions, emotional turbulence, and a radical loss of touch with
reality. Hallucinations are common but not necessary for a diagnosis. Some psychotic disorders
include schizophrenia, schizoaffective disorder, bipolar disorder (not in all cases), and psychotic
depression.
Often, psychotic disorders have a stronger genetic component and are unavoidable, even with
healthy coping mechanisms. Alternative causes for psychosis include substance use, brain
tumour, head trauma, childhood abuse, and prolonged sleep deprivation.
•
•
•
Content validation
– Issues
• Assumption of interpretation
• Patient accuracy
• Honesty
• “Expert” definitions
Empirical criterion keying
– Minnesota Multiphastic Personality Inventory (MMPI)
– No assumption based on content of item
– What matters is that those in the diagnostic group share responses
• If those in a certain group consistently respond to an item in the same way,
it can be considered a “sign” of their diagnostic status
– Empirical basis, not always rational
– Difficult to interpret meanings
Factor analysis
– Intercorrelations among items
– Exploratory
• Reduce to the basic dimensions
– Confirmatory
• Test hypothesized structure
– Empirical emphasis
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•
Construct validity
– Combination of approaches
– Specific scales for specific concepts
– Valid when scale matches target
– Feedback modifies theories and measures
I WISH I COULD BE HAPPIER
•
•
•
MMPI & MMPI-2
– Self-report inventory
– Purpose
• Originally to identify psychiatric diagnoses
• Categorical organization
• Also used to infer personality traits
• Computerized
The original MMPI was composed of 550 items to which the patient answers “true,”
“false,” or “cannot say.” Only those items that differentiated a given clinical group from a
non-clinical group were included. For example, items were retained if they distinguished
individuals with depression from non-clinical individuals, or individuals with
schizophrenia from non-clinical individuals, or individuals with psychopathic features
from non-clinical individuals. No attempt was made to select items that differentiated one
diagnostic category from another. As a result, some items tend to be highly correlated
with each other, and the same item may appear in several different scales.
For restandardization, all 550 items were retained, but 82 were rewritten (though most
changes were slight). The original meaning of items was preserved, but the language was
made more contemporary. In addition, 154 new items were added to the item pool,
bringing the total to 704 items. After adjust- ments, the final version of the MMPI-2 now
includes 567 of the larger pool of 704 items. However, only the first 370 items in the test
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booklet are administered when only the traditional validity and clinical scales are of
interest.
Simulated MMPI Items
•
MMPI & MMPI-2
– Validity
• Issues
– Test taking attitudes
– Response sets
– Response bias
– Validity Scales
• ? (cannot say)
• F (infrequency)
• L (Lie)
• K (defensiveness)
– Addendums
• Fb (back page)
• VRIN (variable response infrequency)
• TRIN (true response infrequency)
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•
•
Some respondents may wish to place themselves in a favorable light; others may “fake
bad” to increase the likelihood of receiving aid, sympathy, or perhaps a discharge from
military service; still others have a seeming need to agree with almost any item regardless
of its content. Obviously, if the clinician is not aware of these response styles in a given
patient, the test interpretation can be in gross error.
To help detect malingering (faking bad), other response sets or test-taking attitudes, and
carelessness or misunderstanding, the MMPI-2 continues to incorporate the traditional
four validity scales that were included in the original MMPI.
? (Cannot Say) Scale
This is the number of items left unanswered.
F (Infrequency) Scale.
These 60 items were seldom answered in the scored direction
by the standardization group. A high F score may suggest
deviant response sets, markedly aberrant behavior, or other
hypotheses about extra test characteristics or behaviors.
L (Lie) Scale.
This includes 15 items whose endorsement places the
respondent in a very positive light. In reality, however, it is
unlikely that the items would be truthfully so endorsed. For
example, “I like everyone I meet.”
K (Defensiveness) Scale.
These 30 items suggest defensiveness in admitting certain
problems. These items purportedly detect faking good, but they
are more subtle than either L or F items. For example,
“Criticism from others never bothers me.”
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•
Fb (Back-page Infrequency) Scale.
These 40 items occurring near the end of the MMPI-2
are infrequently endorsed.
VRIN (Variable Response
Inconsistency) Scale.
This consists of 67 pairs of items with either similar or
opposite content. High VRIN scores suggest random
responding to MMPI-2 items.
TRIN (True Response
Inconsistency) Scale.
This consists of 23 item pairs that are opposite in
content. High TRIN scores suggest a tendency to give
true responses indiscriminately; low TRIN scores
suggest a tendency to give false responses
indiscriminately.
MMPI & MMPI-2
– Screening capabilities
• Severity
• Hypothesis generation
• Issues of test length
– Personality traits
• Atheoretical test
• Not developed with constructs in mind
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Short Forms. Over the years, a variety of short forms of the MMPI have appeared. These scales
typically shorten the MMPI to considerably less than the traditional 550 items.
– Reliability and Validity
• Difficulties in evaluating
• Poor internal consistency
• Incremental validity
• Cutoff scores
– Concerns
• Non-clinical usage (e.g., personnel selection)
• Necessary revisions?
• Appropriate test pool?
• Unclear validity
• Excessive overlapping among scale items
Concerning reliability, the MMPI-2 clinical scale scores have been evaluated in terms of internal
consistency as well as test–retest reliability. Perhaps not surprisingly (given the way the
instrument was originally constructed), many of the clinical scales do not have good internal
consistency
•
Revised NEO-Personality Inventory (NEO-PI-R)
– 240 items
• 5 point response scale
– Five factor model
• Neuroticism
• Extraversion
• Openness to experience
• Agreeableness
• Conscientiousness
The NEO-PI-R consists of 240 items (8 items for each of the 30 facets, or 48 items for each of
the five domains). Individuals rate each of the 240 statements on a 5-point scale (strongly
disagree, disagree, neutral, agree, and strongly agree).
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•
Revised NEO-Personality (NEO-PI-R)
– Rational-empirical test
– Reverse scoring
– Strong reliability & stability
– Relevant to psychological disorders
The NEO-PI-R was developed using a rational-empirical test construction strategy that
emphasized construct validity. Each personality trait to be included was identified, defined,
and then analyzed so that items measuring various aspects of the trait could be generated.
Approximately half of the NEO-PI-R items are reverse scored; that is, lower scores are more
indicative of the trait in question. This was done to address a potential acquiescence (or naysaying) bias that may present problems for inventories in which all or most items are keyed
in the same direction.
•
Revised NEO-Personality
– Limitations
• Lack of validity scales
• Need for more demonstration of clinical relevance
• Treatment planning
• Psychometric criticisms
•
Norms. Adult norms are based on a total of 500 men and 500 women drawn from several
samples of community residents. The normative sample closely approximates U.S. Census
Bureau projections for 1995 in the distribution of age and racial groups. (College students)
NEO-PI-R scores show excellent levels of both internal consistency and test–retest
reliability. Internal consistency coefficients range from .86 to .92 for the domain scales and
from .56 to .81 for the facet scales.
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Projective Testing
•
Procedure for discovering a person’s characteristic modes of behavior by observing
behavior in response to a situation that does not elicit or compel a specific response
William Shakespeare wrote about the projective qualities of clouds, and William Stern used
clouds as test stimuli before Rorschach and his inkblots. Sir Francis Galton (1879) suggested
word-association methods, and Kraepelin made use of them. Binet and Henri (1896)
experimented with pictures as projective devices. Alfred Adler asked patients to recall their first
memory, which is also a kind of projective approach.
•
Characteristics
– Examinee imposes own structure
– Unstructured stimulus
– Indirect methodology
– Freedom of response
– Many variables to rate
For some, the definition of a projective test resides in Freudian notions regarding the nature of
ego defenses and unconscious processes.
•
Standardization
– Benefits
• Facilitation of communication
• Established norms
– Issues
• Misleading descriptions
• Too many variables
The dissenters argue that interpretations from projectives cannot be standardized. Every person is
unique, and any normative descriptions will inevitably be misleading. There are so many
interacting variables that standardized interpretive approaches would surely destroy the holistic
nature of projective tests. After all, they say, interpretation is an “art.”
•
•
Reliability
– Test retest
– Split half issues
Validity
– Must be specific in what is predicted
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•
Rorschach inkblots
– Multiple variation in scoring
– 10 cards
– Administration
• Card is shown, responses offered & noted
• Evaluation and rating of answers
– Scoring
• Location
• Content
• Determinants
• Popular/original answers
• Exner’s Comprehensive system of scoring
• Research based approach
• Psychometric data
However, it is now virtually a requirement for research publication that Rorschach protocols be
scored in a systematic fashion and that adequate interscorer agreement be demonstrated (Weiner,
1991). At a minimum, we expect that Rorschach responses should be scored similarly by
independent raters.
The Rorschach consists of ten cards on which are printed inkblots that are symmetrical from
right to left. Five of the ten cards are black and white (with shades of gray), and the other five are
colored.
-
“Tell me what you see—what it might be for you. There are no right or wrong answers.
Just tell me what it looks like to you.”
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•
•
Reliability
– Facing challenges
– Lacks retest studies
– Reliability of clinicians’ interpretations
Validity
– Anecdotal accounts vs. empirical research
– When is the test most useful?
– Environmental conditions, and influence on interpretations
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•
Thematic Apperception Test (TAT)
– Reveals personality characteristics
• Interpretation to stories about pictures
– Infers psychological needs, themes, interpersonal styles
– Rarely formally scored
– Subjective instrument
– 31 TAT cards
• Situational images
• Ambiguous in detail
– Administration
• 6-12 pictures selected
• Examinee creates story
– Scoring
• Less emphasis on quantified system
– Avoids distortion
• Lacks empirical data
– Reliability
• Difficult to evaluate
• Must rely on judges’ interpretation
– Validity
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•
•
•
•
•
Comparisons to case data & therapist evaluations
Matching techniques & analysis of protocol
Comparison of clinical diagnoses & judgment
Principles of interpretation
Sentence completion
– Rotter Sentence Blank
• 7 point scale
• Varied for youth
• Objective scoring, free response
• Cognitive & behavioral assessment, in some sense
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Projective Testing:
•
•
Illusory Correlation
– Clinicians learn false association of test responses to specific characteristics over
time
– Powerful source of error
Incremental validity
– Degree to which procedure adds to prediction
– Must be beyond base rates
Use & Abuse of Testing:
•
•
•
•
•
Protection
– APA standards require training
– American Board of Professional Psychology (ABPP) certifications
– Restrictions in purchasing tests
Privacy
– Right to explanations
– Relevancy of testing
– Informed consent
Confidentiality
– Right of privileged communication for psychologists and psychiatrists
– Influence of Tarasoff case
• Breaches of confidentiality warranted when safety is an issue
– Influence of managed care
– Consent for release
Discrimination
– Knowingly or unknowingly
– Influence of civil rights movement
– Can be built into test items themselves
– Phrasing and constructions
Test Bias
– Validity issue: if it can be demonstrated that the validity of a test varies
significantly across groups, then a case can be made that the test is “biased”
– Things to remember:
• Differences in mean scores do not necessarily indicate test bias
• Tests may be valid (and not biased) for some purposes, but not for others
• One can “overcome” test bias by using different prediction equations for
the different groups
– For example, a personality inventory for hostility – scores vary for men and
women. Is it biased?
• Correlation between hostility scores and predicted verbal fights similar
for men and women
• Not biased, since the test’s predictive validity was comparable for
both groups: similar scores “mean” the same thing
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•
•
•
Correlation between hostility scores and predicted physical fights
different for men and women
• Potentially biased, since the test’s predictive validity is not the
same for both groups: similar scores do not “mean” the same thing
Computer based assessment
– Administers & interprets testing
– Advantages
• Cheaper
• Enhances client attention and motivation
• Standardization
– Issues
• Misuse, poor training/understanding
• Reliability & validity
• Testing situational control
• Test security & cultural biases
Computer-Based Test Interpretation (CBTI)
– Advantages
• Speed of results & interpretations
• Database access
• Processes complex scoring patterns
– Issues
• Scientific scrutiny
• Inappropriate usage
• Reliability
• Validity
• Clinical usefulness
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IV. BEHAVIORAL ASSESSMENT
Tradition
•
•
Sample
– Identify characteristics of interest
– Assume these traits carry over to non-test situation
Sign
– Inference about performance or response
– Symbolic of other characteristics
Sample: Thus, if a person responds aggressively on a test, one assumes that this aggression also
occurs in other situations as well.
Signs: An example is a predominance of Vista responses on the Rorschach, in which the
individual reports that his precepts are viewed as if they were seen from a distance.
- In interpreting such a response, one does not typically conclude that the individual is in
great need of optometric care, but rather that such responses presumably indicate the
person’s ability for self-evaluation and insight.
For the most part, traditional assessment has employed a sign as opposed to sample approach to
test interpretation. In the case of behavioral assessment only the sample approach makes sense.
•
Functional analysis
– B.F. Skinner
• Precise analysis of stimuli that precede behavior and consequences that
follow
• Learned behaviors
• Influence of consequence
• Precise description
– Antecedent conditions
– Consequent events
– Can use this knowledge to understand motive and alter behavior
***
Assessing the manner in which variations in stimulus conditions and outcomes are related to
behavior changes makes possible a more precise understanding of the causes of behavior
(Yoman, 2008). The major thesis is that behaviors are learned and maintained because of
consequences that follow them. Thus, to change an undesirable behavior, the clinician must (a)
identify the stimulus conditions that precipitate it and (b) determine the reinforcements that
follow. Once these two sets of factors are assessed, the clinician is in a position to modify the
behavior by manipulating the stimuli and/or reinforcements involved.
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Crucial to a functional analysis is careful and precise description. The behavior of concern must
be described in observable, measurable terms so that its rate of occurrence can be recorded
reliably. Suppose, for example, a child is aggressively disruptive in the classroom. A
psychodynamic assessment might be directed toward analyzing the needs that the child is trying
to satisfy. The hope is that once these needs are identified, they can be modified and the
undesirable behavior eliminated.
•
SORC method (Kanfer & Phillips, 1970): a model for conceptualizing clinical problems
from a behavioral perspective
– Stimulus to behavior (stimulus or antecedent conditions that bring on the
problematic behavior)
– Organismic variables (organismic variables related to the problematic behavior)
– Response or problem (response or problematic behavior)
– Consequence (consequences of the problematic behavior)
Organismic variables include physical, physiological, or cognitive characteristics of the
individual that are important for both the conceptualization of the client’s problem and the
ultimate treatment that is administered.
Behavioral clinicians use this model to guide and inform them regarding the information needed
to fully describe the problem and, ultimately, the interventions that may be prescribed
•
Behavioral Assessment is an ongoing process
– Before, during, after
• Diagnostic formulations
• Patient environment
• Continual, thorough assessment
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Behavioral Assessment in Therapy
1. Diagnostic formulations provide descriptions of maladaptive behaviors, or potential
targets for intervention.
2. the patient’s context or environment (social support system, physical environment) is
important to assess because of the relevance to treatment planning and the setting of
realistic treatment goals
3. An evaluation of client resources, such as skills, level of motivation, beliefs, and
expectations, is also important.
The initial assessments of diagnosis/maladaptive behaviors, treatment context, and client
resources will naturally lead to a data-based initial treatment plan. This plan involves
collaborative (patient and therapist) goal setting as well as mutually agreed-upon criteria to
indicate improvement. Formal assessments of treatment progress serve as ongoing feedback as
well as avenues for building the patient’s self-efficacy as progress is made. Assessment
following completion of treatment provides objective data regarding the patient’s end-state
functioning, which can then be compared to data from the pretreatment assessment. Finally,
thorough assessment throughout all these stages will provide information regarding the
likelihood of symptom recurrence, including identification of “high-risk” environments that may
lead to relapse.
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Behavioral Interview
•
•
•
•
•
Define ultimate outcomes
Identify chain of changes necessary to achieve outcomes
Short term vs. long term
Structured diagnostic interviews are also an option
Goals
• Identify SORC variables
• Therapy
• Establish patient
• Expectations
• Strengths
• Past attempts
Typically, ultimate outcomes involve consequences like happiness, life satisfaction, or making
the world a better place (Yoman, 2008). By going through such an exercise, the client’s priorities
for behavior therapy become clearer, and the therapist can identify his or her own skills and
expertise that can be helpful as well as map out short-term obstacles to achieving these end
goals.
During behavioral interviews, the clinician attempts to gain a general impression of the
presenting problem and of the variables that seem to be maintaining the problem behavior
(Goldfried & Davison, 1994).
Other information sought includes relevant historical data and an assessment of the patient’s
strengths and of past attempts to cope with the problem. Also of interest are the patient’s
expectations regarding therapy.
Observational Method
•
Naturalistic
– Direct observation
– Ethical standards
– Infrequently used in clinical contexts
– Requires reliability and validity
•
Home observation
– Mealtime Family Interaction Coding
– Use of a videotaped interaction of the entire family eating together
– Trained coders watch and rate the family using 6 rating scales
• Task accomplishment, affect management, interpersonal involvement,
behavioral control, communication, roles
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Task Accomplishment (meeting and balancing of family members’ needs in the context of the
meal)
Affect Management (expression and management of feelings expressed by family members)
Interpersonal Involvement (the degree to which family members show concern for one anothers’
needs)
Behavior Control (use of discipline and consistency)
Communication (appropriateness and directness of verbal and non-verbal communication
Roles (how family members divide tasks and responsibilities) (Hayden et al., 1998)
Moens and colleagues (2007) asked parents to report the degree of support and control they
provided to their children. They also collected observational data using the MICS on these same
dimensions.
- parents of overweight children reported that they provided similar levels of support to
their children, as compared to parents of normal- weight children, observational data
indicated that they provided significantly less support.
- Moreover, observational data indicated that as compared to other children, parents of
overweight children exhibited significantly higher levels of maladaptive control, such as
an overly permissive approach.
The predictive value of naturalistic observation (over more traditional ratings by parents) was
demonstrated.
•
School observation
– Influence of untrained observers
– Direct Observation Form
• Used to assess problem behaviors in school settings
• Assessors rate frequency of 88 problem items during several observation
periods in morning and afternoon
• Helpful in forming diagnostic formulations
Clinical child psychologists must often deal with behavior problems that take place in the school
setting; some children are disruptive in class, overly aggressive on the playground, generally
fearful, cling to the teacher, will not concentrate, and so on.
Assessors are instructed to rate each item according to its frequency, duration, and intensity
within a 10-minute observation period. (2days, morning and afternoon)
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Example: Direct Observation Form
•
Hospital observation
– More controlled environment
– Time Sample Behavior Checklist (TSBC)
• Observations made at regular intervals
• Daily behavioral profile can be constructed by compiling observations
– High inter-observer reliability
TSBC -Time-sample means that observations are made at regular intervals for a given patient.
Observers can make a single 2-second observation of the patient once every waking hour.
TSBC scores were most strongly and significantly related to discharge-readiness decisions by
staff compared to ratings of paranoia and of patient hostile belligerence.
•
Controlled observation
– Clinical or natural settings
– Environment is “designed”
– Trigger specific behaviors so they can be observed
– Situational testing
The important feature is that the environment is “designed” such that it is likely that the assessor
will observe the targeted behavior or interactions—for example, asking couples to discuss
relationship problems in the laboratory to observe couple interaction patterns (Heyman, 2001).
These are really situational tests that put individuals in situations more or less similar to those of
real life.
•
Parent-adolescent conflict
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– Interaction Behavior Code (IBC)
– Audiotaped discussions of families attempting to solve an issue about which they
disagree
– Behaviors rated and summary scores calculated
Example: Interaction Behavior Code
These researchers offered behavioral family systems therapy to 119 families and used the IBC to
measure conflict before and after the treatment.
Results suggested promising effects for this form of therapy for reducing family conflict, and
IBC offered a less-biased outcome mea- sure than either child or parent reports of conflict
(Wysocki et al., 1999).
•
Controlled performance technique
– Contrived situations that allow for control & standardization
– Used for phobia therapy
– Behavioral avoidance: series of tasks requiring increasingly threatening
interactions
– Fear arousal assessed in addition to behavior
– Influence of researcher can be an issue
After each step, the participants rated their level of distress and if they refused a step rated their
perceived level of distress when they imagined themselves doing the step. In this way, the
researchers were able to quantify behavioral avoidance (number of steps completed) and distress
(total distress ratings).
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•
Self-monitoring
– Records of emotion, thought, behavior
– Frequency, duration, intensity
– Shows stimulus & triggers
– Dysfunctional Thought Records: a compilation of the patient’s automatic thoughts
– Can be inaccuracies in self-reports
– Resistances
-
it can provide an index of change as a result of therapy (e.g., by comparing baseline
frequency with frequency after 6 weeks of therapy).
- it can help focus the client's attention on undesirable behavior and thus aid in reducing it.
- clients can come to realize the connections between environmental stimuli, the
consequences of their behavior, and the behavior itself.
Self-monitoring diaries are especially useful when assessing or treating problems such as mood
dysregulation, obesity, substance use problems, anxiety, and even psychotic experiences (Trull &
Ebner-Priemer, 2009).
“not feeling good about myself”
•
•
•
•
•
Complexity of behavior
– Higher complexity, higher unreliablity
Training observers
– Clear definitions & ratings
– Observer Drift (begin to drift away from other observers in their ratings.)
• Subtle shift in ratings
• Reliability checks
to identify an instance of interpersonal aggression, one observer might react to sarcasm
while another would fail to include it and focus instead on clear, physical acts.
Training observers
To guard against observer drift, regularly scheduled reliability checks (by an independent
rater) should be conducted and feedback provided to raters.
Observation method
• Validity
– Content: the degree to which an item adequately measures all aspects of the
construct being assessed
– Concurrent: the degree to which scores of one measure correlate with other
relevant measures
– Construct: the extent to which scores of one measure correlate with other
measures/behaviors in a logical, consistent way
– Ecological: the extent to which the behaviors analyzed or observed are
representative of a person’s typical behavior
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Aggression is aggression?
- Content: Behavioral Coding System (BCS), Jones et al. (1975) circumvent this problem
by organizing several categories of noxious behaviors in children and then submitting
them for ratings. By using mothers’ ratings, they were able to confirm their own a priori
clinical judgments as to whether or not certain deviant behaviors were in fact noxious or
aversive
- Concurrent: For example, do observational ratings of children’s aggression on the
playground made by trained observers agree with the ratings made by the children’s
peers? In short, do the children perceive each other’s aggression in the same way that
observers do?
- Construct: For example, the BCS of Jones et al. (1975) was derived from a social
learning framework that sees aggression as the result of learning in the family. When the
rewards for aggression are substantial, aggression will occur. When such rewards are no
longer contingent on the behavior, aggression should subside. Therefore, the construct
validity of the BCS could be demonstrated by showing children’s aggressive behavior
declines from a baseline point after clinical treatment, with clinical treatment defined as
rearranging the social contingencies in the family in a way that should reduce the
incidence of observed aggression.
•
Mechanics of rating
– Unit of analysis must be specified
• Length of time observations will be made, plus type and number of
responses to be considered
– Intensity
• How strong was the behavior?
– Duration
• How long did the behavior last?
– Frequency
• How often did the subject exhibit the behavior?
Mechanics of Rating. It is important that a unit of analysis be specified (Tryon, 1998).
One could decide to record behaviors along a dimension of intensity: How strong was the
aggressive behavior? One might also include a duration record: How long did the behavior last?
Or one might use a simple frequency count: How many times in a designated period did the
behavior under study occur?
•
Observer Errors
– Mishearing
– Misunderstanding
– Individual bias
– Influence of reactivity
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Observer Error. No one is perfect. Observers must be monitored from time to time to ensure the
accuracy of their reports. Ex: yelling : aggression or camaraderie?
•
Improving reliability & validity
– Specify objective behaviors
– Establish explicit theoretical framework
– Use trained observers
– Standardized observational format
– Awareness of potential errors
– Consider reactivity
– Consider representativeness
Reactivity. Another factor affecting the validity of observations is reactivity. Patients or study
participants sometimes react to the fact that they are being observed by changing the way they
behave.
Trends in Data Acquisition
•
•
Role of technology
– Real time self-monitoring
– Automated scoring & analysis
Ecological momentary assessments
– Time stamping
Other Behavior Assessment Techniques
•
•
Role-playing
– A technique in which patients are directed to respond the way they would
typically respond if they were in a given situation
Inventories and checklists
– Self-report techniques
– Identify behaviors, emotional responses, and perceptions of environment
Cognitive-Behavioral Assessment
• Assessment
– Behavior influenced by cognitions & thoughts
– Approach
• Functional analysis of thinking process
• Strategies
• Thinking aloud
• Reporting thoughts
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•
Rating scales
•
•
•
Assertiveness Self Statement Test
Attributional Style Questionnaire
Social Thought and Belief Scale
•
Strengths
– Systematic
– Precise
– Multiple assessment periods
– Continually modified
Weaknesses
– Sometimes clinically impractical
– Time intensive
– Expensive
•
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V. Clinical Judgement
Whether the construct is neuroticism, introversion, paranoia, or resilience, this view is
concerned with relatively stable personal characteristics that contribute to behavior.
Behavior therapists and assessors, however, do not look at personality in the traditional
fashion. They see personality more in terms of behavioral tendencies in specific
situations (Yoman, 2008).
The focus shifts from a search for underlying personality characteristics to one that looks
for the interaction between behaviors and situations. This kind of conceptualization leads
some to view personality much like a set of abilities (Wallace, 1966). For such people,
personality becomes a set of abilities or skills rather than a constellation of
predispositions (e.g., needs or traits) that convey the essence of the person.
A behavioral assessment would ignore such hypothesized internal determinants as
“needs” and focus instead on the target: aggressive behavior. It might be discovered that
the child usually takes objects (e.g., a pencil) from another child (i.e., behaves
aggressively) when the teacher is paying attention to others in the classroom. When the
aggressiveness occurs, the teacher almost invariably turns her attention to the disruptive
child.
A functional analysis, then, reveals that lack of attention (stimulus) is followed by taking
a pencil from another child (behavior), which in turn is followed by attention
(consequence).
Functional behavioral assessment: ABA (applied behavioral analysis )
Implemented to have long-term lasting effect/ long-term behavior change= behavior
implementation plan (BIP), implementation, monitoring
Support team: teachers, para professionals, family, behaviorist, case managers.
Process and Accuracy
•
Clinical Interpretation
– Influence of theoretical framework
• This framework influences interpretation
• Can also help to generate new hypotheses
– Samples, Signs, and Correlates
• Sample of general behavior
• Sign of underlying state or condition
• Behavioral, attitudinal, or emotional correlate
“Clinical Judgment” is enough to suggest that clinicians sometimes use inferential
processes that are often far from objective.
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Data can be viewed as a sample of behavior, as a sign of some underlying condition, or as
a correlate of other behavioral or emotional constructs. Likewise, interpretations can take
many forms, ranging from the more straightforward and less inferential to the highly
complex and highly inferential variety.
Two clinicians may each observe that a child persistently attempts to sleep in his
mother’s bed. For the Freudian, this becomes a sign of an unresolved Oedipus complex.
For the behaviorist, the interpretation may be in terms of reinforcement.
•
•
•
Clinical Interpretation
– Levels of Interpretation
• Level I---involves little inference; data� prediction
• Level II---involves inference about person in general (descriptive
generalization; hypothetical construct)
• Level III---involves inference about individual in a particular situation
Theory and Interpretation
– Behavioral clinicians
• Levels I and II
– Psychometrically-oriented clinicians
• Levels I and II
– Psychodynamic clinicians
• Level III
Quantitative/Statistical Approach
– Obtain scores for one or more relevant characteristics; use these to predict
outcome
– “Mechanical” prediction
– Must keep careful records of test data, observations, etc. so that
interpretations/judgments can be quantified
Clinical psychology has for some time debated the merits of clinical (subjective) versus
statistical (objective, quantitative) prediction. Research clearly supports the statistical
approach to clinical prediction. Although intuitively appealing, clinical prediction is
subject to a variety of biases (e.g., race, social class, and gender), may lead to
unwarranted overconfidence, and is characterized by unreliability and validity problems.
•
Subjective/Clinical Approach
– More subjective and intuitive
– Integrate data from multiple sources
– Summary of behaviors
Two additional observations: First, there are individual differences in clinical sensitivity. Second,
for every instance of brilliant and sensitive clinical inference, there probably lurks in the
unrecalled recesses of memory an equally impressive misinterpretation.
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Clinical interpretation, then, involves the sensitive integration of many sources of data into a
coherent picture of the patient. It also fulfills a hypothesis-generating function that is best served
by guidance from a well-articulated theory of personality. But it be appropriate for responsible
clinicians to make every effort to articulate the cues involved in their judgments and to explicate
the manner in which they make the leap from cues to conclusions. It is not enough to be good
clinicians. There is also a responsibility to pass on these skills to others.
•
The case for the Quantitative/Statistical Approach
– More specificity
– Predictions are “mechanical”
– Large group application
– Avoid Barnum effect
Barnum effect
- clinicians make interpretations that seem valid but in actuality characterize everybody.
- Barnum statements appear to be self- descriptive, but in reality, they describe almost
everyone and are not very discriminative.
- Barnum-like statements apply to almost everyone and therefore appear to be selfdescriptive. In reality, however, they are descriptive of people in general and lack both a
discriminative ability and clinical utility.
- Positive and what people wants to hear
•
•
Why don’t clinicians use the quantitative approach?
– Predictors seem short-term and not profound
– Clinicians remember their successful predictions and forget their errors
– Ethical arguments
The case for the Subjective/Clinical Approach
– Formulas are not available for all prediction situations
– Judgment can add to prediction in some situations where statistical approach does
not allow for flexibility
– Clinician as data gatherer
Clinical and Quantitative Approaches
•
•
Many comparison studies
Goldberg (1965)
– Clinicians made judgments solely on MMPI scores
– Statistical predictions made with a variety algorithms using MMPI scores
– The results of these two approaches compared to actual diagnoses from patients’
records
– Statistical predictions were comparable to or outperformed clinicians’ predictions
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Results of Goldberg (1965)
Comparing Clinical and Quantitative Approaches
•
•
•
Grove et al. (2000):
– Quantitative superior 50% of studies
– Clinical only 6%
Quantitative less expensive
Limitations of clinical
– Applications
– Definitions
In a comprehensive review of studies pitting clinical versus statistical prediction, Grove et al.
(2000) reported, once again, that statistical prediction was superior in roughly 50% of the
studies, whereas clinical prediction was superior in only a small number of studies
(approximately 6%). This trend held true regardless of the judgment task (e.g., predicting
psychotherapy outcome), type of judges (physicians vs. psychologists), judges’ amount of
experience, or types of data being combined. Thus, because it is typically less expensive than
clinical prediction (primarily because of the personnel costs involved), statistical prediction is
preferred.
•
•
•
Objections to findings
– Studies had limitations
– Not “true” experts
– Not real clinical prediction tasks
Human “need” for predictability---don’t want to hear that we are not particularly good at
this
Bias in clinical judgment?
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•
•
•
– Little support for belief that lower socioeconomic-class patients judged to be
more seriously disturbed; women judged to be more dysfunctional
– Strong support for bias that African-American and Hispanics misdiagnosed with
schizophrenia; even with same symptoms, men more likely diagnosed as
antisocial, women as histrionic; African-American patient more likely to be
prescribed antipsychotic meds.
Experience and training
– No strong support for increased clinical experience resulting in increased
accuracy in prediction
– One profession not better than another
– “Myth” of experience
Clinical approach is valuable when
– No adequate tests available
– Rare or unusual events are to be predicted
– No statistical equations have been developed
– Circumstances may negate accuracy of equation
Statistical approach is valuable when
– Outcome to be predicted is objective and specific
– Interest in individual case is minimal
– There is reason to be concerned about human judgment error or bias
Improving Judgment and Interpretation
•
•
•
•
•
•
•
•
Information processing: although there are many bits of information available, we must
guard against over-simplifying and “cherry-picking”
Reading-in syndrome: don’t over-pathologize; note strengths too
Validation and records: record your interpretations and predictions to track later
Vague reports, concepts, criteria: be specific as possible
Effects of predictions: knowledge of prediction may influence actions and perceptions of
others
Prediction to unknown situations: risky without knowledge of situational influence on
behavior
Fallacious prediction principles: failure to consider base rates, regression to the mean,
etc.
Influence of stereotyped beliefs: belief despite empirical evidence to the contrary
The Clinical Report
•
•
Referral source: address the referral question!
Aids to communication
– Language
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– Individualize reports
– Level of detail
• Cite items and observations
Sample Psychological Report
Personal life and Developmental
History
- Family History
-School/work History
Medical History
(see sample report in gdrive)
-
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The clinical report serves as the major form of communication to convey the findings from a
clinician's assessment and evaluation. The report should address the referral questions and use
language that is tailored to the person or persons who will be reading the report. Finally, the
report should contain information that is detailed and specific to the client and should avoid
vague, Barnum-like statements.
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Revise following
DSM V
(Clinical Assessment)
References:
Trull, T.J., Prinstein, M. J. (2013) Clinical Psychology. Eight Edition
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A. Course Title: How are Psychological Disorders Treated?
B. Learning Objectives:
Student will be able to understand the process of application of concepts learned from
previous modules. This includes:
1. Medical and intervention
2. Useful Treatments
3. Simple CBT treatment programme
4. Ethics
C. Duration and Platform:
1. Week 4-5
2. 1 hour Discussion (Synchronous Discussion via google meet)
3. 2 hours Recorded Lecture and other Activities (Asynchronous via Blackboard
LMS)
D. Assessment:
1. Online Quiz
E. Topic Outline:
S1: Medical versus Psychological approaches
Treatment for mental health
medication
•
•
psychotherapy
Some psychologist are licensed and trained to prescribe medication.
Psychologists often tend to be quite negative about medications
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Pros and Cons of prescribing medications for psychological disorders
Pros
Cons
It is usually cheaper to medicate than to offer
therapy
Medication does not usually work in the long term
(unless you keep talking this long term). Good
psychological therapies have been shown to have
long-lasting effects that are maintained after they
are terminated.
There are nowhere near enough therapists
qualified to give therapy to all who would benefit.
Giving medication means that people do at least
get some help
.
Some patients prefer medication to therapy.
Taking medication requires less time and effort,
and it can be less stressful and difficult
Sometimes therapy fails, and medication is the
only approach left. Sometimes, in these situations,
the medications work quite well.
Medications often have unpleasant side-effects.
This means that quality of life is impaired. It also
means that some people will stop taking the
medication, and end up relapsing.
Some medications are dangerous if an overdose is
taken.
Medications have been linked to fatalities.
Although these are rare, they can occur through an
overdose or side effects, or interactions with food
or other drugs.
Some drugs (particularly the older ones) require
lifestyle changes that can cause problems. For
instance, if someone is taking Monoamine
Oxidase Inhibitor (MAOI) drugs (usually
prescribed for depression), they will have to stay
away from a wide range of foods, including most
cheeses, pickled things, red wine and chocolates.
Combination treatment
•
•
‘multi-disciplinary team’
– Whole range of professionals who are contributing to each client’s care.
– e.g. A client will undergo psychological therapy and medication (but this
combination is not always as successful as we thought)
– The research into combining medications and therapy is in its early days, and the
interactions between the two are not yet fully understood
Foa et. al (2002)
– Three studies of cognitive behavioral therapy (CBT) plus medication for panic
disorder, only one study showed more improvement for those receiving
medication plus CBT, compared to those getting CBT alone.
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•
•
– Later, those receiving both medication and CBT were doing worse than those who
had received CBT alone.
Medication: dampens down the emotions
Therapy: cognitive processes
– If emotions and cognitive processes are not fully activated during CBT, then a
patient cannot fully to deal with them, and in the end, the therapy does not work
as well as it could have done.
What works best?
•
•
•
Are meds as good as therapy?
Do psychological treatments tend to do better?
Would it depend on the symptoms or diagnosed mental and behavioral disorder?
Answer is not simple one.
It depends who you ask.
This is not usually due to any kind of fraud on the part of the researchers, but because of the
difficulties inherent in running treatment outcomes research, which leads nicely on to our next
section
S2: Researching and evaluating treatments for psychological disorder
It is vital that professionals using those therapies are able to read the treatment outcome research
and understand its limitation
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RCTs ate very difficult to conduct
Placebo effect- trail for drug treatment : sugar pill (neither the patient nor the doctor knows who
is getting the new treatment and who is in the control group. “DOUBLE BLIND” TRIAL
•
•
•
•
Possible bias from researcher or research assistant (i.e. credibility of the doctor)
Trials
Participant drop-out
Difficult to generalize its result (if carefully selected client and therapist)
– e.g. Purely anxiety disorders (exclude with comorbidity)
– However, upon published and practiced, professionals may end up confused
because of the random clients who may experience different symptoms and
problems (difficulty in English, etc.) that those who were part of the study
(participants with ‘purely’ anxiety disorders)
Stages in treatment outcome research
1. Case studies
2. Pilot/ feasibility study
3. Randomized controlled trials
4. Meta-analyses
5. Meta-meta analysis
Effectivity of a treatment from analysis of different studies
Meta-meta analysis only included data on patients up until the end of treatment, so the study
could tell us nothing about the long-term usefulness of the interventions
Success of therapy
• The success of therapy varies hugely from client to client
• Some disorders are more ‘treatable’ than others
• Success is vague and would depend
• It is between the psychologist and client to decide
 Some trials of treatment for panic disorder have claimed
success rates of over 80%
 30 yrs ago, panic disorder was considered ‘untreatable’
by psychological therapy
 Personality disorder (which is more enduring and severe
ones) the figure is much lower
 SUCCESS doesn’t mean full remission of all symptoms
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S3: The range and scope of a psychologist’s work
A.
Prevention
Primary: with the intention of preventing emotional disorders from arising later on, even though
there was no indication that any of those children were going to have problems with this
- Psychologist wants to prevent symptoms before they have ever become full blown and
have caused problems
Secondary: these clients might be taught skills for spotting changes in their mood, and ways of
avoiding triggering low mood, such as getting enough sleep and exercise, eating properly,
watching out for negative thinking and so on. In case the client have already suffered from
depression, and the goal of this approach is to prevent them from suffering relapse (or reduce the
number they experience)
- Psychologist takes a population who have already suffered from psychological disorders
and tries to prevent them from suffering again
Universal- attempting to prevent are so common, difficult to predict who is and is not at risk
- universal is very expensive
- Offer the prevention to everyone, whether they are likely to need it or not
- People getting vaccines
- ‘Triple P’(designed to prevent behavioral and emotional problems in children)
- (Australia) Offering short course in parenting to everyone
Targeted- Target people who are at high risk of developing symptoms and impairment
- Children with high behavioral inhibition who are at increased risk of developing anxiety
disorders.
- Then, providing training to children’s mom in techniques to prevent anxiety from
developing
PROS
UNIVERSAL PREVENTION
•
•
No-one is stigmatized or labelled by
being invited to take part
Less effort is needed to identify who
needs what
PREPARED BY: DONNA P. SOMBREA, MPSY
TARGETED PREVENTION
•
•
It is cheaper, as fewer people are
treated
Efforts can be focused on engaging
those who really need the treatment
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•
•
(and who, typically, may be more
difficult to engage).
You catch everyone, including some
low-risk people who would have gone
on to develop difficulties, and would
have been missed by a targeted
approach
Psychological disorder is not black and
white. Most people exist in the grey
areas, and universal treatment may still
be beneficial to those who run the risk
of very minor problems
CONS
UNIVERSAL PREVENTION
•
•
•
It is very expensive. Typically you
have to treat very many healthy people
to prevent one person from becoming
symptomatic
Typically, it is the people who need it
least who are most likely to take up the
offer
There may be a risk to the intervention,
which for those with very low risk
might outweigh the benefits. The
concept of risk from psychological
therapies is fairly new and underresearched
TARGETED PREVENTION
•
•
•
Those who are identified as at risk
may be stigmatized or labelled
Identifying someone as at risk who
was not actually going to develop any
problems may be damaging for that
person
It is almost impossible to accurately
predict who is and is not at risk of
developing a psychological disorder.
With targeted prevention, some
people who are at risk will always be
missed. Likewise, you will always
end up treating some people who
didn’t need to be treated
B.
•
•
Formulation-based approach (‘gold-standard’)
– psychologist meets a clients, works out exactly what the goals are for that specific
person, also works out exactly what is causing their particular difficulties, and
then designs a tailor-made intervention just for them.
Manual-based approach
– Psychologist takes a ready-made treatment off the shelf and gives this to their
client
– Assessment with the client to work out which ‘package’ might be best for them,
and then monitors the client to make sure all is going well
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Manual-based approach to treatment
•
•
Advantages
– Manualized treatments can be used by less experiences and less highly-trained
therapists. (cheaper)
– Undergone years of rigorous research (developed by experts in the field)
Disadvantages
– Designed to cover as many areas as possible, and lots of these may be relevant to
your client
– Very rarely get clients with nice clean-cut disorders (comorbidity will get in the
way) – professionals need to pick and choose bits from different manuals
C.
•
Group
– Cost-effective than just seeing one person at a time
– Helpful to some cases (e.g. moderate depression: social setting, parents who are
learning to deal with an excessive anxious child)
– Coming together as a group means that you can have a bit of fun and laughter
– However, you cannot give a tailor-made approach to each person in a group.
– Just one difficult client in a group can make the whole thing very difficult to run
(requires 2 attending psychologist)
– Individual
– Sessions still as to be done individually (e.g. follow ups, phone calls, after care)
Working with children
•
•
•
•
•
Children have much less control over their lives than most adults.
Actions of parents, other carers, relatives, teachers, friends, neighbors, health
professionals, and a multitude of others, have a big impact on the emotional life of the
child.
Clients with learning disabilities
• People with learning disabilities (depending on the impairment and strengths) do
not generally lead independent lives, and are very vulnerable to events going on in
their system.
• Concentration spans will need to be assessed and taken into account
Older adults
• Specialized in diagnosing dementias and helping clients and their relatives to cope
with these conditions
• Working with issues around loss: abilities (physical and mental) and
independence.
Other groups
• Psychologist in physical health settings
• Neuropsychology
• Psychologist in forensic settings
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S4: How CBT works
The beginning of any good psychological treatment is always a thorough assessment
Aim of psychologist: (1) to get a good baseline measure of how the client is doing at the start of
therapy. –This measurement will then be repeated throughout the course of treatment, to make
sure that things are progressing (and it not, so that the psychologist can take some action). (2) to
try fin out all the factors that might be involved in the difficulty with which their client is
presenting, and to draw up a formulation.
Idiosyncratic measure- can be anything that you want to be (asking client to range their
symptoms “today, on a scale of 0-10, where 0 is scary at all, and 10 is completely terrifying, how
scary do you think candy floss is” or rate client based on how they approach (phobia) ‘behavioral
walk’- known as behavioral approach test, and is widely used as a measure of fears.
Formulation:
In order to draw up this formulation, the psychologist will want to find out:
-How did the problem start?
-What do they do when they get these symptoms?
-Does anyone else do anything that helps or hinders?
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Sample case:
• Mike was a 52-year old man who had been referred to his GP by the Job Centre. He had
been unemployed for six months, but was at risk of losing his benefits because he was
failing to turn up to Job Centre appointments, and was not actively trying to get a new
job. His GP suspected that Mike was seriously depressed and referred him to the local
mental health services, where he was seen by a clinical psychologist called Poppy. Poppy
carried out an assessment, and together with Mike, drew up the simple formulation:
Sample formulation:
Background factors
Resulting beliefs
-Born with a sensitive disposition
=Bullied at school
-Mike’s mother was often depressed when he was young, and
he sometimes experienced mild emotional abuse and neglect as
a result
-I am not a worthwhile person
-I am unlovable
Trigger
-Mike was made redundant from his job, and six months later was still struggling to find a new one
-Mike’s relationship with his wife was deteriorating
Thoughts
I am no good at anything
The whole world is against me
I will never find a job
Behavior
Feelings
Sitting on sofa all day, not going out
Critical towards wife
Given up applying for jobs
Hopelessness
Misery
Helplessness
Establishing goals –psychologist and the client must work these out together. No matter how
complex the goals are, psychologist must try to ensure that the are measurable, so the client and
therapist can tell whether they are achieving them or not.
Having completed some baseline measures, developed a formulation and established some goals,
the formal assessment period is almost complete.
** for a good psychologist an assessment will never be truly be over until the client is
discharged.
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Intervention – at the start of intervention, the psychologist will have a plan of action
Ex: (1) use the cognitive techniques to get him active again (and also to test out some of his
beliefs about himself, the world and the future)
(2) Use behavioral techniques to get him active again (and also test out some of his beliefs about
himself, the world and the future)
•
•
Cognitive techniques:
– Tell me about the people you love- Carol, your children
– Tell me about the people who are on your side, and who tried to help you
– Tell me about the times in your life when you have done well.
– Have any of the people who were made redundant at the same time as you found
jobs?
Behavioral techniques
– Behavioral activation
– Activities to work on
– Interacting with people
Home work: thought diary is used to write down negative thoughts that can then be discussed in
therapy. It also helps to identify the triggers to such thoughts, and over time, for the client to
practice coming up with more positive ways of thinking
MAINTENANCE AND GENERALISATION- relapse is a big problem. Eventually, despite
marked initial improvements, many clients’ symptoms will begin to creep back. There are two
main reasons for this:
(1) The therapy is too restricted, and although the patient is fine in the psychologist’s office
or in their own home, when they have to cope in a new situation they lack either the skills
or the confidence to do this
(2) the client forgets to keep practising their new behaviors and ways of thinking, and the
old difficulties gradually creep back.
**To minimise the chances of this happening, client and psychologist drew up a ‘first aid kit’ of
‘tools’ that he could use if he ever felt his mood slipping again. This includes all client’s thought
diaries and handouts from the therapy, and a list of activities that could reliably be used to lift his
mood
Finally, the clinician carried out a last assessment to do formal check on how he was doing. The
questionnaires all showed that the client’s symptoms of depression had reduced dramatically and
were now well within the normal range.
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S5: The ethics of psychological therapy
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PAP CODE OF ETHICS
VIII. Therapy
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
Confidentiality
Informed Consent
Client’s Wellbeing
Relationship
Record Keeping
Competence Practice
Working with Young People
Referrals
Interruption
Termination
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PREPARED BY: DONNA P. SOMBREA, MPSY
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References:
Field, M. and Hatton, S. C., 2015. Essential Abnormal & Clinical Psychology, Chapter 1: The
Big Issues in Classification, Diagnosis and Research into Psychological Disorders. SAGE
Publications
PREPARED BY: DONNA P. SOMBREA, MPSY
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