Clinical Psychology Study Guide
MOTIVATIONAL INTERVIEWING
- A way of interacting with a client about chance
- Goal is eliciting internal motivation for chance
- Used to help the client progress through the stages of change
- Can be integrated with other treatments
Pre-contemplation  Contemplation  Preparation  Action  Maintenance
Change = ambivalence
The Spirit of Motivational Interviewing:
Partnership
- Collaborative rather than prescription
- Willingness to suspend “expert” role
- Joining the client’s perspective/logic
- Respecting client’s autonomy, potential, strengths
- Evoking/eliciting rather than imposing
- The best ideas for change come from the client
- Dancing vs. wrestling
OARS
- (O)pen questions
- (A)ffirmations (help build a sense of self-efficacy)
- (R)eflections
- (S)ummary
Components of Motivational Interviewing:
- Expressing empathy
- Developing discrepancy (recognizing change and resistance talk, eliciting and
strengthening change talk)
- Rolling with resistance (ambivalence)
- Supporting self-efficacy (developing a smart change plan)
Diaphragmatic Breathing
- Hard for people with panic disorders
Chapter 5 – Assessment Overview
What is a psychological test?
“An evaluative device or procedure in which a sample of an examinee’s behavior in a
specified domain is obtained and subsequently evaluated and scored using a standardized
process”
Qualities of a psychological test:
Standardization  Reliability  Validity  Norms
Canadian psychologists
- 28% of time devoted to assessment
Testing
- Yields scores on a measure (e.g., IQ)
- Requires standard administration and scoring
- Can be conducted by a trained technician
Assessment
- Addresses a specific question
- Usually has multiple sources of data, including standardized testing, but also interview
- Requires integration and interpretation
Psychological assessment
- Assessment-focused services vs. intervention-focused services
- Can be stand-alone or integrative
- Screening (example of stand-alone): to identify individuals who may have (or are at risk
of developing) clinically significant problems
DIAGNOSIS/CARE FORMULATION
- Use of assessing date to reach a conclusion about diagnosis and to create a
comprehensive formulation of a patient’s psychological functioning
PROGNOSIS/PREIDCTION
- Use of assessing data to predict future course of client’s psychological functioning
TREATMENT PLANNING
- Information from assessment combined with knowledge from empirical literature used to
develop a course of action
TREATMENT MONITORING
- Iterative process, evaluate response to treatment compared with functioning at intake and
change treatment plan in accordance
TREATMENT EVALUATION
- Information on client’s functioning
Specialized Types of Assessments: e.g., Child Custody
- Extensive (and expensive) assessments to support custody decisions
- “professional minefield”
- Special guidelines (many do not adhere to)
Accuracy and Errors in Clinical Prediction
True positives
True negatives
False positives
False negatives
Testing Practices in Clinical Psychology:
CHILDREN
- Cognitive functioning
- Symptoms checklists
- Personality
- Usually multi-informant
ADULTS
- Cognitive functioning
- Symptom checklists
- Personality
- Usually single-informant
Evidence-based Psychological Assessment
An approach to assessment that uses research and theory to guide:
- The variables assessed
- The methods/measures used
- The way the assessment unfolds
- The way information is integrated/interpreted
Ethical Considerations in Assessment
Informed consent
- What will assessment involve?
-
Who will get a copy of the report?
Awareness of limits of confidentiality
Responsible caring
- Selecting tools that are suitable to address the question
Interpreting data in an even-handed way
What skills/knowledge do psychologists have to have to conduct assessments?
Developing a plan for assessment
- Determining the primary purpose
- Generating multiple hypotheses that need to be examined to address the question
- Gathering data to test the hypotheses using a biopsychosocial approach
- ALWAYS keeping ethical issues in mind
Chapter 6 – Interviewing and Observation
The most common form of assessment is the clinical interview
What happens before the “first interview”?
Ethical issues: Limits of confidentiality and protection from harm
- Self-harm
- Harm to others
- Child in need of protection
When required by law
- Legal obligation to disclose to a judge when requested (psychologists in Canada do not
have ‘client privilege’ like lawyers do)
- Case-specific limits
What are the major differences between assessment interviews and:
- Conversation with friends? Job interviews?
Qualities of the Interview
Interview’s Frame of Mind
- Quieting yourself
- Being-self-aware
- Goal of developing positive working relationship with client
Specific Behaviors
- Eye contact
- Body language
- Vocal qualities
How do you build rapport in a “first interview”?
- More cautious
Unstructured Interviews
- Safe environment
- Positive relationship
- Gathering pertinent information
Role of psychologist in an unstructured interview:
- Setting context
- Asking open and closed questions
- Pursuing a line of questioning
- Clarifying, reflecting, paraphrasing
Structured Diagnostic Interviews
Specific format for:
- How to ask questions
- Sequence of questions
- e.g., Structured Clinical Interview (SCID), most widely used in North America
What are the pros and cons of unstructured and structured interviews?
What info do you get from an interview? Beyond answers to questions?
Adapting interview style to:
- Children
- Couples
- Families
- Older adults
- Developmental level (e.g., individuals with intellectual disabilities)
General Issues in Interviewing
Skills in Listening:
- No interruption
- Minimize noise
- Position relative to the client
- Posture
- Nonverbal indicators: nodding
- Verbal indication
The therapist (gently) directs the session
Questioning
- A mix of open-ended and close-ended questions; when should you use it?
Asking About Sensitive Issues
Cultural Sensitivity
- Microaggressions: a psychologist makes an assumption based on a stereotype
Special Challenges Interviewing Children
- Being careful about leading questions
- Ability to understand and describe emotions
- Understanding of time, duration, frequency
- e.g., puppets, feelings thermometer
Problem Definition Questions
- Clients often come in to a first session with a vague description of their concerns
- “Tell me more about…” “Can you explain what you mean by…” “Help me
understand…” “Tell me about the last time when…”
- Questions About frequency, intensity, duration
Using Silence
- Allowing brief periods of silence is important in interviews
Paraphrasing
- Rephrasing the content of what a client has stated
Clarification
- Paraphrasing plus a verification of accuracy, “Am I understanding that right?”
Client Expressing Emotion
- How do you create conditions in which a client is comfortable expressing emotion?
Behavioral Observation
- When would a psychologist conduct behavioral observation?
- Where might observation take place?
- What types of behaviors might you be observing?
- Consistency in behaviors across settings?
- What factors might lead to inaccurate or invalid observations?
- What can be challenging about behavioral observation?
The ABCs
- Importance of not just assessing frequency but also (A)ncedents, (B)ehavior, and
(C)onsequences
- To change a behavior, understand the function of the behavior
Functional Analysis
- Systematically applying behavioral principles to discern the “purpose” of the behavior in
question
Self-Monitoring
- When would you have a client do self-monitoring?
- Advantages and disadvantages
- Define behavior observed
Chapter 7 –
Defining Intelligence
- What is intelligence?
Early Conceptualizations
- Goal of educational streaming, therefore heavy emphasis on skills relevant to school
success
Raymond Cattell
- Two forms of intelligence:
1. Crystallized intelligence – what we have learned in life
2. Fluid intelligence – ability to solve problems without drawing on prior knowledge
Correlates of Intelligence
- 40-80% genetic factors
- Environment affects the extent to which individuals achieve their full genetic potential
- 280 genes associated with intellectual disability identified; no single gene attributed to
intelligence
- There are no sex differences in overall intelligence
- Ethnic bias in intelligence testing
- Stereotype threat
Variables That Are Protective
- Breast feeding
- Socioeconomic status (higher status, 12 pt. increase in IQ)
- Aerobic exercise
Theories of Intelligence
- Disconnect between psychological science on cognitive abilities and the ways we assess
clinically
Why Assess Intelligence?
- To identify possible impairments/weaknesses/strengths
- To identify appropriate learning environments
- To make recommendations for modifying work/home/school environments
Examples of Uses for Cognitive Testing
Wechsler scales
- The most widely used measures of intelligence today
-
Measures spanning 2-90
All use standard deviation scores: mean of 100 and standard deviation of 15
WAIS (Ages 16-90) and WISC (Ages 6-16)
4 Indices
- Verbal comprehension
- Perceptual reasoning
- Working Memory
- Processing Speed
WPPSI (Ages 2.6-7.7)