Clinical psychology Test 2

Describe how the Wechsler Intelligence tests are used for intellectual assessment

(currently 3 Wechsler IQ tests) 1. they yield a single full-scale intelligence score (spearmans "g") 2. Also yield 4-5 index scores: Verbal comprehension, Perceptual Organization, Working memory, Processing speed -mean of 100 for full scales and index scores, and 10 for subtests -Large sets of normative data -impressive psychometric data to support reliability and validity -*Approach to interpretation: full scale IQ first, followed by increasingly specific scores and patterns* -Yield about a dozen specific sub-test scores -One-to-one, face-to-face administration subtests: -vocabulary -similarities -information -comprehension -block design -picture -completion -matrix reasoning -coding -symbol search

Evaluate criticisms in the DSM-5

*Breadth of Coverage:* Too many disorders? Some not actually forms of mental illness? Too many people stigmatized? Concept of mental illness becoming trivialized? *Controversial cutoffs:* How many symptoms should be necessary for a particular disorder? What constitutes "significant distress and impairment"? *Cultural issues:* Some criticize lack of diversity, despite major efforts to address this issue while creating recent DSM's *Gender bias:* Do some diagnostic categories pathologize one gender more than the other? (premenstrual, dysphoric disorder? *Non-empirical influences:* Do non-empirical factors (politics, finances, morality) influence decisions about abnormality (inclusion of homosexuality in the DSM I-III) *Limitations on objectivity:* even with increased empiricism, do opinion and judgment still play significant roles in decisions about abnormality?; opinion and judgment still play a role

Dimensional Approach vs. Categorical Approach

*Dimensional Approach:* "Shades of gray" rather than "black and white" --place clients' symptoms on a continuum rather than into discrete diagnostic categories --Five-factor model of personality could provide the dimensions --More difficult to efficiently communicate, but more thorough description of clients? --May be better suited for some disorders (personality disorders) *Categorical Approach:* Current approach of the DSM --An individual falls in the "yes" or "no" category for having a particular disordeer --"black and white" approach--no "shades of gray" --May correspond well with human tendency to think categorically --Facilitates communication

List major neuropsychological batteries and instruments used by clinical neuropsychologists

*Halstead-Reitan Neuropsychological Batter (HRB):* -Comprehensive battery of 8 neuropsychological tests -Primary purpose is to identify people with brain damage and to provide detailed information or hypotheses about any brain damage identified -Some of 8 tests involve *sight, hearing, touch, motor skills, and pencil and paper tasks.* *Luria-Nebraska Neuropsychological Battery (LNNB)* -Similarly long and comprehensive -Emphasizes qualitative data in addition to quantitative data. INSTRUMENTS: -*Bender Visual-Motor Gestalt Test (second edition)* -most commonly used neuropsycholgical screen among clinical psychologists -6 minutes to administer -simple copying test using 9 geometric designs -quick "check" followed by more tests as necessary -can suggest brain damage in a diffuse, but not specific way *Rey-Osterrieth Complex Figure Test* -Brief pencil-and-paper drawing task, but unlike Bender-Gestault, involves just a single, more complex figure -Also includes a memory component (recall figure and draw from memory) *Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) -updated in 2012 -Neuropsych screen focusing on a broader range of abilities than Bender-Gestault or Rey-Osterrieth -12 subtests in less than half an hour *Wechsler Memory Scale--Fourth Edition (WMS-IV)* -Assesses memory problems, due to brain injury, dementia, substance abuse, etc. -Ages 16-90 -Assesses visual and auditory memory, immediate and delayed recall

Identify objective personality tests commonly used by clinical psychologists- know their main features, creators, purpose

*Minnesota Multiphasic Personality Inventory-2 (MMPI-2):* --Most popular and most psychometrically sound objective personality test -Used worldwide; translated into dozens of languages -Pencil & paper format -567 self-descriptive sentences -Client marks true or false for each *Original MMPI was published in 1943* --Primary authors were *Starke Hathaway and J. C. McKinley* Empirical criterion keying was used as test construction method Revised edition, MMPI-2, was published in 1989 Better norms; less outdated wording of items *MMPI and MMPI-2 feature 10 clinical scales* 1—Hypochondriasis 2—Depression 3—Hysteria 4—Psychopathic Deviate 5—Masculinity/femininity 6—Paranoia 7—Psychasthenia 8—Schizophrenia 9—Mania 0—Social Introversion MMPI and MMPI-2 also feature validity scales To measure test-taking attitudes Can identify clients who "fake good" or "fake bad," or clients who respond randomly MMPI-A (for adolescents, age 14-18) was published in 1992 Similar clinical scales, validity scales, and administration *MMPI-2-RF—most recent edition published in 2008—briefer, less overlap between clinical scales* -strengths include psychometrics (established reliability and validity) and comprehensiveness -Limitations include length, reading requirement, attention requirement, and emphasis on pathology/abnormality -Therapeutic Assessment *Interesting use of MMPI-2, developed by Stephen Finn and colleagues* -MMPI-2 feedback used as a brief therapeutic intervention -What psychologists intend as assessment clients can experience as therapeutic -Therapeutic Assessment *Millon Clinical Multiaxial Inventory (MCMI-IV)* -Originally created by Theodore Millon -Like the MMPI-2 in some ways -Comprehensive objective personality test -Self-report, pencil-and-paper format -Main difference: MCMI-IV emphasizes personality disorders -Its clinical scales are based on DSM personality disorders (e.g., antisocial, borderline, narcissistic, paranoid) *NEO Personality Inventory—Revised (NEO-PI-R)* Originally created by Paul Costa and Robert McCrae -Another objective personality test -Pencil & paper, self-report format -Main distinction: measures "normal" personality traits (not pathologies) -Based on Five Factor model of personality -Neuroticism, Extraversion, Openness, Conscientiousness, Agreeableness (OCEAN) -Lacks validity scales, and of limited help with clinical diagnosis *California Psychological Inventory* -Another objective personality test -Pencil & paper, self-report -Like NEO-PI-R, doesn't emphasize pathology -Emphasizes positive attributes of personality—strengths, assets, internal resources -Consistent with recent positive psychology movement -Two versions: CPI-434, CPI-260 -The CPI yields scores on 20 scales, the names of which reflect the positive nature of this test: Independence, Self-Acceptance, Empathy, Tolerance, Responsibility, and Flexibility, among others (regarded negatively by clinicians) *Beck Depression Inventory-II (BDI-II)* -Not a comprehensive test of personality, but a brief, targeted measure of one characteristic (depression symptoms) 21 items; takes 5-10 minutes to complete Pencil & paper, self-report format Lacks validity scales, and much more limited scope than other tests discussed to this point

Differentiate between objective and projective assessments of personality.

*Objective assessment* -Include unambiguous test items, offer clients a limited range of responses, and are objectively scored ◉Typically self-report questionnaires ◉Typically a series of brief statements or questions to which clients respond in a true/false or multiple choice format *Projective assessment* Based on the assumption that clients will "project" their personalities when presented with unstructured, ambiguous stimuli and an unrestricted opportunity to respond ◉Lack of objectivity in scoring and interpretation○Considered by many to be empirically inferior to objective tests○Usage has declined in recent decades ◉Advocates claim they are less "fake-able"

Key skills and Behaviors for a Psychologist conducting an interview:

*SKILLS* 1. *Quieting yourself* (minimize internal, self-directed thoughts that detract you from listening) 2. *Being self aware* (know how you tend to affect others inter-personally, and how others tend to relate to you 3. *Develop positive working relationships* (can segue into psychotherapy, respectful and caring is key!) ---*Clarification*: question to make sure the interviewer accurately understands the clients comments ---*Confrontation*: for discrepancies or inconsistencies in a client's comments ---*Paraphrasing*: restatement of client's comments to show they have been heard *BEHAVIORS* 1. Listening (primary task) 2. Eye contact 3. Body language 4. Vocal qualities 5. Verbal tracking 6. Referring to client by proper name

explain behavioral assessment methods used by clinical psychologists.

*behavioral observation is the most essential technique* -Direct, systematic observation of a client's behavior in the natural environment -Also known as naturalistic observation -Requires operationally defining target behavior and measuring its frequency, duration, or intensity across specified time periods -Often more accurate than asking client to self-report behaviors -When naturalistic observation is not possible, analogue observation is used -Replicate situation in clinic -Recording of behaviors is crucial -Done by parent, teacher, friend, or client -Enables functionality of behavior to be determined - *this functionality is key concept in behavioral assessment*

Describe major projective personality tests used for psychological assessment

- *Rorschach Inkblot Method* created in 1921 by Hermann Rorschach -10 inkblots (5 in color, 5 black & white) are presented -Clients say what they see in each blot (in "response" phase) -Later (in "inquiry" phase), explain what features of the blot caused them to make their responses -John Exner's Comprehensive System is most widely used scoring system -scoring client perception and what they see *Thematic Apperception Test (TAT)* -Published in 1943 by Henry Murray and Christiana Morgan -Like Rorschach, it involves a series of cards with ambiguous stimuli -Cards feature interpersonal scenes rather than inkblots -Client tells a story to go along with each scene -Often, not formally or empirically scored -Reliability and validity are questionable *Tell-Me-A-Story (TEMAS)* -Recent TAT-style apperception test -Greater emphasis on cultural sensitivity (via portrayal of diverse individuals in urban settings) -Greater emphasis on empirical scoring via normative data *Sentence Completion Test* -The ambiguous stimuli are not inkblots or interpersonal scenes, but beginnings of sentences - *Rotter Incomplete Sentence Blank (RISB) is most widely used* -Simulated examples: I enjoy_______________. It makes me furious_______________. My greatest weakness_________. -Not often formally or empirically scored -Reliability and validity are questionable

Revised Disorders in the DSM-5

--Removed "bereavement exclusion" from major depressive episode (if someone close to you dies, you cannot classify as depressed) --Consolidation of Asperger's Disorder into autism spectrum disorder --Age of first symptoms of ADHD changed from 7 to 12 years old --Frequency of binge eating decreased from twice to once pr week in bulimia Nervosa --Substance abuse and substance dependence combined into substance use disorder --Mental retardation renamed intellectual disability --Learning disabilities renamed specific learning disorder --OCD moved from Anxiety Disorders category to Obsessive-Compulsive and Related Disorders --Mood disorders category split in two: Depressive Disorders, Bipolar and Related Disorders

Propose ways a psychologist could acknowledge cultural differences while interviewing clients from differing backgrounds. Know the general differences in communication styles that have been observed in previous research (Box 8.1 in text book)

-Asian Americans and Hispanic Americans tend to speak more softly than whites. -Whites tend to speak more quickly than other cultural groups -African Americans tend to maintain more direct eye contact when speaking than when listening whereas the opposite is true for whites -Native Americans often display an indirect gaze during conversation -Asian Americans are inclined to avoid eye contact when speaking to people of higher status. -African Americans and whites are likely to respond rather quickly, whereas Native Americans, Asian Americans, and Hispanic Americans may demonstrate a mild delay *Men and women* -Men tend to use talk to assert themselves, promote their ideas and achieve goals -Women are more likely to use talk to build rapport and sustain relationships -Women are apt to value self-disclosure for the closeness it brings -Men are apt to believe that self-disclosure increases vulnerability -Men use speech to help others (advice, problem solving) -Women use speech to help others (empathy, understanding of emotions)

DSM 5: The current edition (2013)

-Task Force and Work Groups shaped it development ~Primarily composed of researchers (not clinicians) -Greater consistency between DSM and ICD

DSM-5 CONT'D.... New Features

-Title uses Arabic (5) vs. Roman (V) numeral -DSM as a "living document" -Elimination of the multiaxial diagnostic system (BIG CHANGE)

What is the Universal Nonverbal Intelligence Test-2? What is its goal?

-entirely language free -No speaking necessary for test administrator or test taker -all instructions are hand gestures -all responses are manual, not verbal Some drawbacks: only for age 5-21, limited psychometric data *GOAL*: to measure the general intelligence and cognitive abilities of children and adolescents from ages 5 years through 21 years, 11 months who may be have speech, language, or hearing impairments; have different cultural or language backgrounds; or be verbally uncommunicative. As such, the UNIT-2 provides a fair assessment of culturally and linguistically different examinees.

The different types of Validity and Reliability

1. *Validity:* measures what it claims to measure 2. *Content Validity:* has content appropriate for what is being measured. (a survey) 3. *Convergent Validity:* correlates with other techniques that measure the same thing (measurement of depression) 4. *Discriminant Validity:* does not correlate with techniques that measure something else 1. *Reliability:* Yields consistent, repeatable results (intelligence) 2. *Test-retest reliability:* yields similar results across multiple administrations at different times 3. *Interrater Reliability:* yields similar results across different administrators 4. *Internal reliability:* consists of items that are consistent with one another (all things being asked have something in common--suicidal thoughts, sleep patterns, anxiety=depression) 5. *Clinical utility:* improves delivery of services or client outcome (most important)

Compare major theories of intelligence from the early 1900s to present.

1. Charles Spearman- "g" or general (single) intelligence ("a" thing we could assess) 2. Louis Thurstone: Intelligence is plural abilities that may not relate to each other (different dimensions) 3. Hierarchical models of intelligence blend singular and plural theories 4. James Cattell: two separate intelligences - *fluid intelligence:* ability to reason when faced with novel problems (you can problem solve) - *crystallized intelligence:* body of knowledge accumulated through life experiences (could change over time due to life experiences)

types of clinical interviews

1. Intake interviews: to determine whether to "intake" the client into the agency or refer elsewhere 2. Diagnostic interviews: To provide DSM diagnosis -Structured interviews often used -Minimize subjectivity, enhance reliability -SCID is an example -Semi-structured interviews include some structure but also some flexibility or opportunities to improvise 3. Mental status exam: typically used in medical settings; to quickly assss how a client is functioning at that time 4. Crisis interviews: Assess problems and provide immediate intervention; clients are often considering suicide or other harmful act.

Pioneers and their theories

1. Jerome wakefield: Harmful Dysfunction: considers both scientific data (dysfunction) and social context (harmful) 2. *Hippocrates*: emphasized natural causes; imbalance of bodily fluids (blood, phlegm, black bile, yellow bile) as the uderlying reason for various forms of mental illness 3. *Philippe Pinel*: proposed specific categories such as melancholia, mania, and dementia. 4. *Emil Kraepelin* put forth some of the first specific categories of mental illness such as manic-depressive psychosis and dementia praecox.

Compare major definitions of abnormality proposed in the field of clinical psychology

1. Personal distress: if it bothers someone, its a problem 2. Deviance from cultural norms 3. Statistical infrequency 4. impaired social functioning 5. Harmful dysfunction: considers both scientific data (dysfunction) and social context (harmful)

New Disorders in the DSM-5

1. Premenstrual dysphoric disorder (women experiencing symptoms before menstruation) 2. Disruptive mood dysregulation disorder: intense. emotional reactions. 3. Binge eating disorder 4. Mild neurocognitive disorder 5. Somatic symptom disorder 6. Hoarding disorder

Explain the role of achievement testing in diagnosing specific learning disorders.

Ability Achievement Discrepancy Achievement tests produce standard scores that can be easily compared to scores from intelligence tests but are specific to math, reading, or other abilities. The Wechsler individual achievement test--Third Edition is for reading, math, written language, and oral language; administered for ages 4-50 When diagnosing a learning disorder, the academic results are usually below those expected for the individuals chronological age and cause significant interference with academic or occupational performance. Learning difficulties are not better accounted for by intellectual disabilities.

Behavior Assessment

Assumes that client behaviors are not signs of underlying issues or problems; instead, those behaviors are the problems The behavior a client demonstrates is a sample of the problem itself, not a sign of some deeper, underlying problem

propose how a psychologist conducting a personality assessment can demonstrate cultural competence

Culturally competent clinical psychologists are aware of this, and of the influence of their own cultural perspective ◉Especially important not to overpathologize ○View as abnormal what is culturally normal

Evolution: DSM-I (1952) and DSM-II (1968)

DSM-I and DSM-II: Not scientifically or empirically based, based on "clinical wisdom" of leading psychiatrists ~Psychoanalytic/Freudian influence ~Contained three broad categories of disorders (psychoses, neuroses, character disorders) ~No specific criteria; just paragraphs with somewhat vague descriptions.

Know differences between intelligence, achievement, and neuropsychological tests

Intelligence testing: Intelligence is what a person CAN accomplish intellectually; measures intellectual abilities Achievement Testing: is what a person HAS accomplished, especially in reading, spelling, writing, or mathematics; accomplishments in academic areas --typically produces standard cores that can be easily compared to scores from intelligence tests (mean=100) -A significant discrepancy between intelligence an achievement is the basis of a specific learning disorder diagnosis (formerly learning disability) --They also typically produce age or grade equivalency scores --Some are specific to math, reading, or other abilities. --*Wechsler Individual Achievement Test*--Third Edition (WIAT-III); For ages 4-5; administered face to face and one on one; reading, math, written language, oral language Neuropsychological testing: Measure cognitive functioning or impairment of the brain and its specific components or structures --Additional purposes: to make prognosis, plan accommodations, etc. --Often used after head injury, brain illness, or prolonged alcohol or drug use --Some neuropsychological tests are lengthy and comprehensive; others are brief and targeted

Technology in Behavior assessment

Laptop computers or handheld devices can be used to record observed behaviors Numerous software programs and apps have been created for this purpose Clients can use similar technological tools for self-monitoring

Define the purpose of neuropsychological testing

Measures cognitive functioning or impairment of the brain and its specific components or structures (NEURO FOCUS) -Purpose is to make *prognosis, plan rehab, determine eligibility for accommodations* -often used after a head injury, brain illness, or prolonged alcohol or drug use

List the advantages of a multimethod assessment approach when conducting a psychological evaluation.

No measure of personality or behavior is perfect ◉It is best to use multiple methods ◉Convergent conclusions can be made with more confidence

Rapport

Positive, comfortable relationship between interviewer and client -How an interviewer is with the clients -Does the client like you?

Medical Model of psychopathology

The DSM reflects this model in which each disorder is an entity defined categorically and features a list of specific symptoms

Explain major techniques that a clinician may use during a clinical interview

What an interviewer does with clients Directive and non-directive styles *Open ended questions:* allow individualized and spontaneous responses; Elicit long answers that may or may not provide necessary info *Close ended questions:* allow less elaboration and self expression by the client; yield quick and precise answers. *Clarification:* questions to make sure the interviewer accurately understands the clients comments (to get a good picture of what happened) *Confrontation:* for discrepancies or inconsistencies in a clients comments *Paraphrasing:* restatement of clients comments to show they have been heard *Reflection of feeling:* Echo client's emotion, even if not explicitly mentioned; "reaching under" the words *Summarizing:* tie together various topics, connect statements that may have been made at different points and identify themes.

Intelligence testing vs Achievement testing

intelligence testing: what a person CAN accomplish intellectually Achievement testing: What a person HAS accomplished, especially in reading, spelling, writing, or mathematics Achievement testing is the basis of a specific learning disorder diagnosis

Know This:

the DSM does not require an experience to be uncommon in the population in order to be classified as a disorder.

Evolution: DSM-III (1980) and DSM-III-R (1987)

~More reliant on empirical data, less reliant on clinical consensus ~Specific criteria defined disorders ~Atheoretical (NO psychoanalytic/Freudia influence) ~Multiaxial assessent (5 axes) ~Much longer--included many more disorders -DSM-III-R (minor changes from DSM-III)