Clinical Psych Exam 2

Binge eating disorder (BED)

--Person overindulges in food, but does not engage in compensatory behaviors (e.g., excessive exercise) --Binges must take place at least once per week for three months --Other symptoms include: ===lack of control over the eating, rapid eating, eating until overly full, eating alone to avoid embarrassment, and feelings of guilt or depression afterward

What is IQ related to?

-Academic performance --IQ accounts for about 25% of the variance in school performance -Occupational success --People who work in in professions generally considered to be high status tend to have higher IQs -Unknown causal connection

Even More Case History

-Alcohol and Drugs --Pattern of use of alcohol and drugs --Any legal, employment, or social problems due to use? -Physical Health --Significant medical problems (e.g., head injuries, chronic illnesses) --Allergies -Other considerations --Also gives the clinician the opportunity to make observations about the client's speech pattern, thought processes, ability to regulate their emotions, etc.- -Gathering collateral information can be important --E.g., when working with a child, asking parents, teachers, etc. for information

Wechsler Intelligence Scales

-All Wechsler Intelligence Scales yield: --A single full-scale intelligence score ===Reflects a global level of intelligence (similar to "g") --Four index scores --Specific subtest scores ===Index scores and subtest scores are reflective of more specific areas of ability -All are administered one-on-one and face-to-face -Each subtest is brief (lasts 2-10 minutes) and consists of items that increase in difficulty as the subtest progresses -Each Wechsler has a small number of unique subtests, but most subtests appear in all three -Not true or false questions, more in depth questions -For sub tests: if you fail too many questions you move on to the next sub test

More Wechsler Intelligence Info

-All have carefully collected sets of normative data --Each set includes data collected from ~2,000 people --Sample closely matches recent US census data in terms of gender, age, race/ethnicity, and geographic region -The full-scale and index scores are "IQ" scores—they reflect an intelligence "quotient" --Mean IQ score is 100; with a standard deviation of 15 -Strong psychometric properties --Strong reliability and validity

Who defines Abnormality?

-Although the definition is still debated, in the US Clinical Psychologists use the Diagnostic and Statistical Manual of Mental Disorders (DSM) to make diagnoses -DSM-5 defines abnormality as a significant disturbance in "cognition, emotion regulation, or behavior" that indicates a "dysfunction in mental functioning" --"usually associated with a significant distress or disability" in work, relationships, or other areas of functioning

Sentence Completion Tests

-Ambiguous stimuli are the beginnings of sentences --Assumption that the client's personality is revealed by the endings they add -Rotter Incomplete Sentences Blank (RISB) tests are most widely known and commonly used --40 written sentence stems ===I enjoy _____________________. ===It makes me furious __________________________. ===I feel very nervous _______________________. ===My proudest moment _________________________. ===My greatest weakness _____________________. --There is a formal scoring system, but it is not used regularly by clinical psychologists

MMPI Validity Scales

-Another key feature of the MMPI was a way to assess clients' test-taking attitudes -Self-report measures are vulnerable to dishonest efforts by clients --"Fake bad" --"Fake good" --Random answering -Validity Scales --Provide information about how the client approached the test and allows psychologists to determine if a test is valid -Three specific validity scales --L—Lying—suggesting "faking good" --K—Defensiveness—also suggesting "faking good" --F—Infrequency—suggesting "faking bad" ===Quantifies how much a person's deviate from the general population; hence, how infrequent the answers are when compared to everyone else

Defining Intelligence

-Assessment of intellectual ability is an important component of clinical psychology -Symposium in 1921 involving expert psychologists in field of intellectual assessment attempted to define intelligence -1986—asked 24 scholars to define intelligence -Important common elements of intelligence --Adaptation—the ability to modify one's behavior to meet the demands of the situation --Ability to think abstractly --Ability to acquire new information or to learn through experience -The central question has typically been the singular versus plural nature of intelligence

Assessment

-Assessment tends to be more uniquely associated with clinical psychology -Assessment techniques should possess: --Validity --Reliability --Utility -Assessment also commonly involves giving clients feedback -Clinical psychologists most frequently rely on the clinical interview

Beck Depression Inventory-II

-Assessments discussed thus far provide a broad overview of personality -Sometimes clinical psychologists want more targeted, non-comprehensive measures --Often focus exclusively on one characteristic ===E.g., Depression, Anxiety, Eating Disorders -Beck Depression Inventory-II (BDI-II) --Self-report, paper-and-pencil test that assesses depressive symptoms in adults --21 items (~5-10 minutes) ===Each item is a set of four statements regarding particular symptom of depression; listed in order of increasing severity ===Simulated Example Item: ===="I never think about dying" ===="I occasionally think about dying" ===="I frequently think about dying" ===="I constantly think about dying"

DSM -- More Recent Editions Axials

-Axis 1 Disorders thought to be more episodic: depression, anxiety; flucation with how often you experience episodes -Axis 2 Disorders thought to be stable or long-lasting: more permanent disorders; personality disorders, learning disorders Last the rest of your life -Axis 3:General medical conditions; have a brain tumor that is causing hallucinations -Axis 4 Psychosocial and environmental problems: experiencing conflict at home -Axis 5 Global Assessment of Functioning Scale: 1-100 100 is you're a very stable person 1 is your very significantly impaired by the diagnose you have

Halstead-Reitan Neuropsychological Battery (HRB)

-Battery of eight standardized neuropsychological tests -Suitable for clients 15 years of age and above -Primary purpose is to identify people with brain damage -Example Tests --Trail Making Test ===Resembles dot-to-dot puzzles --Finger Tapping (FingerOscillation) Test ===Estimates motor speed ===Single type writer key, type the key as fast as you can in 10 Seconds

More Wechsler Subtests

-Block Design—re-create a specific pattern or design of colored blocks -Picture Completion—view picture of a simple object or scene and identify the important part that is missing --See a toothbrush but the brush doesn't have any bristles --Dog with no tail -Matrix Reasoning—View an incomplete matrix and select the missing portion from multiple choices provided -Coding:using pencil and paper, repeatedly copy simple shapes/symbols in appropriate spaces according to a key provided -Symbol Search:scan a group of visual shapes/symbols to determine if target shape(s)/symbol(s) appear in a group

Why Do we use Diagnoses?

-Categorization facilitates research -Diagnostic labels can facilitate treatment -Diagnostic labels can facilitate communication

Fluid and Crystallized Intelligence

-Cattell and Horn (1966) developed a theory that posited two types of intelligence: --Fluid intelligence: the ability to reason when faced with novel problems --Crystallized intelligence: the body of knowledge one has accumulated as a result of life experiences -Fluid intelligence measured by tasks that require new learning, novel problem solving -Crystallized intelligence measured by assessing vocabulary, general information, and abstract word analogies

Objective MEthods

-Characteristics of an objective personality assessment --Unambiguous test items --Offers clients a limited range of responses --Objectively scored -Projective personality tests tend to have ambiguous stimuli and an open-ended range of client responses -Examples --Minnesota Multiphasic Personality Inventory-2 (MMPI-2) --Millon Clinical Multiaxial Inventory-III (MCMI-III) --NEO Personality Inventory-Revised (NEO-PI-R) --California Psychological Inventory-III (CPI-III) --Beck Depression Inventory-II (BDI-II)

More Interview Techniques

-Clarification --The purpose of a clarification question is to make sure the interviewer has an accurate understanding of the client's comments --Also communicates that the interviewer is actively listening -Confrontation --Used when an interviewer notices discrepancies or inconsistencies in a client's comments -Paraphrasing --Used to assure clients that they are being heard—not to clarify or resolve contradictions --A rephrasing of the content of the client's message

Universal Nonverbal Test of Intelligence (UNIT)

-Completely language-free test of intelligence -Individual administering the test uses hand signals -Examinee responds by pointing fingers or through the minor manipulation of objects with hands -Ages 5-17 -Normed on 2,100 children who match recent US census data -Consists of six subtests organized into a two-tiered model of intelligence --Memory and Reasoning -Memory --Includes three subtests: Object Memory, Spatial Memory, Symbolic Memory -Reasoning --Includes three subtests: Cube Design, Mazes, Analogic Reasoning

Why is the definition of abnormality important?

-Consider proposed criteria for disorders... --How the task force defines each disorder (and whether or not they decide to make it an official disorder listed in the DSM to begin with): ---Impacts research ---Impacts clinicians (in terms of diagnosis and conceptualization) ---Impacts clients

General Criticisms of DSM-5

-Controversial Cutoffs --Seemingly arbitrary requirement of a certain number of symptoms/certain time period ===E.g., why a minimum of 5 symptoms for MDD? Why for two weeks? -Cultural Issues --Original creators of DSM were overwhelmingly Caucasian males --Much of the research it is based on comes from homogeneous samples -Starting to include diverse members of races and backgrounds to revise groups writing and researching for the DSM -Much of the research for the first DSM volumes were primarily based on similar groups of people with little diversity

Stanford-Binet differences from Wechsler Tests

-Covers the entire life span (ages 2-85 years) in one test -Normative sample matches recent US census data, but also includes normative data from individuals with more specific disorders for comparison -Each subtest has a greater number of very easy and very difficult items --Adaptive

Alternative Directions in Diagnosis and Classification

-Current approach: categorical --An individual "has" or "does not have" a given disorder --There are certain disorders that seem to be categorical -Alternative approach: dimensional --The issue is not the presence or absence of symptoms, but where does an individual's symptoms fall along a continuum? -Moving more towards dimensional approach to show you were you fall on a scale of severity of a disorder

DSM-5

-DSM-5 (2013) made many changes --First substantial revision in 20 years --Involved hundreds of experts from over a dozen countries—initially formed a Task Force --Work Groups—composed of experts, each work group focused on a particular area of mental disorders (e.g., the Eating Disorders Work Group) --Considered proposals for revision including ideas for adding, eliminating, combining, splitting, or revising definitions of disorders -Scientific Review Committee Scientific review committee --Involved experts separate from the work group --Independent experts that decided if there was enough research to add something to the DSM ===Did field trials of doctors who had to go out and make the diagnoses added to the DSM

New Features in DSM-5

-DSM-5 not DSM-V --Enables more frequent minor updates (e.g., DSM-5.1, DSM-5.2) -Elimination of multiaxial assessment system --Disorders that are thought to be more short-term are no longer listed on a separate axis than those that are thought to persist long-term --Elimination of Axis V (Global Assessment of Functioning)

Earlier DSM Editions (I and II)

-DSM-I (1952) and DSM-II (1968) --Very similar in content --Only three broad categories of disorders: ===Psychoses (would contain today's Schizophrenia) ===Neuroses (would contain today's major depression, bipolar disorder, and anxiety disorders) ===Character Disorders (would contain today's personality disorders) --Psychoanalytic in orientation --Did not provide diagnostic criteria, only vague paragraph long descriptions of the disorder --Not empirically based -Most people on the panel who made the book were psychoanalytic supporters --Talked more about unconscious forces instead of what symptoms were needed to be seen to diagnose a disorder

Case History

-Detailed description of a client's background -Often provides information necessary to make a diagnosis or determine necessity of treatment -What information is typically gathered? --Birth and Development ===Complications during pregnancy, normative developmental milestones -Family of Origin --Who was the client raised by? Is the family still intact? --Relationships with parents, siblings, etc. --Family history of mental health problems, drug and alcohol abuse, etc. -Education History --Highest level of education obtained --Learning disabilities, special education services --Significant behavioral problems (e.g., suspensions, expulsions

Robert Sternberg

-Developed a triarchic theory of intelligence --Analytic intelligence:school smarts --Practical intelligence:problem solving in day to day --Creative intelligence:artistic, thinks outside the box

Development of the MMPI cont.

-Developers evaluated items using individuals who had been diagnosed with particular mental disorders and a group of "normals" with no known diagnosis -Began with 1,000 items, retained 550 after empirical criterion keying method -Items were divided into groups related to 10 specific pathologies—Clinical Scales --Same 10 Clinical Scales on MMPI-2

Criticisms of DSM-5

-Diagnostic Overexpansion --Concern that diagnoses take difficult or inopportune life experiences and label them as mental illnesses -Transparency of Revision Process --Some critics argued that the DSM-5 authors were vague and selective about what they shared and too many decisions were made behind closed doors -Membership of the Work Groups --Work Groups were not clinicians but were researchers --Those invited into revision process were predominantly researchers --Concerns about clinical utility -Price --DSM-IV sold for $65 in 1994; DSM-5 has a list price of $199

Theories of Intelligence

-Early 1900's—Charles Spearman --Intelligence is represented by: ===A general factor (g)—a person's global, overall intellectual ability ====Found a strong correlation between a wide range of abilities: abstract reasoning, comprehension, problem solving --One or more specific factors (s) ===Influences things such as visual-motor coordination, motor speed, and attention

More Case History

-Employment History --What types of jobs has client held --History of being fired, changing jobs frequently -Recreation/Leisure --How client spends free time; hobbies and interests -Sexual History --Nature of client's first sexual experience (e.g., coercive?) --Sexual functioning -Dating and Marital History --When client began dating --Significant romantic relationships --Number of marriages -Alcohol and Drugs --Pattern of use of alcohol and drugs --Any legal, employment, or social problems due to use

Intake Interviews

-Essentially to determine whether to "intake" the client—whether the client needs treatment and what type of treatment --Should we intake you or refer you else where

Five Factors of Stanford-Binet Intelligence Scales (Fifth Edition)

-Fluid Reasoning -Knowledge -Quantitative Reasoning -Visual-Spatial Processing—the ability to analyze visually presented information, including relationships between objects, spatial orientation, assembling pieces to make a whole, and detecting visual patterns -Working Memory

Repeatable Battery for the Assessment of Neuropsychological Status

-Focuses on a broader range of abilities --Tests visuomotor abilities, verbal skills, attention, and visual memory ===Show pictures of objects and come up with names, tell them a story and after 20 minutes ask questions about the story --20-30 minutes to complete --Includes 20 subtests in 5 categories

The Interviewer

-General skills an interviewer should have --Quieting yourself --Being self-aware --Ability to develop a positive working relationship -Specific behaviors --Eye contact—both facilitates and communicates listening --Body language --Vocal qualities --Verbal tracking --Referring to the client by the proper name

WIAT-III general info

-Has standard scores on the same scale as most intelligence tests --Mean of 100, Standard Deviation of 15 -Standardized on about 3,000 people who were chosen to match recent US census data --Many individuals were also administered the Wechsler intelligence scales -Overall strong reliability and validity data

Rorschach Inkblot Method

-Hermann Rorschach—created the Inkblot Method in 1921 --10 inkblots --Administration occurs in 2 phases ===Response or Free Association Phase ===Inquiry Phase ====Tell me where you see what you said you saw --Not published with a scoring method ===Rorschach died about a year after publishing the measure

Objective Methods: Personality Assessment

-Highly structured -Scoring is objective and interpretation is relatively objective

Changes DSM-5 Didn't Make

-Initially considered emphasizing the biological roots of mental disorders (e.g., using PET scans, gene analyses, blood tests, etc.) --IE: using PET scans (Positron Emission Tomography), gene analyses, blood tests, etc. -A dimensional approach was considered for some disorders, but was ultimately rejected -Many additional disorders were considered for inclusion, but ended up in the "proposed criteria sets" section --E.g., Internet gaming disorder

Tests of Achievement

-Intelligence tests are designed to assess an individual's cognitive capacity—what the individual can accomplish intellectually --IQ test Tests of Achievement are designed to measure what the individual has accomplished ===What have you learned --Especially in subjects people are expected to learn in school (reading, spelling, writing, math) -Clinical psychologists often say that IQ "predicts" achievement in that if we know an individual's IQ, we can expect their level of achievement to correspond --Discrepancies are meaningful ===Learning disability may be present; not learning what they should be, achievement is lower than IQ

What are intelligence scales used for?

-Intelligence tests have a wide range of clinical applications --Evaluation of intellectual disability/developmental delays --Giftedness --Educational and vocational planning --School placement/qualification

Neuropsychological Testing

-Intent of neuropsychological tests is to measure cognitive functioning or impairment of the brain -Can be used to: --make a prognosis for improvement --plan rehabilitation ===Identify deficits, can create plan to address them --determine eligibility for accommodations at school or work --establish baseline neuropsychological abilities -Some neuropsychological testing procedures are lengthy comprehensive batteries, others are much briefer and typically used as screens for impairment

Wechsler Intelligence Info Cont.

-Interpretation typically starts with examining the Full Scale IQ score -Look at each index score in relation to the others -Next, specific subtest scores are examined --What did the individual obtain the lowest and highest scores on? Any patterns? -Then note more detailed information --Take the individual's behavioral responses into consideration ===E.g., Does the examinee fidget or have difficulty staying seated?

Thematic Apperception Test (TAT)

-Involves presenting the client with a series of cards, each with an ambiguous picture --TAT cards feature interpersonal scenes --Client must create a story to go along with the scene --Includes 31 cards, but typically not all are used --Often analyzed without formal scoring ===TAT interpretation is often more of an art than a science

Rorschach Inkblot Method cont

-John Exener combined aspects of scoring systems to create the Comprehensive System -Includes normative data collected from thousands of children and adults -A small sample of variables considered in scoring: --Location—does the response involve the whole inkblot, a large portion of it, or just a small detail? --Determinants --Form Quality --Popular- some answers are given more than others for an inkblot --Content -The way a client makes sense of the inkblot parallels the way they make sense of the world --IE: form quality - clients who consistently offer distorted, atypical perceptions of inkblots are thought to perceive situations ways in real life -Psychometric issues --Numerous studies have found weak reliability, validity --Scoring is often inconsistent - clinical psychologists do not always follow guideline ===Not scored consitently from person to person

Criticisms of Projective Methods

-Lack of objectivity in scoring and interpreting -Proponents say... --They aren't as "fake-able" as objective tests --Only way to gather information about unconscious desires and motivations

Projective Methods: Personality Assessments

-Less structured -Involve a greater degree of judgment in scoring and interpretation -Based on the assumption that people will "project" their personalities if presented with unstructured, ambiguous stimuli and an unrestricted opportunity to respond -To avoid contaminating an individual's response, instructions are often vague --E.g., "Tell me what you see" -Purpose and procedures are usually disguised to some degree

MMPI-2-RF

-MMPI-2 Restructured Form (MMPI-2-RF) --Released in 2008, shorter version of MMPI-2 ===Contains only 388 of the 567 MMPI-2 items ===Restructured Clinical Scales ====Close to the 10 Clinical Scales of earlier versions ====Removal of items that overlapped between scales ======Separate scale created for demoralization ===Omission of Scale 5 (Masculinity-Femininity) and Scale 0 (Social Introversion) ===Addition of PSY-5 Scales—correspond to personality disorders ===Added to assess personality disorders that may be present -Not yet as well-established in the field

MMPI-2 and MMPI-A

-MMPI-2 published in 1989 -Addressed several weaknesses of original --Normative data was obtained from a much larger, more diverse group --Some test items were removed or revised that had outdated or awkward wording -MMPI-A (Adolescent Inventory) --Ages 14 to 18 years --Published in 1992 --Similar in administration, scoring, and interpretation to MMPI-2

Uses of MMPI

-Making diagnoses, determining placement (i.e., inpatient or outpatient), exploring treatment options --Note: Multimethod assessment should be used to make diagnoses -Used in numerous specialty areas of psychology --Forensic settings, personnel testing

Tests of Achievement Cont.

-Many different types of Achievement Tests --Some are subject specific (e.g., Gray Oral Reading achievement tests), others are more broad -Wechsler Individual Achievement Test -Third Edition (WIAT-III) --A comprehensive achievement test for ages 4 to 50 years ===Beyond that there isn't a need to test achievement because new learning disabilities are rare --Administered face-to-face, one-on-one --Measures achievement in reading, math, written language, and oral language

WIAT-III Cont

-Mathematics Composite --Numerical Operations --Math Problem Solving -Written Language Composite --Spelling --Sentence Composition --Essay composition

Wechsler Memory Scale fourth Edition

-Memory test used to assess individuals aged 16 to 90 -Assesses both visual and auditory memory across 7 subtests --Also assesses both immediate and delayed recall -Example subtests: --Logical Memory- read a story to client, wait 20-30 minutes then ask them comprehensive questions --Visual Reproduction-abstract picture or shape and recreate the picture without the template

Wechsler Intelligence Test

-Most commonly used measures to assess intelligence -Three separate Wechsler intelligence tests for different developmental periods --Wechsler Adult Intelligence Scale—Fourth Edition (WAIS-IV) ===Ages 16 to 90 --Wechsler Intelligence Scale for Children—Fourth Edition (WISC-IV) ===Ages 6 to 16 --Wechsler Preschool and Primary Scale of Intelligence—Third Edition (WPPSI-III) ===Ages 2 years and 6 months to 7 years and 3 months

Bender-Gestalt Test Second Edition

-Most commonly used neuropsychological screen -Straightforward copying task --Client is given a pencil, paper, nine simple geometric designs and asked to copy each design as accurately as possible -Very brief—takes about 6 minutes to administer -Appropriate for clients above 3 years of age -Typically included as quick"check" for neuropsychological problems -Poor performance is indicated bya variety of errors --E.g., Figures that collide with eachother on the page, not closing a figure, incorrect angles, not oriented right

Measurement of Intelligence

-Most contemporary intelligence tests produce a single overall score of intelligence --Also produce a number of other scores representing more specific abilities -Commonly used intelligence tests that we will discuss: --Wechsler Intelligence Tests --Stanford-Binet Intelligence Scales (Fifth Edition) --Universal Nonverbal Intelligence Test (UNIT)

Mental Status Exam

-Most often used in medical settings—assesses how the client is functioning at the time of the evaluation -Areas typically assessed in a Mental Status Exam (MSE) --General Appearance and Behavior ===Gait, posture, dress, personal hygiene, level of activity ====Did they dress for the weather, were they dirty, do the seem clean, did they brush their hair and or shower ====Did they seem active or more lathargic -Speech and Thought --Is client's speech coherent? Is the client's speech pressured (i.e., does it seem that the client is having a difficult time speaking fast enough to express his/her thoughts?) -Evidence of delusional thinking? -Consciousness --Is client alert, attentive? -Perception --Evidence of hallucinations? -Memory --Ability to accurately recall events from past (e.g., names of parents, place of birth) ===Who is the president --Recent memory—assessed by asking about knowledge of current events --Short-term memory—often assessed by asking the client to remember the names of three items and checking his/her recall later in the assessment

Tests of Aptitude

-Most often used to determine an individual's readiness for some future learning experience --Often referred to as "readiness" tests for young children ===E.g., Metropolitan Readiness Test, SAT, GRE --Concerns about actual predictive value of SAT/ACT etc. ===Biased against low-income students?

MMPI-2

-Most popular and psychometrically sound personality assessment -Consists of 567 self-descriptive sentences --Pencil-and-paper answer sheet to mark whether each statement is true or false as it applies to the client --Simulated Example Items: ===I feel like I am low on energy much of the time ===I often find myself in conflicts with people in authority ===During times of stress, I usually experience an upset stomach ===Most of the people I know have plans to hurt me in some way ===I have visions of things that aren't real and that other people can't see

Pragmatics of the Interview

-Note taking --Should an interviewer take notes during an interview? ===There are many different approaches—no consensus on what's best ===Different job settings may have different expectations -Audio and video recording --Requires written permission from client ===Can potentially hinder rapport/openness -The interview room --Clients tend to prefer comfortable, neat rooms ===E.g., with soft lighting, comfortable furniture, art on the wall -Clinical psychologists typically steer clear of overtly personal items (e.g., family photos) --Want to make the room neutral, don't want to risk starting a double relationship or if the client lost a child or wife it might be better to not remind them of it with pictures of your family

Interview Techniques

-Open- and Closed-Ended Questions --Has a large impact on the information a client provides --Open-ended questions allow for individualized and spontaneous responses from clients ===E.g., "Can you tell me more about the depression that you've been experiencing?" ===Consistent with nondirective interview style -Closed-ended questions allow for less elaboration and self-expression by the client, but yield precise answers --E.g., "Have you been hospitalized for depression in the past?" --Consistent with directive interview style -Common mistake when asking closed questions to gather information --Both asking and answering a question ===E.g., "How much beer do you typically drink on a weeknight? ...a sixpack?" ===Often done to fill silence, give a client an idea of an expected answer

Louis Thurstone

-Opponent of Spearman --Believed intelligence should not be understood as a single, unified ability -Used multiple factor analysis to determine what underlies intellectual ability --Found several independent factors: ===Verbal comprehension, numerical ability, spatial reasoning, and memory

WIAT-III

-Oral Language Composite (derived from two subtests) --Listening Comprehension ===Answer questions about a story they recently listened to -Oral Expression --Show pictures that tell a story and ask them to create a story from the pictures --Explain in words how to do a specific task ===Using a vending machine -Reading Composite --Word Reading ===Reading a list of words out loud --Pseudoword Decoding—using phonetic skills to sound out nonsense words, such as plore or tharch --Reading Comprehension

Hoarding Disorder

-Person has continual difficulty discarding possessions no matter how objectively worthless they are -As a result—live in congested, cluttered home -Experiences impairment in important areas (e.g., work, socialization, safety) -May not want to bring people in to home, could be a fire hazard/safety hazard in your house, may not be able to get work done in your house

More General Criticisms of DSM

-Potential gender bias --Some disorders are diagnosed far more frequently in men, some are diagnosed more frequently in women ===Are some disorders biased toward pathologizing one gender more than the other? -Nonempirical influences --At times politics and public opinion may ===have influenced DSM E.g., the changing status of homosexuality—an official disorder in DSM-I and DSM-II, but absent from the manual since a revision of the DSM-III

New Disorders in DSM-5

-Premenstrual dysphoric disorder (PMDD) --Essentially a severe version of premenstrual syndrome (PMS) ===Symptoms include (must be present in the final week before onset of menses): affective lability, irritability or anger, depressed mood, anxiety/tension, and other typical symptoms of depression (IE difficulty concentrating, hypersomnia, or insomnia) -Disruptive mood dysregulation disorder (DMDD) --Essentially frequent temper tantrums in children 6-18 years old --Need to be in atleast two settings because it may just be the environment or the context of the place that makes the child act out ===At least 3 tantrums per week over a year-long period ===Tantrums are clearly below expected level of maturity ===Occur in at least two settings (e.g., school, home) ===Irritable or angry mood between tantrums

Components of the Interview

-Rapport --A positive, comfortable relationship between interviewer and client ===Typically leads to client disclosing more information -How can this be accomplished? --Remember that the first visit to a clinical psychologist is often intimidating --Follow the client's lead -Technique --Technique is what an interviewer does with clients—questions, responses, and other specific actions ===Directive—questions targeted toward specific information ===Nondirective—allows the client to guide the course of the interview ===Both have advantages and disadvantages

Even More Techniques

-Reflection of feeling --Echoes the client's emotions—intended to make the client feel that their emotions are being recognized --Often involves the interviewer making an inference ===Example:Client: "Everything is humdrum. There's nothing new going on, nothing exciting. All my friends are away. I wish I had money to do something different ===."Clinician Paraphrase: "With your friends gone and no money around, there is nothing for you to do right now. ==="Clinician Reflection: "You feel bored with the way things are for you right now." -Summarizing --Typically involves tying together various topics that may have been discussed and identifying themes that have recurred

Howard Gardner

-Rejected idea of singular intelligence -To qualify as an intelligence it must enable the individual to solve genuine problems -Eight different types of intelligence --Gardener 1. verbal 2. mathematical 3. spatial 4. bodily-kinesthetic 5. musical 6. interpersonal 7. intrapersonal 8. naturalistic -Impact in.... The filed of education than in clinical psychology --There are no widely used assessment measures based on theories of multiple intelligences

Luria-Nebraska Neuropsychological Batteries (LNNB)

-Respected and popular alternative to the HRB -Also a wide-ranging test of neuropsychological functioning -Primary difference from HRB is that it depends more on qualitative written comments from examiner about testing process --What you're observing as a clinician of the patient ===Inappropriate display of emotion written down -LNNB tends to be slightly briefer -Strong psychometric data to support reliability and validity

Rey-Osterrieth Complex Figure Test

-Similar to Bender-Gestalt in that it is a brief drawing task -Uses only a single, more complex figure -Also includes a memory component --Wait 20 minutes, then redraw the figure again but without the template this time

Millon Clinical Multiaxial Inventory-III

-Similar to MMPI-2, but stronger emphasis on personality disorders --Separate clinical scales for each of the current DSM personality disorders (e.g., Borderline Personality Disorder) -First created in 1977 by Theodore Millon -Current version (MCMI-III) published in 1994 -175 true/false items -Also includes "modifier indices" (similar to MMPI validity scales) --Detect test taking attitudes -Best use: identifying personality disorders

Stanford-Binet Intelligence Scales (Fifth Edition)

-Similar to Wechsler tests --Administered face-to-face and one-on-one --Employs a hierarchical model of intelligence ===Yields a singular measure of full-scale IQ, five factor scores, and specific subtests --Features the same mean (100) and standard deviation (15) --Similarly strong reliability and validity data

Crisis Interview

-Special type of clinical interview that is designed to assess a problem demanding urgent attention (most often clients considering suicide or harming others) and provide immediate intervention -Must quickly establish rapport, express empathy for crisis -When assessing suicidality, must take into account five specific issues: --How depressed is the client? --Does the client have suicidal thoughts? --Does the client have a suicide plan? --How much self-control does the client currently appear to have? --Does the client have definite suicidal intentions?

More about Wechsler Subtests

-Subtests to assess attention, concentration, mental control: --Digit Span ===Giving test taker a string of numbers and to repeat them back, goes up to 9 numbers --Letter-Number Sequencing ===Putting a group of numbers and letters in order ====Numbers from smallest to largest ====Letters by alphabetical order

Traditional Personality Assessment

-Techniques discussed thus far have been traditional personality assessment techniques -Traditional techniques tend to have several basic assumptions: --Personality is a stable, internal construct --Assessing personality requires a high degree of inference --Client behaviors are signs of deep-seated, underlying issues or problems, sometimes taking the form of DSM diagnoses

DSM -- More Recent Editions

-The DSM-III (1980) was very different from DSM-I and DSM-II: --Relied on empirical data to determine which disorders to include and how to demine them --Specific diagnostic criteria used to define disorders --Atheoretical:no theories just what ever has been supported by research and empirical data -Wanted multiple doctors to be able to diagnose the same client with the same disorder if they both met them --Needed to know the symptoms to diagnose

HRB continued

-The examiner compares a client's test scores to published norms to assess overall performance, determine strengths and weaknesses -Strengths of HRB --Empirical research suggests that the HRB and its tests are reliable and valid --Comprehensive -Weaknesses of HRB --Length (hours to administer) ===Have to use every single sub-test --Inflexibility (as a fixed battery) --Limited overlap with real-life, day-to-day tasks ===How is tapping keyboard key in 10 seconds really helpful in day to day tasks

Diagnostic Interviews

-The purpose is to diagnose the client --At the end, the interviewer should be able to assign DSM diagnosis/diagnoses

A Word of Caution about IQ

-The terms IQ and intelligence are often synonymous to the general public -IQ scores are descriptive, not explanatory --An IQ score provides a summary of an individual's behavior at a specific point in time. -Scores should be used to gain a better understanding of an individual, but not to label them

More Major Revisions in DSM-5

-The two separate DSM-IV diagnoses of substance abuse and substance dependence were combined into substance use disorder --Previously, tolerance and withdrawal linked solely with dependence—research has demonstrated this is not true -Mental retardation was renamed intellectual disability -Learning disabilities in math, reading, and writing were combined into a single diagnosis: specific learning disorder -Substance abuse: difficulty at work or personal relationships, legal difficulty -Dependence: tolerance of substance, and will have withdrawal without it

Major Revisions in DSM-5

-There were also a number of revisions made to existing disorders. We'll highlight just a few... -"bereavement exclusion" was dropped for major depressive episode --Ensures that people in mourning who are suffering from depression will be recognized, diagnosed, and receive prompt treatment -Diagnoses of autistic disorder and Asperger's disorder were combined into a single diagnosis: autism spectrum disorder --Represent various points on the same spectrum of impairment—mild, moderate, or severe versions of the same problem -Autism: difficulty in forming relationships, working, --Aspergers no longer exists --Now asks can this person support their own needs -Bereavement exclusion: are you actually a depressed person or are you just mourning a death

Addressing Cultural Fairness for Intelligence Tests

-To the extent that that an intelligence test is based on culture-specific concepts, it may unfairly assess the intelligence of people of other cultures --Efforts have been made to make tests less culturally biased and new tests have been developed

Criticisms of MMPI

-Too lengthy and time-consuming -Requires reading ability and prolonged attention -Focuses on forms of psychopathology as the factors that make up personality -Shouldn't use to make a diagnosis without other reasons for the diagnosis

Criticisms of Utilizing Diagnoses

-Use of a diagnostic label implies understanding of the problem --Label may assist in communicating to other professionals, obtaining insurance reimbursement, but may not serve any other function -Lack of reliability of diagnoses historically --Poor agreement between clinicians about whether or not an individual meets criteria for a specific disorder -Associated stigma --Individuals with certain diagnoses may be discriminated against in job opportunities, housing, social relationships

Wechsler Subtests

-Vocabulary—orally explain the meaning of a word -Similarities—orally explain how two things or concepts are alike -Information—orally answer questions focusing on specific items of general knowledge -Comprehension—orally answer questions about general social principles and social situations --Why is it important to vote, using minimal amount of water when you shower

The Clinical Interview

-What kind of information would we want to gather from a client? --What do you need to know about them to make a diagnosis? --What other information would you want? -What skills should an interviewer generally have? -What info do you want --Where they grew up --How they grew up --Cultural background --Relationships with family/friends --"So what brings you here today" "why did you feel the need to come in"

Who defines abnormality? cont

-Who is involved in the creation of the diagnostic categories in the DSM? --Task Force --Published by the American Psychiatric Association --Follows a medical model of psychopathology ---Each disorder is defined categorically and features a list of specific symptoms -The task force historically (particularly DSM I through DSM-III) has been a fairly homogeneous group --Recent efforts to include more diversity

Structured Interview

-a predetermined, planned sequence of questions that an interviewer asks a client --basically just following a script - a diagnostic interview -Provide a diagnosis based explicitly on DSM criteria -Tend to be more highly reliable -Format is typically rigid—can inhibit rapport -Don't typically allow for inquires such as relationship issues, personal history, etc. -Tend to be fairly lengthy -Most prominent structured interview: Structured Clinical Interview for DSM-IV Disorders (SCID) --Modular—clinician can choose only those modules that are relevant to a particular case -Many clinicians have blended structured and unstructured interviews and utilize semistructured interviews

Intelligence Tests

-measure a client's intellectual abilities

Achievement Tests

-measure what a client has accomplished with those intellectual abilities

Unstructured Interview

-no predetermined or planned questions—interviewers instead improvise based on what they believe is relevant during the interview

Hierarchical Model of Intelligence

-specific abilities ("s") exist and are important, but they are all at least somewhat related to one another and to a global, overall intelligence ("g"). --Spearman and Thurstone compromised by settling on this model

Development of the MMPI

-the original MMPI --published in 1943 by Starke Hathaway and J.C. McKinley --Emphasis on constructing an empirical measure --Used empirical criterion keying to construct the test ===This method involves identifying distinct groups of people, asking them all to respond to the same test items, and comparing responses between groups to select items that yield different patterns of responses between groups -Must distinguish between the groups on an empirical basis, not theoretical --Example: "I have visions of things that aren't real and that other people can't see." --Similar to shopping recommendations made on sites like Amazon

What defines abnormality

-there have been many definitions of abnormality --IE: IF it causes personal distress to the individual deviance from cultural norms, statistical infrequency, impaired social functioning -Jerome Wakefield proposed his "harmful dysfunction theory" (1992) which has been fairly well accepted: --emphasized the need to consider both scientific data as well as the social values in the context that the behavior takes place in

Wechsler Intelligence Scales: Four Index Scores

1.Verbal Comprehension Index -A measure of verbal concept formation and verbal reasoning --Can you read out loud, can you explain answers 2.Perceptual Reasoning Index -A measure of fluid reasoning, spatial processing, and visual-motor integration --Picture completion, block design 3.Working Memory Index -A measure of the capacity to store, transform, and recall incoming information and data in short-term memory 4.Processing Speed Index -A measure of the ability to process simple or rote information rapidly and accurately