Flashcards in Clinical Psychology 6 Deck (43):
What are some negative stereotypes of elderly clients and what does research say about them?
stereotypes: physical and mental impairment, irritability, resistance to change
research: intellectual stability, active involvement in community, respond to therapy more slowly than, but nearly as effectively as younger adults
What are the percentages of overall population and MH services use among the aged?
- US population: 11%
- outpatient clinic population: 2%
- community MHC population: 4%
- inpatient population: 28%
What are some of the foci of therapy with older clients?
- identity transitions
- involvement in satisfying activities and relationships
- treatment of depression
Describe Reminiscence Therapy.
- facilitates acceptance of successes and shortcomings in life
- stresses resolution of past conflicts, creation of future goals
- commonly group setting
- effective Tx for depression among elderly
Describe Cass' six stage model of homosexual identity development.
- identity awareness, consciousness of being different
- identity comparison, acting heterosexual but feeling homosexual
- identity tolerance, realization of homosexuality
- identity acceptance, exploration of gay community
- identity pride, becoming active in gay community
- synthesis, full acceptance of self & others
Describe Troiden's four age-based stages of homosexual identity development.
- sensitization, pre-pubescent awareness of homosexual feelings without understanding
- identity confusion (self-recognition), awareness of one's homosexuality, age ~17 (males) or ~18 (females)
- identity assumption, coming out, age ~19-21 (males) or ~21-23 (females)
- identity commitment, adoption of homosexual lifestyle, age ~21-24 (males) or ~22-23 (females)
Describe some advantages of the term "sexual prejudice" over "homophobia" and "heterosexism."
- homophobia implies a pathological fear, rather than a socially reinforced prejudice
- heterosexism is limited to biases against non-heterosexuals, but sexual prejudice addresses bias based on sexuality in any form
Describe the distal and proximal factors affecting mental health outcomes among LGBT clients, according to Meyer's Minority Stress Model.
- distal factors: external, objective events and conditions, such as discrimination and violence
- proximal factors: internal, subjective appraisals of or responses to events and conditions, such as expectations of rejection, concealment of sexual orientation, and internalized homophobia
Discuss Eysenck's research on psychotherapy outcomes.
His 1952 19-study comparative analysis indicated that 2/3 or neurotic patients recovered within two years, whether or not they received psychotherapy. Thirty years later (1985), he indicated that behavior therapy was superior to placebo or no treatment.
Discuss the results of Smith, Glass & Miller's meta-analysis of psychotherapy outcomes.
- 475 studies, 2500 patients, 78 treatment types, average of 16 sessions
- psychotherapy is better on average than no treatment (d = .85)
* average client better off than 80% of controls
* 66% of clients improve (34% of controls improve)
- more recent research indicates that effect size is as large as 1SD
List nine client variables that have been studied as predictors of psychotherapy outcome.
- intelligence: generally positively related
- openness/nondefensiveness: generally positively related
- understanding of goals: generally positively related
- personality characteristics: ego strength, suggestibility, anxiety tolerance are generally positively related
- expectations: moderate expectations generally more successful than those with very high or very low expectations
- motivation: early motivation appears unrelated, but motivation during therapy appears positively related
- SES: negative relationship appears to be function of tendency for low SES patients to be referred to less-experienced treaters
- gender: appears not to be related, although more women than men seek psychotherapy
- age: appears not to be related
List nine therapist variables that have been studied as predictors of psychotherapy outcome.
- competence: little studied, but appears to be positively related
- expectations: some evidence that outcomes are enhanced when client expectations are effectively addressed early in treatment
- emotional well-being: there is a clear, but modest positive relationship with therapy outcome
- professional background & experience: paraprofessionals are as effective as those with advanced degrees, but clients view education level and an important factor; also experience is more important with challenging patients, complex treatments, and early assessment of outcome- ethnicity: not a factor in outcome, but may affect early termination/drop-out
The following appear to have little to no effect on outcome:
List three treatment variables that have been studied as predictors of psychotherapy outcome.
- therapeutic alliance: accounts for more than any other factor, including treatment type
- treatment type: no consistent relationship, although some studies have found behavioral interventions to be more effective for specific disorders
- duration/dosage: relationship is ambiguous, but generally time-limited treatments are favored over longer ones; some research finds a linear improvement up to about 26 sessions
Discuss treatment outcome research on children and adolescents.
- little done overall
- outcomes appear to be similar to those with adults
- some evidence that teen girls respond best
- overall effect size of d = .71, 76% are better than no treatment
- most studies do not reflect clinical practice (1% meet Tx representativeness criteria)
- low rate of self-referral (13%), high recruitment through others (77%)
Describe the three stages of Howard's Phase Model of Psychotherapy Readiness.
- remoralization: focus on and improvement in client's feelings of hopelessness and desperation
- remediation: focus on symptom relief; typically between sessions 5 and 15 (able to do this because of regaining hope in remoralization)- rehabilitation: gradual improvement in life functioning, e.g., work, relationships, etc.
Name the 10 clinical scales of the MMPI-2.
1. Hypochondriasis (Hs) [somatocentrism]
2. Depression (D)
3. Hysteria (Hy) [physical problems with functional origin, conversion reactivity]
4. Psychopathic Deviate (Pd) [psychopathy]
5. Masculinity-Femininity (Mf)
6. Paranoia (Pa)
7. Psychasthenia (Pt) [neuroticism]
8. Schizophrenia (Sc)
9. Hypomania (Ma)
10. Social Introversion (Si) [intro-/extroversion]
Name the five validity scales of the MMPI-2.
- ? or "Cannot Say": # unanswered/both-answered items; >30 uninterpretable; >10 interpret with caution; may indicate reading diff, overcaution, indecisiveness, paranoia, rebelliousness, intellectualization
- L or "Lie": high scores = unwillingness to admit minor shortcomings, bias toward favorable presentation, lack of self-insight; low scores = independence, bluntness, negative self-view
- F or "Infrequency": high scores (T=70-90) = psychopathy, malingering, eccentricity; >90 invalidate test; low scores = social conformity, lack of pathology
- K or "Correction": aka "defensiveness", better indicator than L of positive bias; high scores = unwillingness to reveal problems/conflicts, desire to "fake good," associated with poor Tx prognosis; low scores = poor self-image, frankness, self-criticism, poor self-defense; non-defensive, but high-education can score high (60-70)
- TRIN, VRIN, Back Side (F[B]): item consistency scores
Describe the MMPI-2.
- 338 T/F items (most recent version; previous version had 567 items)
- MMPI originally developed using empirical criterion keying, second iteration (MMPI-2) used content analysis
- designed for clinical populations
- T-score scaling (M=50, SD=10), =>65 is pathological
- relies on pattern analysis of two or three highest scores- 10 clinical scales
- 5 validity scales
- 15 content scales
- supplemental scales
- use of "cookbook" interpretation resources and services risks validity and applicability of MMPI-2 output
Describe some score patterns commonly seen in the MMPI-2.
- conversion V: 1(Hs) and 3(Hy) are high, with lower 2(D); somaticization, chronic pain, conversion or somatiform disorder
- psychotic V (aka paranoid valley): 6(Pa) and 8(Sc) are high, with lower 7(Pt); paranoid schizophrenia and related behavior
- passive-aggressive V: 4(Pd) and 6(Pa) are high, with lower 5(Mf); sociopathy and paranoia with passive traits
Describe the Millon Clinical Multiaxial Inventory-III (MCMI-III).
- based on Millon's personality theory
- 175 T/F items
- 21 scales corresponding to DSM-III and -IV
- adolescent version (MACI) is available for ages 13-19 with => 6th grade reading level
Describe the Symptom Checklist 90 (SCL-90).
- self-report inventory
- general psychiatric symptoms
- typically treatment outcome dependent measure
- 90 items, 5 point scale, 0-4
Describe the NEO-Personality Inventory-Revised (NEO-PI-R).
- based on Big Five personality traits
- includes six facets of each (e.g., neuroticism: anxiety, depression, hostility, self-consciousness, impulsiveness, vulnerability to stress)
What is the projective hypothesis?
the expectation that an individual's responses to vague or ambiguous stimuli will be revealing about his/her personality and underlying conflicts
Describe the Rorschach Inkblot Test.
- most frequently used projective test
- used age 2 and older
- 10 symmetrical inkblots, five black/grey, two black/grey/red, three pastel (final set published 1921)
- most commonly used scoring system is Exner's Comprehensive System (1986)
What are the four steps in administering the Rorschach Inkblot Test?
- introduction: allaying of anxiety
- instruction: asking Pt to say all s/he sees, "What might this be?"
- response: Pt freely associates with image and examiner records responses verbatim, including time on each card, time to first response, odd responses
- inquiry: after all 10 cards are done, clarifying responses and collecting additional info
What are some of the scoring categories of Exner's Comprehensive System of Rorschach interpretation?
- location: areas of inkblot; could be whole (W) or unusual detail (Dd); W responses may indicate intellectual organization; many Dd responses my indicate compulsiveness, avoidance
- determinants: form, movement, shading, color; form (F) relates to perceived shape of blot features; form quality relates to how closely response resembles actual blot structure
- content: human (H), animal (A); lack of H may indicate identity issues or detachment; A common in children
- frequency/occurrance: populars (P) are most commonly seen; high P may reflect conformity, depression, low intellect; low P may reflect rebelliousness, disordered thought
What are some of the special scores used on the Rorschach Inkblot Test and what do they indicate?
- deviant verbalizations (DV): incorrect words, redundancies
- contamination (CONTAM): two or more impressions fused together ("butterflower")
- inappropriate logic (ALOG): strained reasoning
- all are indiciative of psychosis, but CONTAM and ALOG are more serious
What is the Thematic Apperception Test useful for?
research suggests it is good for making diagnostic distinctions, but not for determining specific diagnoses
Describe the Strong-Campbell Interest Inventory (SCII).
- assesses a person's personal interests relative to norms from people successful and satisfied in various occupations
- more valid for predicting job satisfaction than success
- three ways interests are reported:
* General Occupational Themes (realistic, investigative, artistic, social, enterprising, conventional; derived from Holland)
* Basic Interest Scales (GOTs are specified, e.g., realistic = agriculture, nature, adventure, military activities, mechanical activities)
* Occupational Scales (124 empirical criterion-keyed scales comparing examinee scores to occupation-based criterion group norms)
Describe the Newly Revised Strong Interest Inventory (NRSII) and how it is different from the Strong-Campbell Interest Inventory (SCII).
- replaced general reference sample with general representative sample (1994)
- comprised of five scales:
* General Occupational Themes (GOTs), like SCII, six OTs but including computers and technology
* Basic Interest Scales (BISs), more contemporary interests, such as Entrepreneurship, Protective Services, Research
* Occupational Scales (OSs), expanded to 244 (from SCII 124), including technology and business-related items
* Personal Styles Scales: work style, learning environment, leadership style, risk taking, team orientation
* Administrative Indices: types and consistency of examinee responses
Discuss the validity and application of the Strong scales (SCII and NRSII).
- career choices consistent with SCII/NRSII results result in more success and satisfaction than those inconsistent
- ~.30 predictive validity
- NRSII is applicable for high school and college students, and adults.
Describe the Kuder career tests.
- iterations: 1) Kuder Vocational Preference Record (KVP-R), 2) Kuder Occupational Interest Survey (KOIS), 3) Kuder Career Search (KCS)
- ipsative (forced-choice), based on content
-validity, rather than norm-comparison (as with SCII/NRSII)
- scores convey relative strengths per examinee
- KCS includes Activity Preference Scale and Kuder Career Clusters scale, suggesting best/least suitable careers based on interest patterns
List applications of neuropsychological assessment.
- measuring deficits in neurological function and comparing them to known or suspected brain lesions
- ID of post-brain-injury residual strengths
- differentiating between cases with/without brain dysfunction
- evaluating impact of deficits
- making rehabilitative recommendations
- localizing brain lesions (less common with the advent of advanced imaging)
Describe the Halstead-Reitan (H-R) neuropsychological test battery.
- measures various psychomotor, perceptual, reasoning, and attentional processes
- 11 subtests
- 4-5 hours for administration
- Impairment Index score => .60 suggests pathology
- usually supplemented with WAIS and MMPI
Describe the Luria-Nebraska Neuropsychological Battery (LNNB).
- 169 items, 11 scales
- assesses various psychomotor, perceptual, reasoning, and attentional processes, plus severity, acuteness, and localization
- scaled score 0-2 (high = brain injury)
- faster, more standard, and more thorough than Halstead-Reitan.
Describe three visual-motor skills neuropsychological tests.
- Bender Visual-Motor Gestalt Test, 2nd Ed (Bender-Gestalt II): geometric designs are copied and recalled; indicates LDs and school performance, brain damage, and emotional problems in persons age 3 and older; usually used with other assessments; not useful for psychiatric diagnoses
- Benton Visual Retention Test (BVRT): reproduction from memory simple geometric figures; more errors indicates more likely brain damage in persons age 8 and older; tables for accounting for IQ level and age included in scoring
- Beery Developmental Test of Visual-Motor Integration (Beery-VMI): copying geometric figures; learning and behavior issues in persons ages 3 to 18
Describe the Illinois Test of Psycholinguistic Abilities (ITPA).
- based on Osgood's theory of communication process
- assesses auditory-vocal and visual-motor channels, and processes and levels of function
- children 2 to 10
Describe the Wisconsin Card Sorting Test (WCST).
- measures ability to shift cognitive strategies in response to feedback
- ages 6.5 to 80 years
- examinee must determine card sorting strategy, which changes as test continues, based on examiner's binary feedback
- sensitive to frontal lobe damage
- poor performance associated with autism, malingering, schizophrenia, depression, alcoholism
Describe the Stroop Color-Word Test.
- measure of cognitive flexibility and selective attention
- examinee states color of printed word, rather than reading word (which is a color name); requires frontal lobe activation to suppress reading
- poor performance associated with depression, ADHD, mania, schizophrenia
Describe the Tower of London test.
- examinee moves disks on pegs to different configurations
- tests executive functioning, implicit and procedural memory
- poor performance related to frontal lobe damage, ADHD, autism, depression
Describe the Mini Mental Status Exam (or Mini Mental State Exam).
- tests cognitive functioning in older adults
- 11 questions on six areas: orientation, registration, attention/calculation, recall, language, visual construction
- cutoff below 23/24 out of max score 30 indicates impairment
- affected by visual or hearing impairments, language limitations, education
Describe the Glasgow Coma Scale.
- assesses post-brain-trauma consciousness
- three responses: eye opening, best motor response, best verbal response
- score 3-15, lower = more severe injury