Psychotherapy And Behavior Change

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Wilhelm Wundt -empirical tradition
-beginning of modern psychology
-founded first laboratory for studying "mental processes"
-emphasized empirical research methods
-trained many students who established early psychology labs in the US
Lightner Witmer -empirical tradition
-student of Wundt
-former school teacher
-agreed to take on a case with a student who was a chronic bad speller
-considered to be the first "clinical psychologist"
-director of psychology lab at UPenn
-established first psychological clinic at UPenn
Franz Gall -created phrenology
-psychometric tradition
-german anatomist
Phrenology -created by Franz Gall
-study of the proposed relationships between mental characteristics and the shape of the head
-early form of psychological assessment
Charles Darwin -UK
"origin of species"
-natural selection
-basis for theory of evolution
Sir Francis Galton -UK
-psychometric tradition
-Darwin's cousin
-applied Darwin's theory of inheritance to variations in intelligence
-early "mental tests"
Early "mental tests" -created by SIr Francis Galton
-systematic collection of behavior samples in response to standard sets of stimuli
Alfred Binet -France
-psychometric tradition
-was commissioned by the french government to create the Binet-Simon Scale

Binet-Simon Scale -created by Alfred Binet
-method that identified school children who could not benefit from education due to intellectual limitations
Lewis Terman -US
-psychometric tradition
-Stanford University
-revised the Binet-SImon scale into the Standford-Binet Intelligence Test
Standford-Binet Intelligence Test -created by Lewis Terman
-revised the Binet-SImon Scale
-still in use today
-ages 2-85
-hierarchial structure of scores
-2 factors and 5 subfactors
-full scale inclues 2 facts: verbal and nonverbal intelligence
-intelligence=g
James McKeen Cattell -US-psychometric tradition-student of Wundt-established the study of "sensorimotor tests of mental abilities" in the US-was fired from Columbia for his opposition to WWII-founded the "Psychological Corporation"
The Psychological Corporation -founded by James McKeen Cattell-manufactures professional intelligence test-still used today
Hippocrates -created first "medical model" of abnormalities
-bodily humors

Ancient Cultures -thought abnormality was due to possession
Middle Ages -catholic schools emerged as primary social and legal institutions in Europe-many physicians were priests-medica models were replaced by demonological explanations-treatment was exorcism-Malleus Maleficarum-witch hunting manuel
Malleus Maleficarum -witch hunting manuel in the middle ages-written by two german priests
Renaissance Age -early asylums were established
-a means to care for mentally ill? -a means to removed them from society?-St Mary of Bethelehem was opened in London-medicine began being used again to treat the ill, but limited types were available
St Mary of Bethlehem -a monastery that was turned into an asylum-nicknamed "bedlam"-known for abominable conditions and inadequate care -violent patients were put on exhibition to get money -less violent patients were put on streets to seek charity
Who were they Reformers of CP? -led efforts to improve care of the mentally ill-Dorothea Dix-Phillipe Pinel-Benjamin Rush-William Tuke

Who were the forerunners to Psychoanalysis? -Franz Mesmer
-animal magenetism
-Jean Marie Charcot
-used hypnosis to treat hysteria and conversion disorder
-Pierre Janet -dissociation
Emil Kraepelin -german psychiatrist-developed first formal classification system for mental disorders (nosology)
Nosology -created by Emil Kraepelin-the first formal classification system for mental disorders
Sigmund Freud -australia-university of vienna-theory of psychoanalysis-not well accepted at first-thought that abnormality was due to unconscious conflict between instinctual drives and societal demands upon behavior
Army Alpha & Beta Tests -developed during WWI for military recruits-group-administered intelligence tests for literates and illiterates
Personal Data Sheet -also called Woodworth Psychoneurotic Inventory-developed during WWI for military recruits-detected emotional/behavioral problems
Psychodynamic Approach -primary theoretician was Freud-originated in european neurology and psychiatry-studies on hysteria
Treatments of Hysteria under the Psychodynamic Approach -hypnosis (the talking cure)-cathartic method-free association-analysis of dreams-analysis of fantasies and wishes
Free Association -psychodynamic approach-Freud's treatment of hysteria-patient lies on couch facing away from psychologistand says whatever comes to mind-psychologist writes it all down-thought to be an access to unconscious material
Freud's Basic Postulate -human behavior is motivated by conflict between -instinctual impulses -demands of reality-this conflict produces anxiety which is uncomfortable-person develops defenses to manage this anxiety-goal is to develop insight (bringing conflicts into awareness) as a way of curing yourself of anxiety
Freud's Structural Model of Personality -id-ego-superego
Id -freud's structural model of personality-present at birth-contains psychic energy (libido) which motivates behavior-operates on "pleasure principle" (immediate gratification)
Ego -freud's structural model of personality-develops over time-operates on "reality principle" (negotiates between Id impulses and demands of reality)-uses defense mechanisms to keep conflicts out of awareness and thus reducing anxiety
Superego -freud's structural model of personality-develops over time-operates on "morality principle" (ethics, morals, values)
Humanistic Approach -developed as an alternative to psychodynamic approach-originated in existential philosophy
-humans are viewed as: -creative & growthful -motivated to realize their full potential -problems result from disturbance of awareness or restriction of existence-emphasis is placed on what the patient is perceives thinks and feels in the "here and now"-people value positive regard of others
Carl Rogers -humanistic approach-initially trained in psychoanalysis
-nondirective psychotherapy-later change to client-centered psychotherapy and then person-centered psychotherapy-actualizing tendency
The Actualizing Tendency -carl rogers-humanistic approach-the directional trend which is evident in all organ and human life-the urge to expand, develop and mature-the tendency to express and activate all capacities of the organism
General Steps of Clinical Assessment Process
-receive and clarify referral question
-plan data collection procedures
-carry out assessment process
-process data and form conclusions
-communicate assessment results
Referral Source
-person or entity requesting the assessment
Referral Question
-questions or issues to be addressed by the assessment
-drives the choice of instruments and techniques
-drives the interpretation of results
-drives the communication of results
Basic Sources of Information
-interviews
-behavioral observations
-psychological tests
-case history
-review of records
Factors affecting which Data Collection Procedure used
-conventions and traditions
-psychometric properties (reliability and validity)
-efficiency
-cost
-patient's capabilities
Collecting Assessment Data
-step in the clinical assessment process
-best to use multiple sources of information so you can cross-validate the info
-you can look for consistencies amongst the results
-checking for accuracy by assessing the same thing in different ways
-relying on one type of info yields
-higher efficiency and lower costs
-higher error rates
-lower quality work
-can be incompetent
Processing Data & Forming Conclusions
-step in the clinical assessment process
-determine what the collected data means
-interpret the results
-determine how the results pertain to the referral question
-gets complicated when you use multiple data sources
Communicating Assessment Results
-step in the clinical assessment process
-organize background info, procedures, results and recommendations
-prepare a clearly written written assessment report that addresses the referral question and is audience appropriate
Goals of Clinical Assessment
-diagnostic classification of the patient
-description of a problem/condition
-treatment planning
-prediction:
-prognosis and likelihood of future behavior (often combined)
Diagnostic Classification
-goal of clinical assessment
-Multiaxial Diagnosis (DSM-IV-TR)
-5 axis
-can be a diagnosis on some and not others
-tree table
Axis I
-Multiaxial Diagnosis (DSM-IV-TR)
-clinical syndromes
-the treatable things that you can stabilize and learn how to manage
Axis II
-Miltiaxial Diagnosis (DSM-IV-TR)
-personality disorders
-tends to be more chronic and less apt to change
-originate earlier in life
Axis III
-Multiaxial Diagnosis (DSM-IV-TR)
-General medical conditions
-high choloesterol, high blood pressure, chronic pain, cancer, etc;
Axis IV
-Multiaxis Diagnosis (DSM-IV-TR)
-current psychological stressors
-bidirectional (one thing could be due to another factor, and vice versa..a person is homeless and thus depressed, or a person was depressed and led to him becoming homeless)
Axis V
-Multiaxial Diagnosis (DSM-IV-TR)
-Global Assessment of Functioning (GAF)
-current (0-100)
-best past year (0-100)
Description
-goal of clinical assessment
-generally intended to provide much more information than a simple diagnostic label
-focus is description, explanation and conceptualization of the patient's problems
CBT Perspective
-conceptualization perspective
-provide a rationale for why they;re in treatment and what might be causing it
Psychodynamic Perspective
-explains someone's problems in terms of their advantages and weaknesses
oops ignore this
Treatment Planning
-goal of clinical assessment
-some diagnoses lead to a preferred treatment
-examines what previous treatment efforts have failed and why them failed
Prediction -goal of clinical assessment
-expected to use expertise to have an accurate prognosis
-expected course of a disorder
-expected response to a treatment
-expected risk of relapse
-expected future performance
-expected recidivism
-expected risk of self-harm
-expected future performance

Types of Interviews
-intake interviews
-problem-referral interviews
-orientation interviews
-termination and debriefing interviews
-crisis interviews
Intake Interviews
-most common type of clinical interview
-typically at the beginning of psychotherapy
-sometimes performed by an intake worker
-usually performed by the person who will provide psychotherapy
Who performs an intake interview?
-usually the person who will be providing ongoing psychotherapy
-sometimes performed by an intake worker who then transfers them on to someone based off of the interview who can better assist the patient
Purpose of an Intake Interview
-to establish nature of the clinical problem
-render diagnosis
-describe nature and history of the problem
-provide social history
-outline treatment plan and recommendations
-mental status examination (MSE)
Problem-Referral Interviews
-patient is referred to psychologist by another professional or entity
-goal is to assess something or answer a specific question (referral question)
-"psychological evaluation"
Orientation Interviews
-special interview that precedes participation in some specialty treatment
-anger management group, parent training group etc;
-purpose is to inform patient about the nature of the treatment
-to correct any misconceptions
-to outline expectations of the patient
-screening: determine patient appropriateness for that treatment
Termination Interviews
-typically used for psychotherapy
-healthy way of providing closure
-review of treatment progress
-review response to future problems (what happens if symptoms come back)
Debriefing Interviews
-review results and findings
-make recommendations and referrals
-not always appropriate; sometimes you're not allowed to disclose results (in forensic cases)
Crisis Interviews
-usually occurs impromptu
-part of crisis intervention
-purpose is to collect assessment data
-provide support
-determine whether or not hospitalization or police intervention is necessary
-provide referrals
-arrange for follow-up
Types of Interview Structures
-directive
-non-directive
-semi-structured
Nondirective Interview
-clinical says very little
-uses subtlety
-emphasizes "rogerian" techniques

Rogerian Technique
-non-directive technique
-active listening, reflection, paraphrasing, summarizing, open-ended questions
Semi-Structured Interview
-mix of open ended and closed ended questions
-often developed to assess specific conditions
-protocols:
-predetermined, organized set of topics and questions
-some flexibility for clinicains
Structured Interview
-protocol uses standardized, closed-ended questions in an established order and format
-often includes rules for coding and scoring responses
-often used to assess specific conditions/areas
-emphasis on high degree of consistency across interviewers and interviewees
-often used in research (because it has high diagnostic reliability)
example: decision trees
-can become dependent of on protocols
-patients responses can be inaccurate or dishonest
Decision Trees
-tell interviewer what to do at certain junctures
-structured interview
Advantages to Structured Interviews
-decreases sources of interviewing error such as:
-patient variance
-information variance
-criterion variance

Patient Variance
-variations w/ in the same patient in how the patient responds to same question by different clinicians
-decreases likelihood in systematic interviews

Information Variance
-variations among clinicians in what/how questions are asked. Different questions, different answers.
-decreases likelihood in systematic interviews
"what gives you anxiety?" "do you feel anxious in crowds?"
Criterion Variance
-differences in judgments made across different clinicians
-decreases in likelihood in systematic interviews
-when is it low mood as opposed to depression?
Disadvantages to Structured Interviews -less flexibility (some ppl don't like no spontaneity)
-can be lengthy
-limits range of responses
-clinicians may become dependent on protocols
-miss important info not included in the protocol
-can alienate patients if rapport isnt established (patient and clinican arent connected)
-quality of results depends on quality of responses
Error and Bias in Interviews
-mental retardation
-certain neurological conditions
-dementia
-psychopathy
-might be dishonest people
-malingering (a source of secondary gain)
-personal biases and theoretical orientation of the interviewer
Test -a systematic procedure to measure a behavior, skill, trait, attribute or feature
Standardization -consistency of administration and scoring procedures
Tests Measure:
-intellectual or cognitive abilities
-personal characteristics
-attitudes, interests, preferences, values
Commonly used Tests
Wechsler Adult Intelligence Test
Minnesota Multiphasic Personality Inventory
Wechsler Intelligence Scale for Children
Multiphasic Personality Inventory-2
-objective psychopathology test
10 clinical scales
3 validity scales
567 true/false answers

Clinical Scales of Multiphasic Personality Inventory-2
1.) hypochondriasis
2.) depression
3.) hysteria
4.) psychopathic deviate
5.) masculinity-femininity
6.) paranoia
7.) psychasthenia
8.) schizophrenia
9.) hypomania
0.) social introversion
Validity Scales of Multiphasic Personality Inventory-2
lie scale
infrequency scale
correction scale
lie scale
-validity scale on the MMPI-2
-items reflective of tendency to present oneself in overly-positive light
-high scores=defensiveness
infrequency scale
-validity scale on the MMPI-2
-items describing very rare symptoms
-high=exaggerated symptoms
correction scale
-validity scale on the MMPI-2
-overt defensiveness about admitting to problems in functioning
-high score=defensiveness
Milton Clinical Multiaxial Inventory-III
-objective psychopathology test
-175 t/f items
-alternative to MMPI-2
-focuses more on personality disorders
-4 validity scales
-10 clinical syndrome scales
NEO-PI-R
-objective personaltiy test
-243 items
-five factor model of personality
-openness
-conscientiousness
-extraversion
-agreeableness
-neuroticism
objective personality tests
-self reported data
-standardized questions
-t/f questions
-yields an objective score
-scores typically compared to normative data
projective tests
-grew out of the pscyhodynamic tradition
-rorschach
-TAT
-CAT
-Rotter Incomplete Sentences Blank
-Projective Drawings
-DAP
-H-T-P
Wechsler Adult Intelligence Scale-IV
-most widely used intelligence and psychological test in the US
-hierarchial structure
-2 factors, 4 subfactors, 11 sub-tests
-full scale intelligence score=g
-4 index scores: verbal abilities and nonverbal abilities

TAT Thematic Aptitude Test
projective test
shown a picture and asked to tell a story about it
CAT Children's Apperception Test
projective test
shown a picture of an animal and asked to tell a story about it
Rotter Incomplete Sentences Blank
projective test
I feel _____. I think _____. My mom is ____.
DAP projective test
draw a person test

H-T-P projective test
house tree person
Achievement Test
-testing to measure what has already been learned, given prior to participation in an educational program
WIAT-II
WJ-III
KTEA-II
WRAT-4