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66 Cards in this Set
- Front
- Back
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When is it particularly important to solicit collateral information during a clinical interview?
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When client has a serious mental disorder, cognitive limitations, or substance-related disorder that prevent providing reliable info on own.
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Functional Analysis
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Assessment of antecedents and consequences of a behavior.
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When to use behaviorally oriented interview
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To gain impression of presenting problem and varibales maintaining it, relevent history, clients past efforts to cope wi problem
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Cogfnitive-behavioral assessment
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Explores client's cognitions & strategies to identify which contribute to the problem
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Psychophysiological assessment
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Using physiological activity (MRI, CAT, PET, biofeedback) to assess psychological states
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Naturalistic Observation
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+Observing client in evironment in which problem occurs. Allows u a more precise understandi9ng b/c u see the behavior at variables that control it.
-Client may behave diff if know is being observed (reactivity) -may be exprensive |
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Controlled Observation
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You force target behavior to take place in a simulated manner & then observe it firsthand (roleplay)
-Reactivity |
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Self-Monitoring
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=Having the client record info about frequency and conditions surrounding target behavior
=Client may also keep record of thoughts and feelings assoc wi this behav =Tells u abouit nature and magintude of behv, dev tx strategy +self-mon often changes nature of target behav in desired direction, promotes pos behav |
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Stages of Change Model (Prochaska & DiClemente, 1982)
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1.Precontemplation-unwilling/unaware of problem. 2.Contemplation-person considers possibility of change. 3.Determination-person becomes determined to change. 4.Action-takes action to change. 5.Maintenance-attempts to maintain change over time. 6.Relapse-before stable change a relapse occurs.
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Steps to take if client doesn't speak language requested by client.
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1.make referral to therapist who works in the language requested by cl. 2.offer cl translator wi cultural knowledge & prof background. 3.may use para-prof from client's background. 4.do not use someone who will have a dual role wi the client
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Cultural Relativity
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Judgements about the abnormality of given behaviors vary from culture to culture.
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Minority Identity Development (Atkinson, Morten, & Sue) 5 stages
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1.Conformity= +attitude toward maj culture & -attitude toward own culture. 2.Dissonance=confusion about attitudes towards one's culture,dom culture and self. may believe personal probs related to cultural identity issue. 3.resistance & immersion= rejection of dom culture;+attitude toward self &group; conflict with outside groups, personal proibles due to oppression. 4.introspection=uncertainity about the rigidity of previous stage,conflict between loyality nd personal autonomy. 5.synergistic artiuclation & awareness= sense of fulfillment in cult identity, objective exam & acceptance of other groups, want to eliminate oppression.
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A client who strongly idenitifies with with her racial or ethnic group and may not feel comfortable with a therapist who is racially or culturally dissimilar is in what stage of Minority Identity Development
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Stage 3 - Resistance and Immersion
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A client with this worldview emphasizes personal self concept over family life, relates sense of well-being to personal control, sees events in terms of personal preferences
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Indiviudalism
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What style of communication does a personal with a worldview focused on indiviudalism prefer? In conflict resolution what approach do they prefer?
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1. Low-Context Communication.
2. Confrontational and attributional approach |
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What style of communication does a personal with a worldview focused on collectivism prefer? In conflict resolution what approach do they prefer?
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1. High-Context communication
2. Accommodation & negotiation approach |
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Low-Context communication
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-Transmitted explicitly & concretely through language.
-less unifying & changes rapidly -Euro-american cultures -self worth tied to individual terms |
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High-Context communication
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-Grounded in situation, depends upon group understanding, relies on nonverabl cues, use of gestures, facial expression, stories to convery a point
-Unifies a culture & changes slowly -Many culturally diverse groups in U.S. -self worth tied to the group |
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Refugee process: 4 stages: name,time, event,stressors (Gonsalves, 1992)
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1.New arrival (1wk-6months) learns about nw cult but highly involved in old, stress=saddness,loss,guilt (some feel excitement)
2.Destabilization (6mo-3yrs) acculturate,survival skills, support network. stress=lonliness,angry withdrawl, resistance 3.exploration & restabilization (3-5yrs) acquires more flexible ways of learning about culture, may connect wi other refugees to avoid further adaption, siolation, fear of failure, anger about reduced status 4.Return to normal life (5-7yrs)cult accomodation wi retention of naive cult values,forms pos personal identity,develops realistic expecations 4 next generation stress=delayed grief reaction |
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Credibility & Giving (Sue,1981)
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1.Credibility=being seen as trsutworth helper, must acheive this wi cultural diff client
2.Giving-client believes that something is gained by having met you. If client's mistrust is too high due to cultural diff and exp - refer client out |
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Credibility & Giving (Sue,1981)
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1.Credibility=being seen as trsutworth helper, must acheive this wi cultural diff client
2.Giving-client believes that something is gained by having met you. If client's mistrust is too high due to cultural diff and exp - refer client out |
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Advantages of Structured Diagnostic Interviews vs. unstructured
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1.Higher Diagnostic Reliability through standardization
2.Less subject to threats of clinician bias. 3.Diagnostic criteria is applied more correctly. 4.Using unstructured format may lead one to ignore comorbidity |
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Advantages of unstructured Diagnostic Interviews vs. structured
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1.Can't tailor interview to client't indiviudal needs.
2.If interview seems too rigid, some client's may reject whole process 3.Focusing too much on words may make clinician ignore observations |
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"Mood" versus affect?
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Mood is a realively stable emotional state (depressed,anxious) while affect may be more variable
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Attention vs. concentration
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Attention is ability to focus on current topic. Concentration is ability to attain attention over a sustained period of time. Both require client to filter out extrtaneous stimuli
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Internal Consistency/Split-Half reliability is best used when...
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+Best when test measures single characteristic
+Characteristic fluctuates over time +scores will be a affected by repeated exposure to test |
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reliability in state vs. traits
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Unstable attributes (states) produce lower reliability than traits.
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Reliability of True/false vs. multiple choice
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Multiple choice is more reliable b/c a person has 50% chance of getting a T/F question right by chance.
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Content validity
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test is used to obtain information about familiarity with content or behavior domain
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construct validity
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administered to determ extent to which one possesses a hypothetical trait
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criterion-related validity
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used to estimate an examinee's performance on a single criterion
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MMPI-2
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Scales
1 (Hypochondriasis) 2(Depression) 3 (Hysteria) 4 (Psychopathic Deviate)5 (Masculine-Feminine Interests) 6 (Paranoia) 7 (Psychasthenia) -Anxiety 8 (Schizophrenia) 9 (Mania) – excessive energy 10 (Social Introversion-Extraversion) T = 65+ = clinically sig |
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MCMI-III Millon Clincial Multiaxial Inventory
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Age: 18 + w/8th grade reading lev MACI = age 13-19 if reading level above 6th grade.
11 clincial scales: 1 Schizod, 2A Avoidant, 2B Depressive, 3 Dependent, 4 Histrionic, 5 Narcissistic, 6A Antisocial, 6B Agressive/Sadistic, 7 Compulsive, 8A Passive-Agressive/Negativistic, 8B Self-defeating 3 Sever Pathology Scales= S Schizotypal, C Borderline, & P Paranoid 7 clinical syndrome scales = A Naxiety, H somatform, N Bipolar: manic, D Dysthymia, B Alcohol Dependence, T Drug Dependence, and PT PTSD 3 Severe syndrom scales = SS Thought Disorder, CC Major Depression, & PP Delsuional Disorder |
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Base Rates MCMI-III
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~75-84 = Prescence on a scale
~85+ = Prominence ~greater the score of BR, more likely client possesses personality/clinical features meas by scale. |
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Usefulness of MCMI-III
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1.Only used for clincial assessment, not gen population.
2.Indicual scale cutting lines can reveal disorders/behaviors & level of severity 3.Should not be only source to det disorder (use to rule in or out) 4.shorter than MMPI and takes 20-30 mins to take |
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NEO Personality Inventory
Revised (NEO-PI-R) BIG 5 Personality Traits |
1.Extraversion 2.Agreeableness 3.conscientiousness 4.neuroticism 5.openess to experience
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Rorscach Advice
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~Don't use alone to create tx plan
~The infor about personality organization in useful in making general predictions |
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Verbal-Performance Discrepancies on the WAIS-III
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+More than 12 points is clinically significant
+Higher verbal IQ is assoc w/depression,bipolar,ms,alcoholism,poor vmi,High SES,Higher education. +Higher performance IQ linked to bilingualism,illiteracy,autism, delinquency,psychopathology,learning dis,MR,low SES |
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WISC-IV
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~Ages 6.0 - 16.11
~WPPSI-III = 2 yrs,6 mo to 7 yrs 3 months. ~Based on Catell-Horn-Carroll's cognitive abilities:Verb Comp, Percep Reasoning,Working Memory,short term memory,processing speed,quantatative knowledge |
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Requirements for Diagnosis of MR
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~Measure of IQ
~Low adaptive functioning (may be scored on Vineland or AAMR |
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Malingering
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~Faking Bad~ conscious effort by the client to present self as being worse than they are.~to get into therapy or hospital,get off on a crime,suing for damages
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Defensiveness
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~Faking Good~ conscious effort by client to present self as better than they are.~custody eval,to get released from hospital,for family members
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Clinical Biases affecting clinical judgment
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1.Preconceived Notions-race,sex orientation, ethnicity. the client is already a mental health client,the setting in which u see client. theoretical orientation may lead one to associate certain symptoms together.
2.Confirmation bias-paying attention to symptoms that confirm your hypotheses 3.Primacy effect-giving more weight to info obtained early in data collection,seek support for your initial assertion 4.Hindsight bias-tendency to believe, once an outcome is known,that outcome could have been predicted more easily than is the case 5.overconfidence-psychologists tend to remember vividly the cases in which they predicted correctly and less of those that they were wrong. |
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Clues to malingering
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a.person has a test protocol that indicates symptoms, but they are calm and appear normal.
b.inconsistent response w/in same test ~disturbed~ normal c.inconsistency btwn interview or tests and actual circumstances. |
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Mental Retardation
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subaverage intellectual functioning & deficits in 2 areas of adaptive functioning - measured on vineland
IQ~Mild=50-70, mod=35-50, severe=20-20 to 40, profound= below 20-25. ~90% of MR have mild |
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Borderline Intellectual functioning
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IQ = 71-84, but not 2 deficits in adaptive functioning.
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Symptoms of schizophrenia
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1. Psychotic symptoms during active phase for 1 mo, continuous symps for 6 mos, marked deterioration in func.
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Active phase symptoms in schizophrenia
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hallucinations, disorganized speech, catatonic or disorganized speech,negative symptoms
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5 types of schizophrenia
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catatonic, disorganized, paranoid, undifferentiated, residual
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6 differential diagnosis for schizophrenia
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1. brief psychotic disorder - symps of schiz lasting at least one day, but less than one month
2. schizophreniform - symps of schiz lasting 1 month, but less than 6 mos 3. schizoaffective dis - sig mood symp concurrent with psychotic symp & 2 wks when only psych symps present 4. mood dis wi psych feas - psyh features occur only during course of mood episode 5. delusional dis - delusions are nonbizarre & overall func is not impaired |
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Depression time frame
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-depression = depressed mood most of the day, nearly every day, for at least 2 weeks.
-at least 1 discrete episode that is dif from person's norm func |
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dysthymia
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depressed symptom present more days than not over period of 2 years (1 yr in kids/teens)
at least 2 symptoms of depression, less vegetative symps than dep |
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Bipolar Disorder basic def
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one or more mixed or manic episodes - history of major depressive disorder. sig impairment in func or hospitalization.
manic = at least 1 week; elevated exp mood, irriatble, an d 3 other symp like dectreased need for sleep, grandiosity, racing thoughts, flight of ideas -mixed = lasts 1 week and nearly every day person meets criteria for dep and manic ep |
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bipolar disorder types
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~single manic episode- 1 manic ep only
~most recent ep manic- previously had a mixed, manic or dep episode, most recent ep mixed, hypomanic, depressed |
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severity specifiers for bipolar
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mild, moderate, severe without psychotic features, severe with psychotic features, in partial remission, in full remission, with rapid cyclingh if has had at least 4 mood episodes in past year
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Bipolar II basics
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1 hypomanic episode & 1 major depressive episode. never had a manic or mixed episode.
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hypomanic episode
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lasts 4 days and includes abnormally elevated, expanisve, or irritable mood and 3 symptoms of a manic episode. no psychotic symptoms and not sever enough to hospitalize.
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Cyclothymic Disorder
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2 or more years of depressed mood and hypomanic episodes for 2 years with no more than 2 months without either. depressed moods never meet criteria for major dep disorder
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Basics of social phobia
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~marked fear of performance or social situations in which one is exposed to unfamiliar people or scrutiny by others.
~lasting at least 6 mos. ~may include situationally bound attacks *for children, child must have capacity for soc relationships & occurs with peers, not only adults. may do poorly at school or refuse. |
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OCD basics
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~recurrent obsessions and/or compulsions severe enough to produce distress, time consum, interfere w/ func,
~an adult must be aware of that this is excessive. w/poor insight if they don't ~ocd in teens & kids more common in males |
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PTSD basics
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1.exposure to traumatic event
~starts with intense fear, helplessness, horror 2.one sign of reexperiencing the event 3.at least three signs of avoiding stimuli associated with event 4.persistent symptoms of increased arousal ~lasts one mosth ~acute=less than 3 months ~chronic=3 months or longer ~delayed onset = 6 mo between trauma and onset of symptoms - poorer prognosis when delayed |
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Generalized Anxiety Disorder
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excessive worry about multiple life events or activities - present for at least 6 mos.
~must have 3 symptoms (1 in kids) restless, o edge, irritability, trouble concentrating. ~symptoms r extreme given nature o feared event |
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somaticize their psychological symptoms; lack psychological sophistication; and be unlikely to benefit from insight-oriented therapy.
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These are characteristics associated with a 12/21 code
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have low self-confidence; be suspicious and distrustful; and be likely to benefit most from concrete, behavior-oriented interventions.
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These characteristics are associated with a 68/86 code.
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have severe adjustment problems; be impulsive, nonconforming, and unpredictable; and be unable to form a beneficial therapeutic relationship.
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These characteristics are associated with a 48/84 code.
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have antisocial tendencies; be self-indulgent, impulsive, and sensation-seeking; and, in therapy, express little motivation to change.
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A two-point code of 49/94 on the MMPI-2
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