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Chapter 2

Clinical Psychology Chapter 2.docx

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John Stephens

Chapter 2: Historical Overview of Clinical Psychology Diagnosis and Assessment: Beginnings • Assessment of Individual Differences (Galton, Cattell) – Galton pursued his interests in sensory acuity, motor skills, and reaction time and established an anthropometric laboratory in 1882 – Cattell turned his attention to reaction time differences – Witmer became interested in variation in psychological skills among children – Mental testing was a term coined by Catell to describe his measures of reaction time differences – Psychometrics • Classification of Psychopathology (Kraepelin) – Took a very systematic approach – Divided mental illness into those types determined by exogenous factors (curable) and those caused by endogenous factors (incurable) – The first to articulate constellations of symptoms that we can group together with consistency as being related to bi-polar etc. Diagnosis and Assessment: Advent of Modern Era • Assessment of Intelligence (Binet, Terman) • The Binet Assessment is very good with specialized populations • He was the first to develop a norm based assessment (grouping 8 year olds together and testing their intelligence across a large spectrum i.e. perception, attention, language, memory, etc.) He had the results of the assessments related to the norm of that age • Personality Testing • Carl Jung began using word association methods around 1905 to attempt to uncover unconscious material in patients • In 1904, Charles Spearman offered the concept of a general intelligence that he termed g • World War I ability testing (Army Alpha Beta test in 1917) • There was a desire to be efficient with all the recruits who showed up for World War I • They wanted to match the skills of persons to positions in the war • Perhaps the first questionnaire to assess abnormal behaviour Diagnosis and Assessment: Interwar Period • Intelligence debate (Spearman, Thorndike, Thurstone) – How to define? Measure? Study? – Is there a core factor that we can define as intelligence? – Is there a common g, or different subsets? • Doll’s Vineland Social Maturity Scale- 1936 – Approached behavior not strictly in terms of intelligence, but in terms of an individual’s social maturity or competence • Wechsler Intelligence Test – 1939 first satisfactory measure of individual adult intelligence – What we currently use • Projective testing: 1921 patients respond to ambiguous test stimuli – Hermann Rorschach Inkblots • Would show inkblots of now particular object or shape and get people to say what they thought it was • Proposed that when people respond to an ambiguous test stimulus, they will reveal something of their responses to real- life experiences • Led to L.K. Frank coining the term projective techniques in 1939 • Psychological testing techniques such as the Rorschach or the Thematic Appreciation Test, that use people’s responses to ambiguous test stimuli to make judgments about their personality traits or their psychological state – Thematic Apperception Test • Showed fuzzy pictures and then had to make up a story to describe the activities, thoughts, and feelings of the people in those pictures – Bender-Gestalt Test • Not very projective, a measure of developmental maturity in drawing things – Projective measure- ambiguous, they present to you stimually that aren’t significantly concrete (how you answer questions is how you project yourself) Diagnosis and Assessment: Post-war and Beyond - More complex questions were being asked, no longer interest in intelligence level but whether that level was because of an evolving disease process • MMPI – Minnesota Multiphasic Personality Inventory • Allowed in court (paper and pencil, 500+ questions) • Much more on the abnormal side of things (psychopathological) • Objective self-report test whose major function seemed to be attaching psychiatric labels to patients • It was unique in that no theoretical interpretation of scores or responses was necessary • Wechsler published the Wechsler Intelligence Scale for Children and later the Wechsler Intelligence Scale was made to replace the Wecshler-Bellevue Scale • Clinical psychologists were now seen as experts in psychodiagnosis • The use and interpretation of psychological test scores as a basis for diagnostic formulation as well as treatment planning • A rift developed between objective measures and projective measures • Objective measures such as the MMPI and its revision the MMPI-2 are based on a nomothetic approach to assessment in which test scores are interpreted using empirically based rules involving the contrast between an obtained score and the average score • Responses from projective measures in contrast are often interpreted using an ideograph approach. The focus may be more on the individual, and interpretations are often guided as much by psychodynamic theory as they are by empirically supported rules • Radical Behaviorism • Only overt behaviors can be measured and it is neither useful nor desirable to infer the level or existence of personality traits from psychological test results: personality traits cannot be measured directly • I can’t measure it unless I can hear it, smell it, taste it, etc. • Measure the amount of times the eyes blink for example • The DSM –I (Diagnostic and Statistical Manual of Mental Disorders) appeared in 1952 • Diagnostic manuals & structured diagnostic interviews • Structured Diagnostic Interviews could be used instead of inferring a patient’s diagnostic status from his or her psychological test scores • Consist of a standard list of questions that are keyed to the diagnostic criteria for various disorders from the DSM • Could be quick and casual or on the phone when they call in • Highly individualized from therapist to therapist • Obviously some ground rules (you don’t ask right away if they have considered suicide) • Neuropsychological Assessment: An assessment approach—based on empirically established brain–behavior relationships—that evaluates a person’s relative strengths and weaknesses across a number of areas • Some use a uniform group, or battery, of tests for all patients. Others use a small subset of tests initially and then, based on the results of these initial tests, use additional tests to resolve and answer the referral questions • Led to EEG • Managed Care including mental or behavioural health • Developed in response to rapidly increasing cost of health care • Considering the impacts of war on someone • Development of clinics • Became less focused on a singular position but more towards a team and networks to respond to • Interested in tests that • Aid in treatment planning by identifying and accurately assessing problematic symptoms • Are sensitive to any changes or improvments in client functioning as a result of treatment • Are relatively brief in nature • Brief, focal assessment • A crisis situation, figuring out what is going on Interventions: Beginnings • Treatment of Hysteria - Charcot (Hypnosis) • Pure psychological • Believed that only patients with hysteria could be hypnotized • Roots of psychoanalysis (Freud) • Began by a collaboration between Breuer and Freud who treated a young patient named “Anna O” • Led to psychoanalysis • The single most influential theoretical and treatment development in the history of psychiatry and clinical psychology • Asylums in the US • Leprocy decreas
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