Transcript
Introduction to Clinical Psychology
洪福建
What is clinical psychology
1).a subfield of the large discipline of psychology
2).conduct research on behavior and mental
processes
3).involvement in the assessment or measurement
of the abilities and characteristics of individual
human beings
4).effort to help people who are psychologically
distressed
Clinical attitude or clinical approach
The activities of clinical psychologist
Assessment 衡鑑
Treatment 處置
Research 研究
Teaching 教學
Consultation 諮詢
Administration 行政管理
Distribution of clinical activities(Table 1.1)
Clients and their problems
Employment settings and salaries for
clinical psychologists (Table 1.2)
Sociocultural diversity among clinical
psychologists
The roots of clinical psychology
The research tradition in psychology
Attention to individual differences
Changing conceptions of behavior disorder
Clinical psychology in the 21st century
The challenges of health care reform
Trends toward integrated theories and
interdisciplinary work
Specialization of clinical activity
The challenge of cultural diversity
The scientist-practitioner issue
Assessment in Clinical Psychology
Definition
the process of collecting information to
be used as the basis for informed decision
by the assessor or by those to whom results
are communicated.
a process of solving problems (answering
questions) (Maloney, & Ward, 1976)
Reasons for Psychological Assessment
Help answer specific questions & aid in making
relevant decisions (Groth-Marnat, 2003)
Common reasons:
1). Diagnosis
2). Treatment planning
3). Identifying functional status
4). Self-control problems
5). History
A Model for the Assessment Process
Cushman & Scherer (1995)
1). Determine the information you need to
answer the referent questions
2). Identify who is to be involved
3). Obtain informed consent & releases
4). Collect & examine medical records
5). Identify what is to be measured
e.g. cognitive function, mood, personality
6). Identify & select your measures
7). Administer your assessment. Modify as
needed
8). Score measures; analyze & interpret
results
9). Seek consultation if you are unable to
make sense of the results
10). Write report
11). Provide feedback to client & other
appropriate parties
Phases in Clinical Assessment
Groth-Marnat (2003)
1). Evaluating the referral questions
2). Acquiring knowledge relating to the
content of the problem
3). Data collection
4). Interpreting the data
“Conceptual Validity” (Maloney &
Ward, 1976)
The Clinical Assessment Process
Nietzel, Bernstein, & Millich (2003)
A schematic view of the clinical assessment process
Ⅰ
Ⅱ
Ⅲ
Ⅳ
Planning
data
collection
procedure
Collecting
assessment
data
Data
Communicating
processing assessment data
and hypothesis
formation
Planning for Assessment
What do we want to know?
Assessment levels
1). Somatic
2). Physical
3). Demographic
4). Overt behavior
5). Cognitive/intellectual
6). Emotional/affective
7). environmental
Factors guiding assessment choices
Theoretical Model
Reliability & Validity
Clinician-specific factors
personal preferences, training experiences
Clinician’s assessment strategy
bandwidth-fidelity issues
The goals of clinical assessment
Diagnostic classification
Psychodiagnosis; Differential Diagnosis
DSM-Ⅳ, ICD-10
Description
Person-environment interactions
Prediction
for Selection
Collecting assessment data
How should we go about learning it ?
Sources of assessment data
1). Interviews
2). Observations
3). Tests
4). Life records
The value of multiple assessment sources
Processing assessment data
“Data Processing” or “Clinical Judgment”
determine what their mean
transformed from raw data into interpretations
& conclusions
Levels & Types of clinical inference
1). Goal:
2). Underlying theoretical approach
3). Level of abstraction:
Lowest vs. Highest inference level
Three views of assessment data
1). Samples
2). Correlates
3). Signs
Approaches, Views, and Levels
The process of clinical inference
Clinical intuition
The Clinician as inference expert
Formal vs. informal inference
Communicating assessment data
1). Report clarity
2). Relevance to goals
3). Usefulness of reports
Clarity, Meaningful, Synthesis
Clinical interview
A conservation with a purpose or goal.
An interaction:
at least 2 persons(interviewer v.s. interviewee)
face to face
Interview v.s. Conservation
specific purpose
participant’s role
time &place
Interview structure
The degree to which the interviewer determines
the content and course of the conversation.
Nodirective
semistructured
structured
影響使用因素：
1). Goals of interview
2). Course of interview
3). Theoretical orientation
4). Personal preferences
Trends toward structured interview
Stage in the interview
Stage 1: Beginning the interview
establishment the rapport
Stage 2: The middle of the interview
informational gathering
a). nondirective techniques
b). directive techniques
c). combining interview tactics
Stage 3: Closing the interview
Communication in the interview
Verbal v.s. Nonverbal communication
Use of Language
Focus on the interviewee
Active listening
Response to silence
Channel of communication
The clinician’s values & bacground
Rapport of interview
A comfortable atmosphere and a mutual understanding of
the purpose of the interview
Positive rapport:
1). be more receptive to the message being sent.
2). be characterized by feelings such as trust, relaxation,
comfort, respect, warmth, safety
Negative rapport:
1). Less desire to share oneself and less readiness to
believe what’s being said
2). be characterized by feelings such as hostility,
defensiveness, unease, mistrust, disrespect, dagerous
Techniques of interview
Interviewer attitude:
acceptance, understanding, sincerity
Five types of interview questions
1). Open-ended
2). Facilitative
3). Clarifying
4). Confronting
5). Direct
基本的溝通技巧
注意（ Attending ）
S ：直接地面對 O ：開放的姿勢
L ：身
體前傾
E ：眼睛接觸
R ：保持放鬆
傾聽（ Listening ）
經驗（ Experiences ） VS. 行為（ Behaviors ）
VS. 感受（ Feelings ）
外顯（ Overt ） VS. 內隱（ Covert ）
內容（ Contents ） VS. 歷程（ Processes ）
瞭解（ Understanding ）
同理心瞭解（ Empathic understanding ）
探求（ Probing ）
澄清（ Clarify ）：問題具體化
（ Concrete ）的歷程
聚焦（ Focusing ）
聚焦主題的標準：嚴重性（ Severity ）、緊急
性（ Urgency ）、
重要性（ Importance ）、即時性（ Timing ）
、複雜性（ Complexity ）
溝通技巧 ( 柯 )
1). 增強談話的動機
2). 減低個案對於談話的焦慮
3). 幫助個案想起過去發生的事以利晤談
4). 潤滑交談過程的幾種提問或接洽技巧
The physical setting arrangement
Note taking & recording
The patient’s frame of reference
The clinician’s frame of reference
Reliability of interview
Reliability
1). information variance:
refer to the variation in the questions the clinicians ask,
the observations that are made during the interview, and
the method of integrating the information that is obtained.
2). Criterion variance:
refer to the variation in scoring thresholds among
clinicians
Two types of reliability:
1). Interrater or interjudge reliability
2). Test-retest reliability
Validity of interview
Content validity
Criterion-related validity
Discriminant validity
Construct validity
Suggestions for improving
reliability & validity
Whenever possible, use a structured
interview
If a structured interview does not exist for
you purpose, consider developing one
Certain interviewing skills are essential
Be aware of the patient’s motives &
expectancies with regard to the interview
Be aware of your own expectations, biases,
and cultural values
Varieties of interview
The intake-admission interview
The case-history interview
Mental status examination interview
The crisis interview
The diagnostic interview
Mental status examination(MSE)
General appearance and behavior
Speech & thought
Consciousness
Mood & affect
Perception
Obsessions and compulsions
Orientation
Memory
Attention & concentration
Fund of general information
Intelligence
Insight & judgment
Higher intellectual functioning
The diagnostic interview
Structured diagnostic interview
1).Careful history-taking
2).Clinical examination:
eliciting clinical sign
Clinical Observational Assessment
Goals:
1). Collect informational that is not
available in any other way
2). Supplement other data as part of a
multiple assessment approach
Benefits of observational assessment
Supplementing self-reports
Highlighting situational determinants of behavior
signs v.s. samples
Minimizing inference
Enhancing ecological validity
Observational method
1). Selection:
people, classes of behavior, events, situations, time
2). Provocation:
provoke or wait
3). Recording:
observer memory, record sheet, audio- or videotape,
physiological monitoring system, timers, counters
4). Encording: most difficult
a system for encoding raw observations into usable form
must be developed
Approach to observational assessment
Naturalistic v.s. controlled observation
Participants v.s. nonparticipants
1). Complete observer
2). Observer as participant
3). Participant as observer
4). Complete participant
Naturalistic observation
Hospital observations
School observations
Home observations
Observations by insiders
Self-observation(self-mnitoring)
Controlled observation
Also referred to as analogue behavior
observation (ABO), situation tests, and
contrived observation
Performance measures
Role-playing tests
Reliability & Validity of observation
Reliability of observation:
1). Complexity of target behavior
2). Training observers
Validity of observation
1). Mechanics of rating
2). Observer error
3). Reactivity
4). Ecological validity
Behavioral Assessment
SORC Model (Kanfer & Phillips, 1970)
Stimulus(S)
Organism(O)
Response(R)
Consequence(C)
Functional analysis(ABC Model)(Skinner, 1953)
Antecedent event(A)
Behavior(B)
Consequence(C)
Two broad categories of behavior
1). Respondents: are the antecedent-controlled behaviors
which function in a reflexive manner
a). Somatic reflexes
b). Emotional reactions & other responses of the smooth
muscles, gland & heart
c). Sensations
2). Operants: are consequence-controlled
a). Actions
b). Instrumental responses of the smooth muscles, gland
c). Cognitions
Assessment task
1). Identify:
respondent, operant, consequence of operant,
setting event
2). Classify:
behavioral excesses, behavioral deficits,
behavioral anomalies, behavioral assets
3). Prophesy:
theoretical orientation:
4). Specify: recommendations
precise goals, methods of interventions,
therapeutic agents
5). Evaluation: what changes are occurring
in behavior treatment
processes evaluation,
outcome evaluation
follow-up evaluation
Methods of behavioral assessment
Behavioral interview
Direct observation
Psycho-physiological measures
Behavioral Inventories & Checklist
BDI, CBCL
Behavioral Sampling
Event sampling
Duration sampling
Time sampling
Interval sampling
Subject sampling
Situation sampling
臨床工具的選擇
使用心理測驗的目的
時間向度的考量
個案條件的考量
年齡、教育程度、生理條件等
受測動機
選擇測量不同心理特質的測驗
增加效度 (incremental validity)
概念效度 (conceptual validity)
經濟效益考量
臨床上常使用的心理測驗
WAIS - Ⅲ
WISC
B-G Test
Rorschach Test
TAT
Projective drawing
Self-Report: MMPI, CPI, KMHQ, HPH….
心理測驗的臨床使用
觀察記錄施測時的各項反應
標準化的施測、計分、及解釋程序
解釋測驗意義時，需重視其他收集到資料
在施測時，同時利用其他方式收集更多資
，如簡短晤談
觀察→記錄→問自己問題→回答問題→再
提出問題… .
各項測驗的施測順序
簡單的先做
順序不可減低測驗原有的效度
費時的測驗放在最後
心理測驗的評價
理論取向 (Theoretical Orientation)
實務考量 (Practical Considerations)
標準化 (Standardization)
信度 (Reliability)
效度 (Validity)