progressing from immature to mature forms (newborns to adults) occurs in essentially the same pattern for all biological 'normal' members of a species

psychological problems in children/adolescents result from some deviation in one or more areas of development (cognitive, biological, physical, emotional, behavioral, social); what is expected/typical/normal for children that age AND, AND THIS IS VERY IMPORTANT children’s (and family, school, community) emotional and behavior reactions/adaptations to their developmental delays, abnormalities, etc. (e.g., LD => anxiety/avoidance vs. aggression)

reciprocal interaction

developmental processes and the environment interact 

parents and teachers often do not have a good understanding of what is/is not developmentally appropriate or abnormal --  Role of psychologist can be to assess, typical versus atypical, educate (parents, teachers, etc.),  help them develop appropriate expectations and compassion, develop intervention programs

reciprocal person-environment interaction

people affect their environments

(choosing and modifying their environments) and environments, in turn, affect people

diatheses-stress model of etiology of psychopathology

biological (and/or psychological) predisposition combined with sufficient environmental stress. Both the diatheses and the stress are necessary to develop the disorder.

bio-psycho-social models

incorporate all three levels of analysis into conceptualizations of psychopathology - examples: - PKU; dyslexia, motor and social skills deficits

Resilience

Correlation between adversity and outcome is mediated by resilience factors; qualities that are associated with overcoming adversity and achieving good developmental outcomes.  For example, degree of physical or sexual abuse does not well predict outcomes; most “children of divorce” do just fine; children become healthy adults in war zones and refugee camps; but personal and environmental variables play a role; psychologist/therapist can help identify and develop these factors as part of an intervention plan => community psychology interventions (discussed later)

examples:

-relatively high intellectual functioning

-appealing, sociable

-close relationship with caring parental figure

-relationships with pro-social adults/organizations

focus on coping and adaptation

how do individuals and families cope and adapt to illness, adversity, etc.

examples:

            - reframing adversity as challenge, finding meaning and purpose

            - accessing other people/families coping similar illness/adversity

primary and secondary prevention

counteract harmful circumstances before they have a chance to produce illness/pathology; early identification and intervention at an early stage so that illness/pathology does, attack problems while still manageable; screening for children "at risk" (head start, health care, DARE, Social Problems Solving Training)

Strained family relationships

-Modifications in family activities and goals

-Burden of increased task and time committments

-Increased financial burdens

-Need for housing adaptation

-Social isolation

-Medical concerns

-Differences in school experiences

-Grieving

Perception & Functional Coping 

Family perception/definition of the stressor

            redefine or reframe (reframe adversity as a challenge)

            hopeless, shameful, overwhelming => challenge, opportunity for growth,

                        endow the situation with meaning 

• Eden
• Reinforcers
• Shaping
• Develop, maintain, generalize

parallel way person is likely to behave in other settings

Functional Analyses 

stimulus conditions and outcomes, antecedents and consequences, attend to contextual variables, behaviors are learned and maintained because of consequences that follow them, identify stimulus conditions and reinforcements

Increasing Reliability and Validity

-       Consider how representative? Can observations be generalized?

competence

represent training and expertise actively and accurately;

sensitive to gender, ethnic or racial background, age, sexual orientation, etc.;

guard against impact of personal issues/problems that could impact performance; practice only where you have expertise; continuing education, reading, consulting with colleagues, etc.; expand practice only after gaining appropriate training, developing competence

respect and protect the confidentiality of client information, limit disclosure, be clear and open about matters of confidentiality and the conditions under which it can be breached, do not promise absolute confidentiality; exceptions for abuse, suicide, murder - life-threatening situations; ethical obligations to protect patient and others;   patient's consent required before records, communications, etc. can be disclosed, except when . . . .   the patient has the "privilege" - they are the patient's records; educate the patient; minimal disclosure; safely store records; conflicting state and federal regulations, laws and cases; Tarasoff decision - all appropriate persons 

mandatory reporting laws

clinician does not decide whether or not abuse or neglect is happening, clinician brings the facts to the attention of the authorities

informed consent/informed decision making 

respect client's autonomy, provide clients with information they need to give informed consent (limits of confidentiality, nature or record keeping, expertise and training, estimated length of therapy, fees and billing practices, whom to contact in an emergency, right to terminate); responsibility to educate clients about services they are purchasing and how they will be delivered; type of therapy, anticipated course of treatment, fee, confidentiality, risks and expected benefits

standard of care 

standards of practice within profession; ordinary and reasonable member of the profession, "duly careful member of the profession"

blurred, conflicting, multiple or dual relationships

power differential; possibility of exploitation, client's welfare and needs come first, if psychologists needs are being met then potential for conflict of interest; sex with a client, employing a client, selling a product to a client, becoming friends with a client, consulting with relatives and friends, bartering for services, etc.; avoid relationships that could impair professional performance or exploit or harm the patient; small rural town exceptions; manage care issues; multiple role relationships by far most frequent cause for disciplinary action, legal action, most of these involve dual relationships of sexual nature -- How much power differential is their between the psychologist and the client?  Has the professional relationship been permanently terminated? Whose needs are being met?

willingness to terminate therapy when it is no longer being helpful to the client  

make an appropriate referral, etc.; know the difference between abandonment and termination -pre-termination counseling and suggest alternative providers; making referrals 

Tarasoff case

• Client said he was going to kill gf
• Told police, they arrested him, but released him bc gf was away on vacation
• She returned and he KILLED HER
• Paraents sued EVERYONE
• Supreme court upheld bc therapist only told police and not all relevant parties

symptoms that are present but should be absent such as delusions, hallucinations, disorganized speech, disorganized behavior, thought disturbance such as loosening of associations

characteristics that are absent but should be present such as restricted range/intensity of emotional reaction (affective flattening), restricted fluency and productivity of thoughts and speech (alogia) and impaired initiation of goal-directed behavior (avolition) - apathy, social withdrawal, poverty of thoughts, blunting of emotions, slowness of movement, lack of drive

prognosis/course of schizophrenia

predictive factors include: pre-morbid functioning (’normal’, friends, etc. Vs ’always strange’, isolated, etc.); gender (women better than men); family history of mental illness in general and schizophrenia in particular; age (younger-poorer); sudden VS gradual onset; positive VS negative symptoms

neuropsychological and neurological deficits of schizophrenia

attention/executive func.memory

primary treatments/interventions of schizophrenia

medication; counseling/supportive psychotherapy; cognitive-behavior therapy?; rehabilitation (housing-employment-social skills) - patients do better with medication AND counseling/therapy 

medication non-compliance schizophrenia 

approx 70% of patients noncompliant with medication by the end of 2nd year following hospitalization; important role of therapist, doctor-patient relationship important, address denial, delusional beliefs regarding medication, education

de-institutionalization and the community mental health movement regarding schizophrenia

failure for resources to follow patients into the community; remarkably neglected by mental health system despite high numbers and social-economic impact (homeless, shelters, jails/prisons, etc.)

AND explanations focusing on bad mothers, family interaction => parent organizations, self-help groups, critique of mental health system, support AND ADVOCACY

Community Psychology

individual focus VS social systems/environment focus

-treating already developed problems VS Primary and Secondary Prevention

-office/clinic VS out in the community, out in the field

- resources are always limited

- roles for para and non-professionals, professionals train/assist, SELF HELP GROUPS

- psychologist as consultant/facilitator, client groups/communities make decisions

- focus on strengths, competencies, resources, adaptation, empowerment

- social change, redistribution of power and resources, role in politics?

Experimental Method

to determine if cause-effect relationships exist among events

            - experimental group Vs control group

            - manipulate independent variable - under the control of the investigator

            - independent variable expected to have a causal effect on dependent variable

            - ideally control all other variables other than those being studied so that any                        change in dependent variable can be attributed to independent variable

Internal Validity (Vs external validity)

the extent to which we can believe the outcome of an experiment can be attributed to manipulation of the independent variable; a well designed experiment rules out alternative explanations; when other variables not controlled or cannot be shown to exist equally between in experimental and control groups, these variables confound results.

experimental and control groups should be as similar as possible at the beginning of  intervention so that can claim differences on dependent variable are result of manipulation of  independent variable, not differences between groups/third variable

experimenter bias

contaminating effect of bias in collecting and processing data

observer effects 

errors in making and recording observations tend to be biased, not random    

interpreter effects 

variety of interpretations can be made about same data set, tendency to make and hold onto preferred interpretations

intentional effects 

intentional self- serving errors

demand characteristics

interaction between experimenter and subject influences subject and biases results

biosocial effects 

subjects respond differently to experimenters or experimenters behave differently towards subjects based on gender, age, race, etc. - gender differences are clear and call into question sex differences research

psychosocial effects 

attributes of researcher/clinician such as social status, warmth, social skills, etc

situational effects

for example, more experienced experimenters obtain different results, experimenters acquainted with subjects obtain different results, results of first few subjects influence experimenters behavior with remaining subjects

expectancy effects

a subtype of demand characteristics; the hypotheses held by the investigators can lead them to unintentionally alter their behaviors toward their subjects in ways that increase the likelihood that subjects will respond so as to confirm the investigator's hypotheses 

double-blind procedures

experimenter and subject blind to group assignment;

have dispassionate observers and raters judge clinical change, with minimal knowledge about the patients, therapists, or modes of therapy involved;     taped - rated by other evaluators (reliability)  GOLD STANDARD FOR INTERNTAL VALIDITY

generalization

can observations/result be generalized to other people/situations; be used to develop relatively universal laws and principles? Can results in a laboratory be replicated in real-life settings?  How representative are the subjects being studied, the techniques being studied, etc.   efficacy versus effectiveness SAMPLING

random/representative sample

also helps us to be able to generalize; in

a truly random/representative sample each person in the group we want to generalize to must have an equal chance of being in the sample  gold standard external validity

statistical Vs practical (clinical ) significance

correlation coefficient vs percentage of variance;  p. < .05 is traditional, not god-given; size of sample is important: a larger sample means smaller correlations or differences will be significant

• efficacy refers to clinical settings
• effectiveness refers to applicability in a medical sense

psychotherapy

generic term, practiced by all professions and non-professionals, problems in living

psychological treatments 

evidenced based, uniquely identified with the profession of psychology, specific treatments for individuals presenting with problems severe enough to place them in the health care system; -- -- especially cognitive behavioral treatments based on cognitive science and behavioral science

• Symptom oriented
• Teach the child that certain behaviors are just defense against anxiety
• Utilize day dreams and play therapy

• methods can easily be applied by parents and teachers
• Very similar to CBT techniques used with adults
• Part of therapy is training parents to continue reinforcement at home
• Enhance problem solving and delay gratification
• Can be used w pediatric to make hospital stays less stressful

• Controlling behaviour by altering the consequences
• Shaping
• Time-out
• Contingency contracting
• Grandma's Rule (first work then play)

• Cultral Identity of the client
• Cultural explanation of client's problems
• Cultural factors related to psychosocial environment
• Cultural influences on the relationship btwn client and mental health professional
• Overall cultural assessment for diagnoses and care