Is he mentally ill?

Object relations theory: importance of the caregiver is key

• Melanie Klein
• Healthy relationships as infants result in healthy relationships as adults

Attachment theory: Bowlby, 1969; Ainsworth, 1978

• Secure, ambivalent, avoidant, disorganized (in 4/5 abused kids)

Classical conditioning

• Classical conditioning

• Pavlov
• Important for fears and anxiety

• Instrumental conditioning AKA operant conditioning

• Thorndike
• Law of effect—behavior that is followed by consequences affects repetition
• Generalization
• Discrimination
• Shaping—successive approximations

• Observational learning

• Behavior therapies—systematic desensitization, assertion training, token economy, role playing

Can be tested in the laboratory

• Can be tested in the laboratory

• We can show that symptoms can be acquired these ways, but is this the way they are ordinarily acquired?

• Improvements in therapists’ offices do not always extend to real life, nor do they always last without continued therapy

• Critics argue that it is too simplistic—no cognitions involved; pts. must develop self-efficacy

Schemas

• Schemas

• Observable behavior can be influenced by mental processes

• Automatic thoughts

• Cognitive distortions

• Attributions

• Assessing the Cognitive Model

• 24 % of psychologists identify approach as cognitive
• Appealing because it focuses on a process unique to humans
• Lends itself to research
• Precise role of cognitions (cause or effect) has yet to be determined
• Narrow—deals only with cognitions, not values, meaning, etc.

Family Systems Theory

• Family Systems Theory

• Identified patient
• Homeostasis
• Family structures (parents in charge) and alliances (parents united) are often disrupted
• Communication is also often disrupted
• Can be enmeshed or disengaged

Macrosystem—beliefs and values of the culture

• Macrosystem—beliefs and values of the culture

• Exosystem—social structures like family, neighborhood, SES

• Mesosystem—interconnections between various community systems like peer groups, religious organization, etc.

• Microsystem—child’s immediate environment, family, school, work

• Ontogenic Development—the child’s own development and adaptation

Neglect and abuse in the home:

• Neglect and abuse in the home:

• Disorganized and disoriented attachment
• Problems in all domains
• 1/3 will go on to repeat the trauma

• Parental Psychopathology

• Tiffany Field—transmission of depression, even with those as young as 6 mos. 

• Parenting styles:

• Authoritative—energetic/friendly
• Authoritarian—conflicted/irritable—also moody, eating disorders
• Permissive/Indulgent—impulsive/aggressive—demanding, immature
• Neglectful/Uninvolved—low s-e, conduct problems, moody, peer and academic problems

• Divorce

• Ongoing stressor—not just one
• Most (3/4) will be fine
• But…2x as likely to repeat a grade, report more delinquency, more negative health stuff like smoking, more depression

• Poverty! 

• Peer Relationships

• Deviancy training
• Rejected, neglected, controversial, accepted—neglect is particularly negative

Universal vs. culture-specific

• Universal vs. culture-specific

• Schizophrenia—different presentation, more paranoia in Western cultures, also more negative outcome
• Depression—universal, but different presentation—more somatic in China, for instance
• Overcontrolled vs. undercontrolled behavior—more under in US, over in Thailand (Weisz et al, 1993)
• Culture bound syndromes

Intake interview—

• Intake interview—

• History of present problem
• Thorough personal and family history
• Social context
• Structured vs. unstructured

• Physical assessment

• General exam
• Neurological exam for neurological disorders. For example, may want an EEG if there are memory deficits, etc.

Variety of sources in assessment

• Variety of sources in assessment

• Reliability—consistency or agreement among assessment data

• Test-retest
• Internal consistency
• Interrater

• Validity—does it measure what it is supposed to measure

• Content validity—all domains that is supposed to measure
• Predictive validity
• Concurrent validity

• Diagnostic errors—true positives, true negatives, false positives (Type 1), false negatives (Type 2)

• Sensitivity—correctly diagnose someone with any disorder

• Specificity—likelihood that people without disorder will be diagnosed that way