A Psy.D students perspective

Psychotherapies I

2010-05-01T19:45:00.000-07:00

I took Clinical Interviewing last semester which introduced me to the physical presence of being in a room with a client. The majority of the work in that class was spent teaching me to a) relax my nerves at seeing a client... a challenge, I promise you, b) use an economy of language, and c) equip me with some basic counseling techniques to help me listen effectively and help the client process.

This class was my first introduction (barring the Master's program at SAGU) to techniques for making a more lasting change in the client's life. Having someone caring listen to you who can ask precise questions to really facilitate your thinking is an amazing resource that can really do a lot of good. This class gave me an introduction into techniques for being more active in the counseling session, like assigning specific things for the client to do outside of session.

It also covered different ways of conceptualizing a problem. For example: a person comes to you because he's tired of losing control his temper and ostracizing friends or getting fired. You could look at it as a pure behavior problem. After all, the problem is his behavior. In this case when you're talking to... let's call him John, you're going to look at ways that he gets rewarded by losing control. Even though he loses friends over it, they cave to his pressure Or maybe people treat him really nice for a few days to keep from "setting him off again." Your therapy will focus on helping him to get these rewards in a more healthy way.

Another way to look at it would be from the perspective that thoughts cause behaviors. If John is blowing up and yelling at friends, there's something going on inside his head before he does that. So if John can learn to detour the mental progression to a blowup before it gets there, he can prevent it. Time will likely be spent helping him to discover this mental road. Therapy might then focus on helping John to be more aware of his thoughts and be more aware of alternate paths.

A derivative therapy of this would focus more on learning to balance necessary opposites in life (dialectics) like the rational part of our mind vs. the emotional part of our mind. Depending on the specifics of the situation John may focus here on how to accept the anger that he feels as a valid emotion, but not let it overwhelm the rational part of his mind that may say to temper it and channel it into something useful.

The list goes on and on. Some focus on changing the immediate situation. Others look into a backgrounds that set the stage for the situation ever arising in the first place. Some are very concrete and action-oriented while others are abstract and insight-oriented. It all depends on the client and what's going to be a best fit for him or her.

I've heard most of these therapies before, but it stuck so much more now than it ever has before. Maybe it's because I've seen a couple clients now and I understand more what it means to "do therapy." Maybe it's because I'm immersed in other classes (psychopathology, personality/intelligence testing) that help me to picture what it would be like to have these clients. I don't know. But I do know that what I did above where I took a sample case, conceptualized it in multiple ways, and developed a cursory treatment plan would have been totally out of my reach a semester ago. Props to the prof.

Personality Assessment

2010-05-01T19:13:00.000-07:00

Over the course of the semester, I was taught a number of tools for assessing personality, the MMPI-2 (Minnesota Multiphasic Personality Inventory-2), the PAI (Personality Assessment Inventory), the MCMI (Milan Clinical Multiaxial Inventory), and the Rorschach Inkblot Technique. Of these, you're most likely to be aware of the last. It has enjoyed (suffered?) countless references in pop-culture through movies, comics, and even cartoons as "the test with the weird shapes you're supposed to see something in."

The MMPI-2 has a long history of use and has been more heavily researched than probably any other test, with the possible exception of the Rorschach. It's a long test that yields a lot of information on the person taking it. It gives a profile with ten different primary scales such as "paranoia" or "introversion," a number of scales that measure attempts to minimize or exaggerate negative characteristics, a number of scales that measure more precise characteristics like "addiction potential," and the list goes on. It's a fascinating test. I've even gotten to work alongside a couple more advanced students who are conducting their own research on the MMPI.

The PAI and MCMI are both shorter (though still lengthy) tests that approach personality from a different angle. Specifically, the items in the PAI are made in such a way that they can be used with a broader range of clients and the interpretation is a little more straight-forward. The MCMI was designed with being able to give a specific diagnosis in mind with personality disorder scales, and clinical syndrome scales. (A personality disorder is a negative way of interacting with the world that a person has had since they were young, while a clinical syndrome can be much shorter in duration, like depression or panic attacks.)

The Rorschach is a very different sort of personality test. Rather than being a pen and paper test where you answer yes/no to a series of questions, or on a 4-point scale like the PAI, the person taking the test is shown cards where he describes what he sees. Once what the person sees has been described to the psychologist in sufficient detail, the psychologist is able to code on a worksheet not only the content, but the method which the test taker used to come up with the mental image, the use of color, shading, or blank space, etc.

The theory (called the projective hypothesis) is that when you have a situation that you're not given any cues about how to act, the things you say or do reveal characteristics about you. I was really skeptical of the test, but I was shocked when I did my first interpretation at how accurately it described the person I was testing. As a "final" of sorts, I did a joint interpretation in which someone was given both MMPI-2 (the pinnacle of objective testing) and the Rorschach (the pinnacle of projective testing) and there was surprising amount of agreement between the two. While I have some reservations still, the Rorschach is onto something.

In short, the class was fascinating, informative, and a lot of work. I walked away from the class knowing a lot that I had never heard of or even thought about before. I walked away with a much better understanding of what being a psychologist will entail. But lest I pat myself on the back too much, there are entire volumes providing alphabetical lists of psychological tests. What I have learned is the most widely used of the tests in this one domain. "Being a psychologist" will likely also entail countless hours spent, unpaid, reading up on a specific test when a client who has come to see me needs something specific I've not learned already.

Finally, a structure

2010-03-02T02:13:00.000-08:00

I knew that I wouldn't write just on the pressure to maintain this blog, so I've struggled to find an easy structure to follow. I finally hit on something that I'm willing to commit to trying.

After each semester I can write an article covering what I learned out of each class, both academically and professionally. Then I can write an article summarizing each professional event I go to, such as a formal luncheon, colloquium, or this upcoming MMPI symposium. Memorable, practical, realistic. I can do that. I'll do my best to write a few back-issues, but no promises there. Hope you enjoy.

Micah

Core values

2009-10-11T05:04:00.000-07:00

Food for Thought

Service last week had to do with core values and I've realized that I don't know my core values. Under pressure between multiple desirable choices (or multiple undesirable choices), my drive for action fails. I have nothing to guide my decisions and I fall into a milky uncertainty.

When the church is persecuted (Acts 8 - 9:31) there is great purpose. Under trial, we realize how little some things matter, and how important other things are. We are stripped down to our core values and our entire energy becomes devoted to fulfilling those values. It's a natural and automatic thing we have seen over and over in the history of the church (and humanity in general). And in these settings, the church booms. But the American church has not faced persecution, except in a very passive sense, for quite some time. Nor have I. We've forgotten our core values. As have I.

So what do I do? It is a true saying that "what you spend your time and money on is whats important to you." I find mine. Self-examination. What do I spend my time thinking about? (cognitions) What churns up the most powerful emotions in me? (emotions) Where does my time and money go? (behaviors) These all point towards a few select things that I value. They may be good. They may also not be so pretty.

If I want to live anything close to the manner of a church under persecution, then I have to understand what persecution does. One result is an awareness of core values. Another is devotion to them.

Forensic Psychology

2009-10-10T13:28:00.000-07:00

No, not figuring out what dead people are thinking. Shawn can take the lead on that. I went to an informational meeting for the forensic psychology research initiative. In short, forensic psychology is the intersection between psychology and law.

Psychological evaluations for civil and criminal cases
"The job caused me psychological harm and I need 2 million dollars to feel better!" Oh really?
"I'm incompetent for trial because I had a bad childhood!" We'll see about that.
Developing and using screening tools for adult and juvenile cases
"Let's see if this person would be better served by a mental health institution than a prison."
Advocacy
"You think you were screwed up before? Let's put you in close quarters with a bunch of other screwed up people for 20 years and see how psychologically healthy you are then."
Research
"Crunching fancy numbers on all the above is both exciting and fulfilling as a career!"
And the one you've all head about... expert testimony.
"Yes, your honor, it is scientifically documented that people with trichotillomania are compelled to pull their own hair out. Without help, they're unable to stop themselves."

Ehh... I'm not so focused on law applications of psychology, but the prof's very statistically-minded, so I think I'll join just to help her crunch numbers and glean from her knowledge. Who knows... maybe I'll fall in love with the field?