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Learning Objectives

After reading this chapter, you should be able to

ሁ Identify the waves of personality theories. ሁ Explain the differences between eclectic psychotherapy and integrative psychotherapy. ሁ Identify a treatment intervention that corresponds to the theory of personality used in case

conceptualization. ሁ Explain ethical issues in the practice of psychology, including how to obtain informed consent. ሁ Discuss career options at the bachelor’s level related to psychology or the practice of psychology.

Personality and Abnormal Psychology

Stephen Brewer, PsyD—Ashford University

Leolintang/iStock/Thinkstock

Section 6.1What Is Your Theoretical Orientation?

Jon is a 45-year-old male who decides to investigate whether supportive psychotherapy with Dr. Cozy might help him process some emotions related to a recent loss. Dr. Cozy is a psycholo- gist who is trained in psychodynamic psychotherapy and prefers to focus therapeutic work on interpersonal attachments. During the first session, Jon reports feeling sad and having low motivation after losing his mother two weeks prior. During the standard clinical interview, Dr. Cozy learns that Jon was born a female named Johanna and transitioned to being a male approximately 25 years ago. Jon adds that he has been in a loving and happy relationship with a woman for 20 years and they have adopted several children together. Dr. Cozy com- ments that Jon passes well as a male and reflects back to Jon that the sadness he feels might be related to the stressors involved in being a transgender person and not the recent loss of his mother. Jon denies this possibility and goes on to describe a warm, supportive, and accept- ing relationship between he and his mother. He states to Dr. Cozy that he would like to focus on processing the loss and moving on with his life. Later in the clinical interview, Dr. Cozy asks questions about Jon’s transition from female to male and his social supports. Jon states that his social supports are excellent and his transition was supervised by a treatment team of spe- cialists in the area. Again, Dr. Cozy suggests that Jon’s symptoms might relate more to uncon- scious conflicts he has within himself regarding his transition and whether his mother truly accepted him before she died. Jon thanks Dr. Cozy for his time and leaves the session abruptly.

ሁ What led Dr. Cozy to emphasize Jon’s transition rather than the issue Jon wanted to discuss?

ሁ How might Dr. Cozy have handled the situation differently to avoid Jon’s sudden departure?

6.1 What Is Your Theoretical Orientation? Earlier in the curriculum for the psychology program, you learned about theories of person- ality. In your abnormal psychology course, you had an opportunity to use those theories to understand typical, atypical, and pathological ways of thinking and behaving. These experi- ences allowed you to explore different theories of personality while investigating whether one or more theories fit your natural way of working with people who need the attention of a mental healthcare provider—a general term for any licensed or otherwise appropriately credentialed professional who provides counseling, psychological, or psychiatric services. This section will briefly review the most widely recognized theories of personality.

For those of you who are planning to enter the workforce with your bachelor’s degree, this section will help you see multiple ways of understanding a person’s psychological situation. Each theory presented in this section emphasizes different aspects of people to focus on when understanding possible reasons for why they behave or think the way they do. This can be very useful in any field involving human interactions, as having a framework to understand a person can help us communicate better. For example, professionals in any field should com- municate better information than “that person is crazy!” Instead, professionals should com- municate more nuanced views of people such as, “this person has difficulty in socializing well with others, but he is a hard worker and is important to the team’s efforts.”

For those of you who are planning on getting advanced degrees in psychology, you will inevi- tably be confronted with the task of identifying yourself as a follower of a particular psy- chological theory. Usually, this question is expressed in professional settings as, “what kind

Section 6.1What Is Your Theoretical Orientation?

of psychology do you practice?” While experimental and research psychologists might be excused from answering this question with regards to theories of personality, counseling and clinical psychologists generally align themselves to at least one theory. As a recent graduate, you are not expected to have an answer to this important question in the very early stages of your career, but you will need to settle on a particular theory and approach as you get deeper into the field, especially if you choose to go into clinical or counseling psychology. This pro- cess may come naturally to you as you learn more about theories and their corresponding treatments. However, some people might find it difficult to choose only one theory to align their conceptualization and treatment approaches with.

Aligning yourself with one theory or a more general school of thought will be an important task as you develop your career, and it is critically important to be aware of the history of the- ories in psychology as well as new theories that are emerging so you can make an informed decision for your professional development.

Building Up to the New Wave of Psychotherapy At this point over the course of your degree, you have been exposed to the most common and prevalent theories of personality including psychoanalytic, behaviorist, humanistic, and cog- nitive theories. Each of these make up the four major waves of thought within psychology and the evolution of our understanding of human thoughts and behaviors. We will review these waves briefly before moving on to a new and emerging fifth wave of psychotherapy later in the chapter.

The first wave is psychoanalysis. This wave of thought encompasses the early 20th century theories of Sigmund Freud while also including the more modern analytic and psychodynamic theories that developed from Freud and other research- er’s early ideas. Psychoanalysis places an emphasis on unconscious processes and seeking relief from internal psycho- logical conflict through catharsis and the development of insight. Freud’s model of the psyche included three parts (Freud, 1923). The first part is the id, which is driven by the pleasure principle. Essen- tially, the id is simple and hedonistic, seek- ing to drive an individual toward pleasure in any way possible. For example, the id is the part of the mind that may drive you to eat an entire cake at a friend’s birthday party, by yourself, in one sitting, if it had its way. The second part is the superego, which can be thought of as the conscience. This part of the psyche is also essentially simplistic, as it provides a strict internal moral voice based on societal and famil- ial standards that are internalized by the

Science and Society/SuperStock ሁ The concept of the “unconscious” was

popularized by the famous psychoanalyst Sigmund Freud.

Section 6.1What Is Your Theoretical Orientation?

individual through the lifespan. For example, the superego is the part of the mind that may drive you to eat no cake at all at a friend’s birthday party because eating cake is unhealthy. The third part of the psyche is the ego, which is driven by the reality principle. This part of the psyche can be thought of as the referee between the id and superego, giving us the ability to maximize pleasure while minimizing pain through techniques such as delaying gratifica- tion. For example, the ego would recognize that while it is unhealthy to have cake, it would be meaningful to your friend if you had at least a small piece of cake as part of the birthday celebration.

The second wave is behaviorism. This wave of thought was a reaction against psychology’s early reliance on the nebulous and immeasurable unconscious processes that psychoanalysts based their work on. In place of unconscious processes, behaviorists emphasized measuring observable aspects of human behavior in an effort to understand and change problematic behavior patterns (Watson, 1913). Theorists such as John Watson and B.F. Skinner forged a path for this influential wave that would remain at the front of psychological practice and research from the 1950s through the 1980s. From behaviorism came the concepts of classi- cal conditioning and operant conditioning. For an example of classical conditioning, or the process of pairing a neutral stimulus with a conditioned stimulus, refer to the famous case of Pavlov’s dog, which you should have learned about in your introduction to psychology course. Let us briefly review operant conditioning, or the process of strengthening or weakening behaviors (Skinner, 1938).

The goal of reinforcement is to encourage a particular behavior, whereas the goal of punish- ment is to discourage or reduce a particular behavior. When the terms positive and negative are used in this context, they do not mean good and bad. Instead, positive means something is added to the environment, and negative means something is taken away from the environ- ment. Therefore, positive reinforcement involves adding a stimulus to encourage a particular behavior (e.g., rewarding a dog with a treat after it does a trick to encourage the dog to do the trick again), while negative reinforcement involves removing something to encourage a particular behavior (e.g., having someone wear gloves to avoid being burned by fire, remov- ing the possibility of being burned which increases the likelihood the person will wear gloves around fire again in the future). Positive punishment involves adding a stimulus to discourage a behavior (e.g., a spanking after a child does something wrong to discourage the child from repeating the behavior). Negative punishment involves removing a stimulus to discourage a behavior (e.g., taking away driving privileges after breaking a rule to discourage rule breaking in the future). See Table 6.1 for a matrix representation of these concepts.

Table 6.1: Reinforcement and punishment

Encouraging a behavior Discouraging a behavior

Adding a stimulus Positive reinforcement Positive punishment

Removing a stimulus Negative reinforcement Negative punishment

Punishment only works as long as the punisher is physically present, which is why reinforce- ment is psychologist’s preferred method for shaping behavior and creating lasting, substan- tial changes (Gershoff, 2002).

Section 6.1What Is Your Theoretical Orientation?

The third wave is humanism/existentialism. This wave rejected the automatic processes explored by the previous two waves and instead focused on self-determination, emotions, and the human potential for growth and self-actualization (Rogers, 1946). Theorists and phi- losophers such as Carl Rogers and Abraham Maslow emphasized the importance of accep- tance, genuineness, and empathy in the development of an individual’s psyche. Their belief was that people can realize their goals if they are given enough psychological support. Thera- peutic strategies such as unconditional positive regard grew out of this school of thought, as well as the theoretical model of the hierarchy of needs, which continues to influence our therapeutic priorities in triage situations. Additionally, the concept of being patient-centered arose from this wave, which directed providers to focus on their patient’s complaints rather than exclusively on what the provider believed the patient’s problems might be.

The fourth wave is cognitivism. This wave emphasized the power of a person’s internal thoughts and external observations in the development of personality. Theorists such as Albert Bandura emphasized the role of observation and interpretation of others, leading to social learning theory and the idea of reciprocal determinism (Bandura, 1977). In a radical departure from behaviorism, Bandura put forward the idea that learning could take place without direct experience. Instead, according to social learning theory, a person could learn merely by observing another. The ideas of modeling and imitation in social learning theory emphasize that people tend to imitate the behavior of people they admire or respect. This led to new strategies in media and education for influencing positive social change through “entertainment-education” programs (https://www.apa.org/monitor/oct02/theory.aspx). However, this model also recognized that observation and social learning did not necessarily lead to changes in behavior. Where behaviorism emphasized the interaction between behav- ior and the environment, the idea of reciprocal determinism emphasized the complex interac- tion between an individual’s thoughts, behavior, and environment. Thus, Bandura recognized that people have the ability to think ahead and anticipate situations, which can then influence their behavior and environment. For example, a person might avoid going into a crowded party if they think being in a crowd will give them anxiety or other uncomfortable feelings. Aaron Beck was another theorist in this area who emphasized the role of core beliefs and how these beliefs shape our interpretations of ourselves and others (Beck, 1967). For example, people who are depressed generally have core beliefs of being unlovable and inferior to oth- ers. Thus, even when encountering someone who appears to like him or her, a depressed person will tend to dismiss the other person as a liar.

The Fifth Wave of Psychological Thought There is an emerging fifth wave of thought within psychology—integrative psychology. This wave of thought allows for the potential incorporation of concepts and interventions from all four previous waves, sometimes merging them with ideas gathered from Eastern ways of thought (Norcross & Goldfried, 2005). Arguably, this is the first wave to recognize the signifi- cance of multiculturalism and the impact of culture on a person’s psyche. Two notable models are worth mentioning here.

The diathesis–stress model was an early idea within integrative psychology that attempted to explain why some people develop conditions or traits while others do not, especially in situa- tions where it appeared one person developed a condition or trait while their identical twin, separated at birth, did not. The model explains that a person’s genetics predisposes them to a particular condition or trait, while the environment determines whether that trait will be expressed. Thus, a man who is genetically predisposed to develop schizophrenia and lives in

https://www.apa.org/monitor/oct02/theory.aspx

Section 6.2What Is Normal?

a calm and supportive family environment might be psychologically healthy, while his identi- cal twin who lives in a profoundly volatile family environment might develop schizophrenia.

The transtheoretical model, or stages of change model, developed by Prochaska and Di Cle- mente conceptualizes a person’s readiness to change and their overall process of change. In this model, change is a five-stage process, not including the final termination stage (1983). These stages include pre-contemplation, contemplation, preparation, action, and mainte- nance. Although there are criticisms of stage models in general, this model continues to be used widely amongst psychologists and professionals in substance use disorder treatment programs. We will come back to this model later in the chapter when we cover treatment interventions.

6.2 What Is Normal? Your course in abnormal psychology spent a significant amount of time exploring the cri- teria for diagnoses and the subjectivity of abnormal psychology. While psychologists use approaches such as the statistical frequency method (defining normal based on how fre- quently a behavior or thought appears) and the social norms perspective (defining normal as acceptable or expected behavior within a culture) to understand abnormality, there are still many questions about what we consider normal and abnormal.

Concepts from abnormal psychology are used by clinical and counseling psychologists on a daily basis, and other careers often draw on this knowledge to inform their decision-making processes. Educators often use knowledge about learning disorders to refer students for eval- uation or to assist in making individualized education programs, while law enforcement per- sonnel use knowledge about severe psychiatric conditions to interact effectively, safely, and peacefully with people who may be a danger to themselves and others. In everyday life, knowledge in this area can help anyone understand behaviors and thoughts that may other- wise be dismissed immediately as bizarre or sick.

A F O R E N S I C P S Y C H O L O G I S T S P E A K S Ellen Scrivner, PhD Police and Public Safety Psychologist

Helping to Shape Police Work

When Ellen Scrivner, PhD, took her first job as a psychologist with the Fairfax County, Virginia, Police Department, she thought the position would last about a year. She stayed for seven, then moved to a neighboring jurisdiction, the police department in Prince George’s County, Maryland. Now, more than 30 years later, she looks back on a career that also took her to the U.S. Department of Justice, the Chicago Police Department, the John Jay College of Criminal Justice and the Police Foundation—with a few stops in between, includ- ing a presidential appointment as deputy director of the National Institute of Justice, the research arm of the Department of Justice. Along the way, she has been involved in shaping and witnessing enormous changes in the way police do their work.

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A F O R E N S I C P S Y C H O L O G I S T S P E A K S ( c o n t i n u e d ) Historically, police departments were paramilitary organizations, she says. “You answered up the line and you responded to calls,” Scrivner says of police officers. “It was more a reac- tive style of policing.” There was no psychological screening of officers. However, several federal commissions in the 1960s and 70s recommended changes in hiring practices. Police departments began to realize they needed to do things differently, and that was where psychologists came in. Scrivner began by helping to develop pre-employment psychologi- cal screening, but soon police chiefs were asking for more, including counseling for officers and their families, training programs, and assessment of officers’ fitness for duty. “We had something to offer that made them think about things in a different way,” she says. “It’s a field that grew and grew, and it continues to grow.”

Police work started to become more proactive in the late 1980s and early 1990s because crime rates were soaring, Scrivner recalls. “Police were saying, ‘We can’t just keep arrest- ing people, something else has to be done,’” she says. The answer was to institute “com- munity policing,” where police are visibly out in the community, engaging in collaborative problem-solving to enhance public safety, even when no crimes are in progress.

Policing the Post 9/11 World

When Sept. 11 happened, policing changed again in an effort to predict who was likely to commit crimes in a community. “Community policing didn’t go away but people started talking about ‘intelligence-led policing’—you needed to be able to predict who was going to do bad things in your community,” Scrivner says. This style persisted for a while, but, even- tually, it began to blend with community policing.

One of the most important recent trends in policing has been the spread of collaborative police reforms that are designed to strengthen the effectiveness of police agencies. Crisis intervention teams are one element of this reform and are very important for helping peo- ple in emotional distress, according to Scrivner, an expert in this area. These teams “came out of the community policing movement and were designed to pair police officers trained in crisis intervention with mental health professionals who respond to individuals in the community who are in a state of behavioral crisis,” she says. Often, these teams are created following a series of community complaints into how the department is interacting with citizens, thus triggering a federal investigation into police patterns and practices. “Crisis intervention teams have become almost a staple in what the government recommends,” Scrivner says. They have led to more people getting mental healthcare, rather than being arrested and put in jail, she says.

Making a Difference in People’s Lives

Scrivner earned bachelor’s and master’s degrees in psychology from St. Louis University, then got married and moved to Washington, D.C. When her two children were older, she returned to school, earning her doctorate in psychology from Catholic University in 1985. While completing a visiting fellowship at the National Institute of Justice, she was recruited to help establish the Office of Community Oriented Policing Services, or COPS, at the Department of Justice, where she subsequently served in leadership positions (1994– 2003), including as deputy director. The COPS program has trained more than 500,000 police officers, community members, and government leaders to form partnerships to help prevent crime and address public safety issues. After 9/11, the FBI requested her assis- tance in helping its newly appointed assistant director set up an Office of Law Enforcement

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Section 6.2What Is Normal?

a calm and supportive family environment might be psychologically healthy, while his identi- cal twin who lives in a profoundly volatile family environment might develop schizophrenia.

A F O R E N S I C P S Y C H O L O G I S T S P E A K S Ellen Scrivner, PhD Police and Public Safety Psychologist

Helping to Shape Police Work

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Policing the Post 9/11 World

Making a Difference in People’s Lives

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Section 6.2What Is Normal?

The following subsections will discuss assessment, the role of diagnosis in mental healthcare, and treatment interventions. For a comprehensive review of widely accepted psychiatric diagnoses and criteria in the United States, please refer to the current version of the Diagnos- tics and Statistical Manual (DSM; American Psychiatric Association, 2013) which can usually be found in your school’s library.

A note on terminology: through this chapter, you will see references to “the patient” rather than “the client.” Some psychologists prefer to use the term “client” because their theoreti- cal orientation leads them to create a more egalitarian therapeutic relationship. Often, these psychologists follow a humanistic or client-centered approach. Other psychologists prefer to use the term “patient” because their theoretical orientation leads them to recognize that the psychologist has advanced knowledge and skills in the area of psychology that can be used to help the patient. These psychologists often align more closely to the medical and psychoana- lytic models. Other variations in language will be discussed later in this chapter.

Personality Assessment Psychologists in the area of personality assessment have created several ques- tionnaires since the 1920s, known broadly in the field as objective measures, that attempt to capture an individual’s person- ality style. Some questionnaires found in magazines and on online dating websites might use similar techniques to those found in these objective measures, but these knockoff tests often lack the validity and reliability of the more refined objec- tive measures used by psychologists. Per- sonality tests used by psychologists might be used for a variety of non-clinical pur- poses including self-improvement, career

A F O R E N S I C P S Y C H O L O G I S T S P E A K S ( c o n t i n u e d ) Coordination to improve the coordination among local, state, and federal law enforcement agencies. Scrivner also served as deputy superintendent for administration from 2004 to 2007 for the Chicago Police Department and headed a leadership program for criminal jus- tice and public safety officials at the John Jay College of Criminal Justice from 2007 to 2009. As she was thinking about changing career direction to devote more time to consulting and writing, she was named an executive fellow at the Police Foundation, a post that allows her to continue to advise police departments and other law enforcement agencies in areas including crisis intervention and changing leadership models.

Asked what has been most satisfying about her career as a psychologist, Scrivner sums it up simply: “Through my work with law enforcement, I know that I have made a dif- ference in people’s lives, both individually and community-wide. It gives me a good feel- ing that I studied something that enabled me to make a contribution and a difference in people’s lives.”

Vladwel/iStock/Thinkstock ሁ Personality assessments can be used for both

clinical and non-clinical purposes.

Section 6.2What Is Normal?

progression, and relationship development. Personality tests are also often used in clinical settings, which we will cover in more detail later in this chapter. For now, we will cover two popular personality assessments used in non-clinical situations where psychological abnor- mality is not suspected or is not necessarily the issue at hand.

The Myers Briggs Type Indicator (MBTI) is an objective forced-choice assessment that asks an individual to answer 93 true/false questions that fall into one of four different catego- ries (Myers & Myers, 1995). These categories represent distinct components of personality including extraversion (E) vs. introversion (I), sensing (S) vs. intuition (I), thinking (T) vs. feeling (F), and judging (J) vs. perceiving (P), allowing for 16 different personality types. Upon completion of this assessment, the person is provided with their MBTI type and a report on the characteristics often found in people who have their particular type. While the MBTI reports on a person’s apparent preference for a particular type, it differs from other per- sonality assessments in that it does not report on the strength of that type. This assessment is sometimes used in couple’s therapy or in workplace settings to enhance teamwork and mutual understanding.

The NEO Personality Inventory-3 (NEO PI-3) is a personality assessment that looks at an individual’s personality traits as conceptualized by the five factor model, otherwise known as the Big Five (McCrae, Costa, Jr., & Martin, 2005). This assessment includes 240 questions that are answered on a five point Likert scale and can be answered either by the person being assessed (Form S) or by an observer (Form R). At the conclusion of the assessment, a report is generated that shows the person’s strength on each of the five areas of the Big Five—open- ness to experience, conscientiousness, extraversion, agreeableness, and neuroticism. An easy way to remember the personality dimensions included in the Big Five is to think of the acro- nym OCEAN. A shorter version of this personality assessment—the NEO FFI—is also avail- able and has only 60 questions. This personality assessment is sometimes used for career guidance, coaching, and employee selection.

Assessing the Patient Compared to a personality assessment, writing a psychological report or a biopsychosocial assessment is far more involved. Usually, there are several steps a mental healthcare provider must follow before considering whether the patient’s situation is abnormal and whether that abnormality reaches the threshold for a psychiatric diagnosis. This section will encourage you to think like a diagnostician and will cover tasks that a healthcare provider must complete before diagnosing their patient. This way of thinking can be useful for any situation where the goal is to understand a person in-depth rather than to fit the person into a particular category.

The assessment portion of the report typically includes the following:

1. Presenting problem—This section closely relates to the question presented to every patient in the first session: “What brings you in today?” Often, reports include a verbatim quote that captures the essential complaints and concerns a patient has regarding his or her situation. Remember the scenario at the beginning of the chap- ter? Dr. Cozy did a poor job focusing on his patient’s presenting problem, choosing to focus on his own assumptions and not on Jon’s complaints. A patient-centered provider would have focused on Jon’s bereavement rather than on his being a trans- gender person.

Section 6.2What Is Normal?

2. Personal and family history—This section includes developmental history begin- ning as early as the patient can recall in addition to any medical and mental health history and corresponding treatment outcomes. Family medical and mental health history are also included in this section.

3. Collateral—This includes all information that is gathered from the patient’s family, friends, and healthcare providers (if available).

Usually the process of assessment begins with a semi-structured clinical interview wherein the provider and patient discuss the patient’s reasons for seeking out services, personal his- tory, and any goals for treatment the patient has. Sometimes, this clinical interview may be supplemented by personality tests mentioned earlier, clinically-oriented personality tests such as the Minnesota Multiphasic Personality Inventory-II (MMPI-II), or projective tests such as the Rorschach Inkblot Test. In fact, mental healthcare providers are increasingly rely- ing on multiple measures, such as patient questionnaires and structured clinical interviews, to assess a patient’s baseline or average level of functioning and to monitor the patient’s prog- ress and improvement throughout treatment. This is because it is not generally a good idea to base conclusions on only one test or one interview. These multiple measures often serve as evidence to support the continued treatment of patients when insurance companies perform utilization reviews, or reviews where the medical necessity of treatment is assessed by an outside third party.

Another very important task involved in assessing the patient is to gather all of the patient’s relevant medical and mental health records for review. No patient lives in a social vacuum, so it is very important to get the perspectives of the patient’s friends, family, and healthcare providers where this information is relevant to treatment and available. For example, some mental healthcare providers might get the patient’s permission to interview family members or friends who may have valuable perspectives to contribute to the assessment process. If a person describes symptoms similar to obsessive compulsive disorder, his roommate might be interviewed to get a better idea of the extent and the nature of the behavior. Additionally, assessments and testing conducted by other providers should be included when records are shared between providers. All of this information together is known as collateral. Once these steps are complete, the provider can begin creating a report that will outline evidence leading to a case conceptualization, diagnosis, and treatment recommendations.

Case Conceptualization Remember the waves of personality theories we reviewed earlier? This next section of the report is where providers choose one theory to use to interpret the assessment section of the report. In other words, this section of the report summarizes and rewords information in the assessment section using terms and ideas from a specific psychological theory. Taking into account the patient’s presenting problem and history, the psychologist creates a summary of their situation through the lens of a theory of personality. In the case of Jon and Dr. Cozy, a humanistic psychologist would have emphasized the present experience of Jon’s grief while encouraging the development of Jon’s capacity to live as full a life as possible after his loss. Alternatively, a cognitive psychologist would have focused on exploring the role Jon’s mother had in his life while allowing Jon to express his life story and grief, challenging unhelpful or problematic thoughts, and guiding Jon to finding a way to live without his mother.

Section 6.2What Is Normal?

Diagnosing the Patient Finally, we arrive at the task of diagnosing the patient. Diagnosis occurs only after the men- tal healthcare provider collects all relevant information from the patient and evaluates that information against symptoms found in a diagnostic manual. This is significantly different from methods found in other fields, in which an investigator starts with a hypothesis, con- ducts a test for the hypothesis, and then determines whether the hypothesis holds true. A psychologist who makes a diagnosis before collecting all relevant information would right- fully be accused of prejudice.

After collecting as much information as possible and developing a case conceptualization, the diagnostic process can begin. Using the DSM or another accepted diagnostic manual such as the ICD, the psychologist can compare the case conceptualization to symptoms for disorders found in the manual (First & American Psychiatric Association, 2014). If sufficient symptom criteria are met, a diagnosis can be made. If sufficient symptom criteria are not met, no diag- nosis is made or the diagnosis may be delayed or deferred until more information is available either through direct observation or more collateral.

In previous versions of the DSM, diagnoses were made according to something called the multiaxial system. You may still encounter medical notes and professionals who use this sys- tem, even though we do not use this system as of the DSM-5. Axis I included all psychiatric disorders except personality disorders and mental retardation, Axis II included personality disorders and mental retardation, Axis III included medical conditions, Axis IV included social and environmental problems, and Axis V included a score that captured a person’s level of functioning from 0 (dead) to 100 (perfect). Additionally, in some professional settings, you may encounter providers who refer to patients as “Axis 2” patients. This term, often used to refer to a patient who is difficult or has received a personality disorder diagnosis, is pejora- tive, inappropriate, and should be avoided.

Career Spotlight: Jack Singh

Name: Jack S.

Primary job title: Client Receptionist

Type of employer: Community Mental Health Center

How long have you been employed in your present position? 1 year.

What degrees do you hold? I have a Bachelor of Arts in general psychology.

Describe your major job duties and responsibilities. I am usually the first person that clinic patients interact with when they visit, so my job is really important. I schedule appointments, help patients finish their initial paperwork, and sometimes help patients calm down when they are in crisis mode and our clinicians aren’t available right away. I can’t diagnose patients, but I’m familiar with some psychiatric conditions since I learned about abnormal psychology in college.

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Section 6.2What Is Normal?

Career Spotlight: Jack Singh (continued)

What do you like most about your job? I love seeing the DSM come to life every day around me. I also like interacting with patients as a receptionist, because they don’t see me as a psychologist or healthcare provider. Sometimes they tell me things they say they wouldn’t tell their therapist. Since I’m part of the treatment team, this information gets shared with the doctors, especially in cases where the patient might be a danger to them- selves or others. I think this experience is really getting me ready for graduate school and eventually becoming a licensed practitioner.

What do you like least about your job? I really dislike the amount of paperwork that is involved, but I guess it should be expected as receptionist. Clinics are really concerned with avoiding lawsuits, so they tend to document everything, and part of my job is to make sure all patient files are complete. There are forms after forms to fill out for every patient, and even more forms for complicated situations. When I become a private practi- tioner, I’m going to find some way to minimize paperwork while keeping up with my legal responsibilities.

Beyond your bachelor’s degree, what additional education or specialized training have you received? I just have a BA in psychology, but I’m taking continuing education courses and certifications to get ahead of some other students who are applying to gradu- ate school. I’ve found the Zur Institute’s offerings to be easy to follow and very interesting (www.zurinstitute.com). These certifications don’t qualify me to provide treatment of course.

What is the compensation package for an entry-level position in your occupation? Since I work here full-time, I make about $15 an hour and have health benefits, life insur- ance, paid vacation and sick leave, and some discounts offered through my clinic’s parent company.

What are the key skills necessary for you to succeed in your career? To be a recep- tionist at a community mental health clinic, I need to be able to adapt quickly to whatever happens in the moment. I also need to be able to remain composed in the face of very stressful or verbally aggressive situations. Organization, patience, and a friendly personal- ity have really helped me succeed in this position.

Thinking back to your undergraduate career, can you think of outside of class activi- ties (e.g., research assistantships, internships, honor societies, student groups, etc.) that were key to success in your type of career? Yeah, I used my university’s psychology club to connect with my classmates, which turned out to be one of the most valuable expe- riences I had. Through the club, I also made professional connections with my professors that I’ve kept to this day. Actually, two of my professors have been pushing me lately to attend a graduate program that I’ve had my eye on for a long time.

As an undergraduate, do you wish you had done anything differently? If so, what? I wish I hadn’t waited to the last minute to complete my homework as often as I did. Getting my work done ahead of time and going over it with my professors was so valuable when I was able to do it, and my grade usually went up a lot when I took the time to do this.

What advice would you give to someone who was thinking about entering the field you are in? It isn’t too early to start looking at graduate programs and opportunities to get involved in the field. Join professional organizations, go to conferences, and use every opportunity to make professional connections with people who are already established in the field.

http://www.zurinstitute.com

Section 6.2What Is Normal?

Sometimes, healthcare providers fall into the trap of diagnosing a patient based solely on the diagnoses that patient might have received from previous healthcare providers. This auto- matic carrying over of diagnoses is not favored in reputable healthcare settings and is often reflective of a healthcare provider’s reluctance to put in time and effort creating an indepen- dent diagnostic assessment of a patient. In almost every setting, the patient’s diagnosis his- tory is valuable information, but the diagnosing provider must always come to an indepen- dent conclusion.

One situation when patients’ previous history might be given more weight would be in emer- gency care settings where assessment is impossible and immediate care is needed. For exam- ple, an EMT dealing with an unfamiliar suicidal person about to jump off a bridge would need to make immediate intervention choices based on very limited information. In this kind of sit- uation, the patient’s previous history would be strongly considered if it were available, along with any other information the EMT could gather to direct immediate intervention choices. Once the crisis passed, the diagnosing provider would be able to conduct a more thorough assessment and provide a diagnosis if the patient remained in a healthcare setting such as a hospital.

Finally, not every patient who attends psychotherapy regularly has a diagnosis. In some situa- tions, patients might be well-adjusted psychologically for the most part. For example, a person might seek out psychotherapy to develop a deeper understanding of themselves or others, or to simply discuss their life issues and concerns with an impartial and objective healthcare professional. In other words, some people seek out psychotherapy when they really want a philosophical discussion, or to use it as a secular confessional, and thus may not necessarily meet criteria for a psychiatric diagnosis. Since insurance will only pay for treatment that is considered medically necessary, some providers in these cases might diagnose their patient with a disorder in order to take advantage of insurance benefits. This is considered insur- ance fraud and can result in sanctioning from a provider’s licensing board if such fraud is discovered.

Developing a Treatment Plan Once a diagnosis is made, a treatment plan can be created. This plan is often developed in consultation with the patient, rather than a doctor imposing a particular treatment on the patient. This collaborative process grew out of humanistic styles of psychotherapy in which emphasis was placed on being patient-centered. This strategy for ensuring a patient’s invest- ment in treatment has carried over into many areas of counseling, psychology, medicine, and

T E S T Y O U R K N O W L E D G E Imagine you are working in a community mental health clinic as a treatment provider. During a treatment team meeting where collateral information is being reviewed, you dis- cover that your clinical supervisor diagnosed a patient based only on diagnoses made by other providers and not on the intake specialist’s assessment and recommendation. How would you address this with your clinical supervisor? How would you respond if the clini- cal supervisor stated, “We need to trust the judgment of this patient’s previous providers”?

Section 6.2What Is Normal?

other healthcare fields, collectively known as helping professions. In this section, we will cover language considerations in treatment planning, the importance of evidence-based practices, and a brief review of treatments within each wave of personality theories, including the new integrative psychotherapy and emerging biological approaches.

One important language consideration in the area of treatment planning is the use of the words “therapy” and “psycho- therapy.” When professionals in the same profession talk about therapy, it might be safe to assume that they all understand what kind of therapy is generally being discussed. However, in the vast majority of cases, the patient’s treatment team is made up of professionals from different areas of the helping professions. As there are several types of therapy, including massage therapy, aromatherapy, psychotherapy, and equine therapy, using just the term “therapy” might become confusing very quickly. Even within psychotherapy, there are several types of therapy, including psychodynamic psychotherapy, behavioral ther- apy, cognitive therapy, and gestalt therapy. When creating a treatment plan, it is best to be as specific as possible about the type of therapy being included.

Another important language consideration in treatment planning is the use of the word inter- vention. In the general public, the word intervention tends to evoke images of families con- fronting a drug user before sending them to a rehabilitation program. This type of interven- tion is known in the field as the Johnson method and has been popularized on reality TV shows such as Intervention. However, in the psychology field, the word intervention is used to refer to any psychotherapeutic strategy designed to minimize symptoms and provide psy- chological relief to a patient. Thus, healthcare providers might refer to cognitive interventions or behavioral interventions when discussing a new prescription or course of therapy. Keep this in mind as we discuss treatment strategies and interventions within the different waves of personality theories.

Additionally, healthcare providers are generally expected to follow evidence-based practices when treating patients. This essentially means that the treatment method being used has been shown to be effective through peer-reviewed research or substantial data collection. It also means introducing therapeutic interventions that match the psychological theory used in the case conceptualization. For example, a provider would not conceptualize a patient’s situ- ation using psychoanalytic terms and then use behavioral interventions to set up a treatment plan. In rare cases, a provider might use new treatment methods with the patient’s permis- sion and awareness that the treatment may not be effective. The Society of Clinical Psychol- ogy, Division 12 of the American Psychological Association, compiled a list of disorders, their corresponding evidence-based treatments, and additional resources in an easy to understand online database (https://www.div12.org/psychological-treatments/). Some of these treat- ments are reviewed here.

Psychoanalysis, the first wave, introduced the potential for unconscious processes to influence our thoughts and behaviors. One notable intervention strategy within classical psychoanalysis

DragonImages/iStock/Thinkstock ሁ Treatment plans drafted with the input of both

the doctor and patient come out of the humanistic tradition, which centers on patients.

https://www.div12.org/psychological

Section 6.2What Is Normal?

is dream interpretation. In classical terms, psychoanalysts pointed to the images presented to us through dreams, or manifest content, and the meanings behind those images, or latent content. The goal of the analyst in dream interpretation is to find symbols within a dream and meanings for those symbols that would help a person understand unconscious processes. For example, a person who dreams about showing up to a test in nothing but underwear might be holding onto some feelings of inadequacy and be afraid of being exposed as a fraud, symbol- ized by the lack of clothing, in addition to having more general anxiety about passing a test. Although dream dictionaries have gained recognition in some pop psychology circles, their validity remains questionable, since the meaning of a particular symbol may change dramati- cally from person to person.

Out of classical psychoanalysis came the more flexible psychodynamic psychotherapy and corresponding evidence-based treatments. One notable intervention strategy is Interper- sonal Psychotherapy for Depression (IPT), which is a well-established treatment for Major Depressive Disorder. IPT is a brief, short-term treatment consisting of 12–16 semi-structured sessions that target interpersonal dynamics and relationships (Klerman, 1994). This form of treatment has been shown to be as effective as antidepressant medication (Cuijpers, Donker, Weissman, Ravitz, & Cristea, 2016).

From the second wave of personality theories, behaviorism, came an understanding of the environment’s effects on an individual’s behavior. One notable intervention strategy within behaviorism is systematic desensitization, a treatment strategy that is incredibly effective at reducing fears and phobias. This strategy involves three steps. First, the patient and provider create a fear hierarchy where stimuli around a particular fear or phobia are ranked accord- ing to the amount of subjective distress the person experiences when confronted with each stimulus. For example, a person who has arachnophobia (fear of spiders) might start with a picture of a spider as their lowest ranked stimulus, followed by a video of a spider in the wild, a video of a person holding a spider, having a spider in a small cage across the room, and so on up to the highest rank, which would be that person holding a spider. Second, the patient learns coping techniques for anxiety such as progressive muscle relaxation and deep breathing exercises. Third, the previous two steps are put into action and the patient is guided through their fear hierarchy.

When the patient feels anxiety or fear that is too overwhelming, the therapeutic exercise stops until the patient calms down and begins again with the stimulus highest on the hierarchy that produced no anxiety. In the arachnophobia example, the person might be able to relax when shown images and videos of spiders, but become too anxious when a spider is in the room. The therapy would stop until the patient calmed down, and then resume with the patient watching a video of a spider, trying to work up to being in the room with one, and eventually holding one, without feeling anxiety or fear.

Part of the third wave of personality theories, humanistic psychology reminded us of the par- amount importance of the quality of the therapeutic relationship in psychological treatment. It also reminded us of the role of unconditional positive regard and empathic support in the development of an individual’s psyche. These interventions are used throughout the help- ing professions but are most noticeable among counseling psychologists. Techniques within this wave emphasize the here and now of the patient’s genuine and authentic experience of the self and the world. Two notable therapies that grew from humanistic psychology include narrative therapy and gestalt therapy. In narrative therapy, patients are given the opportu- nity to examine their own knowledge, skills, and values while questioning the origin of those qualities. With the healthcare provider’s assistance, patients decide whether to co-author a

Section 6.2What Is Normal?

new narrative of their life. In gestalt therapy, the role of the therapist departs radically from psychoanalysis; the therapist is called on to behave in a genuine and authentic manner while encouraging the same kind of genuine and authentic presence from the patient. Again, the emphasis in this therapeutic style is on experiencing the here and now, and the therapist and patient are expected to surrender to any event that happens naturally through the course of the therapeutic encounter rather than trying to control the outcome of the encounter.

Part of the fourth wave of personality theories, cognitive psychology recognized the reciprocal determinism between behavior, thoughts, and the environment. The most widely recognized treatment from this wave is cognitive behavioral therapy, or CBT, which seeks to address the problems that can arise from the complex interaction between a person’s behavior, thoughts, and feelings. One of the most widely used concepts from this wave is the idea of cognitive dis- tortions (Burns, 1989). These distortions are common, problematic thoughts that can create a significant amount of distress for the person. Some of these distortions, like disqualifying the positives, can be easily challenged and changed by talking through them once they are recognized. When a person disqualifies the positives, they tend to hyperfocus on negative information, no matter how weak, even in the face of overwhelming positive information. For example, a music student after his first performance might hyperfocus on the few mistakes he made, even after receiving a standing ovation. Other distortions, such as splitting, might be more reflective of serious mental illness and are far more resistant to change. When a person splits, they think of things as all good or all bad. This is also referred to as black-and-white thinking. For example, a person who is in the process of buying a home finds out that the loan company will not approve the purchase because too many repairs need to be made. If the person splits, they may give up on the process of buying a house altogether, thinking that the entire process is a waste of time and hopeless.

Integrative psychology, from the fifth wave of personality theories, recognized that there is no one size fits all approach to helping patients. Therefore, it is the provider’s task to conceptu- alize the patient’s overall situation through the lens of a theory while using techniques from multiple waves in order to adapt to the patient’s current level of functioning. This is where the transtheoretical model that we touched on earlier becomes relevant.

Remember that the transtheoretical model includes five (sometimes six) stages of change (see Figure 6.1). The first stage, pre-contemplation, recognizes that a person may be in denial about their condition or might not recognize a problem. In this stage, ideas from cog- nitive psychology might be used in addition to strategies from motivational interviewing. In some cases, psychoanalytic interventions to develop insight or humanistic interventions to build self-confidence might be valuable in this stage as well. In the second stage, contem- plation, the patient and provider weigh the pros and cons of changing a target behavior or mindset. Again, motivational interviewing techniques are valuable here. The third stage, preparation, asks the patient to start making small changes to see how he or she adapts and functions. Practical interventions such as stress management from cognitive therapy or sys- tematic desensitization from behavioral therapy are valuable during this phase. In the fourth stage, action, the patient makes substantial changes in his or her life. Continued application of cognitive and behavioral interventions is key here. Finally, in the fifth stage, maintenance, the patient continues the new pattern for a prolonged period. Cognitive and behavioral inter- ventions continue to help here while incorporating strategies from humanism to maintain self-confidence and self-monitoring.

Section 6.2What Is Normal?

There is a final stage in this model called relapse that is sometimes included. Relapse occurs when a patient falls out of maintenance and returns to a harmful habit or way of thinking. Due to findings that relapse is common, especially among substance abuse populations (CBSHQ, 2016), researchers acknowledge that people may cycle through the stages any number of times before achieving long-term maintenance of positive behavioral changes. The cycling process can be an upward or downward spiral. In an upward spiral, each time a person goes through the cycle, she or he learns from the relapse and grows stronger so that subsequent relapses are shorter or less damaging. In a downward spiral, each time a person goes through the cycle, she or he grows weaker, self-efficacy and belief in the ability to change weakens, and the relapses may be longer or cause greater damage to self and others.

Figure 6.1: The transtheoretical, or stages of change, model ሁ A flow chart illustrating the stages of change model and the actions taken by people in each stage.

Pre-contemplation

Denying there is a problem

Action

Making significant changes

Contemplation

Weighing pros and cons of change

Preparation

Making small changes

Relapse

Returning to harmful behaviors

Maintenance

Continuing improved behaviors

Section 6.3Ethics in Personality and Abnormal Psychology

To some people, the transtheoretical model might sound like eclecticism. However, this is not a correct interpretation of integrative psychotherapy. Eclectic psychotherapy represents a way of thought that uses interventions from multiple theories to address a problem without regard to how these interventions might fit together. For example, if a person complains of depression, an eclectic clinician might use CBT treatment interventions one day and then switch to psychoanalytic treatment interventions another day with no conceptual reason for the change. While this gives the healthcare provider a significant amount of freedom, its lack of evidence-based reasoning has made it a discouraged practice in psychology. In contrast to eclectic psychotherapy, integrative psychotherapy melds ideas from multiple waves or schools of thought to form a new understanding of humans and potentially new treatment options. Integrative understandings are closest to holistic understandings, in which the entirety of a person is conceptualized from biological, psychological, social, and spiritual perspectives. In this school of thought, a mental healthcare provider might conceptualize a person’s situa- tion using psychoanalytic concepts, but may use treatment interventions from other theories based on the person’s current level of functioning. For example, a patient who was conceptu- alized using psychoanalysis might need a behavioral intervention if the person has a sudden and unexpected psychotic break and begins acting out violently. In practice, many providers who identify with one wave or school of thought are, in part, integrative practitioners when they use treatment interventions from other waves.

6.3 Ethics in Personality and Abnormal Psychology As we covered earlier in this chapter, there are several pitfalls a healthcare provider might fall into, including relying too heavily on past diagnoses or artificially inflating a patient’s diagno- sis in order to take advantage of insurance benefits. Each profession within mental healthcare has an ethics code that can be referenced when in doubt of a particular course of action. For example, as discussed in previous chapters, psychologists are expected to follow the Ethical Principles of Psychologists and Code of Conduct (http://www.apa.org/ethics/code/index .aspx).

In treatment, one essential goal is to acquire a person’s informed consent before beginning any healthcare treat- ment or assessment. This is the process by which the healthcare provider goes over the potential benefits of a course of action, any limitations, and any foreseen poten- tial risks. In mental healthcare settings, informed consent also includes a discus- sion of confidentiality and the limitations of confidentiality, which is a large ethical issue in itself. In many states, confiden- tiality must be broken when a provider hears from the patient about current child abuse, elder abuse, or intent to harm one- self or others. In these cases, the provider must contact the appropriate law enforcement agency within a statutory window of time. One common misconception in the field is that the patient must sign an informed consent

Shironosov/iStock/Thinkstock ሁ Before treatment, doctors must obtain informed

consent from patients.

http://www.apa.org/ethics/code/index.aspx

Section 6.4Career Applications in Personality and Abnormal Psychology

document before beginning treatment. While this is a best practice and creates a paper trail for the provider to fall back on, having a signature is not a requirement as it is sufficient to note in the patient’s record that informed consent was covered and the patient agreed to terms.

One final consideration here is the use of the title “psychologist.” Legally, the only people who are allowed to use the title “psychologist” are people who have a doctorate in psychology and are licensed by their state to practice psychology independently. Doctoral students in psychology sometimes get in trouble for using this title inappropriately, and licensing boards are known to prosecute people for practicing or appearing to practice psychology without a license. Therefore, the appropriate title to use at any time before licensure would relate directly to your degree. For example, an undergraduate student in psychology can describe herself as “an undergraduate student in psychology,” while a person who holds a doctorate in psychology but does not have a license to practice may describe himself as a “doctor of psychology.” As the holder of a psychology degree, people may see you as an authority on this topic and ask for your opinions on their or their loved ones’ mental health. Keep in mind the limits of your degree and, rather than diagnosing them yourself, refer them to a local profes- sional. As you finish your bachelor degree in psychology, be sure to use your degree and your knowledge in an ethically-conscious manner.

6.4 Career Applications in Personality and Abnormal Psychology

As shared in the career spotlights throughout this chapter, there are several career options in psychology once a person obtains a doctorate and license to practice. But what career options might be available to those who choose to enter the workforce with a bachelor’s in psychol- ogy? In the context of this chapter, entering the workforce with this degree requires some imagination and thinking outside the box, as many popular careers in psychology require an advanced degree and license. There are, however, a few options at the bachelor’s level in other fields related to psychology, which we will cover in this section. At the end of each description, you will find a link to the most recent training and salary information from the U.S. Bureau of Labor Statistics.

Psychiatric Assistance Psychiatric technicians, or “psych techs” as they are often referred to, play a valuable support role in our modern mental healthcare system. Psych techs assist in many areas of psychiatric care, including providing support for psychological interventions implemented by a licensed provider, maintaining files and notes, and contacting collateral sources for additional infor- mation as necessary. One of the most valuable services they offer to psychologists is their ability to carry out support work in a psychological testing setting. While psychologists are usually the only providers authorized to score and interpret psychological tests, there are often few or no restrictions on who can administer the tests beyond the requirement that the person be supervised by someone qualified to score and interpret the test. Although there may be few restrictions, responsible clinics and hospitals will only allow those with a formal education in psychology any access to psychological testing settings. A psychologist might employ a psych tech to help administer the Minnesota Multiphasic Personality Inventory-II (MMPI-II) to a group of prospective law enforcement officers while the psychologist scores

Section 6.4Career Applications in Personality and Abnormal Psychology

and interprets tests that were completed earlier. This kind of system has the poten- tial to generate a significant amount of income for the psychiatric team while offering relatively quick turnaround for law enforcement departments.

Follow the link to find information on the most recent training and salary informa- tion from the U.S. Bureau of Labor Statis- tics: https://www.bls.gov/ooh/health- care/psychiatric-technicians-and-aides .htm

Law Enforcement Law enforcement positions rely heavily on psychological knowledge, especially in situations where the officer might interact with members of the public who are impacted by severe psychiatric conditions. Police officers, FBI agents, fraud investigators, and many other law enforcement positions rely on concepts from abnormal psychology and personality theories to inform their work. In some special cases, law enforcement might be paired with a licensed mental health professional to better serve the public in psychiatric emergency situations. For example, many cities have a Psychiatric Emergency Response Team, or PERT, to respond to situations where a person might be suicidal or otherwise disturbing the peace due to hallu- cinations or delusions. For those who are interested in law enforcement and interacting with people who have psychiatric conditions, being part of a PERT is one of the best career fits.

Follow the link to find information on the most recent training and salary information from the U.S. Bureau of Labor Statistics: https://www.bls.gov/ooh/protective-service/police-and -detectives.htm

Social Work Social workers in this context use psychological concepts in situations where they are called on to investigate and assess whether complaints of abuse or neglect are valid. In these situa- tions, they may create reports for the court or other agencies to initiate or support legal pro- ceedings. It is important to distinguish social workers from case managers and licensed clini- cal social workers. We will cover case managers in the next section. Licensed Clinical Social Workers (LCSW) are mental health professionals who have an advanced degree in social work and are licensed to practice psychology by their state. The training for LCSWs closely resem- bles that of psychologists, but with more emphasis on linking the individual with community resources and social supports.

Follow the link to find information on the most recent training and salary information from the U.S. Bureau of Labor Statistics: https://www.bls.gov/ooh/community-and-social -service/social-workers.htm

Case Management Case managers in this context often work in support roles to connect individuals in need with community resources, social supports, and ancillary services intended to improve patients’

Ian Cook/Image Source/SuperStock ሁ Psychiatric technicians offer support in the

psychiatric care process.

https://www.bls.gov/ooh/healthcare/psychiatric-technicians-and-aides.htm

https://www.bls.gov/ooh/protective-service/police-and-detectives.htm

https://www.bls.gov/ooh/community-and-social-service/social-workers.htm

Summary

healthcare outcomes. Case managers also help mental health patients with making appoint- ments, filling out necessary forms, and staying organized in general. Being front-line pro- viders, case managers might also engage in emergency response situations where they may assist with basic psychological first aid if they have the necessary training and supplementary certifications to do so. Trainings in psychological first aid are available online and can be completed by anyone willing to help in a coordinated response to an emergency situation or disaster. Again, this position is different from the social worker and licensed clinical social worker positions.

Follow the link to find information on the most recent training and salary information from the U.S. Bureau of Labor Statistics: https://www.bls.gov/ooh/management/social-and -community-service-managers.htm

Summary This chapter provided a review of personality theories including psychoanalytic, behavior- ism, cognitivism, and humanism while introducing the fifth wave of psychology, integrative psychology. We explored integrative psychology using the transtheoretical model as an exam- ple, in which each of the five stages of change incorporate views and concepts from multiple theories of personality rather than being confined to just one. We also covered general con- cepts in abnormal psychology and emphasized the unique way of thinking needed to be an effective diagnostician. While these skills are highly relevant to the areas of clinical and coun- seling psychology, thinking like a diagnostician will help in almost all areas of life where it is important to understand human behavior and human interaction. In other words, it rarely serves anyone well to make conclusions about a person before gathering all available evi- dence. We also covered some of the more common treatment options in each theory of per- sonality, including strategies such as dream interpretation, systematic desensitization, cogni- tive behavioral therapy, and narrative therapy. Finally, we covered some critical ethical issues in abnormal psychology and theories of personality and also covered some career options related to psychology such as psychiatric assistance, law enforcement, and case management.

Concept Check 1. In order to use the title “psychologist,” what qualification(s) must an individual

hold? a. A license from the state board to practice independently and an earned doctor-

ate in psychology from a regionally accredited university. b. A doctorate in any field related to mental health. c. Certification from a continuing education program in any area related to

mental health d. A license from the state board to practice independently.

2. The term “Axis 2” or “Axis II” a. refers to a group of belligerents from World War II. b. is a relic from pre-DSM-5 diagnostic methods and is generally regarded as a

pejorative term when used to refer to difficult patients. c. relates to the second wave of personality theories. d. refers to the complex interaction between person and environment in reciprocal

determinism.

https://www.bls.gov/ooh/management/social-and-community-service-managers.htm

Summary

3. The concept of reciprocal determinism was a radical departure from behaviorism and came from a. psychoanalytic theory. b. humanistic theory. c. cognitive theory. d. integrative theory.

4. Integrative psychotherapy differs from eclectic psychotherapy in that integrative a. uses interventions from multiple theoretical perspectives. b. relies on a theoretical basis for case conceptualization. c. allows the provider to adapt interventions to the patient’s current level of

functioning. d. None of the above

5. In operant conditioning, spanking a child in order to reduce problematic behavior is known as a. negative reinforcement. b. positive punishment. c. positive reinforcement. d. negative punishment.

Answers

1. a. The answer can be found in Section 6.1. 2. b. The answer can be found in Section 6.2. 3. c. The answer can be found in Section 6.1. 4. b. The answer can be found in Section 6.2. 5. b. The answer can be found in Section 6.1.

Questions for Critical Thinking 1. Which do you think relates more to treatment success in the long run: the therapeu-

tic relationship, or the interventions used in treatment? 2. How might our understanding of abnormal psychology be limited by the cultural

lenses that have been used in psychological research to date? 3. What are the costs and benefits of labeling psychiatric patients using diagnostic

terms?

Key Terms action The fourth stage of the transtheo- retical model wherein the person makes substantial changes.

collateral All information gathered by the treatment provider relating to the patient’s personal and medical history.

contemplation The second stage of the transtheoretical model wherein a person weighs the pros and cons of changing a tar- get behavior or mindset.

eclectic psychotherapy A way of thought that uses interventions from multiple theo- ries to address a problem without regard to how these interventions might fit together.

helping professions The fields of medi- cine, psychology, and other healthcare professions collectively.

Summary

humanism A theory of personality that focuses on self-determination, emotions, and the human potential for growth and self-actualization.

informed consent The process by which a patient is given as much information as possible for them to meaningfully consent to treatment.

integrative psychology A theory of per- sonality that allows for the potential incor- poration of concepts and interventions from all other theories of personality, sometimes merging them with ideas gathered from Eastern ways of thought.

intervention A term used to refer to any psychotherapeutic strategy designed to min- imize symptoms and provide psychological relief to a patient.

Johnson method A treatment approach that involves confronting a substance abuser. The term intervention is used in common language to refer to this method.

maintenance The fifth stage of the trans- theoretical model wherein the person continues the new pattern for a prolonged period of time.

mental healthcare provider A general term for any licensed or otherwise appro- priately credentialed professional who pro- vides counseling, psychological, or psychiat- ric services.

pre-contemplation The first stage of the transtheoretical model wherein a person may be in denial about their condition or might not recognize a problem.

preparation The third stage of the trans- theoretical model wherein the person starts making small changes to see how he or she adapts and functions.

psychoanalysis A theory of personality that places an emphasis on unconscious processes and seeking relief from internal psychological conflict through catharsis and the development of insight.

relapse An additional stage in the transthe- oretical model that is sometimes included and refers to the patient’s regression to a previous stage of change.

transtheoretical model A health behavior change model that conceptualizes a person’s readiness to change and their overall pro- cess of change.

treatment team All professionals involved in treating a patient.

Professional Resources Ashley Snyder, PsyD, has a doctoral degree in forensic psychology. This presentation goes over the steps involved in becoming a forensic psychologist. https://youtu.be/JWEAgJ24iHo

Stephen Brewer, PsyD, is a licensed clinical psychologist in San Diego, CA (PSY26277). In this presentation, he goes over the steps involved in becoming a clinical psychologist. http://bpiedu.adobeconnect.com/p9rojb5ccz1/

Shalanda Moten, EdD, is a counseling psychologist in Orlando, Florida. In this presentation, she goes over the steps involved in becoming a counseling psychologist. https://www.youtube.com/watch?v=Pg5ZBIsgB88

https://youtu.be/JWEAgJ24iHo

http://bpiedu.adobeconnect.com/p9rojb5ccz1

https://www.youtube.com/watch?v=Pg5ZBIsgB88

Summary

American Psychological Association Main website: http://www.apa.org/

Divisions (student memberships often available): http://apa.org/about/division/index.aspx

Professional Associations American Psychiatric Association: http://psychiatry.org/

American Psychoanalitic Association (APsaA): http://apsa.org/

American Board of Professional Psychology (ABPP): http://abpp.org/

American Counseling Association (ACA): http://counseling.org/

National Association of Social Workers (NASW): http://socialworkers.org/

American Association of Marriage and Family Therapy: http://aamft.org/