Manual For Clinical Psychology Trainees

Assessment, Evaluation And Treatment

James P. Choca, Eric J. Van Denburg

• Editorial: Routledge
• Año: 2013
• ISBN:
  9781135062880
• Edición: 3
• Categoría: Psychologie
• Categoría: Geschichte & Theorie in der Psychologie

First published in 1996. The revised and expanded third edition of the Manual for Clinical Psychology Trainees is directed primarily to graduate psychology students-although it will prove valuable for everyone involved in patient care. This book presents easily understood, brief guidelines for each step in the provision of psycho­ logical services. The authors do not attempt to document every possible approach to every potential issue; instead, their goal is to clear a path through a complex and multilayered field. By targeting the discussion in this way, the format allows for the provision of actual methods that work, thus enabling the newcomer to accomplish a variety of clinical tasks. The authors draw upon their extensive firsthand experience in training to offer essential guidelines for effective clinical work. This concise, easy-to-use edition has been thoroughly updated to take into account the numerous advances that have occurred in the field since the previous edition was published in 1988. New to this edition are chapters addressing supervision in clinical psychology and research in a practicum setting. Plentiful examples of the interviews, reports, and records that the practitioner is called upon to conduct or compile are included throughout the text. In addition, there are extensive tables detailing various syndromes, as well as tests and classes of medication.

CHAPTER 1

Basics

INTRODUCTION

A functional mental health perspective is best achieved if professionals take into account the entire system in which their client exists. The system is made up of the individual, the environment, and the interaction between the two. Understanding the individual involves understanding his or her abilities, motivations, personality structure, and developmental stage in life.

The environment includes the racial, ethnic, and social aspects of the individual's family, job, and community. All parts of the system are intimately interrelated. The individual both influences and is influenced by the environment. Professionals guide their energies toward understanding or changing the individual, the environment, or both. Those who emphasize the former feel that the problems are often with the client and with his or her ability to adjust to the environment. It then makes the most sense to help the client overcome what would be perceived as his or her deficiency. An environmental approach argues either that environmental forces have precluded a viable adjustment, or that the client has little ability to cope with his or her situation; in either case, this option proposes that changing the environment makes the most sense. Finally, the systemic viewpoint would hold that the problem is in the interaction of the different aspects of the system, including both the individual and the environment. This manual will attempt to present all three areas of focus and will encourage the student to approach each client with an open mind. In other words, the stance would be that the professional should learn as much as possible about the client and his or her environment before deciding whether the emphasis should be placed on the client, the environment, or both.

ABILITIES

Understanding the client's abilities becomes most important when such abilities are out of the ordinary. The opportunities that are afforded an individual who has outstanding abilities become an important part of his or her life. More often, however, clinicians have to help those who for some reason have less ability than most.

An ability that is less than adequate to function normally is referred to a disability, a deficit, or an impairment. The findings generally have been that the milder the deficit, the longer the individual has had to struggle with it, and that the younger the person was when the deficit manifested, the easier the adjustment will be. A good adjustment usually involves a capacity to see oneself as other than a “handicapped” person, while retaining a good appreciation for the abilities that are lacked (Schontz, 1982).

MOTIVATION

A person's conscious and unconscious goals at any particular time will determine to a great extent how the person will behave. As a result, many clinicians invest much time and effort in discovering and evaluating what the client's goals may be.

PERSONALITY STYLE THEORY

Another element that an individual brings into any situation is his or her personality. The person's behavior may change from one situation to another, but other attributes tend to remain stable and may be seen as the “essence,” or personality style, of that particular person. Lorna Benjamin (1993) equates personality style to a song the person sings throughout life, which may undergo a variety of different renditions while the melody remains recognizable.

The personality style is a cluster of traits that can be seen in individuals who are able to function well psychologically and that fit together as an integrated whole. Personality styles include:

1. A basic assumption about the self and the world that may or may not be at the conscious level.

2. Feelings about the self and the world that are usually compatible with the basic assumptions.

3. Habitual behaviors that are consistent with the basic assumptions and feelings. By far the most important behaviors are those that affect a person's interpersonal relationships.

Every personality style has advantages and disadvantages. For instance, the histrionic's spontaneity and easy emotionality allow such a person to communicate feelings well, but may result in the person's being overly dramatic and too uninhibited. The effectiveness of a particular personality style partly depends on the situation that the person is facing; the assumption that life is a competitive situation in which others may try to exploit us might be helpful when buying a used car, but be less useful when dealing with a spouse. The trait of orderliness gives the individual an edge when organizing a term paper, but may cause the same person to be seen as a bit of a stuffed shirt in social situations.

According to personality style theory, the more adaptive individuals are those who (1) have a definite personality style involving assumptions, feelings, and behaviors that are within some “normal” range, and (2) are flexible and able to adjust to different situations. This flexibility involves being able to accept assumptions, have feelings, and produce behaviors that differ from the particular individual's usual tendency. Thus, for example, a well-adjusted individual who tends to be submissive and dependent needs to play a somewhat more dominant role in order to be successful when teaching a class.

A personality style can be a source of pathology if:

1. It is so disorganized or undeveloped that it does not serve to provide a routine way of relating to the world and/or a reasonable self-identity.

2. It contains incompatible assumptions, feelings, or behavior trends so that the individual is constantly struggling to overcome conflict.

3. It contains assumptions, feelings, or traits that are exaggerated to such a degree that they are no longer within a viable range.

4. The individual adheres to the personality style so rigidly as to be unable to adjust to situations in which the particular personality style is not functional.

Most of the terms that will be used here to describe personality styles have a negative connotation. This is unfortunate since most people have recognizable personality styles and, in several, these clusters of personality traits serve them well. However, positive terms are much less revealing. For one thing, positive terms have less power in differentiating among people. (Most of us would admit to being “cooperative” but not to being “submissive” or “compliant.”) Moreover, a term such as schizoid or compulsive is much more meaningful to an experienced mental health professional than is any substitute because it is the term used in the professional literature. Nevertheless, the terms in parentheses given in the next section represent reasonable alternatives.

The difference between personality disorders and personality styles should be emphasized. Most individuals have some assumptions about themselves and the world; these assumptions are dictated by and define their personality styles. Only a few individuals have such problems with their assumptions or feelings that they are unable to function, and only they can be said to have a “personality disorder.” The personality style of an individual does not imply the presence of psychopathology.

Personality styles are so unique that a classification of possible styles will never be complex enough to do justice to the concept. However, when no system is attempted, it is very difficult for anyone but the most experienced clinician to use the concept productively. When formally classified, few individuals fit nicely into one of the personality styles. Most of us combine the basic styles in proportions that are fairly unique to us. Thus, it is often advisable to take two or three of the individual's most prominent personality styles into consideration.

Since it is often difficult to conceptualize the different personality styles, the following literature is offered as approximate descriptions of the styles.

• Ward No. 6, by Anton Chekhov (avoidant)
• Oblomov, by Ivan Goncharov (dependent)
• Paul's Case, by Willa Cather (histrionic)
• The Eternal Husband, by Fyodor Dostoevsky, and My Last Duchess, a poem by Robert Browning (narcissistic)
• Defender of the Faith, by Philip Roth, and Les Liaisons Dangereuses, adapted by Christopher Hampton (antisocial)
• The Man in a Case, by Anton Chekhov (compulsive)
• Tobias Mindernickel, by Thomas Mann (explosive, negativistic)

PERSONALITY STYLES

Figure 1 maps out the scheme to be followed. The following descriptions were adapted from Theodore Millon (1969). Table 1 summarizes the eight styles.

Figure 1. Flowchart showing organizational scheme for Millon's eight basic personality styles

TABLE 1. Characteristics of the Millon Personality Styles

Name	Cognitive	Emotional	Interpersonal
1. Schizoid	Lack of ability and interest in communicating and understanding others	Unemotional, apathetic, indifferent	Lacks friends, relates in a distant manner
2. Avoidant	Values acceptance, fears rejection	Apprehensive, uneasy, anxious, and nervous	Lacks friends, relates in a tentative manner, and is likely to pull away
3. Dependent	Sees self as inferior, and less capable or less valuable than others	Unassuming	Cooperative, submissive, or dependent; tries to please others
4. Histrionic	Life becomes boring without frequent stimulation	Dramatic, emotional	Seeks attention, has temporary but involved relationships
5. Narcissistic	Sees self as superior, and more capable or more valuable than others	Proud, expansive	Assertive and dominant, seeks others who follow his/ her lead
6. Antisocial	Views life as a competition, fears being taken advantage of	Cold, unemotional	Self-reliant, distrusting of others, tends to use others
7. Compulsive	Values perfection, fears making mistakes	Controlled, formal, proper	Compliant with those above, domineering and controlling of those below
8. Negativistic	Sees self as needing others but does not see others as superior	Emotional fluctuations with frequent changes in mood	May be cooperative and friendly but then becomes resentful or hostile

1. The schizoid style. Schizoid individuals are characterized by a relatively unemotional existence. When things turn out well, they don't seem particularly happy but are not too saddened by misfortune. They tend to be quiet, often staying by themselves and taking the role of passive observers. They remain uninvolved, very seldom taking sides or a strong position. Rarely the center of attention, these individuals often fade into the social background. They have a small number of friends and their relationships are without deep commitments. They do not fear or actively avoid people, but they are somewhat indifferent and apparently have little need to communicate with or to obtain support from others. They are unlikely to be passionate or to lose control of their behavior, even in the most emotional situations. As a result, they may be seen as good judges or crisis workers; they may be good at any job that calls for the ability to remain detached, uninvolved, and objective. Schizoid people are often viewed, however, as somewhat dull, quiet, and colorless, and as indifferent and apathetic.

2. The avoidant style. Both the schizoid and avoidant styles are similar in that they characterize people who lack interpersonal involvement in their everyday lives. In both cases, these individuals do not have close friends, tending to remain detached and isolated. In contrast to the unemotional schizoids, however, the avoidant individuals feel apprehensive when relating to others. They are usually shy and nervous in social situations. Strongly wishing to be liked and accepted by others, they fear rejection. Their concern with this rejection tends to put them on guard and to make them uncomfortable. Social gatherings and other interpersonal situations are experienced with distaste. Relating to others is a difficult task that they often try to avoid. In so doing, however, they give up the support and affection that the avoided relationship could have brought. These individuals are sensitive, compassionate, and emotionally responsive, but also are often nervous and awkward in social situations, mistrustful of other people, and lonely and isolated.

3. The dependent style. The life assumption of dependent individuals is that they are incapable of taking care of themselves and must find someone who is benevolent and dependable and who will support them emotionally. Individuals with this personality style have a tendency to form strong attachments to other people, who then take a dominant role in decision making. They are followe...