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Chapter 1 The Evolution of Clinical Psychology Multiple Choice Questions 1. A national survey found that 1 of _____ Canadian adolescents and adults reported that in the last year they experience symptoms consistent with a diagnosis of a mental disorder such as abuse, alcohol dependence, mood disorder, or anxiety disorder. a. 3 . b. 10. c. 25. d. 50. Answer: B Page: 2 2. In 2014, a health survey of active Canadian military personnel found that ______ reported a mental disorder in the previous year. a. 3.6% b. 10% c. 16.5 d. 45.5% Answer: C Page: 2 3. The cost of mental illness to Canadian society is estimated at ______ dollars. a. $57 million b. $121 million c. $1.5 billion d. $63 billion Answer: D Page 2 4. In 2006, the London School of Economics released The Depression Report, which translated epidemiological data into economic terms, and found that: a. in order to meet the needs of the population, 20% of the National Health Service’s expenditures are allocated to the treatment of anxiety & depression. b. in order to meet the needs of the population, 10% of the National Health Service’s expenditures are allocated to the treatment of anxiety & depression. c. the cost of treating mental health issues is lower than the cost of prevention. d. the cost of treating mental health issues is lower than the cost of paying disability benefits due to mental disorders. Answer: D Page: 2 5. Systematic literature reviews conducted by the UK National Institute for Health and Care Excellence (NICE) find that evidence-based psychological treatments are a. no more effective than placebo treatment for anxiety and depression. b. at least as effective as medication for anxiety and depression. c. more costly than disability payments associated with mental illness. Chapter 1: The Evolution of Clinical Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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d. effective for less than 15% of people with anxiety or depression. Answer: B Page: 3 6. The World Health Organization (WHO) estimates that the accurate diagnosis and treatment of mental disorders worldwide occurs for _________ of people who suffer from mental disorders. a. only a small percentage b. a large percentage c. approximately half d. the majority of individuals Answer: A Page: 2 7. Data from the World Health Organization (2004) indicate that most mental disorders a. are diagnosed and treated effectively in developed countries, but not in developing countries. b. are overlooked and misdiagnosed and therefore remain untreated or mistreated. c. are diagnosed accurately, but go untreated. d. tend to go undiagnosed but remit on their own, regardless of the country’s level of development. Answer: B Page: 3 8. A large-scale study (Mokdad, Marks, Stroup, & Gerberding, 2004) demonstrated that many of the leading causes of mortality in the United States are related to a. chronic physical health issues that have been resistant to treatment. b. violence and crime. c. treatable or preventable factors, such as diet, exercise, tobacco use, and alcohol. d. motor vehicle accidents. Answer: C Page: 3 9. The Mental Health Commission of Canada (MHCC) is designed to a. illustrate the incomplete and patchwork nature of mental health services that are available across Canada. b. spearhead fundraising and awareness efforts to promote the need for mental health services among Canadians. c. explicitly distinguish between provincial and federal responsibilities for health care. d. encourage collaboration between those who provide and require services for mental health (such as government, service providers, and clients). Answer: D Page: 4 10. The nature and definition of clinical psychology has expanded and evolved over the decades from an initial primary focus on assessment, evaluation, and diagnosis to now include: a. a primary focus to help those with mental disorders or distress. b. a branch of psychology that emphasizes assessment over research. c. a focus on the individual rather than on the group. Chapter 1: The Evolution of Clinical Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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d. intervention and prevention services for individuals, couples, and families.. Answer: D Page 5 11. One of the criticisms levelled at a science-based approach to clinical psychology is that a. it discounts an individual psychologist’s experience and intuitionclinical psychology is best conceptualized as a healing art. b. drawing similarities across various groups of human experiences is a valuable tool for therapy. c. research covers so many human problems confronted by clinicians that it is cumbersome to select the appropriate treatment. Answer: A Page: 7

12. Evidence-based practice refers to the practitioner only offering services that: a. have been demonstrated in a series of RCTs to be efficacious. b. are listed in clinical practice guidelines. c. are in areas in which the clinician has received training and demonstrated competence. d. are based on the synthesis of research evidence, client’s history and treatment preferences, and the clinician’s experience. Answer: D Page: 7 13. Compared to counselling psychologists, clinical psychologists have more training in the treatment of a. patients with more severe psychopathology. b. a diverse clientele. c. difficulties related to developmental transitions. d. interpersonal problems. Answer: A Page: 8 14. Traditional distinctions between clinical and counselling psychologists are currently a. shrinking. b. increasing. c. the same as they have always been. d. a topic of intense debate. Answer: A Page: 8 15. Over recent years, many clinical psychologists have a. narrowed their focus to treating mental disorders rather than interpersonal problems. b. begun to take on more of the roles of a psychiatrist. c. begun to address health issues. d. been granted prescriptive authority. Answer: C Page: 8 16. School psychology has expanded in order to Chapter 1: The Evolution of Clinical Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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a. address students’ mental health and life circumstances more broadly. b. broaden the scope of psychological and intelligence testing in schools. c. provide parent counselling and training programs. d. all of the above Answer: A Page: 10 17. Psychiatrists complete a. all of the same medical training that other physicians receive. b. a different type of basic training than other physicians. c. clinical training that is comparable to that of clinical psychologists, in addition to their c medical training. d. research and clinical training that is comparable to that of clinical psychologists, in addition to their basic medical training. Answer: A Page: 10 18. Psychiatrists are better trained than psychologists to a. identifyl interactions between physical health problems and mental health problems. b. understand human psychological development. c. understand cognition and learning. d. Identify interactions between mental health problems and environmental influences. Answer: A Page: 10 19. Psychiatrists generally receive a. the same amount of training in research as do clinical psychologists. b. far less training in research than do clinical psychologists. c. more training in research than do clinical psychologists. d. a different type of research training than do clinical psychologists. Answer: B Page: 10 20. Psychiatrists currently receive training in a. diagnosis and pharmacotherapy. b. diagnosis and psychotherapy. c. diagnosis, psychotherapy, and pharmacotherapy. d. pharmacotherapy and psychotherapy. Answer: C Page: 11 21. A key difference between psychologists and psychiatrists is that a. only psychiatrists can prescribe medication. b. only psychologists can prescribe medication. c. in most jurisdictions, only psychiatrists can prescribe medication. d. only psychologists practice psychotherapy whereas psychiatrists prescribe medication. Answer: C Page: 11 Chapter 1: The Evolution of Clinical Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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22. ________ was the primary developer of cognitive therapy for depression. a. Carl Rogers b. Alfred Adler c. Aaron Beck d. Cesare Lombroso Answer: C Page: 11 23. Worldwide, the number of medical students specializing in psychiatry has: a. decreased and is insufficient to meet the demand for psychiatrists. b. decreased over the decades but sufficiently meets the demand for psychiatrists. c. increased dramatically in Canada but not in the United States. d. increased decades but sufficiently meets the demand for psychiatrists. Answer: A Page: 11 24. Which of the following is true regarding clinical social workers? a. Many function as case managers who help patients coordinate their services. b. Many have prescription privileges. c. They are not trained to provide psychotherapy. d. They receive extensive training in psychological assessment. Answer: A Page: 11 25. Which early Greek scholar is credited with emphasizing the biopsychosocial approach to understanding physical and psychological disorders? a. Hippocrates b. Plato c. Aristotle d. Hippocleides Answer: A Page: 14 26. Hippocrates emphasized which approach to understand psychological and physical disorders? a. The metaphysical approach b. The philosophical approach c. The biopsychosocial approach d. The magical-meditative approach Answer: C Page: 14 27. During the period of the Enlightenment in Europe and North America, a. a new world view emerged where mental health problems could be approached with religious and spiritual healing. b. the supernatural view of mental phenomena burgeoned. c. a new world view emerged where mental health problems could be approached with reason and science. d. the treatment of those suffering from mental illness continued to be as inhumane as in the 1500s. Answer: C Page: 14 Chapter 1: The Evolution of Clinical Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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28. As a result of the Enlightenment in Europe and North America, a. Philippe Pinel demanded humane treatment of asylum patients. b. William Tuke advocated for the development of mental hospitals. c. Benjamin Rush promoted the use of moral therapy. d. All of the above Answer: D Page: 14 29. In the latter half of the 1700s, ________ had a large impact on the treatment of the mentally ill. a. the philosophical period of the enlightenment b. symptom-focused forms of psychotherapy c. religious and spiritual leaders d. the law and reform movements Answer: A Page: 14 30. Increased attention to mental disorders in the 1800s led to the recognition that hysteria a. was not explainable by purely biological causes. b. could be effectively treated with traditional medicine. c. was entirely explainable by mental causes. d. could be treated with cognitive-behaviour therapy. Answer: A Page: 16 31. Until the middle part of the 20th century, the activities of clinical psychologists were mainly focused around a. intervention to alleviate mental disorders. b. the mistreatment of the mentally ill. c. assessment. d. collaboration with physicians. Answer: C Page: 16 32. This scholar advocated psychology as the study of human experience, and established the first psychology laboratory. a. Wilhelm Wundt b. William James c. Francis Galton d. James McKeen Cattell Answer: A Page: 16 33. Current mental disorder classification systems have their origins in the work of a. Emil Kraepelin. b. David Wechsler. c. Wilhelm Wundt. d. Alfred Binet. Answer: A Page: 16 Chapter 1: The Evolution of Clinical Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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34. Alfred Binet and Theodore Simon designed tests of mental ability mainly in order to a. identify gifted children targeted by for advanced learning. b. classify inmates for remediation programs. c. identify children in need of special education programs. d. classify soldiers for different jobs in the military. Answer: C Page: 16 35. Binet and Simon gathered normative data on children to establish a. probability of future criminal behaviour. b. information on their cognitive abilities. c. norms in social skills and aggression. d. differences in personality characteristics between adults and children. Answer: B Page: 16 36. The Army Beta test was developed to assess the _________________ of American army recruits in the First World War. a. verbal mental abilities b. nonverbal mental abilities c. ability to resist ‘shell-shock’ d. leadership capacity Answer: B Page: 17 37. Psychology’s role in test construction and measurement in the United States was solidified by psychologists’s role in a. developing tests for the American military. b. developing intelligence tests for children. c. developing assessments of personality. d. research on assessment for specific mental disorders. Answer: A Page: 17 38. Projective tests require respondents to a. rate themselves on various dimensions of personality. b. complete a number of tasks measuring speed, number, and digit span. c. respond to ambiguous stimuli. d. make predictions about their future plans. Answer: C Page: 17 39. Paul Meehl’s review of the strengths and weaknesses of clinical and statistically-based assessment for diagnosing adults concluded that a. purely clinical approaches to testing hypotheses were typically superior to purely statistical approaches. b. purely clinical approaches to testing hypotheses were typically inferior to purely statistical approaches. c. a clinical approach to hypothesis generation and a statistical approach to hypothesis testing yields the most accurate results. Chapter 1: The Evolution of Clinical Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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d. a statistical approach to hypothesis generation and a clinical approach to hypothesis testing yields the most accurate results. Answer: C Page: 18 40. What is considered the “gold standard” in the assessment of intellectual abilities? a. The MMPI b. The DSM-III c. The Army Beta test d. The Wechsler scales Answer: D Page: 17 41. The Rorschach inkblot test is an example of a. an intelligence test. b. a retroactive test. c. a projective test. d. a hypnosis test. Answer: C Page: 17 42. The development of projective tests proceeded a. similarly to that of ability testing, with close attention to basic principles of test construction. b. differently from that of ability testing, with minimal attention to basic principles of test construction. c. similarly to that of ability testing, with minimal attention to basic principles of test construction. d. differently from that of ability testing, with close attention to basic principles of test construction. Answer: B Page: 18 43. Compared to the MMPI, projective tests a. rely mostly on clinical judgement. b. rely mostly on statistical norms. c. are a much more recent assessment tool. d. are generally more accurate in predicting antisocial behaviour. Answer: A Page: 18 44. Projective tests rely on _______ while the MMPI relies on __________ a. clinical judgement; clinical judgement and statistical analysis. b. clinical judgement and statistical analysis; clinical judgement. c. the judgement of psychiatrists; the judgement of psychologists. d. the judgement of psychologists; the judgement of psychiatrists. Answer: A Page: 18 45. The main goal of developing the Minnesota Multiphasic Personality Inventory was to provide an easily administered test to screen for a. psychological disturbances. Chapter 1: The Evolution of Clinical Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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b. deviant personality. c. avoidant personality. d. personality changes. Answer: A Page: 18 46. Walter Mischel’s publication in 1968 proposed that it was problematic to rely too heavily on a. personality traits to understand human behaviour. b. behavioural observations to understand human behaviour. c. psychodynamic theories to understand human behaviour. d. psychological testing to understand human behaviour. Answer: A Page: 18 47. Which psychologist’s critique of personality traits for understanding human behaviour impacted the popularity of behavioural approaches to clinical assessment? a. Skinner b. Murray c. Mischel d. Freud Answer: C Page: 18-19 48. Most psychologists agree that assessment data should be obtained a. from multiple methods and informants. b. mainly from the client. c. mainly from expert assessment. d. mainly from psychological testing. Answer: A Page: 20 49. Service evaluation refers to the evaluation of a. the utility of various assessment tools. b. assessment tools to ensure that they are valid and reliable. c. the effectiveness of clinical services. d. psychologists’ abilities. Answer: C Page: 20 50. Anna Freud, daughter of Sigmund Freud, extended her father’s work by a. highlighting the roles of birth order and social comparison on a person’s development. b. recognizing the role of conscious efforts to adjust to life difficulties and obstacles. c. extending the role of unconscious forces in a person’s development. d. questioning the role of dreams in a person’s development. Answer: B Page: 22 51. Who was the first person to be credited for using the term “clinical psychology?” a. Sigmund Freud Chapter 1: The Evolution of Clinical Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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b. Hans Eysenck c. Lightner Witmer d. Wilhelm Wundt Answer: C Page: 22 52. The experiment with little Albert and the furry white animals showed a. that conditioning principles could explain the development of phobias. b. that conditioning principles could explain the development of obsessions. c. that psychodynamic principles could be demonstrated in the lab. d. that psychodynamic principles had a large influence on learning. Answer: A Page: 22 53. In the 1940s and 50s, the demand for psychological services increased dramatically primarily because of the a. increase in homeless individuals. b. need for mental health services for those affected by the war. c. lack of work. d. destigmatization of mental illness. Answer: B Page: 22 54. Carl Rogers’ approach to psychotherapy differed from Freud’s in that a. it was more negative in its assumptions of human nature. b. it was more positive in its assumptions of human nature. c. it proposed that we could never really understand human nature. d. it was the first to take a multi-disciplinary approach. Answer: B Page: 22 55. The primary goal of Carl Rogers’ style of therapy was to provide a a. warm and supportive environment to explore the unconscious. b. demanding and challenging environment to explore the unconscious. c. warm and supportive environment to discover potential for growth. d. demanding and challenging environment to discover potential for growth. Answer: C Page: 22 56. In 1952, Hans Eysenck’s review of the effectiveness of psychotherapy concluded that a. psychotherapy was very effective for reducing symptoms compared to receiving no therapy. b. psychotherapy was no more effective for reducing symptoms compared to receiving no therapy. c. assessment as it existed in the 1950’s was not effective for advising treatment. d. psychotherapy sometimes had deleterious effects on individuals. Answer: B Page: 23 57. In the 1960s and 1970s, there was a marked ______ in the number of psychotherapies available, and an_______ in research concerning psychotherapy. a. decrease; decrease Chapter 1: The Evolution of Clinical Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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b. decrease; increase c. increase; increase d. increase; decrease Answer: C Page: 23 58. In the late 1970s, Don Meichenbaum and Aaron Beck published texts that laid the foundation for current a. behaviour therapies. b. cognitive-behaviour therapies. c. client-centered therapies. d. psychodynamic therapies. Answer: B Page: 23 59. The meta-analysis by Smith, Glass, and Miller of the efficacy of psychotherapies for adult and child problems have found that the average person receiving therapy is better off than approximately ____ of people with similar problems who did not receive therapy. a. 20% b. 40% c. 80% d. 100% Answer: C Page: 23 60. The history of ______ efforts is much shorter than the history of ______or ______. a. prevention; assessment, intervention b. assessment; prevention, intervention c. intervention; consultation, prevention d. assessment; consultation, intervention Answer: A Page: 25 61. The American Psychological Association’s Task Force on Promotion and Dissemination of Psychological Procedures was established because a. there was pressure in the United States for health care practices to be demonstrably effective and cost-effective. b. there was a decrease in the number of individuals seeking psychotherapy as a treatment modality. c. there was a need to develop new treatments that were more effective for alleviating symptoms of mental disorders. d. there was a need for other health care practitioners to appreciate the effectiveness of psychological treatments. Answer: A Page: 24 62. In the coming years, it is likely that clinical psychology will be influenced by a. requirements to provide psychological services for diverse general and physical health problems. b. requirements to provide health care to an aging population. Chapter 1: The Evolution of Clinical Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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c. requirements for assessments, treatments, and prevention programs to be appropriate for a diversity of individuals. d. all of the above. Answer: D Page: 25 63. Effectiveness studies are conducted to examine whether a particular psychological treatment works a. in research settings. b. in real-world conditions. c. for both adults and children. d. for a particular mental disorder. Answer: B Page: 24 64. The term that refers to a group of symptoms that frequently co-occur is a(n) a. disorder b. syndrome c. illness d. cluster Answer: B Page: 16

Short Answer Questions 1. Describe the evidence-based practice model. Describe two arguments that question this model. Suggested answer: Pages 7 & 8 Definition: The evidence-based practice model requires the clinician to synthesize information drawn from research and systematically collected data on the patient in question, the clinician’s experience, and the patient’s preferences when considering health care options Arguments against: a) It is too difficult to determine whether research on groups of individuals is applicable to any specific individual b) Research lags behind the needs of clinicians to provide therapy to distressed individuals c) There is no research concerning many human problems confronted by clinicians d) Each individual’s unique constellation of life experience, culture, and societal context makes it unlikely that general psychological principles can ever provide much useful guidance in alleviating emotional distress or interpersonal conflict. 2. Why was the Minnesota Multiphasic Personality Inventory (MMPI) developed? Suggested answer: Page 18 a) Developed by Starke Hathaway in 1943 b) The goal was the provide an easily administered test that could effectively screen for psychological disturbances among adults Chapter 1: The Evolution of Clinical Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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3. Describe the biopsychosocial approach. Suggested answer: Page 14 a) In order to understand mental and physical disorders, biological, psychological, and social influences on health and illness must be considered 4. Define the term syndrome. Suggested answer: Page 16 a) Syndrome – a group of mental disorder symptoms that frequently co-occur. 5. Who was Emil Kraepelin? Suggested answer: Page 16 a) A German psychiatrist who believed mental disorders could be explained through biological factors. b) He devoted his career to studying and classifying mental disorders in the hope that his work would results in a scientifically based classification system that would serve to inform treatment c) He examined how symptoms covaried d) He coined the term “syndromes” e) His classification system was built around identifying how these syndromes related to and differed from each other f) His classification system of what is now known as schizophrenia was one of his major accomplishments g) The DSM-IV and ICD have their origins in Kraeplin’s work 6. Who was Alfred Binet? Describe one of his major contributions. Suggested answer: Page 16 a) A French psychologist who co-developed the first widely available, scientifically based test of human intelligence. b) It was called the Stanford-Binet Intelligence test and was designed to be administered to children. c) They designed the intelligence test to measure the abilities of school children, in an effort to identify children with limited cognitive abilities who were unlikely to benefit from typical teaching methods 7. What was the primary conclusion of Paul Meehl’s (1954) review of both clinically and statistically based assessments? Suggested answer: Page 18 a) that a purely clinical approach to assessment was inferior to a more statistically or empirically oriented approach to describing and diagnosing. b) Meehl advocated strongly for the use of clinical experience in generating hypotheses about human functioning. However, he stated that, once these hypotheses are formulated, scientific methods must be used to test the viability of these hypotheses. 8. Describe one broad development in psychological assessment that has occurred in the past three decades. Chapter 1: The Evolution of Clinical Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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Suggested answer: Page 20-21 a) increased attention to the relevance of assessment data and the assessment process to both treatment planning and evaluation. b) Agreement among different theoretical orientations that assessment data should be obtained from multiple methods, and multiple informants c) Recognition that best practices in assessment should be based on assessment methods and measures that have solid scientific support 9. What does the term “clinical utility” mean? Suggested answer: Page 20 a) Whether having access to assessment data actually provides information that leads to a clinical outcome that is better (or faster, or less expensive) than what the outcome would be if the psychologist did not have access to assessment data 10. In the early decades of the 1900s what was the primary was approach to psychotherapy that was offered? Describe the basic assumption of this approach. Suggested answer: Page 21 a) Psychodynamic treatment or psychotherapy. b) All psychodynamic approaches were based on the assumption that most psychopathology stemmed from unconscious processes c) Freud posited that, to protect ourselves from the pain of continually re-experiencing negative emotions and memories, and irrational desires located in the unconscious, we use a number of strategies called defence mechanisms (i.e., denial, repression) d) Later psychodynamic theorists placed less importance on the role of the unconscious 11. Who was Carl Rogers? Describe one of his major contributions. Suggested answer: Pages 22 a) A humanistic psychologist and therapist who believed people were inherently good and capable of positive and healthy growth. b) He published the book Counselling and Psychotherapy in 1942 c) His approach was in contrast to the dominant psychoanalytic approach, and he believed that people were inherently capable of developing in a positive, healthy manner d) His idea of psychotherapy was that it served to provide a supportive environment in which clients could reconnect with their emotions, their losses, and their aspirations, and thereby discover their true potential for growth e) Rogers’ work was crucial in the development of humanistic approaches to psychotherapy f) He was a strong advocate of conducting research on the process and outcome of psychotherapy (which was a very different position from that typical at the time – what frequently passed as psychotherapy research was little more than case studies). 12. What were the two effects that Hans Eysenck’s (1952) critique of the effectiveness of psychotherapy had on the field of psychology? Suggested answer: Page 23 Chapter 1: The Evolution of Clinical Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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a) It confirmed (and reaffirmed) the dissatisfaction that some psychologists had with the psychodynamic approach b) It led to a major increase in efforts to evaluate both new and traditional forms of psychotherapy

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Chapter 2 Contemporary Clinical Psychology Multiple Choice Questions 1. Hunsley, Ronson & Cohen’s (2013) survey of Canadian psychologists revealed that the largest percentage of professional time was spent on: a. assessment activities. b. research. c. training. d. intervention. Answer: D Page: 28

2. Surveys of clinical psychologists in Canada by Hunsley, Ronson and Cohen (2013) and in the USA by Norcross and Karpiak (2012) revealed that: a. the majority of psychologists specialize in one major professional activity. b. almost half of them report devoting time to research, but it is a small proportion of their professional time. c. the majority of clinical psychologists spend at least part of their work week teaching. d. clinical supervision is undervalued by clinical psychologists. Answer: B Page: 28 3. Survey data from Norcross and Karpiak (2012) and Hunsley, Ronson and Cohen (2013) indicate that a. most clinical psychologists offer psychotherapy, and devote over 80% of their professional time to this activity. b. the majority of clinical psychologists offer psychotherapy, and devote over 40% of their professional time to this activity. c. approximately half of clinical psychologists do not offer psychotherapy, instead electing to focus upon research, teaching, and/or consultation. d. the majority of clinical psychologists who do offer psychotherapy are only able to devote approximately 20% of their time to this activity. Answer: B Page: 28-29 4. The assessment activities of clinical psychologists most commonly involve evaluating a. the psychological functioning of an individual or a relationship. b. the cognitive functioning of an individual. c. the negative or antisocial inclinations of an individual. d. the psychological functioning of youth both at school and in the community. Answer: A Page: 30 5. The primary goal shared by all assessments conducted by clinical psychologists is in a. establishing whether behaviour or symptoms meet criteria for a disorder. Chapter 2: Contemporary Clinical Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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b. ascertaining eligibility for a particular service. c. determining suitability for a particular form of psychotherapy. d. understanding a person’s current level of psychosocial functioning. Answer: D Page 31 6. Canadian clinical psychologists most frequently provide a. individual therapy. b. marital/couples therapy. c. therapy to children and adolescents. d. group therapy. Answer: A Page: 32 7. Arguments in favour of psychologists having prescription privileges include: a. Underserved segments of the population such as those in rural areas and the elderly could benefit from extension of prescription privileges to psychologists. b. Most psychoactive medications are prescribed by general practitioners whose training in mental health is limited to a few weeks. c. Given brain-behaviour links, a biological approach to the treatment of psychological disorders is not incompatible with psychological training. d. All of the above. Answer: D Page: 33 8. Arguments against psychologists’ having prescription privileges state that: a. extending psychologists’ training to include psychopharmacology would most likely come at the expense of the quality of training in psychological issues. b. full medical training would be necessary to understand the impact of psychoactive medication on other physical systems. c. the population would be better served by increasing the numbers of available psychiatrists, rather than extending prescription privileges to psychologists,. d. although increasing the number of practitioners who can prescribe could decrease healthcare costs, doctoral training in psychology would become too lengthy. Answer: A Page: 33 9. The majority of people who receive psychotherapy a. attend for fewer than 10 sessions. b. attend for approximately 10 to 20 sessions. c. attend for approximately 20 sessions or more. d. attend for several years. Answer: A Page: 31 10. Surveys of clinical psychologists and graduate students in clinical psychology indicate that ___________ treatment is currently the most popular treatment technique with clinical psychologists in North America. a. psychodynamic b. cognitive-behavioural c. experiential Chapter 2: Contemporary Clinical Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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d. interpersonal Answer: B Page: 33-34 11. Prevention efforts are usually based in: a. community settings b. institutional settings c. private clinical psychology practices d. all of the above Answer: A Page: 35

12. Prevention activities are typically designed to a. reduce risk factors. b. enhance protective factors. c. neither of the above. d. both A and B. Answer: D Page: 35 13. Prevention efforts by psychologists are usually based in a. hospitals. b. private clinical practices. c. community settings. d. forensic settings. Answer: C Page: 35 14. Clinical consultation refers to providing information, advice, and recommendations to a. other professionals. b. directly to other psychologists’ clients. c. organizations. d. community agencies. Answer: A Page: 36 15. Organizational consultation refers to services to an organization focused on a. developing promotion programs b. evaluating the efficiency of the organization’s health care or related services c. reviewing and approving the current services set by the organization d. observing without judgment an organization’s practices and services Answer: B Page: 36 16. Providing information, advice, and recommendations to another psychologist or other healthcare professional about how best to assess, understand, or treat a client is referred to as a. informed consent. b. clinical consultation. c. competency of care. d. a clinical assessment package. Answer: B Page: 26 Chapter 2: Contemporary Clinical Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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17. A needs assessment functions to a. determine the extent of training required for new employee psychologists. b. determine the extent of an unmet health care need in an identified population. c. determine whether programs have successfully achieved their goals. d. to assess the extent to which the program was carried out as intended. Answer: B Page: 36 18. Needs assessment are conducted to determine the a. extent of unmet health care needs in a population. b. extent of unmet health care needs in a person. c. efficiency of an organization who provides health care services. d. efficiency of specific health care providers. Answer: A Page: 36 19. Which of the following is a component of a program evaluation? a. Examining if an agency’s policy is congruent with its mission. b. Examining the scope of unmet health care needs in a population. c. Examining the extent to which the program objectives are met. d. Examining the personality characteristics of program participants. Answer: C Page: 36 20. CPA’s ethical codes require clinical psychologists to continue to attend to practice-relevant research ____________ their professional career. a. for the first 5 years of b. for a good portion of c. for all of d. None of the above; there are no specific guidelines Answer: C Page: 37 21. The first clinical experience in which doctoral students in clinical psychology work with patients/clients under the supervision of a licensed psychologist is called a(n) a. practical evaluation. b. internship. c. shadowing and observation. d. practicum. Answer: D Page: 38 22. In most Canadian clinical psychology programs graduate students obtain a. less than 500 hours of practicum experience. b. between 300 and 1,200 hours of practicum experience. c. over 1,400 hours of practicum experience. d. over 4,200 hours of practicum experience Answer: C Page: 39 23. The clinical internship completed by graduate students is completed Chapter 2: Contemporary Clinical Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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a. after receiving their Ph.D. and prior to licensure. b. after completing all coursework, but before receiving their Ph.D. c. on a part-time basis as the student completes coursework. d. whatever is most appropriate in the student’s area of specialization. Answer: B Page: 39 24. The number of clinical psychologists working in private practice has ________ in the past few decades. a. decreased considerably b. remained constant c. increased considerably d. moderately increased Answer: C Page: 39 25. Hunsley et al. (2013) found that in addition to the nearly 28% of Canadian clinical psychologists who work exclusively in a private practice setting, another ____ listed private practice as a secondary work setting. a. 10% b. 25% c. 50% d. 65% Answer: C Page: 39 26. Ethical codes of conduct require that clinical psychologists a. maintain knowledge of research relevant to their activities. b. in private practice are exempt from maintaining knowledge of relevant research. c. are not obliged to maintain their research knowledge if they work exclusively in clinical services. d. in academic settings maintain responsibility for research knowledge and dissemination. Answer: A Page: 40 27. When no research evidence is available Lilienfeld, Lynn, and Lohr (2015) suggested it requires the clinician to strike a balance between a. excessive open-mindedness and excessive scepticism b. clinical judgement and experience c. patient preference and clinician’s experience d. theories and past experiences Answer: A Page: 41

28. According to Sinclair (1993), modern interest in developing ethical codes for research and professional services can be traced to a. the Nuremburg war crime trials that occurred after the Second World War. b. psychologists’ involvement in the First World War. c. America’s involvement in the Vietnam War. Chapter 2: Contemporary Clinical Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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d. lobbying by animal rights groups in the 1960s. Answer: A Page: 41 29. According to the textbook, what is the most important tenet of professional and research ethical codes? a. Random assignment. b. Informed consent. c. Using empirically validated techniques. d. Responsibility to society. Answer: B Page: 41 30. The current concept of informed consent applies to a. only those who cannot provide consent independently. b. any individual participating in research or obtaining healthcare services. c. individuals specifically participating in research. d. individuals receiving care in hospital settings. Answer: B Page: 41 31. The Canadian Code of Ethics for Psychologists is intended to provide guidance for psychologists a. engaged in the delivery of psychological services. b. engaged in research and teaching. c. who are licensed. d. in all their professional activities. Answer: D Page: 41 32. Which of the following are the four ethical principles in the Canadian Code of Ethics for Psychologists? a. Responsibility to society, responsible caring, integrity in relationships, and respect for dignity of persons. b. Respect for confidentiality, responsible caring, integrity in relationships, and dignity of persons. c. Responsible relationships, respect for confidentiality, respect for dignity of persons, and responsible caring. d. Respect for dignity of persons, respect for confidentiality, integrity in research, and responsible caring. Answer: A Page: 42 33. A meta-analysis by Lee, Lim, Yang, and Lee (2011) of studies of psychologists’ work-lives found that those who: a. were less committed to their professional roles worked shorter hours. b. received constructive criticism felt greater sense of accomplishment. c. believed they worked harder than their clients did felt more satisfaction. d. were traumatized by the stories they heard from clients became suicidal. Answer: B Page: 42 Chapter 2: Contemporary Clinical Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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34. Research on the psychological consequences of working with clients who have experienced trauma indicates: a. that emotional responses are more common in those who are less familiar with this type of work. b. that prolonged exposure to clients’ traumatic experiences results in the psychologist’s sensitization. c. that it leads to an erosion of optimism and belief in a just world. d. that effects are so variable no robust conclusions can be drawn. Answer: A Page: 42 35. Research on psychologists’ coping has shown that: a. their training inoculates them and reduces their reactivity to stressful life events. b. scheduling breaks helps them deal with stress. c. they over-estimate their own capacity to cope. d. they need to be more self-reliant as they have are unable to seek services themselves. Answer: B Page: 43 36. What is one feature of the Canadian Code of Ethics for Psychologists that sets it apart from other codes of ethics for psychologists? a. It provides an absolute model for contending with ethical issues, rather than relying on a decision-making model which may not cover all possible scenarios. b. It weights all of the four ethical principles equally, in order to include all relevant perspectives. c. An explicit model of ethical decision-making is embedded within the Code, rather than relying upon an absolute standard. d. It is more user-friendly for psychologists than for non-psychologists. Answer: C Page: 43 37. The Canadian Code of Ethics functions primarily as a(n) a. absolute standards model. b. prescriptive standards model. c. decision-making model. d. All of the above. Answer: C Page: 43 38. Which of the four ethical principles in the Canadian Code of Ethics for Psychologists is given the most weight? a. Responsibility to society. b. Respect for the dignity of persons. c. Responsible caring. d. Integrity in relationships. Answer: B Page: 43 39. Which clinical training model emphasizes clinical skills and competencies as a research consumer (rather than as a research producer)? Chapter 2: Contemporary Clinical Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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a. The clinical scientist model. b. The scientist-practitioner model. c. The practitioner-scholar model. d. The scholar-scientist model. Answer: C Page 43 40. In Canada, the Psy. D. program is offered a. in the majority of universities. b. in provinces that do not require a Ph.D. for licensure. c. in free-standing private professional schools. d. in a small number of universities. Answer: D Page: 44 41. The purpose of a Ph.D. or Psy.D. program having accreditation is to ensure that the training program a. maintains its enrolment to produce enough clinical psychologists to meet the population’s needs. b. maintains standards that meet the profession’s expectations for the education of clinical psychologists. c. maintains high standards for acceptance of students. d. does not overload students with needless courses and excessive clinical training. Answer: B Page: 44 42. The primary benefit of attending an accredited program (as opposed to a unaccredited program) in clinical psychology is that: a. students can choose between a Psy. D and a PhD. depending on their long-term career aspirations. b. licensure is guaranteed after graduation. c. the program has met the standards set out by the Canadian Psychological Association for training in professional psychology. d. funding is guaranteed. Answer: C Page: 45 43. One of the major challenges currently facing clinical psychology training programs is a. ensuring that a sufficient number of students complete their program of study. b. keeping stride with the rapidly expanding field of program evaluation. c. keeping stride with rapid progress in the field of clinical neuroscience. d. preparing students to provide services for an increasingly diverse population. Answer: D Page: 46 44. What is one of the main purposes behind a regulatory body that oversees licensing among healthcare professionals? a. to ensure that healthcare professionals have a resource to turn to. b. to ensure that the public is protected when receiving health care services. c. to provide opportunities for healthcare professionals to network with colleagues. Chapter 2: Contemporary Clinical Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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d. to maintain the standards of undergraduate psychology programs, which will be supplying applicants to accredited graduate programs. Answer: B Page: 47 45. In most European countries, to become a clinical psychologist, licensure requirements stipulate that the candidate a. must have received at least a Master’s Degree. b. must have received a Ph.D. c. must have received a Ph.D. and have completed at least two years of post-doctoral experience. d. must have practiced for at least 5 years after receiving the graduate degree. Answer: A Page: 47

46. As of 2015, a candidate for registration in Ontario a. must have received at least a Master’s Degree. b. must have received a Ph.D. from a program that is accredited by the Canadian Psychological Association or its equivalent c. must have received a Ph.D. and have completed at least two years of post-doctoral experience. d. must have practiced for at least 5 years after receiving the graduate degree. Answer: B Page: 47 47. Graduate training in clinical psychology involves coursework and a. supervised practicum training b. a doctoral dissertation c. a full-time internship d. all of the above Answer: D Page: 47 48. The Examination for Professional Practice in Psychology: a. is designed to identify candidates suitable for graduate training in psychology. b. is a Canadian exam that is used by accredited programs. c. is used in North America by licensing bodies in psychology. d. focuses mainly on assessment, intervention & consultation. Answer: C Page: 48 49. The Mutual Recognition Agreement: a. was signed by the APA and CPA to recognize the equivalence of the accreditation processes in the USA and Canada. b. identifies core competencies required for professional practice in psychology in Canadian provinces and the North West Territories. c. will be signed in 2017 to require that all professional training occur within accredited (as opposed to unaccredited) programs. d. allows licensed psychologists to use the title ‘Dr’. Answer: B Page: 48 Chapter 2: Contemporary Clinical Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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Short Answer Questions 1. Should psychologists seek prescription privileges in Canada? List two arguments in favour of prescription privileges for psychologists, and two arguments opposing prescription privileges for psychologists. Suggested answer: Page 33 Reasons in favour: a. Biological approach to treatment of psychological disorders is not incompatible with psychological training. b. Most psychoactive medications are prescribed by general practitioners whose training in mental health issues is limited. c. Underserved segments of the population (rural areas and elderly) could benefit from extension of prescription privileges to psychologists. Reasons opposing: a. Full medical training is necessary to prepare practitioners to understand the impact of psychoactive medication on other physical systems. b. Psychologists’ distinct expertise is in development and application of evidence-based assessment and intervention. Inclusion of psychopharmacological training would come at the expense of training in psychological issues. c. Psychologists should be working in collaboration with other health care professionals rather than trying to duplicate services. d. Canada’s publicly funded health care system means that the federal government would have concerns that additional numbers of practitioners eligible to prescribe psychopharmacological treatments would contribute to mushrooming healthcare costs. 2. Compare and contrast the terms clinical consultation and organizational consultation. Suggested answer: Page 36 a. Comparison: Both of these terms are related to the psychologist acting in the role of a consultant in terms of his or her psychological expertise. b. Contrast: a. Clinical consultation refers to providing information, advice, and recommendations about how to best assess, understand, or treat a client. b. Organizational consultation (or community consultation) refers to evaluating and providing an opinion of some aspect of health care services set by an organization or program. 3. What is an internship and when is it typically completed? Suggested answer: Page 39 a. An internship is a year-long placement that clinical psychology students complete after they have completed all of the other requirements of their graduate program (except for the defence of their Ph.D. dissertation). b. Students are supervised providing clinical services in settings such as hospitals or community settings.

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4. Clinical psychologists often rely on the basic assumptions of a theoretical orientation to guide clinical practice. Describe two of the three ways that a theoretical orientation directs the clinician’s work with a client: Suggested answer: Page 40 a. A theoretical orientation directs the clinician’s attention to phenomena and to possible explanations that are deemed most relevant to their client. b. A theoretical orientation diverts attention from aspects of the client’s experience that are deemed irrelevant. c. A theoretical orientation assists the clinician in developing hypotheses about their client that need to tested against their client’s experiences (i.e.: theories of human functioning are essentially maps and that, to truly know if the map is accurate, it must be put to the test). 5. Define the concept of informed consent. Suggested answer: Page 41 a. Informed consent is the cornerstone of professional and research ethical codes. b. Informed consent applies to both research participants and patients. c. It is essentially the idea that the person who is being experimented on or is receiving services must understand what is being done and must have agreed to participate. 6. List the four ethical principles that are listed in the Canadian Code of Ethics for Psychologists. Suggested answer: Page 42 a. Respect for the dignity of persons. b. Responsible caring. c. Integrity in relationships. d. Responsibility to society. 7. List at least three features of the Canadian Code of Ethics that sets it apart from other codes of ethics for psychologists. Suggested answer: Page 41-42 a. It was developed from an analysis of the international and interdisciplinary literature on codes of ethics. b. An explicit decision-making model is embedded into the code rather than relying on absolute standards. c. There is differential weighting to the four ethical principles. 8. Define and briefly describe the scientist-practitioner model. Suggested answer: Pages 43 a. It is one of the three models that guide training in graduate studies in clinical psychology. Its guiding philosophy is that clinical psychologists should be capable of producing research and utilizing empirical evidence to guide their clinical services. b. Students must develop and demonstrate competencies in research and psychological service provision. c. Students undertake original research and defend research during a dissertation defence. Chapter 2: Contemporary Clinical Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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d. Clinical skills are learned through practicum placements. Students complete an internship supervised by licensed psychologists. 9. Describe how the clinical scientist model differs from the scientist-practitioner model. Suggested answer: Page 43-44 a. The clinical scientist model more strongly promotes the development of research skills than the scientist-practitioner model. b. The primary goal of programs espousing the clinical scientist model is to produce graduates who are equipped to contribute to the knowledge base of psychology and related disciplines. 10. Describe how the practitioner-scholar model differs from both the clinical scientist and the scientist-practitioner model. Suggested answer: Page 44 a. This model place less emphasis on research skills that are typically taught in Ph.D. programs. b. The model emphasizes training in clinical skills, however, research training is required. c. Programs place less emphasis on experimental designs, and greater emphasis on naturalistic designs and the evaluation of individual cases or service-oriented programs. d. Graduates obtain a Psy.D. degree instead of a Ph.D. e. Psy.D. programs train research consumers who are informed by science in their service activities but who do not need the skills to conduct research. 11. What was the accreditation process designed to accomplish? Suggested answer: Page 45 a. To ensure that training programs in clinical psychology maintained standards that met the profession’s expectations regarding the education of clinical psychologists. 12. What are the necessary prerequisites for psychologists to deal with diversity in their practices? Suggested answer: Page 46 a. To be aware of diversity issues. b. To be open to discussing diversity issues with clients. c. To have the interpersonal skills to effectively communicate about diversity issues. d. To have the research skills to interpret and design research that is sensitive to diversity issues. 13. Across most of the Canadian provinces and territories there are numerous requirements that students must complete before they can register as a psychologist. In most provinces and territories, in addition to time spent in supervised practice, students must also complete which three examinations prior to licensure? Suggested answer: Page 46-48 They must complete the a. EPPP exam (Examination for Professional Practice in Psychology), Chapter 2: Contemporary Clinical Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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b. a written jurisprudence and ethics exam, and c. an oral exam that accesses knowledge across a number of clinical areas. 14. What are the main goals of the Mutual Recognition Agreement (MRA) that was signed in 2001 in Canada? Suggested answer: Page 48 a. To establish conditions under which a licensed psychologist could have his or her qualifications recognized in another Canadian jurisdiction. b. To ensure that psychologists licensed in different provinces have comparable levels of competence in providing services to the public.

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Chapter 3 Classification and Diagnosis Multiple Choice Questions 1. ________ refers to the extent to which the classification system reflects reality, whereas ______ refers to the usefulness of the classification system for directing treatment. a. Reliability, validity b. Validity, utility c. Reliability, utility d. Utility, validity Answer: B Page: 50 2. Classification __________ refers to the extent to which the classification system reflects reality. a. utility b. reliability c. validity d. applicability Answer: C Page: 50 3. Classification __________ refers to the usefulness of a classification scheme. a. utility b. reliability c. validity d. applicability Answer: A Page: 50 4. The underlying assumption of the dimensional approach to categorization is there is an important _________ difference between objects in the extent to which they possess certain characteristics or properties. a. quantitative b. qualitative c. subjective d. objective Answer: A Page: 50 5. The underlying assumption of the categorical approach to categorization is that there is an important __________difference between objects that are members of a category and those that are not. a. quantitative b. qualitative c. subjective d. objective Answer: B Page: 50

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6. The classification approach that is based on the assumption that objects differ in the extent to which they possess certain characteristics or properties is known as the a. diagnostic approach. b. categorical approach. c. qualitative approach. d. dimensional approach. Answer: D Page: 50 7. The classification approach that is based on the assumption that entities that are members of a category are qualitatively different from those that are not is known as the a. diagnostic approach. b. categorical approach. c. qualitative approach. d. dimensional approach. Answer: B Page: 50 8. Research has categorized children’s difficulties into two broad dimensions of problems: internalizing and externalizing. Externalizing problems refer to a. yelling and destroying things. b. sadness and withdrawn behaviour. c. behaviour that occurs when the person is in a social setting. d. attributing blame for one’s problem behaviour to others. Answer: A Page: 51 9. Research has categorized children’s difficulties into two broad dimensions of problems: internalizing and externalizing. Internalizing problems refer to a. yelling and destroying things. b. sadness and withdrawn behaviour. c. behaviour that occurs when the person is in a social setting. d. attributing blame one’s problem behaviour to oneself. Answer: B Page: 51 10. Which of the following is known as ‘a family of empirically derived assessment tools to measure competence and problems (internalizing and externalizing) across the lifespan?’ a. Miller’s Assessment Tool Kit. b. Achenbach System of Empirically Based Assessment. c. Schwartz Assessment Battery. d. Weisner System of Clinical Diagnosis. Answer: B Page: 51 11. Health care providers often diagnose patients because: a. Insurance companies often require a diagnosis before they will reimburse the patient for services received. b. It is unable to provide the required guidance on treatment options.

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c. They cannot rely on the different diagnosis made by clinicians, researchers, and, patients when to use in discussing mental health conditions. d. They do not want trust the diagnosis provided by the insurance companies. Answer: A Page: 51 12. The primary purpose of a diagnostic system to classify mental disorders is that it serves to a. differentiate between categorical and dimensional approaches to classification. b. indicate potential causes and future developments in the disorder. c. facilitate allocation of funding for research programs and community agencies servicing specific diagnostic groups. d. provide a framework with which to train mental health practitioners. Answer: B Page: 51 13. A prototype model implies that a. not all people receiving the same diagnosis have exactly the same set of symptoms. b. all people receiving the same diagnosis have the exact same set of symptoms. c. people with the same diagnosis, but a different set of symptoms, require the same treatment for their diagnosis. d. members of the same diagnostic category resemble each other in level of impairment and in prognosis. Answer: A Page: 52 14. In determining whether or not behaviour is abnormal, one must consider a. the context in which the behaviour occurs. b. the age of the person exhibiting the behaviour. c. the cultural heritage of the person exhibiting the behaviour. d. all of the above. Answer: D Page: 52 15. The underlying assumption of a developmental psychopathology approach is that a. biological and psychological systems are constantly changing. b. human behaviour is predictable in all circumstances. c. normative and nonnormative transitions are important considerations in understanding behaviour. d. there is no such thing as “normal” development. Answer: A Page: 53 16. A psychologist who examines ways that a child’s anxiety symptoms interfere with a child settling into a new school is using a(n): a. developmental psychopathology approach. b. anti-psychiatry approach. c. ICD approach. d. social work approach. Answer: A Page: 53 Chapter 3: Classification and Diagnosis Copyright 2018 © John Wiley & Sons Canada, Ltd.

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17. A psychologist who examines ways that an adult’s depression symptoms interfere with the adult transitioning from living on his/her own to an assisted living facility is using a: a. social work approach. b. developmental psychopathology approach. c. gerontological approach. d. categorical approach. Answer: B Page: 53 18. A first-time father is reporting a great deal of anxiety surrounding his new role as a parent. A psychologist using a developmental psychopathology approach would first: a. ask about the client’s past history with symptoms of mental illness. b. utilize a dimensional approach to diagnosing anxiety. c. investigate how much the anxiety interferes with transitioning into this new role. d. recommend that the new father enrol in parent training to help reduce his anxiety. Answer: C Page: 53 19. A new client reports concerns that her child frequently talks about his imaginary friend and all of the wonderful adventures they have together. A psychologist using a developmental psychopathology approach would first: a. ask about any familial history of mental illness. b. ask if there were birth had complications that may have contributed to developmental issues. c. recommend that the client bring her son for a therapy session. d. ask the son’s age to determine age-appropriateness of his behaviour. Answer: D Page: 53 20. Children diagnosed with attention deficit/hyperactivity disorder (ADHD) show persistent and maladaptive symptoms of inattention and/or hyperactivity-impulsivity that are ______________________. a. consistent with developmental level. b. inconsistent with developmental level. c. consistent with age, but not maturity level. d. inconsistent with age, but not maturity level. Answer: B Page: 53 21. An understanding of not only an individual’s current difficulties, but also a consideration of the course of the problem if left untreated, is considered: a. a developmental psychopathology approach. b. clinical utility. c. a syndrome. d. a social work approach. Answer: A Page: 53 22. A practicum student in clinical psychology is feeling sad over the break-up of a romantic relationship and wonders if this is the beginning of a depressive disorder. It is impossible Chapter 3: Classification and Diagnosis Copyright 2018 © John Wiley & Sons Canada, Ltd.

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to diagnose based on this information because: a. most people get over break-ups after a few weeks. b. the practicum student will know ways to prevent the sadness becoming more serious. c. a diagnosis is based on a constellation of symptoms. d. s/he will probably meet someone else soon. Answer: C Page: 53 23. In determining whether a person meets criteria for a diagnosis a of mental disorder, clinical psychologists rely primarily on a. family history. b. self-report of symptoms. c. laboratory tests to confirm diagnosis. d. intrusiveness of primary symptoms. Answer: B Page: 54 24. In 2013, the director of the U.S. National Institute of Mental Health (NIMH), announced that, due to the lack of validity data on the DSM system, the NIMH would encourage efforts to develop a new diagnostic system for mental disorders based on biological and psychological markers for these disorders, known as the a. Research Domain Criteria (RDoC), b. DSM criteria c. International Statistical Classification of Diseases and Related Health Problems (ICD) d. prototype model Answer: A Page: 54

25. Childhood depression was not diagnosed until the 1980s. This is because: a. there were not so many pressures on young people before the development of the Internet and the advent of cyberbullying. b. there were no reliable antidepressant medications and no effective psychological treatments. c. according to the dominant psychoanalytic model, depression was not possible until the person was old enough to have a superego. d. sexist ideology reduced awareness of problems that were more prevalent in girls than boys. Answer: C Page: 54 26. Wakefield (1992) described ____________ as the behaviours associated with a mental disorder that are problematic, and that these problematic behaviours are damaging to the individual or to those around him or her. a. harmful behaviour. b. harmful dysfunction. c. dysfunctional behaviour. d. dysfunctional control. Chapter 3: Classification and Diagnosis Copyright 2018 © John Wiley & Sons Canada, Ltd.

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Answer: B

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Page: 55

27. Widiger defined the concept of _______ which refers to the impairment resulting from a disorder that is involuntary or not readily managed. a. harmful dysfunction b. dysfunctional control c. dyscontrol d. harmful behaviour Answer: C Page: 55 28. Schizophrenia was not included in the World Health Organization Mental Health Survey Consortium (2004) because a. previous research had shown that schizophrenia is strictly a North American phenomenon. b. previous research had shown that many people diagnosed with schizophrenia would also receive a diagnosis included in the surveys. c. schizophrenia was not of interest to the researchers. d. all of the above. Answer: B Page: 55 29. In the 2004 survey of prevalence rates of mental disorders across 14 countries, the Mental Health Survey Consortium (World Health Organization) found that across most countries, ________ disorders were the most common, followed by _______ disorders. a. mood; anxiety b. anxiety; impulse-control c. anxiety; mood d. mood; substance abuse Answer: C Page: 97 30. Within the biopsychosocial model of the etiology of mental disorders, the contributions of biological, psychological, and social factors are likely to ________ from disorder to disorder, and may _________ over the course of life. a. be comparable; remain constant b. be comparable; change c. vary; remain constant d. vary; change Answer: D Page: 58 31. Turner and Lloyd (2004) conducted a study on the build-up of life stress and the subsequent risk of developing a mental disorder. The researchers found that the odds of developing a disorder a. were unrelated to the number of stressors experienced. b. increased with the number of stressors experienced. c. decreased with the number of stressors experienced. d. were related to the specific type of stressors experienced. Answer: B Page: 58 Chapter 3: Classification and Diagnosis Copyright 2018 © John Wiley & Sons Canada, Ltd.

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32. The Christchurch Health and Development Study of 1,265 individuals, those who were exposed to ____________ had a 1.4 times higher rate of mental disorder than those who were not exposed. a. poor social conditions b. other family members with depressive symptoms c. earthquakes d. physical disorders Answer: C Page: 58 33. Longitudinal studies can inform us about which of the following? a. Variables that predict mental disorders. b. Individual differences in the emergence and development of mental disorders. c. Maintenance and course of mental disorders. d. All of the above. Answer: D Page: 58 34. Cole et. al. (2002) conducted a study to investigate the emergence of depression in children and adolescents. What were the results of the study? a. There was a significant increase in the rate of depressive symptoms between the sixth and seventh grade. b. Depressive symptoms developed differently across males and females. c. The rate at which depressive symptoms occurred in children and adolescents was inconsistent over the course of their development. d. Depressive symptoms decreased between sixth and seventh grade. Answer: A Page: 59 35. Longitudinal research of depression rates in adulthood indicate that rates of depressive symptoms are a. lower in young adulthood than middle adulthood, and then surge in older adulthood. b. highest in young adulthood, decrease in middle adulthood, but increase again in older adulthood. c. highest in young adulthood, decrease in middle adulthood, and then remain constant throughout the remainder of adulthood. d. lowest in young adulthood, but steadily increase through middle and older adulthood. Answer: C Page: 59 36. The 3rd edition of the DSM differed from previous editions in that it a. removed theoretical rationales for mental disorders, allowing for greater acceptance in the mental health field. b. improved the reliability of diagnoses through field trials of the diagnostic system. c. introduced a multiaxial diagnostic system. d. all of the above. Answer: D Page 61 Chapter 3: Classification and Diagnosis Copyright 2018 © John Wiley & Sons Canada, Ltd.

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37. One shortcoming of the original Diagnostic and Statistical Manual of Mental Disorders (DSM; 1952) was that a. the diagnostic descriptions were too vague. b. the diagnostic descriptions were too specific. c. it offered unethical treatment methodologies for various disorders. d. it heavily emphasized biological and neurological aspects of mental disorders. Answer: A Page: 61

38. Dhat syndrome, malady moun, and nervios are examples of a. documented languages spoken by patients with psychotic symptoms. b. culture-specific disorders described in one of the DSM-V appendices. c. culture-specific disorders that remain excluded from the DSM-V. d. Inuit rituals involving the “de-spiritification” of individuals with mental disorders. Answer: B Page: 65 39. The International Statistical Classification of Diseases and related Health Problems (ICD) was developed: a. by the World Health Organization following criticism of the DSM approach. b. by the World Health Organization to diagnose all disorders. c. by a coalition of international psychological organizations to incorporate the scientific evidence on normal development. d. to provide an expanded range of billing codes for health care systems. Answer: B Page: 67 40. The ICD is used: a. far less than DSM as it is a newer system. b. to determine prevalence rates across countries using the same criteria. c. by practitioners who favour biological interventions. d. predominantly in low income countries. Answer: B Page: 67 41. The DSM-5 and the ICD-10-CM are: a. fundamentally different ways of looking at mental disorder. b. a US versus a global approach to diagnosis. c. compatible for most major mental disorders. d. both available in English only. Answer: C Page: 67 42. The extent to which professionals agree on the presence and nature of a diagnosable condition is known as a. diagnostic reliability. b. diagnostic validity. c. diagnostic consensus. d. mutual consensus. Chapter 3: Classification and Diagnosis Copyright 2018 © John Wiley & Sons Canada, Ltd.

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Answer: A

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43. Post traumatic stress disorder is an example of a diagnosis that is defined polythetically, meaning that individuals with the diagnosis a. meet all criteria in the same way. b. may exhibit markedly different patterns of symptoms. c. may exhibit symptoms of personality disorders. d. meet none of the criteria in the same way. Answer: B Page: 70 44. Both Sam and Aimée recently received diagnoses of depression however the symptoms they are each experiencing are very different from each other. This is a. an example of diagnostic reliability. b. an example of a disorder that is defined polythetically. c. evidence they are experiencing comorbid disorders. d. an example of a disorder that is defined monothetically. Answer: B Page: 70 45. An important consideration in diagnostic reliability is the _______ of individuals with the same diagnosis, as this could impact inter-rater reliability, and contribute to ______ in treatment response. a. homogeneity of symptom profiles; similarity b. heterogeneity of symptom profiles; variability c. homogeneity of symptom profiles; variability d. heterogeneity of symptom profiles; similarity Answer: B Page: 70 46. According to Kendell and Jablensky (2003), when a disorder is a discrete entity that has clear boundaries with other disorders, this is referred to as diagnostic a. validity. b. reliability. c. classification. d. specificity. Answer: A Page: 71 47. A DSM diagnosis with questionable validity is: a. Schizophrenia. b. Bipolar disorder. c. Acute stress disorder. d. Selective mutism. Answer: C Page: 71 48. The extent of comorbidity in clinical populations is a. non-existent. b. limited. c. unknown. Chapter 3: Classification and Diagnosis Copyright 2018 © John Wiley & Sons Canada, Ltd.

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d. substantial. Answer: D Page: 72 49. Studies on vulnerability to mental disorder following natural disasters have found: a. the majority of people exposed to natural disaster will develop symptoms of PTSD if they do not receive counseling during the acute phase. b. most countries now have sophisticated systems to ensure continuity of care during disasters. c. those with pre-existing disorders are already getting help, which protects them from further symptoms. d. Although acute distress is to be expected, long-term resilience is the most common outcome. Answer: D Page: 72

50. Compared to individuals with a single mental disorder, those with comorbid conditions are more a. severely impaired in daily life functioning. b. likely to have a fleeting history of mental health problems. c. likely to use few health care services. d. progress quicker in their treatment. Answer: A Page: 72

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Short Answer Questions 1. Two key aspects of the adequacy of classification systems are validity and utility. Define each term. Suggested Answer: Page 50 a. Validity – the extent to which the principles used in classifying an object are effective in capturing the nature of the entity. b. Utility – the usefulness of the resulting classification scheme (i.e., for treatment planning and predicting treatment outcome). 2. Name the two types of classification approaches and explain how they are different. Suggested answer: Page 50 Categorical approach a. An object is determined to either be a member of a category or not. b. Underlying assumption is that there is an important qualitative difference between objects that are members of a category and those that are not (e.g. living vs. not living). Dimensional approach a. Based on the assumption that objects differ in the extent to which they possess certain characteristics or properties. b. Focuses on quantitative differences. c. All objects can be arranged on a continuum to indicate the degree of membership in a category (e.g. weight and height). 3. What is a diagnostic system of classification? How does a diagnostic system of classification differ from a diagnosis? Suggested Answer: Page 51 a. Diagnostic system: classification based on rules used to organize and understand diseases and disorders. b. Diagnosis: the result of applying the decision-making rules of a diagnostic system to the symptoms of a specific individual. 4. List at least three ways a diagnostic system is useful. Suggested Answers: Page 51 a. provides a concise description of essential aspects of the patient’s condition b. reflects best current scientific knowledge of psychopathology c. provides a common language for clinicians, researchers, and patients d. indicates possible causes of the current condition e. indicates possible prognosis, or future developments of the condition f. provides guidance on possible co-existing problems or conditions that should be evaluated g. provides guidance on treatment options to be considered h. provides a key term that can be used by clinicians to search the scientific literature for most current information of the condition i. provides a framework for determining reimbursement of health services and eligibility for special programs or services Chapter 3: Classification and Diagnosis Copyright 2018 © John Wiley & Sons Canada, Ltd.

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5. List two ways a diagnostic system may be disadvantageous to the individual receiving the diagnosis: Suggested Answer: Page 51 a. Potential stigmatization of the person receiving the diagnosis b. Potential for an inaccurate diagnosis to result in harmful or inappropriate treatment. 6. When determining whether or not behaviour is abnormal, what must a mental health professional consider? Suggested Answer: Pages 52 a. The client’s age, developmental stage, cultural heritage, and context of the behaviour. 7. Wakefield (1992) proposed the term harmful dysfunction, whereas Widiger (2004; Widiger & Sankis, 2000) has suggested dyscontrol to define the impairment associated with mental disorders. Define each of these terms. Suggested Answer: Page 55 a. Harmful dysfunction: i. Diagnosis of a disorder does not just require the co-occurrence of a set of statistically rare symptoms or behaviours, but requires that there is something wrong or dysfunctional and that this dysfunction causes harm to the individual or to those around him or her. ii. implies that a classification of abnormality or disorder involves a value judgement b. Dyscontrol: i. the impairment resulting from a disorder must be involuntary or not readily controlled (i.e.: someone who willfully engage in problematic behaviour would not be diagnosed with a mental disorder). 8. What is the biopsychosocial model of mental disorders? Suggested Answer: Page 58 a. The presence of a mental disorder is determined by a blend of biological, psychological, and social factors. The precise contribution of each of the three factors varies from disorder to disorder, and can vary across the lifespan. 9. Concerns over the “medicalization of ordinary life” have led to calls for more stringent definitions of mental disorders. What is one argument that goes against this? Suggested answer: Pages 69 a. Research indicates (i.e.: Kessler et al., 2003) that even those with mild forms of mental disorders may be at elevated risk for subsequent psychosocial problems. a. Compared with people with no diagnosable condition, those suffering from a mild disorder were 2.4 times more likely to develop significant psychosocial problems. b. Accordingly, the researchers argued that although mental disorders, like physical disorders, vary in severity, even mild mental disorders are

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Introduction to Clinical Psychology 4e

associated with substantial subsequent risk for impaired functioning and should therefore be represented within a diagnostic system. b. Additional research (i.e.: Rai, Skapinakis, Wiles, Lewis, & Araya, 2010) supported this: Using ICD-10 diagnostic criteria and UK epidemiological data, they found that over half of the functional disability occurring during mental disorders was accounted for by symptoms that were below the diagnostic threshold. 10. What is comorbidity and explain how people are impacted by it. Suggested Answer: Page 72 a. Comorbidity occurs when a person receives diagnoses for two or more disorders at a specific point in time. b. People with comorbid disorders are likely to be: i. more severely impaired in daily life functioning ii. have chronic history of mental health problems iii. have more physical health problems iv. use more health care services. 11. Describe the three parts of the problem with inter-rater reliability. Suggested Answer: Page 69-70 a. The challenge of accurately identifying uncommon conditions. In general, the less frequently a disorder occurs, the more likely clinicians will disagree about its presence during a diagnostic interview. b. The continuing reliance on a diagnostic system that is based on categories rather than dimensions. The coding of a symptom as a dichotomous can negatively affect the reliability of symptom coding compared with rating the same symptom as a continuous variable. c. Concerns over how reliability is actually evaluated. The process of having two clinicians diagnose based on a single interview does not directly address the key question of whether two clinicians would make the same diagnostic determinations if the client was interviewed separately by each clinician. 12. Describe the limitations of a polythetic approach to diagnosis. Suggested Answer: Page 70 a. The fact that such extensive symptom variability is permitted in the DSM-IV negatively affects inter-rater reliability. b. Defining disorders this way leads to obscuring relationships between subtypes of a disorder and treatment/outcome. c. Variability in response to treatment, whether psychological or pharmacological, could be related to variability in symptom profiles among treated patients. However, because research generally focuses on the relationship between diagnosis and outcome, the connection between different symptom profiles and treatment responsiveness is overlooked.

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Introduction to Clinical Psychology 4e

Chapter 4 Research Methods in Clinical Psychology Multiple Choice Questions 1. Basing clinical services and health care policy on replicated evidence gathered from scientific studies is known as a. eminence-based practice. b. evidence-based practice. c. ethical practice. d. scientific practice. Answer: B Page: 76 2. Basing clinical services on tradition and authority, in which recommendations are accepted because the person delivering them is seen as an expert, has been referred to as a. theory-based practice. b. clinically-based practice. c. eminence-based practice. d. empirically-based practice. Answer: C Page: 76 3. Relying on common sense as a guide to appropriate decision-making can be problematic because a. Information processing and decision-making can be illogical b. rational decision making is based on observation. c. rigidity in thought patterns can lead to faulty reasoning. d. flexibility in thought patterns can lead to faulty reasoning. Answer: A Page: 77 4. A logical error assuming that the most valid conclusion to reach is a compromise between two competing positions is a common error in thinking referred to as: a. false dilemma. b. faulty reasoning. c. golden mean fallacy. d. straw person argument. Answer: C Page: 76 5. Mischaracterizing a position in order to make it look absurd or unpalatable is a common error in thinking referred to as: a. the straw person argument. b. an appeal to ignorance. c. affirming the consequent. d. the golden mean fallacy. Answer: A Page: 76

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6. A person who thinks “There’s no research telling me that this new diet is ineffective, so that must mean that it’s effective!” is engaging in a common error in thinking referred to as: a. affirming the consequent. b. an appeal to ignorance. c. faulty reasoning. d. false reasoning. Answer: B Page: 76 7. A child who isn’t getting along with another child says: “She either wants to be my best friend, or doesn’t want to be friends at all!” By reducing the range of options to just two extremes, this child is engaging in a common thinking error referred to as: a. faulty reasoning. b. affirming the consequent. c. the straw person argument. d. false dilemma. Answer: D Page: 76 8. The prognosis for individuals with Obsessive Compulsive Disorder improved substantially with the development of behavioural treatments that include the key treatment components of a. exposure and systematic avoidance. b. systematic desensitization and response avoidance. c. exposure and response prevention. d. thought-stopping and response prevention. Answer: C Page: 77 9. Practice must change when evidence shows that a theoretically sound intervention does not work. An example of a commonly used, (but ineffective) psychotherapeutic component for treating Obsessive Compulsive Disorder during 1970s and 1980s was a. thought-stopping. b. exposure. c. response prevention. d. systematic desensitization. Answer: A Page: 77 10. Research ideas can be inspired by: a. experience and observation. b. previous research. c. theory. d. all of the above. Answer: D Page: 78 11. When beginning research on a new topic the selection of an appropriate research design should follow: a. formulation of the study procedures. Chapter 4: Research Methods in Clinical Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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b. a thorough review of the published research on the topic of interest. c. consideration of ethical issues in testing of the hypothesis. d. operationalization of key concepts. Answer: B Page: 79 12. In the quest for knowledge, the welfare of research participants can be compromised a. when the potential for benefit outweighs the potential for harm. b. when the research participant gives informed consent. c. when the potential knowledge gained from the study can save the lives of others. d. under no circumstances. Answer: D Page: 80 13. The use of deception in a research study only permissible when a. being straightforward about study goals would likely cause physical or emotional distress. b. participants are informed about the purpose of the study. c. it is justified by the potential benefit of the study and the use of nondeceptive procedures is not feasible. d. the study is conducted by a professional researcher. Answer: C Page: 81 14. Ensuring that participants have an opportunity to promptly obtain information about the nature, results, and conclusions of the research, as well as to correct any misconceptions about the research is referred to as __________. a. communication of findings. b. debriefing. c. informed consent. d. dispensing. Answer: B Page: 81 15. In Canadian institutions, the ____________ are charged with ensuring that any proposed research conforms to the Tri-Council Policy statement Ethical Conduct for Research Involving Humans. a. research ethics boards. b. individual researchers. c. funding agencies. d. provincial governments. Answer: A Page: 82 16. Donald Campbell encouraged researchers to proactively identify and remedy potential design problems that could undermine a study’s _________. a. clinical significance. b. reliability. c. validity. d. procedures. Answer: C Page: 85 Chapter 4: Research Methods in Clinical Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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17. _____________ refers to the extent to which the interpretations drawn from the results of a study can be justified and alternative interpretations can be reasonably ruled out. a. External validity b. Internal validity c. Statistical conclusion validity d. Internal reliability Answer: B Page: 85 18. ________________ refers to the extent to which the interpretations drawn from the results of a study can be generalized to real-world settings. a. External validity b. Internal validity c. Statistical conclusion validity d. Internal reliability Answer: A Page: 85 19. Changes in the participants due to their psychological or physical development that cannot be separated from the experimental manipulation is known as a. testing. b. statistical regression. c. attrition. d. maturation. Answer: D Page: 86 20. Which of the following is a common threat to the internal validity of a study? a. Reactivity of assessment. b. Timing of measurement. c. Sample characteristics. d. Statistical regression. Answer: D Page: 86 21. The loss of participants in a study over time is known as a. regression. b. operationalization. c. attrition. d. maturation. Answer: C Page: 86 22. Which of the following is a common threat to the external validity of a study? a. Selection biases. b. Attrition rates. c. Sample characteristics. d. Repeated testing. Answer: C Page: 86

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23. Case studies can be beneficial in a. making connections between phenomena that have not previously been examined. b. formulating and then testing hypotheses efficiently. c. addressing threats to internal validity. d. providing adequate protection against threats to external validity. Answer: A Page: 86-87 24. The major weakness of the case study method is that a. most threats to internal validity cannot be addressed. b. it is very difficult to achieve inter-rater reliability. c. it favours internal validity over external validity. d. it favours external validity over internal validity. Answer: A Page: 87 25. In an A-B single case design, “A” represents: a. the preferred treatment strategy. b. the level of symptoms following the intervention. c. the level of symptoms prior to the intervention. d. the number of participants in the study. Answer: C Page: 87 26. __________, no matter how complex, can only examine the association among variables. a. Single case designs b. Correlational designs c. Quasi-experimental designs d. Meta-analysis Answer: B Page: 88 27. Correlational designs use which of the following design features? a. Experimental manipulation. b. Random assignment to conditions. c. Random sampling of a population. d. None of the above. Answer: D Page: 88 28. Correlational designs can ___________ determine causality. a. never b. sometimes c. often d. always Answer: A Page: 88 29. When correlational designs are used to examine the underlying structure of a measure or a set of measures, it is known as a. meta-analysis. b. factor analysis. Chapter 4: Research Methods in Clinical Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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c. case-analysis. d. structural analysis. Answer: B Page: 89 30. A __________ variable is one that influences the strength of the relation between a predictor variable and a criterion variable. a. mediator b. independent c. dependent d. moderator Answer: D Page: 90 31. A __________ variable explains the mechanism by which a predictor variable influences a criterion variable. a. mediator b. moderator c. independent d. relational Answer: A Page: 90 32. Structural equation modeling (SEM) is used to a. test all components of a theoretical model within a given data set. b. unequivocally demonstrate that the hypothesized model is true. c. use a relatively small sample, which is easier to obtain. d. all of the above. Answer: A Page: 90 33. One limitation to structural equation modeling (SEM) is that a. its use is limited to small samples. b. it can determine only the extent to which a hypothesized causal model fits the study’s data, not whether the hypothesized causal model is true. c. it is incompatible with experimental designs. d. even though it includes elements of confirmatory factor analysis, it neglects mediator analyses. Answer: B Pages: 90 34. In quasi-experimental designs: a. previous studies are summarized to draw conclusions about the state of knowledge in a research field. b. the researcher manipulates some variables, but is not able to manipulate other important variables. c. participants are randomly assigned to conditions. d. the researcher can clearly demonstrate a cause and effect relationship between variables. Answer: B Page: 90-91

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35. One major weakness of the quasi-experimental design is that a. it provides correlational data, at best. b. there is no random assignment of participants to experimental conditions. c. groups of people are randomly assigned to control conditions. d. meta-analysis cannot be performed on quasi-experimental research results. Answer: B Page: 91 36. Quasi-experimental designs are often used when a. the researcher is attempting to determine causation. b. case studies do not provide enough information. c. it is neither ethical nor feasible to randomly assign participants to conditions. d. the randomization procedures were flawed. Answer: C Page: 91 37. Experimental designs involve both random assignment to condition and _____________. a. some type of manipulation. b. comparison of two previously established groups. c. a laboratory task. d. higher costs than quasi-experimental designs. Answer: A Page: 91 38. Compared with all other research designs, experimental designs provide the best protection against threats to a. external validity. b. internal validity. c. external reliability. d. internal reliability. Answer: B Page: 91 39. Probability sampling: a. is designed to ensure that the research sample is representative of the populations. b. Is designed to obtain a large sample size rather than a representative sample. c. is the most commonly sampling strategy in clinical psychology research. d. often requires web-based advertising to recruit participants. Answer: A Page: 94 40. The degree to which elements of the measure (such as items on a test) measure the same construct is referred to as a. internal consistency. b. criterion validity. c. inter-rater reliability. d. discriminant validity. Answer: A Page: 96 41. The consistency of scores on a measure across different raters or observers is known as a. internal consistency. Chapter 4: Research Methods in Clinical Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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b. test-retest reliability. c. inter-rater reliability. d. face validity. Answer: C Page 96 42. The association of a measure with other relevant data measured at some future point in time is known as a. concurrent validity. b. convergent validity. c. discriminant validity. d. predictive validity. Answer: D Page: 96 43. The extent to which a measure adds to the prediction of a variable beyond what can be predicted with other measures is known as a. incremental validity. b. discriminant validity. c. criterion validity. d. convergent validity. Answer: A Page: 96 44. Aspects of data analysis that influence the validity of the conclusions drawn about the results of the research study is referred to as a. clinical significance. b. face validity. c. self-report measures. d. statistical conclusion validity. Answer: D Page: 96 45.

refers to the ability to detect group differences when such differences truly exist. a. Statistical power b. Statistical regression c. Statistical significance d. Statistical comparison Answer: A Page: 96

46. Concluding there is an effect when no true effect exists is known as a a. type I error. b. type II error. c. low effect size. d. type III error. Answer: A Page: 96 47. Concluding there is no effect when a true effect exists is known as a a. type I error. Chapter 4: Research Methods in Clinical Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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b. type II error. c. type III error. d. low effect size. Answer: B Page: 96 48. Measurement unreliability, participant heterogeneity, and low statistical power are all threats to a. internal reliability. b. statistical conclusion validity. c. Incremental validity. d. inter-rater reliability. Answer: B Page: 96 49. Clinical significance refers to whether a. the intervention has made a meaningful impact on treated participants. b. there is a statistically significant difference between treated and untreated participants. c. the study used participants who were diagnosed by a healthcare professional. d. improvement was rated by a trained clinician. Answer: A Page: 97 50. Which of the following involves a set of statistical procedures to quantitatively review research in an area? a. structural equation modeling. b. quantitative research design. c. meta-analysis. d. systematic reviews. Answer: C Page: 99 51. The difference between the means of the experimental group and the control group, divided by the standard deviation of either the control group or the pooled sample of both groups is the a. clinical standard deviation. b. effect size. c. clinical effect. d. clinically significant effect. Answer: B Page: 99 52. When selecting a sample for study, a researcher must be careful to: a. select members only from certain age, gender, ethnicity, and socioeconomic status demographics. b. ensure that the sample is appropriate considering the population to which the results will be generalized. c. recruit students from university disciplines other than psychology. d. offer large incentives to attract potential participants. Answer: B Page: 99 Chapter 4: Research Methods in Clinical Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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Short Answer Questions: 1. It is important not to rely on common sense as a guide to appropriate decision making, as there are often logical inconsistencies in the way that people process information and make decisions. Define two common errors in thinking/logical fallacies, and provide an example for each. Suggested Answers: Page 76 a. Faulty reasoning – a form of argument that is inaccurate or misleading in some way i. Example: “Psychologists have provided effective services for decades without having research available on what makes treatment effective. Therefore, there is no reason for me to bother reading this research in order to be effective.” b. False Dilemma – this fallacy takes the form of reducing the range of options available to just two (usually extreme) options i. Example: “Either I accept the treatment that the psychologist is suggesting or I just give up trying to change.” c. Golden Mean Fallacy – involves assuming that the most valid conclusion to reach is a compromise of two competing positions i. Example: “I have heard that both cognitive and psychodynamic treatments can be helpful for the type of problems I have, so I really should look for a treatment that combines both cognitive and psychodynamic elements.” d. The Straw Person Argument – mischaracterizing a position in order to make it look absurd or unpalatable i. Example: “Anyone who would prescribe a drug to treat my son’s symptoms just wants to turn active kids into zombies.” e. Affirming the Consequent – assume that X is the cause of y, then, when y is observed, conclude that X must have caused it i. Example: “People who have schizophrenia always act in a bizarre manner. This person is acting bizarrely. So, obviously, this person has schizophrenia.” f. Appeal to Ignorance – arguing that because there is no evidence to prove a position is wrong, the position must be correct i. Example: “There is no scientific evidence that having my patients sing and dance while they remember the trauma that they experienced harms them or is ineffective. So, of course, this new form of therapy has to be helpful.” 2. List and provide examples of three sources of research ideas. Suggested Answer: Page 79 a. Everyday experience and observations i. e.g., noticing that your children’s friends are troubled by their parents’ divorce b. Professional experience and observations

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i. e.g., noticing a pattern among one’s patients that suggests a connection between feelings of social rejection and specific early childhood experiences c. Addressing applied problems and needs i. e.g., testing whether a successful psychoeducational treatment package for helping police officers better manage work stress can be adapted to alleviate the distress of victims of serious motor vehicle accidents d. Previous research i. e.g., attempting to reconcile contradictory findings in previous research by comparing the phenomenon in clinic and community samples, as variations in sampling may be responsible for these inconsistent findings. e. Theories i. Directly comparing the ability of two different theories of motivation to predict which distressed couples will stay in couples’ therapy and which couples will terminate services prematurely. 3. After developing a general research idea, describe the five steps researchers engage in to ensure that the hypothesis is properly formulated and tested. Suggested Answer: Page 79 a. First, the researcher conducts a systematic search of the published research on the phenomenon of interest. b. Second, assuming that there is no research that has directly tested the idea, the researcher begins to formalize ideas so that they can be tested in a scientific manner. a. i.e.: operationalizing ideas into something that can be measured c. Third, the researcher must carefully consider the extent to which the research idea may be based on cultural assumptions that may limit the applicability or relevance of the planned research. d. Fourth, the researcher must consider ethical issues in testing of the idea. e. Fifth, the researcher must draw together all the results of the previous steps to sketch out the study procedures. 4. According to the American Psychological Association Ethical Principles for Research and Publication, when is it justified to use deception in research? Suggested Answer: Page 81 a. Deception is not used in research unless it is justified by the study’s likely value and the use of non-deceptive procedures is not feasible. b. Deception cannot be used if the research is likely to cause physical pain or severe emotional distress. c. When deception is used, participants must be informed about the nature of deception as early as possible. 5. Describe three threats to the internal validity of a study. Suggested Answer: Page 85 a. History – involves the influence of events that occur outside the context of the study that influence or accounts for the results of the study Chapter 4: Research Methods in Clinical Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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b. Maturation – changes in the participants due to their psychological or physical development that cannot be disentangled from the experimental manipulation c. Testing – repeated testing can create familiarity and/or memory effects d. Instrumentation – changes in the definition of constructs and in their measurement can make the interpretation of changes in participants’ responses much more difficult, if not impossible e. Statistical Regression – extreme scores on measures, both high and low, tend to be less extreme upon retesting f. Selection Biases – the effect that systematic differences in recruiting participants or assigning participants to experimental conditions may have on the outcome of the study g. Attrition – the loss of participants over time/ systematic differences in those that stay vs. those who drop out from the study 6. Describe three characteristics of correlational designs. Suggested Answer: Page 88 a. Examines the associations among variables b. Can never determine causality c. Can be analyzed with all types of statistics d. Can be used to examine the underlying structure of a measure or a set of measures e. Employed to examine the relations among discrete variables in an effort to develop or test a conceptual model 7. What feature(s) do quasi-experimental and experimental designs share? How are they different? Why would a researcher choose a quasi-experimental design? Suggested Answer: Page 90-91 a. They both involve experimental manipulation by the researcher. b. Quasi-experimental designs do not involve random assignment to experimental conditions, whereas experimental designs do involve random assignment. c. Quasi-experimental designs are used because, in many situations, it is not ethical or feasible to randomly assign participants to conditions. 8. What is a randomized controlled trial? Suggested Answer: Page 92 a. An experimental design to test the efficacy of a treatment in a research setting b. Participants are randomly assigned to one of two or more treatment conditions c. Often, a no-treatment condition is included (e.g., wait-list condition) 9. Describe the three kinds of reliability described in the text. Suggested Answer: Page 96 a. Test- Retest Reliability: The stability over time of scores on a measure. b. Inter-Rater Reliability: The consistency of scores on a measure across different raters or observers. c. Internal consistency: The degree to which elements of a measure (such as items on a test) are homogeneous, or measure the same construct.

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10. Why is low statistical power a common threat to the statistical conclusion validity of a study? Suggested Answer: Page 96 a. Statistical power refers to the ability to detect group differences when such differences truly exist. If a study has low statistical power, often caused by the use of samples that are too small, the researcher may not be able to accurately conclude that group differences were found in the study. 11. What is meta-analysis, and name one advantage of this procedure. Suggested Answer: Page 99 a. Meta-analysis: A set of statistical procedures for quantitatively summarizing the results of a research domain. Meta-analysis combines the results of prior research using a common metric called an effect size. b. Advantages: a. Statistical analyses, rather than the author’s impressions, guide the conclusions drawn about a research topic. b. By including data from many studies, the number of research participants on whom conclusions are based is dramatically increased. i. This greatly enhances the researcher’s power to detect an effect ii. And improves the generalizability of the conclusions drawn on the basis of the literature.

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Chapter 5 Assessment: Overview Multiple Choice Questions

1. Which of the following is the BEST example of a psychological assessment as a stand-alone service? a. An intervention-focused evaluation. b. A child custody evaluation. c. A pre-treatment evaluation. d. A treatment monitoring evaluation. Answer: B Page: 103 2. Evidence-based assessment uses research and theory to guide the manner in which the a. assessment process unfolds. b. treatment unfolds. c. treatments are provided. d. none of the above. Answer: A Page: 104 3. Assessments conducted primarily to provide information addressing a person’s current or anticipated psychosocial deficits are referred to as _________ services. a. intervention-focused b. assessment-focused c. evaluative d. prognostic Answer: B Page: 105 4. An assessment conducted as a first step in identifying an appropriate and effective service to meet an individual’s unique needs is referred to as a(n)_________ service. a. intervention-focused b. assessment-focused c. evaluative d. prognostic Answer: A Page: 105 5. A procedure to identify individuals who may have clinically significant problems or who may be at risk for developing such problems is referred to as a _______ procedure. a. diagnostic b. screening c. treatment-planning d. treatment-evaluation Answer: B Page: 106 6. Screening may occur at which of the following sites? Chapter 5: Assessment: Overview Copyright 2018 © John Wiley & Sons Canada, Ltd.

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a. Clinic and/or hospital. b. School. c. Employment setting. d. All of the above. Answer: D Page: 106 7. A _______ tool is useful in identifying individuals at risk for a mental disorder. Those who score high on that measure would _______meet diagnostic criteria for a disorder. a. screening; not necessarily b. diagnostic; definitely c. screening; rarely d. diagnostic; almost always Answer: A Page: 107 8. Researchers developed a brief survey of depressive symptoms to be used in schools to evaluate adolescents’ current level of symptoms. This tool is an example of a ______ tool. a. prognosis b. diagnosis c. screening d. treatment monitoring Answer: C Page: 107 9. A diagnosis is useful to psychologists because: a. it provides an initial framework for a treatment plan. b. it helps in searching the scientific literature for information on associated features such as etiology and prognosis. c. It enables communication with other health professionals. d. all of the above. Answer: D Page: 107 10. What term is more commonly used today, replacing the term psychodiagnosis? a. Screening. b. Case formulation. c. Patient conceptualization. d. Clinical presentation. Answer: B Page: 107 11. Case formulation refers to the process of collecting assessment data a. for use in court proceedings. b. to evaluate intervention services. c. as a means of communication among clinicians and with other health professionals through patient files. d. to develop a comprehensive view of an individual’s functioning. Answer: D Page: 107

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12. Psychological assessment _________ prediction regarding the individual’s future functioning. a. should not include any form of b. does not necessarily have to include c. always implies some form of d. is not the same as making a Answer: C Page: 107 13. The use of assessment data, in combination with relevant empirical literature, to make predictions about the future course of an individual’s psychological functioning is referred to as: a. diagnosis. b. prognosis. c. treatment monitoring. d. treatment evaluation. Answer: B Page: 108 14. The collection of large amounts and multiple sources of data can run the risk of a. unnecessary costs. b. unnecessary error. c. less time for intervention. d. all of the above. Answer: D Page: 108 15. Prediction error during an assessment is more likely when the a. base rate of a behaviour is low. b. base rate of a behaviour is moderate. c. base rate of a behaviour is high. d. behaviour has been empirically investigated. Answer: A Page: 108 16. When an event occurs that was not predicted, it is referred to as a a. false positive. b. false negative. c. true positive. d. true negative. Answer: B Page: 109 17. A forensic psychologist predicts that an offender is unlikely to harm himself during a threeyear conditional release, and at the end of the three years the offender has not engaged in any self-harm. This type of prediction would be referred to as a a. true positive. b. true negative. c. false positive. d. false negative. Answer: B Page: 109 Chapter 5: Assessment: Overview Copyright 2018 © John Wiley & Sons Canada, Ltd.

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18. A psychologist initially considers diagnosing a child with ADHD based on reports from several teachers. However, after consultation with the child’s parents, it is clear that the child’s sleep habits are severely problematic, and sleep hygiene training is recommended. Had the psychologist diagnosed ADHD, this type of prediction would be referred to as a a. true positive. b. true negative. c. false positive. d. false negative. Answer: C Page: 109 19. Sensitivity refers to the relative proportion of _________ identified by the assessment. a. true positives b. true negatives c. false positives d. false negatives Answer: A Page: 109 20. Specificity refers to the relative proportion of ________ identified by the assessment. a. true positives b. true negatives c. false positives d. false negatives Answer: B Page: 109 21. Providing a clear focus for treatment, giving the client realistic expectations about the process and likely outcome of treatment, as well as establishing a standard against which treatment progress can be measured are all clear benefits of a. prognosis. b. diagnosis. c. treatment maintenance. d. treatment planning. Answer: D Page: 109 22. Treatment planning: a. allows the client to pre-pay services. b. uses assessment data and relevant scientific evidence to make predictions about the future course of a patient's psychological functioning. c. requires the psychologist to determine the extent to which there are efficacious treatments to address the client’s problems. d. is the process by which agencies decide which services to fund. Answer: C Page: 109 23. A useful treatment plan must cover the general areas of a. problem identification and treatment evaluation. b. problem identification, treatment goals, and treatment strategies/tactics. Chapter 5: Assessment: Overview Copyright 2018 © John Wiley & Sons Canada, Ltd.

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c. treatment goals, treatment evaluation, and treatment strategies/tactics. d. treatment goals, treatment strategies/tactics, and treatment evaluation. Answer: B Page: 110 24. To be most useful, treatment planning should a. focus only on short-term goals of treatment. b. focus on intermediate goals of treatment. c. focus on ultimate goals of treatment. d. focus on both the intermediate and the ultimate goals of treatment. Answer: D Page: 110 25. Treatment monitoring a. helps ensure that the psychologist follows the treatment plan. b. allows for changes in the treatment plan as required. c. helps ensure that clients are completing assigned tasks. d. helps to develop treatment goals at the outset of therapy. Answer: B Page: 110 26. Lambert et al. (2003) found that treatment monitoring a. worsened treatment outcome by increasing distraction and self-consciousness among clinicians. b. did not have any impact on treatment outcome. c. affected treatment outcome in very few cases. d. had the potential to substantially impact treatment outcome. Answer: D Page: 111 27. To be optimally effective, treatment monitoring should be conducted a. once, at the beginning of treatment, to establish treatment procedures. b. twice, at the beginning and at the mid-point of treatment, to determine effectiveness of treatment. c. by a psychologist who is impartial, and not involved with the treatment. d. on a routine basis throughout services. Answer: D Page: 111 28. A study conducted by Lambert et al. (2003) on treatment monitoring compared two groups of therapy clients. In one group, therapists received formal feedback on client symptoms. In the other group, therapists received no formal feedback on client symptoms. The researchers found a. no differences in treatment outcome between the two groups. b. that clients in the “no feedback” condition experienced improved treatment outcome. c. that clients in the “feedback” condition experienced worse treatment outcome. d. that clients in the “feedback” condition experienced improved treatment outcome. Answer: D Page: 111 29. In what way(s) can treatment outcome data can be used? Chapter 5: Assessment: Overview Copyright 2018 © John Wiley & Sons Canada, Ltd.

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a. To help estimate the benefits, duration, and cost of treatment. b. As an indicator of how well an entire system of care is functioning. c. To document the typical range of outcomes experienced by clients as a means of comparison between clients. d. All of the above. Answer: D Page: 111 30. Advances in online technology have a. made it possible to complete a full psychological assessment online. b. led to a number of websites offering psychological testing. c. helped to eliminate a number of previous ethical and practical issues in psychological testing. d. led to increased regulation of the online administration of psychological testing. Answer: B Pages: 113 31. Recent research has identified that internet samples are ______ and results found through internet responses are _______ to those obtained by traditional methods. a. diverse ; similar b. homogeneous ; different c. homogeneous ; similar d. diverse ; different Answer A Page: 113 32. Psychological assessment and psychological testing a. refer to the same activities. b. are related activities, but are not synonymous. c. usually end up examining the same phenomena. d. are different, in that testing is more complex and integrated than assessment. Answer: B Page: 114 33. Assessment is ______ complex and ______ multifaceted than is testing. a. less ; less b. less ; more c. more ; more d. more ; less Answer: C Page: 114

34. Consistency across clinicians and testing occasions in the procedure used to administer and score a test is referred to as: a. normalization. b. standardization. c. inter-rater reliability. d. content validity. Answer: B Page: 116

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35. To be sure that a test is yielding valid data it must meet which of the following criteria? a. It must have norms. b. It must measure all aspects of the underlying construct it purports to measure. c. It must be related with scores of other tests of similar constructs. d. Both B and C. Answer: D Page: 118 36. The extent to which a test provides a relatively pure measure of a psychological construct, and is not contaminated by other psychological constructs, is referred to as a. discriminant validity. b. concurrent validity. c. predictive validity. d. convergent validity. Answer: A Page: 118

37. Developmental norms are used when the psychological construct being assessed a. remains constant over time. b. remains constant over time for some individuals, but not for others. c. develops idiosyncratically over time. d. changes over time. Answer: D Page: 119 38. If a test score of 45 is associated with a percentile rank of 74%, this indicates that a. 74% of those in the normative group scored at or above a test score of 45. b. 74% of those in the normative group scored at or below a test score of 45. c. 45% of those in the normative group scored at or above a test score of 74. d. 45% of those in the normative group scored at or below a test score of 74. Answer: B Page: 119 39. Standard scores are calculated by __________________ a specific test score and dividing the resulting number by the standard deviation of the test scores. a. adding the standard deviation of the test scores from b. subtracting the standard deviation of the test scores from c. adding the mean of the test scores to d. subtracting the mean of the test scores from Answer: D Page: 119 40. To develop a standard score a ____ score is calculated. a. t b. z c. p d. comparison Answer: B Page: 119 Chapter 5: Assessment: Overview Copyright 2018 © John Wiley & Sons Canada, Ltd.

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41. Which of the following tests uses developmental norms? a. Rorschach Inkblot Test. b. Graduate Record Examination. c. Alfred Binet Intelligence Test. d. Thematic Apperception Test. Answer: C Page: 119 42. Compared with ____(i)____, ____(ii)____ are far less likely to be standardized, to have norms, or to possess acceptable levels of reliability and validity. a. (i) intelligence tests/personality inventories/behaviour rating scales; (ii) projective tests b. (i) projective tests; (ii) intelligence tests/personality inventories/behaviour rating scales c. (i) intelligence tests and behaviour rating scales; (ii) personality inventories and projective tests d. (i) personality inventories and projective tests; (ii) intelligence tests and behaviour rating scales Answer: A Page: 120 43. When considering ethical issues in assessment which of the following is/are considered essential? a. Informed consent. b. Confidentiality. c. The assessor’s sound knowledge of the tests’ psychometric properties. d. All of the above. Answer: D Page: 120 44. When conducting assessments, psychologists have an ethical responsibility to: a. be knowledgeable about test properties, such as standardization, reliability, validity, and norms. b. be able to competently administer and interpret the results of each test used. c. clearly indicate to the client the limits to the certainty of assessment findings. d. all of the above. Answer: D Page: 120

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Short Answer Questions 2. List at least five of the Competencies in Psychological Assessment Expected at the Point of Licensure 1. Suggested answer: Page 104 a. Apply knowledge of individual and cultural characteristics in assessment and diagnosis b. Demonstrate effective interviewing c. Select instruments based on available normed data and/or criterion-referenced standards, and address any limitations in that selection d. Administer and score instruments following current guidelines and psychometric research e. Interpret and synthesize results from multiple sources following current guidelines and psychometric research f. Formulate diagnoses, recommendations and/or professional opinions using relevant criteria and considering all assessment data g. Communicate assessment results in an integrative manner h. Evaluate effectiveness of psychological services

3. Provide an example of a specific assessment-focused service. What is the goal of the service? Suggested answer: Page 105-106 a. Child Custody Evaluations Example: To determine the best parenting arrangements for children whose parents are separating or divorcing and who turn to the legal system for advice on how to manage co-parenting arrangements. b. Psychoeducational assessments Example: To diagnose learning disorders and to identify cognitive strengths and weaknesses. c. Neuropsychological assessments Example: To evaluate the extent of cognitive and memory impairment following a serious concussion. d. Psychosocial functioning/diagnostic assessments Example: to evaluate the psychological aftermath of a motor vehicle accident. 3. Name and describe three of the purposes of psychological assessment. Suggested Answer: Pages 107-108 a. Screening – to identify individuals who may have problems of a clinical magnitude or who may be at risk for developing problems. b. Diagnosis/case formulation – to conceptualize psychological functioning of an individual through the use of assessment data c. Prognosis/prediction – to make predictions about the future course of a patient’s psychological functioning, based on the use of assessment data in combination with relevant empirical literature

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d. Treatment planning – to inform what will be done with the client to address their needs and circumstances, using assessment data and empirical literature e. Treatment monitoring – to determine client progress, to enable the clinician to change the treatment plan based on the client’s response to treatment f. Treatment evaluation – to document whether treatment has been effective in meeting treatment goals 4. Why do psychologists use screening measures? Suggested answer: Page 106 a. To screen for a disorder, condition, or characteristic in an attempt to identify individuals who may have problems that will require clinical attention or those who may be at risk of developing such problems. b. Individuals who are screened may not have sought out assessment services; rather, they are receiving the assessment as part of the routine operations of a clinic, school, hospital, or employment setting. 5. What does the term case formulation refer to? Suggested Answer: Page 106 a. It refers to the use of assessment data to develop a comprehensive and clinically relevant conceptualization of a patient’s psychological functioning. b. To complete a case formulation, psychologists often use interview and testing data. 6. Describe the term prognosis as it relates to the assessment process. Suggested Answer: Page 106 a. It refers to the use of assessment data, in combination with scientific literature, to make predictions about the future course of a patient’s psychological functioning. 7. Describe the differences among a true positive, a false positive, a true negative, and a false negative. Provide an example of each. Suggested Answer: Page 108 - 109 a. A true positive means that the prediction of an event occurring was accurate (i.e., the event was predicted and it then occurs) i. Example: A diagnosis was accurately given. b. A false positive means that the prediction of an event occurring was inaccurate (i.e., the event was predicted, but does not then occur). i. Example: A diagnosis was inappropriately given. c. A true negative means that the prediction of a non-event was accurate (i.e., it was predicted that the event would not occur, and then it does not occur). i. Example: A diagnosis was appropriately not given. d. A false negative means that an event occurs that was not predicted (i.e., the event was not predicted, but then it does occur). i. Example: A diagnosis was appropriately not given. 8. Describe sensitivity and specificity. Suggested Answer: Pages 109 Chapter 5: Assessment: Overview Copyright 2018 © John Wiley & Sons Canada, Ltd.

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a. Sensitivity is the proportion of true positive identified by the assessment (i.e., the number of times an event is predicted, across cases, compared with the total number of times that the event actually occurs). b. Specificity is the proportion of true negatives identified by the assessment (i.e., the number of times a non-event is predicted across cases compared with the total number of times that no event occurred). 9. What is the difference between treatment monitoring and treatment evaluation? Suggested Answer: Pages 110 - 111 a. Treatment monitoring is done throughout treatment and can significantly impact the course of the treatment process. b. Treatment evaluation is done after treatment; it examines outcome data and compares it with intake data to examine how much change was achieved by the patient. This can have implications for the entire psychological service. 10. Describe the main difference between the interpretation of the results of a psychological test and a psychological assessment. Suggested Answer: Page 122 a. The results of a test score are interpreted based on comparisons with the scores of others. b. The result from an assessment is a coherent, unified description of the client or selected aspects of the client’s experience. It may or may not incorporate results of psychological testing, and always requires the integration of life history information and clinical observation of the client, and usually information provided on the client by significant others in the client’s life. 11. Why is standardization necessary for psychological testing and how is it achieved? Suggested Answer: Pages 122 a. Standardization is essential because it: i. ensures consistency across clinicians and testing occasions ii. allows for replication iii. and reduces variability in the testing situation b. Standardization is achieved by adhering to scoring criteria and providing detailed instructions regarding all aspects of the testing (such as nature of stimuli and testing procedures). 12. What is meant by test validity? Name and define three of the ways that researchers and clinicians ensure that a test is valid. Suggested Answer: Pages 118 a. The key concern is whether the test is truly measuring what it purports to measure. b. Validity types: i. Content validity: the extent to which the test actually samples the type of behaviour that is relevant to the underlying psychological construct. ii. Concurrent validity: the extent to which scores on the test are correlated with scores on measures of similar constructs. Chapter 5: Assessment: Overview Copyright 2018 © John Wiley & Sons Canada, Ltd.

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iii. Predictive validity: the extent to which the test predicts a relevant outcome. iv. Discriminant validity: the extent to which the test provides a pure measure of the construct that is minimally contaminated by other constructs. v. Incremental validity: the extent to which a measure adds to the prediction of a criterion above what can be predicted by other sources. 13. Describe two of the types of decisions test developers must make when selecting their sample to establish norms for their tests? Suggested Answer: Pages 119 Some of the considerations/decisions include: a. What is the population they want to use to develop their norms (e.g. is it the general population or is it some specific subgroup such as men or women?). b. What is the quality of the normative sample? Is the normative sample representative of age, gender, ethnicity, or educational level to those likely to take the test as part of a clinical assessment? Sample of convenience versus nationallyrepresentative?

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Chapter 6 Assessment: Interviewing and Observation Multiple Choice Questions 1. Which objective(s) apply to both an assessment interview and a psychotherapeutic interview? a. To establish and maintain a professional relationship. b. To guide and promote behavioural, cognitive, and emotional change. c. To obtain information necessary to formulate a diagnosis, develop a case formulation, determine treatment options (including possible need for referral) d. To ensure that sufficient information is gathered in a relatively brief time period (often one or two sessions). Answer: A Page: 125 2. The vast majority of assessment interviews are a. structured. b. semi-structured. c. unstructured. d. multi-structured. Answer: C Page: 125 3. In conducting assessment interviews with children, psychologists now recognize that children a. can provide important and reliable information. b. are less reliable than adults in their reporting. c. should only be interviewed if the information cannot be obtained from other sources. d. can easily complete scaled-down versions of interviews developed for adults. Answer: A Page: 125 4. A psychologist cannot maintain confidentiality when a. s/he suspects a child is in need of protection. b. s/he suspects an older adult living alone is being exploited financially. c. a lawyer asks to see the psychologist’s file. d. all of the above. Answer: A Page: 126 5. The limits of confidentiality should be introduced by the psychologist a. before the client enters into an agreement to receive psychological services. b. as early as possible in the provision of psychological services. c. when the client reports something that cannot be kept confidential. d. once the therapeutic alliance is developed. Answer: A Page: 126 6. Unstructured clinical assessment interviews _____________ regular conversations. a. do not follow a script and should be the same as Chapter 6: Assessment: Interviewing and Observation Copyright 2018 © John Wiley & Sons Canada, Ltd.

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b. do not follow a script and are distinct from c. follow a script and should be the same as d. follow a script and are distinct from Answer: B Page: 125 7. Clinical assessment interviews differ from social conversations in that a. clinical assessment interviews are more free-flowing than are social conversations. b. clinical assessment interviews do not involve reciprocally sharing of information between client and psychologist. c. in social conversations, friends are more likely to interrupt each other, whereas in a clinical assessment interview, the psychologist shows greater patience. d. none of the above Answer: B Page: 127 8. “Who lives in your apartment?” is an example of a(n) a. open question. b. closed question. c. possibly open or closed question. d. mixed-type question. Answer: A Page: 128 9. “Do you feel better after taking some deep breaths?” is an example of a question that is a. open. b. closed c. mixed-type d. leading Answer: B Page: 128 10. Closed questions often facilitate a. long, tangential stories. b. complex, ambiguous answers. c. brief and rapid coverage of many topics. d. elaborate and detailed responses. Answer: C Page: 128 11. Which of the following is most accurate regarding open and closed questions? a. Open questions are typically more advantageous than closed questions. b. Open questions are easier to ask than closed questions. c. Closed questions are typically more advantageous than closed questions. d. Each type of question has advantages and disadvantages. Answer: D Page: 128 12. During a clinical interview, many psychologists find it useful to begin a discussion with a. open-ended questions and follow up with closed questions to clarify details. b. closed questions and follow up with open-ended questions to explore more topics. Chapter 6: Assessment: Interviewing and Observation Copyright 2018 © John Wiley & Sons Canada, Ltd.

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c. a variety of closed and open-ended questions, depending on how much time there is. d. closed ended questions and only ask open-ended questions for clarification. Answer: A Page: 128 13. Semi-structured diagnostic interviews were developed primarily to a. help mental health professionals agree on the general features of a disorder. b. help the client feel more comfortable in the interview setting. c. improve inter-rater reliability in assigning diagnoses among mental health professionals. d. all of the above. Answer: C Page: 128 14. The most widely used diagnostic interview in North America is the a. Structured Clinical Interview for DSM-5 Disorders. b. Structured Clinical Interview for Axis II Disorders. c. Primary Care Evaluation of Professional Mental Disorders. d. Dominic Interactive. Answer: A Page: 129 15. The SCID-5 Clinical Version begins with a. the evaluation of personality disorders. b. closed questions discussing demographic information. c. open-ended questions discussing demographic information. d. discussing mental health problems associated with less stigma. Answer: C Page: 129 16. The strength of the SCID-5 lies in _____________; its weakness is ______________. a. the breadth of the disorders it covers; the variable reliabilities that are obtained for different disorders b. strong validity data; the variable reliabilities that are obtained for different disorders c. strong validity data; the breadth of the disorders it covers d. the short time it takes to complete; the variable reliabilities that are obtained for different disorders Answer: A Page: 129 17. Which of the following has (have) been used to help with interviewing children? a. Visual analogue such as a feelings thermometer. b. Providing specific response options to questions. c. Asking the toughest questions first. d. Providing an abundance of toys to distract the child. Answer: A Pages: 130 18. What is a challenging feature of administering diagnostic interviews to children?

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a. Children are typically unable to provide reliable information about their experiences. b. The adaptations of diagnostic interviews for use with children, such as the use of visual cues, are still too complex for most children to understand. c. Most interviews for children have a parallel version completed by parents, rendering disagreement between these reports difficult to interpret. d. All of the above. Answer: C Page: 130 19. The Dominic Interactive is a diagnostic interview for children aged 6 to11 years, which uses ____________ as cues. a. cartoon drawings b. colours c. animals d. puppets Answer: A Page: 130 20. Based on non-verbal behaviour, a psychologist may observe a discrepancy in which of the following scenarios: a. The client is sitting still and smiling while reporting being happy. b. The client describes a recent argument while gripping the edge of his/her chair. c. The client reports being satisfied with his/her relationship while agitatedly tapping his/her toes. d. The client reports having an affair and covering his/her face and crying. Answer: C Page: 131 21. “Tell me what you mean by that.” is an example of which interview technique? a. Clarification. b. Nondirective reflection of feeling. c. Paraphrasing. d. Attending behaviour. Answer: A Page: 132 22. Which of the following is a non-directive listening skill used by psychologists? a. Summarization. b. Leaning back. c. Questioning. d. Standing up. Answer: A Page: 131 23. When a psychologist rephrases a client’s expressed emotion, such as “It sounds like that event was very difficult and upsetting for you,” this type of non-directive listening response is referred to as a. summarization. b. non-directive reflection of feeling. c. attending behaviour. Chapter 6: Assessment: Interviewing and Observation Copyright 2018 © John Wiley & Sons Canada, Ltd.

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d. a sensory-based paraphrase. Answer: B Page: 131 24. “When the two of you fight, you do things that you are not comfortable with, that you don’t like.” is an example of which interview technique? a. Clarification. b. Non-directive reflection of feeling. c. Attending behaviour. d. Paraphrase. Answer: D Page: 131 25. When a client discloses painful, frightening, or embarrassing experiences, it is appropriate for the psychologist to a. remain silent and maintain a neutral facial expression. b. listen respectfully, non-judgmentally, and provide support. c. provide the client with feedback on what the interviewer considers personally appropriate. d. indicate judgment or pity if the interviewer deems it important information for the client. Answer: B Page: 132 26. Contextual information gathered during the assessment interview may include information about the client’s a. current context, such as living arrangement or school/work responsibilities. b. developmental history. c. medical history and previous psychological services. d. all of the above. Answer: D Page: 132 27. Which of the following is/are true regarding the importance of routine screening of whether a client has been a witness to and/or a victim of violence: a. The psychologist must consider the context in which exposure to violence screening is conducted. b. The psychologist may interpret the individual’s symptoms differently if the individual has been exposed to violence. c. The psychologist must ask in a sensitive way. d. All of the above. Answer: D Page: 138 28. Small slights, misunderstandings, and unwarranted assumptions based on stereotypes on the part of the psychologist that can have a substantial negative impact on the alliance with clients and on the clients’ overall therapy experience are referred to in therapy as a. microaggressions. b. cultural presumptions. c. unintended aggression. d. cultural blind spots. Chapter 6: Assessment: Interviewing and Observation Copyright 2018 © John Wiley & Sons Canada, Ltd.

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Answer: A

Introduction to Clinical Psychology 4e

Page: 134

29. a. A psychologist has noticed a family’s periodic lateness and missed sessions. The psychologist hypothesizes that this may reflect either disorganization or a more casual attitude toward time. The psychologist is addressing b. a potential cultural blind spot. c. countertransference d. resistance. e. unintended aggression. Answer: A Page: 134 30. There is emerging evidence that interpreter-mediated services a. are never effective. b. are harmful to recipients. c. can be effective. d. are not suitable for children. Answer: C Page: 135 31. Early in an assessment interview, cognitive-behavioural psychologists ask questions to a. obtain a behavioural description of the problem. b. determine the cognitive underpinnings of the problem. c. explore childhood antecedents of the problem. d. determine the underlying basis for the problem. Answer: A Page: 135 32. Problem definition questions address a. frequency of the problem. b. duration of the problem. c. intensity of the problem. d. all of the above. Answer: D Page: 136 33. Treatment goals should: a. be important to the client. b. be phrased in terms of feelings, thoughts and behaviours to be reduced. c. be substantial and long-term. d. be expressed in vague terms so that they can easily be adapted. Answer: A Page: 135-136 34. When completing a suicide risk assessment, the psychologist ought to focus questions upon the a. client’s history of suicidal behaviour and current suicidal thoughts. b. degree to which the client has concrete plans to commit suicide. c. client’s access to the means to carry out suicide. Chapter 6: Assessment: Interviewing and Observation Copyright 2018 © John Wiley & Sons Canada, Ltd.

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d. all of the above. Answer: D Page: 137 35. Screening for partner abuse a. may be conducted conjointly with both members of a couple to observe the nature of their interactions. b. must be conducted individually, in order for each person to feel safe disclosing abuse. c. is always completed before either individual or couples treatment can begin. d. is completed at the mid-point of treatment to determine whether new strategies need to be integrated into the treatment plan. Answer: B Page: 138 36. Compared to the general population, older adults are more likely to face issues around which of the following? a. Loss of autonomy. b. Schizophrenia. c. Anxiety. d. Personality disorders. Answer: A Page: 139 37. In delivering psychological services to older adults psychologists ought to a. be aware of the possibility of cognitive changes. b. assess the client’s ability to provide informed consent. c. Integrate data from multiple informants about the client’s functioning. d. all of the above. Answer: D Page: 139 38. Children ________ entitled to know about confidentiality and its limits: a. are not b. are c. are sometimes d. are rarely Answer: B Page: 140 39. Research on the use of dolls in interviews has found that they a. help pre-school age children provide more accurate accounts. b. increase both detail and number of errors in children’s statements. c. secure more convictions of sexual predators. d. decrease both detail and number of errors in children’s statements. Answer: B Page: 140 40. As young children do not have the same sense of __________as adults do, it is helpful to anchor interview questions for children to special events in their lives. a. time b. emotional content Chapter 6: Assessment: Interviewing and Observation Copyright 2018 © John Wiley & Sons Canada, Ltd.

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c. maturity d. sophisticated vocabulary Answer: A Page: 140 41. Which of the following is true about direct observation of client behaviour: a. Observational coding systems developed in research settings have become increasingly used in clinical practice. b. It can add important information that is not easily obtained in self-report data. c. It is unreliable as clients always behave better than usual when they know they are being observed. d. It is useful in the confirmation of clinical hypotheses. Answer: B Page: 141 42. Self-monitoring can involve a. recording occurrences of symptoms. b. tracking efforts to manage symptoms. c. Keeping a log of efforts to curtail symptoms d. all of the above. Answer: D Page: 144 43. Self-monitoring strategies refer to a. strategies for clients to anonymously share their behaviours with other clients. b. strategies for clients to observe themselves in a systematic manner. c. strategies for psychologists to monitor their treatment efficacy. d. none of the above. Answer: B Page: 144 44. A client is asked to systematically keep track of his/her thoughts every time s/he consumes marijuana. This is referred to as: a. a self-monitoring strategy. b. an observation strategy. c. a contextually relevant strategy. d. a self-imposed strategy. Answer: A Page: 144 45. Self-monitoring strategies can provide information on a. the baseline rate of a problem or behaviour. b. conditions that may provoke or maintain problem behaviour. c. behaviour that the psychologist cannot observe in session. d. all of the above. Answer: D Pages: 144 46. Self-monitoring data can sometimes be inaccurate because the client may a. not have fully understood the instructions or purpose. b. wish to hide undesirable thoughts or behaviours. c. may fail to record information at the appropriate time. Chapter 6: Assessment: Interviewing and Observation Copyright 2018 © John Wiley & Sons Canada, Ltd.

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d. all of the above. Answer: D Page: 144 - 145 47. A change in the phenomenon being monitored that is due to the process of monitoring the phenomenon is referred to as: a. a self-fulfilling prophecy. b. self-awareness enhancement. c. reactivity. d. self-monitored change. Answer: C Page: 145 48. A client is asked to monitor her intake of alcohol and immediately starts to consume less alcohol after the recording of her behaviour begins. This is an example of: a. self-monitoring. b. reactivity. c. the extraneous effects of self-observation. d. a self-fulfilling prophecy. Answer: B Page: 145 49. ___________________ refers to strategies that allow research participants and clients to report repeatedly on what is happening for them in real time. a. Self-awareness enhancement b. Ecological momentary assessment c. Reactivity d. Behavioural activation Answer: B Page: 146 50. The association between self-report measures and self-monitoring assessments has been shown to be a. nonsignificant. b. very weak. c. moderate. d. very strong. Answer: C Page: 146

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Short Answer Questions 1. Describe two of the instances in which a psychologist is required to break confidentiality. Suggested answer: Page 126 a. A child is being harmed in some way b. The client is at risk to him or herself, or to another person c. The client’s file is subpoenaed by a judge d. The client is the victim of sexual abuse by a health professional 2. Describe three key differences between a clinical assessment interview and a regular social conversation. Suggested Answer: Page 127 Key differences between clinical assessment interview and conversations: a. In a regular conversation the focus is on both participants but in a clinical assessment interview the focus is exclusively on the client. b. Can take place anywhere vs. usually in an office c. May be overheard by others vs. private d. Variable duration vs. usually 50 minutes to an hour e. Details may be repeated in other conversation vs. confidential f. Purpose is relationship maintenance vs. information gathering and establishing a collaborative relationship g. Free-flowing vs. goal-directed h. Each person waits for an opening to comment vs. clinician interrupts and redirects the conversation i. Relationship maintenance takes precedence vs. persistent questioning in topic areas that may be uncomfortable (e.g., abuse, violence, suicide) j. Commonly avoids painful topics vs. clinician raises painful topics k. Participants rarely take notes vs. clinician usually takes notes l. Not documented vs. session notes are kept by clinicians m. Not recorded vs. could be audio or video-recorded with client’s permission 3. Provide the main distinction between open and closed questions, as well as one disadvantage of each. Suggested answer: Pages 128 a. Open questions allow the client to provide elaborate responses and can’t be answered with a simple “yes” or “no.” However, they may allow the client to ramble and provide unnecessary information. b. Closed questions can be answered with a single word. Closed questions do not encourage more complex or nuanced answers. 4. What is the most widely used structured clinical interview in North America? Describe this interview protocol, commenting on reliability and validity. Suggested Answer: Page 129 Structured Clinical Interview for DSM-5: a. The Research Version is the most comprehensive interview, covering most of the DSM-5 diagnoses. Chapter 6: Assessment: Interviewing and Observation Copyright 2018 © John Wiley & Sons Canada, Ltd.

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b. The Clinician Version is a an somewhat shorter interview designed to cover c. The Personality Disorders interview provides a detailed evaluation of all ten DSM-5 personality disorders. d. The Clinical Trials Version is tailored to the needs of treatment trials, covering only the diagnoses relevant to the inclusion and exclusion criteria for a clinical trial. 5. Which semi-structured interview is designed to assess anxiety and comorbid disorders exclusively? Comment on reliability, validity, and one advantage over using a more general interview schedule. Suggested Answer: Page 129 The Anxiety and Related Disorders Interview Schedule for DSM- 5 (ADIS-5) a. Focuses on anxiety and related disorders with additional coverage of disorders that are commonly comorbid with anxiety b. Main advantage over SCID-5 and other more general diagnostic interviews is the depth of coverage of the disorders that are assessed. 6. List two different types of non-directive listening responses and provide a brief description of each. Suggested Answer: Page 131 Types of non-directive listening responses: a. Attending behaviour – nonverbal behaviour such as eye contact or facial expressions b. Silence – absence of verbal activity c. Paraphrase – reflection of rephrasing of the content of what client said d. Clarification – attempted restating of client’s message e. Reflection of feeling – restatement or rephrasing of stated emotion f. Summarization – brief review of several topics covered during session 7. Why do clinical interviewers need to be especially sensitive when they are questioning and interpreting responses of clients who have been exposed to violence? Describe two reasons. Suggested Answer: Page 132 - 133 a. Exposure to violence can result in feelings of numbing and avoidance – the person who has been exposed may avoiding thinking or talking about it b. They may respond in a dull way that masks the intensity of their feelings c. Repeated exposure to violence can also lead to desensitization and minimization so that the person feels that abusive treatment is to be expected and should not be complained about d. Victims may be afraid of repercussions of talking about the violence – fear of retribution by the perpetrator, fear of blame by others, or remaining in the relationship or for having provoked abuse in the first place e. If clinicians do not ask about exposure to violence, the client’s presenting symptoms may be interpreted differently (and/or attributed to different causes). This could have important implications for diagnosis and treatment recommendations. Chapter 6: Assessment: Interviewing and Observation Copyright 2018 © John Wiley & Sons Canada, Ltd.

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8. Within the context of the clinical assessment interview, name two behaviours described in the text that are likely to be culturally influenced. Provide two ways of interpreting each of the behaviours. Suggested Answer: Page 133 - 134 a. Nonverbal behaviour such as eye contact – e.g., lack of eye contact in Western culture can be reflective of social anxiety, whereas some cultures may perceive too much eye contact as intimidating b. The importance of punctuality – e.g., arriving late to an interview may be a sign of disorganization or lack of motivation within some groups, but may simply reflect a more casual attitude toward time in others. c. Comfort in being asked open-ended questions – a client who expected to be asked highly structured questions might appear disorganized and confused when faced with a less structured interview, whereas disorganization and confusion could also indicate dementia, delirium, or anxiety. d. Shaking hands – in much of western culture, refusal to shake hands could be interpreted as breaking social norms, whereas orthodox Jews observing Shomer Negiyah are not permitted to touch a member of the opposite sex 9. List two potential issues for psychologists to be mindful of when they are assessing or treating specifically older adults. Suggested Answer: Page 138 - 139 a. Problems in daily living/declining health b. Issues of mortality and bereavement c. Loss of autonomy and relationships with caregivers d. Patterns of psychopathology evident in older adults e. Health status f. Recognizing cognitive changes in older clients g. Knowledge of physical challenges that may affect the client – issues around chronic illness and disability may introduce challenges when conducting an assessment h. Effects of medication on client functioning i. Skills in health psychology j. Screening for maltreatment by family members or paid caregivers 10. List two potential considerations when interviewing children and/or adolescents. Suggested Answer: Page 139 - 141 a. Children may associate interviews with adults as evaluative in nature – it is important to reassure the child that there are no right or wrong answers b. Children’s attention span – capacity to stay focused and maintain attention is lower c. Unable to understand certain concepts – developmental considerations affect cognitive functioning (time, vocabulary, etc.) d. Children and adolescents may be uncomfortable with adult-level eye-contact; psychologists should provide play and drawing materials while they are talking

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e. Challenges in understanding what the child is talking about – children’s fashions and trends change quickly f. Easier to potentially prompt a child to say something g. Child may be less likely to indicate that he or she doesn’t understand something – this may be particularly problematic with adolescents 11. List one reason why direct observation of a client may be desirable to a psychologist who is conducting an assessment. List one potential drawback or complication to direct observation as part of an assessment. Suggested Answer: Page 141 - 143 Desirability of Direct Observations: a. It allows the psychologist to obtain information that could not be obtained by other methods. Drawbacks to Direct Observations: a. Lack of an objective coding scheme. b. Representativeness of client’s behaviour. 12. List two benefits and two drawbacks of including self-monitoring strategies as part of a psychological services? Suggested Answer: Pages 144 Benefits: a. Providing precise information about the frequency or severity of problem behaviours b. Assisting in efforts to manage or change problematic behaviours c. Monitoring change over the course of treatment Drawbacks: a. The client may fail to record information at the appropriate time b. The client may not fully understand the task c. The client may be reluctant to record an undesirable task or behaviour. d. There is also the problem of reactivity where whatever the client is selfmonitoring, changes may happen simply because the behaviour is being monitored. This is only problematic as it makes it difficult to ascertain a baseline level of behaviour.

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Introduction to Clinical Psychology 4e

Chapter 7 Assessment: Intellectual and Cognitive Measures Multiple Choice Questions 1. MENSA is an organization that requires members to have an IQ in the __________ of the population. a. top 10% b. top 5% c. top 2% d. top 1% Answer: D Page: 148 2. Currently, tests of intelligence and related cognitive abilities are considered to be among a. the psychometrically strongest of the tests that psychologists have developed. b. the psychometrically weakest of the tests that psychologists have developed. c. the least controversial of the tests that psychologists have developed. d. the most confusing of the tests that psychologists have developed. Answer: A Page: 149 3. Binet’s definition of intelligence was ______________, and Wechsler’s definition of intelligence was_________________. a. more academically focused ; less academically focused b. designed to assess functioning in school ; designed to predict workplace functioning c. culturally focused ; culturally adapted d. focused on verbal skills ; focused on nonverbal skills Answer: A Page: 149 4. The definition of intelligence as a person’s global capacity to act purposefully, to think in a rational manner, and to deal effectively with his or her environment, was generated by ______________ and is an example of a definition that focuses upon _______________. a. Raymond Cattell ; ability related to scholastic/academic tasks b. David Wechsler ; the context of life more generally c. Alfred Binet ; ability related to scholastic/academic tasks d. Charles Spearman ; the context of life more generally Answer: B Page: 149 5. Which of the following is not one of the three dominant theoretical models regarding intelligence? a. Factor models. b. Correlational models. c. Hierarchical models. d. Information processing models. Answer: B Page: 149 Chapter 7: Assessment: Intellectual and Cognitive Measures Copyright 2018 © John Wiley & Sons Canada, Ltd.

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6. ____________ models of intelligence involve two or more factors that are postulated to be at more or less the same structural level, whereas ____________ models are based on the assumption that there are different levels of factors. a. Hierarchical; correlational b. Factor; information processing c. Factor; hierarchical d. Information processing; correlational Answer: C Page: 149 - 150 7. _____________ models of intelligence focus on the identification of the processes and operations that reflect how information is handled by the brain. a. Factor models b. Correlational models c. Hierarchical models d. Information processing models Answer: D Page: 150 8. The earliest and likely most influential factor model of intelligence was developed by a. Alfred Binet. b. David Wechsler. c. Charles Spearman. d. Raymond Cattell. Answer: C Page: 150 9. “g” refers to a. the common core that all intellectual activities share. b. unique factors that influence performance. c. an individual’s overall intelligence score. d. specific factors that influence performance. Answer: A Page: 149 10. Spearman’s theory of intelligence was known as a a. one-factor model (general factors). b. two-factor model (general factors and specific factors). c. three-factor model (general factors, specific factors and contextual factors). d. multi-factor model (influence of contextual factors on general and specific factors). Answer: B Page: 150 11. Thurstone (1938) is known primarily for introducing a. the concept of primary mental abilities. b. a more hierarchical model of intelligence. c. a theory of multiple intelligences. d. an information processing model of intelligence. Answer: A Page: 150 Chapter 7: Assessment: Intellectual and Cognitive Measures Copyright 2018 © John Wiley & Sons Canada, Ltd.

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Introduction to Clinical Psychology 4e

12. Thurstone proposed that primary mental abilities a. were distinct. b. often overlapped. c. overlapped moderately. d. measured one factor. Answer: A Page: 150 13. Raymond Cattell believed that existing intelligence models focused too much on a. non-verbal and perceptual elements. b. verbal and school-based tasks. c. perceptual elements. d. verbal and perceptual elements. Answer: B Page: 150 14. Raymond Cattell proposed ____ general factors of intelligence, known as ____________. a. 2 ; fluid intelligence and genetic intelligence b. 2 ; fluid intelligence and crystallized intelligence c. 3 ; fluid, genetic, and crystallized intelligence d. 3 ; fluid, genetic, and specialized intelligence Answer: B Page: 150 15. Fluid intelligence refers to a. reasoning ability and the capacity to draw upon prior experiences. b. crystallized intelligence. c. innate intellectual potential. d. what has been learned from formal education. Answer: C Page: 150 16. _________ intelligence refers to what we have learned in life, both from formal education and general life experiences. a. Fluid b. Crystallized c. Multiple d. Processing Answer: B Page: 150 17. Information processing models focus on how people a. interact with each other. b. perform during testing. c. solve problems. d. both A and C. Answer: C Page: 150 18. The main interrelated elements in Sternberg’s (1985) triarchic theory are a. componential, contextual, developmental. Chapter 7: Assessment: Intellectual and Cognitive Measures Copyright 2018 © John Wiley & Sons Canada, Ltd.

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Introduction to Clinical Psychology 4e

b. compositional, contextual, experiential. c. componential, contextual, experiential. d. compositional, contextual, developmental. Answer: C Page: 150 19. Gardner argued that intelligence tests: a. should assess more perceptual aspects. b. should focus on determining the manner in which people process information and solve problems. c. should assess the full range of different types of intelligence. d. should focus on academic performance and primary mental abilities. Answer: C Page: 151 20. Gardner’s theory of multiple intelligences proposed that a. there is a single form of intelligence. b. different types of intelligence are inadequately assessed by traditional tests. c. it is crucial for assessment of intelligence to be culturally biased. d. learners have poorly developed auditor skills and therefore don’t like reading or playing word games. Answer: D Page: 151 21. Intellectual functioning prior to an accident or the onset of a neurological decline is referred to as a. premorbid IQ. b. predeficit IQ. c. precise IQ. d. general IQ. Answer: A Page: 152 22. Which method(s) is/are used by psychologists to help estimate premorbid IQ? a. Consulting a client’s achievement records. b. Testing with measures of ability that are less sensitive to decline. c. Examining subtests that are least affected by neurological impairment. d. All of the above. Answer: D Page: 152 23. Giftedness is usually defined as a. having an intelligence score in the top 2% of the population. b. having an intelligence score in the top 5% of the population. c. having an intelligence score in the top 10% of the population. d. an extreme positive discrepancy between achievement test scores and age-based norms. Answer: A Page: 152 24. To meet criteria for a diagnosis of intellectual disability the individual must have an IQ in the lowest Chapter 7: Assessment: Intellectual and Cognitive Measures Copyright 2018 © John Wiley & Sons Canada, Ltd.

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Introduction to Clinical Psychology 4e

a. 2% of the population, and show functional impairments. b. 2% of the population, with or without functional impairments. c. 10% of the population, and show functional impairments. d. 10% of the population, with or without functional impairments. Answer: A Page: 152 25. Contemporary intelligence tests a. measure the full range of abilities that are included in modern theories of intelligence. b. focus on academic abilities and are not designed to measure social, emotional and other domains. c. focus on academic abilities but also measure social, emotional and other domains. d. focus more on social, emotional, and other domains than on academic abilities. Answer: B Page: 152 26. Wechsler intelligence scales are designed for individuals a. of all ages. b. 2 years and 6 months to 90 years. c. 16 to 90 years. d. 6 to 90 years. Answer: B Page: 153 27. Wechsler introduced ________ to measure intelligence. a. mental age/chronological age b. deviation scores c. z-scores d. t-scores Answer: B Page: 154 28. Mental age refers to the a. person’s chronological age at the time of the test. b. average age in the normative sample of those achieving the same test score as the person. c. average age in the general population of those with a similar level of intelligence. d. average age in the general population of those with a similar level of cognitive abilities. Answer: B Page: 154 29. The formula for the Stanford-Binet intelligence quotient is a. IQ = (MA x CA) x 100. b. IQ = (MA x CA)/100. c. IQ = (MA/CA) x 100. d. IQ = (MA/CA)/100. Answer: C Page: 154

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30. If Andrea’s chronological age is 25 and the average age of those receiving the same test score as she did is 25 years, what is Andrea’s IQ? a. 75. b. 100. c. 110. d. 120. Answer: B Page: 154 31. According to the Wechsler scales, if Jose scores one standard deviation above the mean, his IQ is a. 100. b. 110. c. 115. d. 120. Answer: C Page: 154 32. Wechsler translated raw scores into standard scores based on a ____________ distribution. a. bimodal b. normal c. multimodal d. positively skewed Answer: B Page: 154 33. Decades of psychological research on IQ have now conclusively demonstrated that a. IQ is primarily attributable to heredity. b. IQ is primarily attributable to environment. c. IQ is attributable to a complex interaction of heredity and environment. d. an IQ score and the concept of intelligence are the same thing. Answer: C Page: 154 34. In examining research on intelligence, Nisbett et al. (2012) found that: a. there is evidence that breastfeeding increases IQ for both normal weight infants and infants born prematurely. b. SES is unrelated to intelligence. c. children who are deprived of schooling for an extended period do not show IQ deficits when compared to children who have not experienced this gap. d. there is no evidence of ethnic differences in IQ scores. Answer: A Page: 155 35. Perceptual reasoning refers to the ability to: a. do timed tasks that require the use of information in short-term memory. b. use visually presented material. c. quickly process and use new information. d. comprehend and use verbal material. Answer: B Page: 155 Chapter 7: Assessment: Intellectual and Cognitive Measures Copyright 2018 © John Wiley & Sons Canada, Ltd.

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36. Wechsler intelligence tests focus on the a. products of intelligence. b. processes of intelligence. c. cause of intelligence. d. individual’s approach in solving diverse problems. Answer: A Page: 156 37. Standardized administration of the Wechsler scales requires that a. the test be conducted in a stimulating room. b. the test-taker be given information about the nature of the test. c. the administrator should sit directly beside the test-taker. d. the administrator is permitted to give feedback on performance only at the end of each subtest. Answer: B Page: 157 38. A series of studies on the Wechsler scales found a. numerous errors in the scoring of the test, but not administration. b. numerous errors in the administration of the test, but not scoring. c. numerous errors in both the administration and scoring of the test. d. very few errors when clinical psychologists rather than trainee administered the scales. Answer: C Page: 158 39. The general interpretive strategy recommended for the Wechsler tests, is to a. move from the specific (such as the factor scores) to the general (such as the full scale IQ) when interpreting results. b. move from the general (such as the full scale IQ) to the specific (such as the factor scores) when interpreting results. c. Both A and B (depending on the subscale). d. interpret the full scale IQ only, as it is a composite of the factor scores. Answer: B Page: 158 40. What best defines fluid intelligence? a. What we have learned in life, both in formal education and general life experiences. b. The ability to solve novel problems without drawing on previous experiences or formal learning. c. Primary mental abilities such as comprehension. d. Primary mental abilities such as working memory. Answer: B Page: 158 41. Decades of research on the subtest profiles of the Wechsler scales has found that they a. add little to the prediction of academic achievement. b. add considerably to the prediction of academic achievement. c. add considerably to the prediction of learning behaviours. Chapter 7: Assessment: Intellectual and Cognitive Measures Copyright 2018 © John Wiley & Sons Canada, Ltd.

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Introduction to Clinical Psychology 4e

d. have high internal consistency reliability. Answer: A Page: 158 42. Which of the following is one of the perceptual reasoning subtests on the WAIS-IV? a. Block Design. b. Similarities. c. Comprehension. d. Symbol Search. Answer: A Page: 161 43. Digit Span, Arithmetic, and Letter-Number Sequencing are subtests of the WAIS-IV that contribute to the ___________ index. a. processing speed b. working memory c. perceptual reasoning d. verbal comprehension Answer: B Page: 161 44. Which of the following subtests measures crystallized intelligence? a. Digit Span. b. Visual Puzzles. c. Comprehension. d. Block Design. Answer: C Page: 161 45. The WAIS IV has been shown to have ___________ reliability and __________ validity. a. questionable; questionable b. questionable; excellent c. excellent; excellent d. excellent; questionable Answer: C Page: 161 46. To increase the developmental appropriateness of the WISC-V, the developers modified the scale by: a. creating separation versions for children in pre- to early adolescence and for midto older adolescence. b. including sample and/or practice items within each subtest. c. including specific phrases for the administrator to use when providing feedback on the child or adolescent’s performance that are developmentally applicable. d. all of the above. Answer: B Page: 162 47. On average, IQ levels in developed countries have a. been decreasing over the past 40 years. b. been increasing over the past 40 years. Chapter 7: Assessment: Intellectual and Cognitive Measures Copyright 2018 © John Wiley & Sons Canada, Ltd.

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Introduction to Clinical Psychology 4e

c. remained constant over the past 40 years. d. increased, but only in girls. Answer: B Page: 164 48. It has been speculated that the Flynn Effect can primarily be explained by a. genetic factors. b. environmental factors. c. unknown factors. d. measurement error. Answer: B Page: 164 49. The Kaufman Assessment Battery for Children and Kaufman Adolescent and Adult Intelligence Test differs from the Wechsler scales in which of the following ways: a. Focus on how children and adults learn, assessing styles of learning rather than knowledge or skill areas. b. Identifies gaps between an individual’s potential to learn and what the examinee has actually learned. c. Uses different subscales that focus on processing and achievement. d. All of the above. Answer: D Page: 165 50. The Kaufman tests of intellectual ability focus more on a. specific content areas that measure intellectual functioning. b. general content areas that measure intellectual functioning. c. process-based styles of learning. d. none of the above. Answer: C Page: 165 51. __________ memory involves general knowledge of words, concepts, and events, whereas ___________ memory deals with the person’s direct experiences. a. Semantic ; episodic b. Episodic ; semantic c. Semantic ; working d. Episodic ; declarative Answer: A Page: 165 52. Semantic memory and episodic memory are subtypes of __________ memory. a. procedural b. declarative c. contextual d. working Answer: B Page: 165

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Introduction to Clinical Psychology 4e

Short Answer Questions 1. How do Alfred Binet and David Wechsler’s definitions of intelligence contrast? Suggested answer: Page 149 a. Binet developed a test to predict school performance, so his definition of intelligence focused more narrowly on abilities related to scholastic and academic tasks b. Wechsler’s definition is broader, and he defined intelligence as a person’s global ability to act purposefully, think rationally, and deal effectively with his or her environment. 2. Describe three general models of intelligence. Suggested answer: Pages 149 - 150 a. Factor models propose that intelligence is comprised of two or more factors that are believed to be at the same structural level. b. Hierarchical models suggest that there are different levels of factors including higher-order (or primary) factors and lower-order (or secondary) factors. c. Information processing models do not really focus on organizing types of intelligence and focus more on the processes and operations of the brain. 3. What is the difference between “g” and “s”? How are they related and what type of models do they represent? Suggested answer: Pages 149 a. “g” is the single common core (or general factor) that all intellectual activities share. “s” refers to specific factors that are responsible for the unique aspects in the performance of any given task. This is an example of a two-factor model. 4. What is the key difference between fluid intelligence and crystallized intelligence? Suggested Answer: Page 150 a. Fluid intelligence, the ability to solve novel problems, is considered to be innate whereas b. Crystallized intelligence is thought to be learned in life (from education and experiences). 5. List at least three forms of intelligence that are proposed by Gardner’s theory of multiple intelligences. What was Gardner’s general view concerning intelligence tests? Suggested Answer: Page 150 a. Some of the forms of intelligence suggested by Gardner include linguistic, musical, logical-mathematical, spatial, bodily-kinaesthetic, intrapersonal, interpersonal, naturalistic, spiritual, existential, and moral. b. Gardner: i. believed that different types of intelligence are inadequately assessed by traditional intelligence tests. ii. argued that for intelligence assessment to be culturally unbiased, the full range of different types of intelligence must be recognized. Chapter 7: Assessment: Intellectual and Cognitive Measures Copyright 2018 © John Wiley & Sons Canada, Ltd.

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Introduction to Clinical Psychology 4e

6. What is premorbid IQ? Suggested Answer: Page 152 a. Premorbid IQ refers to a person’s intellectual functioning prior to an accident or the onset of a neurological decline. 7. What is the difference between a diagnosis of intellectual disability and a diagnosis of a learning disability? Suggested Answer: Page 152 a. To be diagnosed with intellectual disability, a person must obtain an IQ score in the lowest 2% of the population. b. To be diagnosed with a learning disorder there has to be a substantial discrepancy between a person’s standardized test scores and his or her age and level of intelligence. 8. What was the important innovation that David Wechsler introduced to assist in the measurement of intelligence? Why was this so important for IQ testing? Suggested Answer: Page 154 a. Wechsler used deviation scores to measure intelligence. He translated raw scores into standard scores based on a normal distribution with a mean of 100 and a standard deviation of 15. b. This ensured that there was comparability in the meaning of IQ scores across different ages. 9. List two limitations of the Wechsler scales. Suggested Answer: Page 156 a. Wechsler modelled his original test on other tests evaluating academic abilities. This means that the tests are oriented to measure academic or analytical forms of intelligence, and do not measure abilities in artistic, social, or emotional domains, among others b. This also means that the focus of the Wechsler tests is on the examinee’s current ability or some of the products of intelligence, with little or no attention paid to the processes that underlie intelligence. c. When testing individuals in countries which do not have norms for the scales, examiners should be less confident about the validity of the IQ due to possible differences in population characteristics (norms). 10. Describe the Flynn effect and indicate what is believed to be its cause. Suggested Answer: Page 164 a. The Flynn effect: i. refers to an interesting phenomenon where IQ has been slowly rising in the past few decades (annual increase of .33 IQ score points). ii. IQ is rising at the population level (i.e., this is not necessarily true of each individual)

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Introduction to Clinical Psychology 4e

iii. Not all IQ subtests are rising at the same rate. Visuospatial abilities (fluid intelligence) increased more than measure of acquired knowledge (crystallized intelligence). b. Potential cause: i. James Flynn argued that environmental influences must somehow be the driving force in the rise of IQ. ii. Environmental influences include improvements in educational systems, nutrition, greater parental involvement with children, fewer severe childhood diseases, rapid developments in technology (television, video games, computers, etc.), cognitive complexity of jobs has increased, leisure time has increased 11. What is declarative memory? Name and describe the two subtypes of declarative memory. Suggested Answer: Page 165 a. Declarative memory is memory that involves symbolic representations such as phone numbers. b. It can be further divided into semantic memory (which is memory for general knowledge of words, concepts and events) and episodic memory (which is memory for a person’s direct experiences, such as events in their lives).

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Chapter 8 Assessment: Self-Report and Projective Measures Multiple Choice Questions 1. The tendency to consistently behave in specific ways is termed a(n) a. behavioural specificity. b. personality trait. c. habit. d. objective characteristic. Answer: B Page: 170 2. Many personality measures are called objective personality tests because a. they always use the same scoring system. b. they are based on the unique personality of the client taking the test. c. objective observers rate the behaviour and personality of the individual. d. they are not subject to mood or other contextual influences in testing. Answer: A Page: 170 3. Most personality tests are based on __________ and are often called ___________ personality tests. a. self-report; subjective b. scoring by the test administrator; subjective c. self-report; objective d. scoring by the test administrator; objective Answer: C Page: 170 4. A self-report measure, derived from descriptive characteristics of an experience or an event rather than from personality theories in which the person is asked to rate the frequency, intensity, or duration or particular behaviours or experiences is known as a(n) a. behaviour checklist. b. projective test. c. intelligence test. d. objective personality test. Answer: A Page: 170 5. ___________ are comprised of drawings or responses to ambiguous stimuli, and are based on the assumption that responses reveal information about ____________. a. Behaviour checklists; the frequency, intensity, or duration of behaviours b. Behaviour checklists; personality structure c. Projective tests; personality structure d. Projective tests; the frequency, intensity, or duration of behaviours Answer: C Page: 170 6. Projective tests are used mainly to make inferences about a person’s a. developmental history. Chapter 8: Assessment: Self-Report and Projective Measures Copyright 2018 © John Wiley & Sons Canada, Ltd.

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b. personality structure. c. intelligence. d. likelihood of faking good. Answer: B Page: 170 7. Debate over whether personality traits or contextual factors are more responsible for an individual’s behaviour is known as the a. person-context debate. b. individual-situation debate. c. person-situation debate. d. individual-context debate. Answer: C Pages: 170 - 171 8. Which psychologist ignited the person-situation debate by suggesting that situational factors may influence behaviour more than personality? a. Albert Bandura b. Matthew Sanders c. Theodore Millon d. Walter Mischel Answer: D Page: 170 9. Walter Mischel’s (1968) literature review of research into the link between personality traits and actual behaviour found a. a strong correlation. b. a modest correlation. c. an inverse correlation. d. a correlation that was moderated by age. Answer: B Pages: 171 10. Alicia has been referred to a psychologist due to complaints about anxiety. In the interview she reports that her singing teacher complains she is shy and withdrawn. She also reports that she is an active member of her religious community. Contemporary clinical psychologists view this as: a. evidence of the problem of multi-informant assessment. b. evidence that Alicia is an unreliable informant. c. evidence of conditions in which symptoms are less severe. d. evidence of the need for projective tests to circumvent self-report biases. Answer: C Page: 171 11. _________’s early theories postulated that the unconscious aspect of our personality is something that can be accessed through considerable conscious effort. a. Freud b. Jung c. Wechsler d. Rogers Answer: A Page: 171 Chapter 8: Assessment: Self-Report and Projective Measures Copyright 2018 © John Wiley & Sons Canada, Ltd.

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12. Wilson and Dunn’s (2004) review of research related to self-knowledge found: a. evidence for the usage of conscious suppression. b. evidence for the concept of repression. c. introspection enhances the accuracy of self-understanding. d. no evidence for the usage of conscious suppression. Answer: A Page: 171 13. In their review of research on self-knowledge, Wilson and Dunn (2004) suggested that we can learn more about ourselves by __________. However, social cognitive research suggests that self-knowledge can be increased by _____________. a. introspection; attending to how others view us b. attending to how others view us; intentionally observing our own behaviours and decisions c. intentionally observing our own behaviours and decisions; introspection d. attending to how others view us; introspection Answer: B Page: 171 14. Most personality inventories include validity scales to a. ensure that that the inventory is testing the construct it was designed to test. b. ensure that the inventory is internally consistent. c. ensure that the inventory is psychometrically sound. d. detect whether a person is purposely presenting themselves in a positive or negative way. Answer: D Page: 172 15. Deliberately emphasizing positive characteristics when completing a personality inventory is referred to as a. faking bad. b. impression management. c. faking good. d. positivity bias. Answer: C Page: 172 16. Separated parents are in the middle of a difficult custody case. In completing a personality inventory in a custody evaluation, one parent downplays his/her anger management problems. This is an example of a. maligning. b. faking bad. c. negative image management. d. faking good. Answer: D Page: 172 17. Validity scales focus on three possible tendencies that could distort the answers given by test takers including: a. faking good, faking bad, and inconsistent responses Chapter 8: Assessment: Self-Report and Projective Measures Copyright 2018 © John Wiley & Sons Canada, Ltd.

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b. faking bad, inconsistent responses, and incorrect answers c. faking good, faking bad, and incorrect answers d. faking good, inconsistent responses, and incorrect answers. Answer: A Page: 172 18. Deliberately emphasizing negative characteristics when completing a personality inventory is referred to as a. malingering. b. negative image management. c. maligning. d. undermining. Answer: A Page: 172 19. The Test of Memory Malingering, designed to assess exaggeration of memory deficits among individuals with potential ______________, has demonstrated ________ accuracy in identifying malingering. a. behaviour problems; high b. neurological impairments; high c. psychological problems; low d. physical impairments; low Answer: B Page: 172 20. Research comparing the susceptibility of projective tests and self-reports of personality to faking responses a. is inconclusive. b. indicates that projective tests are consistently more easily faked than are selfreport measures. c. indicates that self-report measures are consistently more easily faked than are projective tests. d. suggests that the ambiguous nature of projective tests makes it difficult for clients to exaggerate or minimize psychological problems. Answer: A Page: 172 - 173 21. When conducting an assessment with a client from an ethnic minority background for whom no culturally validated measures are available, the psychologist should: a. avoid using scores, or indicate that the scores may not provide an optimal assessment of the client’s functioning. b. indicate in the assessment report that accuracy and validity of results may be less than ideal. c. use the test only to aid in generating hypotheses about the client’s functioning. d. all of the above. Answer: D Page: 173 22. In translating and adapting a test for use in a second language, back translation refers to: a. Translation of the items into the second language, then translation back into the first language by a differed translator and comparison of the two versions. Chapter 8: Assessment: Self-Report and Projective Measures Copyright 2018 © John Wiley & Sons Canada, Ltd.

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Introduction to Clinical Psychology 4e

b. conducting pilot testing of the translated measure to ensure it is comprehensible. c. re-standardizing scores on the measure using norms specific to the translated measure. d. establishing construct validity between the two version to determine whether the instruments measure the same psychological qualities in both languages. Answer: A Page: 174

23. After decades of validity research and frequent clinical use, there is ____________ scientific evidence that MMPI or Rorschach scores have a meaningful impact on the outcome of psychological services. a. overwhelming b. adequate c. virtually no d. an unsubstantiated amount of Answer: C Page: 175 24. A study by Lima and colleagues (2005) found that providing clinicians with access to patient MMPI-2 data at the beginning of treatment a. impacted the number of sessions attended, but had no impact on patient improvement. b. did not impact the number of sessions attended, but positively impacted patient improvement. c. impacted the number of sessions attended and negatively impacted patient improvement. d. did not impact either the number of sessions attended or on patient improvement. Answer: D Page: 176 25. Which approach to test construction involves retaining items that discriminate between two clearly defined groups? a. Item approach b. Content approach c. Empirical criterion-keying approach d. Construct approach Answer: C Page: 177 26. Which approach to test construction involves developing items specifically to tap the construct being assessed? a. Item approach b. Content approach c. Empirical criterion-keying approach d. Construct approach Answer: B Page: 177

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27. In the MMPI-2 normative sample, individuals with lower education and lower income were slightly underrepresented. In interpreting results on the MMPI-2 for those with lower education and lower income clinicians must be aware that the: a. cut-off scores for determining presence of clinical problems may be too low. b. test is likely to yield a high number of false positives. c. test may overpathologize these individuals. d. all of the above. Answer: D Page: 180 28. The tendency to exaggerate or overestimate the extent of pathology is known as ______________ the patient. a. improperly coding b. overpathologizing c. overmedicalizing d. overgeneralizing Answer: B Page: 180 29. The MCMI-III is designed to measure a. clinical personality patterns. b. major clinical syndromes. c. clinical personality patterns and major clinical syndromes. d. personality functioning in a non-clinical population. Answer: C Page: 182 30. The Millon Clinical Multiaxial Inventory-IV has the following limitation to its validity: a. the normative sample was smaller than usual. b. partly due to item overlap, the scale has a tendency to overpathologize individuals. c. there is insufficient item overlap between scales to account for symptoms that appear in more than one disorder. d. partly due to item overlap, the scale has a tendency to underestimate rates of pathology. Answer: B Page: 182 31. In interpreting the results of the Millon Clinical Multiaxial Inventory-III, a psychologist must to be aware that the MCMI-III tends to a. underpathologize test-takers. b. overpathologize test-takers. c. Artificially diminish correlations between scales. d. be more accurate in assessing some individuals than others. Answer: B Page: 182 32. The Millon Adolescent Clinical Inventory differs from the MCMI-IV in that it also assesses: a. Expressed concerns, such a peer insecurity. b. Personality styles and disorders. Chapter 8: Assessment: Self-Report and Projective Measures Copyright 2018 © John Wiley & Sons Canada, Ltd.

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c. Major clinical syndromes. d. The suitability of the measure for adolescents not seeking mental health services. Answer: A Page: 182 33. The Personality Assessment Inventory is intended for ___________ and requires a Grade ____ reading level. a. youth and adults; 4 b. adults; 4 c. youth and adults; 8 d. adults; 8 Answer: B Page: 182 34. The overall reliability of the Personality Assessment Inventory scales is superior to the a. Millon Clinical Multiaxial Inventory-IV. b. Millon Adolescent Clinical Inventory. c. Minnesota Multiphasic Personality Inventory. d. All of the above. Answer: D Page: 182 35. The most commonly used measure of normal personality is: a. The NEO Personality Inventory–3 b. The California Psychological Inventory c. Millon Adolescent Clinical Inventory d. Minnesota Multiphasic Personality Inventory Answer: A Page: 183 36. The NEO Personality Inventory-3 is based on what model of personality? a. Cognitive-social b. Five-factor c. Personality type categories d. Triarchic theory of personality Answer: B Page: 183 37. Concerns about the need to use measures that are inexpensive, not too time-consuming, and with direct and immediate relevance to treatment planning and monitoring have led to the increased use of: a. projective tests. b. behaviour and symptom checklists. c. objective personality tests. d. structured clinical interviews. Answer: B Page: 184 38. The Achenbach scales yield scores on which two broad types of problems? a. Physical and mental health problems. b. Cognitive and social problems. c. Internalizing and externalizing problems. Chapter 8: Assessment: Self-Report and Projective Measures Copyright 2018 © John Wiley & Sons Canada, Ltd.

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d. Personality and Axis I problems. Answer: C Page: 185 39. The Symptom Checklist-90-Revised is the most widely used general measure of a. depression. b. anxiety. c. behaviour problems. d. general psychological distress. Answer: D Page: 187 40. In using the Symptom Checklist-90-Revised, psychologists must be aware that a. most subscales do not adequately measure the constructs they are designed to assess. b. there is limited evidence of sensitivity to treatment-related changes. c. there is insufficient overlap among the subscales. d. the scale yields an underestimate of psychopathology. Answer: A Page: 187

41. The Beck Depression Inventory (BDI-II) a. does not provide sufficient detail to determine whether a person meets criteria for diagnosis of a mood disorder. b. provides sufficient detail to determine whether a person meets the diagnostic criteria for a mood disorder. c. does not have strong psychometric properties. d. is unlikely to be an accurate tool for monitoring treatment, as scores remain constant across repeated administrations. Answer: A Page: 188 42. Research indicates that when examiners use Exner’s Comprehensive System (CS) for administering and scoring the Rorschach test that a. administration errors are still easy to make, and can impact examinees’ responses. b. administration errors much less common when using this system for administering and scoring the test. c. the norms for the test underestimate rates of pathology within the nonpatient population. d. the Rorschach is an appropriate tool to use with children and adolescents, yielding valid results. Answer: A Page: 190 43. Research indicates that the Rorschach Inkblot test is likely to a. underpathologize patients. b. overpathologize patients. c. be very accurate at detecting mood and anxiety problems. d. be valid for use with children and youth. Answer: B Page: 190 - 191 Chapter 8: Assessment: Self-Report and Projective Measures Copyright 2018 © John Wiley & Sons Canada, Ltd.

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44. A self-report checklist designed to evaluate recent (in the past two weeks) symptoms of depression in children is the: a. Beck Depression Inventory-II b. Children’s Depression Inventory 2 c. Outcome Questionnaire d. Symptom Checklist-90-Revised Answer: B Page: 190 - 191 45. Research findings suggest that the Rorschach should not be used to a. examine thought disorder. b. aid in the development of clinical hypotheses. c. provide diagnostic information. d. assess personality structure. Answer: C Page: 191

46. Because of the concerns about the quality of the Comprehensive System (CS) norms, considerable efforts have been devoted to developing norms that meet the standards expected of psychological tests. To that end, a series of norms called _____________ has been published that draws on data from over 5,800 people from 16 countries. a. Rorschach Performance Samples b. The International Reference Samples c. The Youth Self-Report d. Symptom Checklist-90 Answer: B Page: 190 - 191

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Short Answer Questions 1. What is the person-situation debate? Suggested answer: Pages 170 - 171 a. The person-situation debate refers to the question of what contributes to the accurate prediction of a person’s behaviour, the situation, or personality. b. It was launched by Walter Mischel in his book Personality and Assessment (1968). c. During that time, it was believed that the more an individual possessed a certain trait, the more likely that person was to behave in a manner consistent with the trait in any situation d. Based on his review of the literature, Mischel questioned whether there was a direct connection between personality traits and actual behaviour. Specifically, he suggested that the type of situation may account for as much (if not more) of the variability in a person’s behaviour. 2. Wilson and Dunn (2004) reviewed research related to questions of how well we can know ourselves and the obstacles to self-knowledge. List two of their general conclusions. Suggested Answer: Pages 171 a. despite decades of research, there is little evidence for the existence of a Freudian concept of repression b. substantial evidence for existence of conscious suppression (trying not to think about something) c. suppression often fails to accomplish its goal. Instead efforts to suppress thoughts result in people paying even more attention than usual to the information they are attempting to ignore d. non-conscious processing occurs, but is largely related to perception, attention, learning, and automatic judgements e. there are no motivational or emotional impediments to people easily accessing this unconscious content f. much of the unconscious is simply inaccessible to conscious inspection g. we can learn much about ourselves by attending to how others view us (however, other research indicates that this is not the case). 3. Explain the three main types of self-presentation biases that validity scales of the major personality inventories attempt to investigate. Suggested Answer: Page 172 a. To see if (a) the test-taker is emphasizing positive characteristics (“faking good”), (b) emphasizing negative characteristics (malingering or “faking bad”), and (c) providing inconsistent or random responding. 4. In considering the cultural appropriateness of personality measures, discuss two ways that personality measures may be biased or unfair. Suggested Answer: Page 172 - 173

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a. Content applicability: The test content may not be equally applicable or relevant to all cultural groups. Therefore, some cultural groups may respond differently to the same question. b. Construct validity: The pattern of validity coefficients may not be similar across groups. In other words, associations between, for example, a negative attributional style and depressive symptoms may be much larger for one group than for another. c. Cut-off scores: The cut-off scores used may not be equally appropriate for categorizing different groups. Bias related to cut-off scores could mean than those in certain cultural and ethnic groups could be either over or under-identified as having scores in the clinical range. d. Factor structure: Is the factor structure the same across groups? Factor analysis is frequently used to explore exactly how components of a construct relate to each other. For example, a measure of anxiety may have a factor structure that has cognitive and physical components for one group but only a physical component for another. If this pattern of results occurred, it would mean that the test is tapping different constructs in the two groups. 5. List the three incremental steps for determining a measure’s clinical utility suggested by Hunsley and Bailey (1999): Suggested Answer: Page 175 a. Is the tool found to be useful by clinical practitioners? b. Is there replicated evidence that the measurement data provide reliable and valid information about clients’ psychological functioning? c. Does the use of the tool and the resulting data improve upon typical clinical decision-making and treatment outcome? In other words, does using the measure eventually make a difference in terms of the client’s functioning? 6. Explain why the Millon Clinical Multiaxial Inventory-IV (and other self-report personality measures) have a tendency to overpathologize test-takers: Suggested Answer: Page 176 a. There is some item overlap among scales, which can artificially inflate correlations between scales. b. Due in part to item overlap, it is common for test-takers to have high scores on several scales, and, thus, the MCMI-IV has a tendency to overpathologize testtakers. 7. Name two benefits of the Personality Assessment Inventory (PAI). Suggested Answer: Page 182 a. It requires only Grade 4 reading level. b. It can be completed in a relatively short period of time (one hour). c. During test construction, much attention was paid to content and discriminant validity. d. Impressive amount of research supporting overall validity.

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8. Provide a brief description of the Rorschach Inkblot Test and list two potential negative aspects of the test. Suggested Answer: Pages 189 a. The Rorschach inkblot Test consists of 10 cards with black and white, as well as coloured, symmetrical inkblots. b. Patients are asked to report what they see in these ambiguous stimuli. Some potential negative aspects of the test are: a. It is complex to administer, score, and interpret. b. Contextual factors during administration can affect responses. c. Likelihood that nonpatient norms overpathologize normal individuals. d. Numerous errors in scoring. e. Test cannot consistently detect several Axis I and II disorders 9. Explain what the study conducted by Hamel, Shaffer, and Erdberg (2000) examining the use of the Rorschach Inkblot Test with children by demonstrated: Suggested Answer: Page 190 a. The study involved 100 children who demonstrated no previous evidence of psychopathology or behaviour problems (based on historical information and assessment of current functioning). b. However, when their Rorschach results were scored, a considerable number of the children scored in the clinical range on Rorschach indices of psychopathology. c. This suggests that nonpatient norms may overpathologize normal individuals.

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Chapter 9 Assessment: Integration and Clinical Decision-Making Multiple Choice Questions

1. In assessing an older adult who is exhibiting symptoms of dementia, a clinical neuropsychologist ought to a. obtain data from multiple informants to assess daily impact of cognitive decline. b. rely upon the client’s description of the changes in his/her cognitive functioning. c. observe the client in a naturalistic setting. d. ask caregivers to complete rating scales. Answer: A Page: 196 2. De Los Reyes et al. (2009) compared maternal and teacher reports of child disruptive behaviours and found that in reporting disruptive behaviours: a) mothers were consistently more accurate than were teachers. b) teachers were consistently more accurate than were mothers. c) depending on the context of the behaviour, both mothers and teachers were equally accurate. d) neither mothers nor teachers were consistently accurate. Answer: C Page: 196 3. When interpreting results from the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), psychologists typically begin by examining scores on the a) main MMPI-2 code types. b) clinical scales. c) various reliability scales. d) validity scales. Answer: D Page: 197 4. The MMPI-2 “code type” refers to the a) highest score on the clinical scales. b) highest two scores on the clinical scales. c) highest four scores on the clinical scales. d) score from the validity scales. Answer: B Page: 197 5. Case formulation is required when: a. there are complex issues of differential diagnosis. b. the psychologist works within a psychodynamic framework. c. there are no evidence based treatments to meet the person’s symptom profile. d. the psychologist has been asked to make recommendations about treatment. Answer: D Page: 198

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6. A case formulation generally consists of identifying (1) symptoms and problems, (2) preexisting vulnerabilities, (3) stressors or events that contributes to symptoms, and (4): a) alternative treatment options should the initial treatment be unsuccessful. b) a mechanism that links all components and maintains the problem. c) options to consider if difficulties are encountered in implementing and following through on treatment. d) pre-disposing life events or triggers. Answer: B Page: 198 - 199 7. Clinical case formulation is especially helpful in that it: a) provides a way of understanding the connections between a patient’s various problems. b) predicts the patient’s future functioning if treatment is not sought and how this functioning will be different if treatment is successful. c) provides alternative treatment options to consider if the initial treatment is unsuccessful. d) all of the above. Answer: D Page: 199 8. A major challenge in case formulation is a) detecting patterns in a wealth of data gathered during an assessment. b) obtaining enough self-report data from clients. c) obtaining consent to conduct assessment interviews. d) considering discrepancies between conflicting reports. Answer: A Page: 199 9. Interpersonally oriented psychodynamic case formulations are likely to focus on __________________ process-experiential formulations are likely to focus on ______________. a) dysfunctional relationship styles; environmental factors b) dysfunctional relationship styles; emotional processing and insight c) emotional processing and insight; dysfunctional relationship styles d) emotional processing and insight; environmental factors Answer: B Page: 199 10. The Cognitive-Behavioural Case Formulation approach, developed by Jacqueline Persons, emphasizes the importance in identifying a patient’s ___________ in the conceptualization of a case. a. overt problems and long-standing beliefs or schemas b. overt problems much more so than long-standing beliefs c. overt problems much less so than long-standing beliefs d. long-standing beliefs or schemas exclusively Answer: A Page: 200 11. Using data that rely on people to remember events that happened to them at some point in the past is known as: Chapter 9: Assessment – Integration and Clinical Decision-Making Copyright 2018 © John Wiley & Sons Canada, Ltd.

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a) retrospective recall. b) recovered recall. c) historical recall. d) recovered memory. Answer: A Page: 202 12. Research has found that when asked to recall recent events, people tend to a) under-report the frequency of socially desirable acts. b) over-report the frequency of socially desirable acts. c) over-report the frequency of socially undesirable acts. d) none of the above. Answer: B Page: 203 13. When interpreting self-report checklists, psychologists ought to know that a) desirability might reduce the accuracy of responses. b) desirability might improve the accuracy of responses. c) people tend to be more accurate when reporting events some time after the fact. d) people tend to provide comparable reports, regardless of whether the information is provided right after the event, or later recalled. Answer: A Page: 203 14. Research conducted by Halford et al. (2002), which compared the daily records of a couple’s life with a recalled description about that same week provided at a later date, revealed that couples with low relationship satisfaction reported the week’s relationship events in overly negative terms. This suggests that: a) the accuracy of retrospective recall is relatively realistic. b) the accuracy of retrospective recall can be influenced by external factors. c) couples low in relationship satisfaction are better attuned to the issues in their relationship than couple higher in satisfaction. d) couples low in relationship satisfaction are less attuned to the issues in their relationship than couple higher in satisfaction. Answer: B Page: 203 15. Research on retrospective recall indicates that a) only minor daily events are recalled poorly. b) both minor daily events and major life events are recalled poorly. c) only major life events are recalled poorly. d) neither minor daily events nor major life events are recalled poorly. Answer: B Page: 203 16. Research has found that adolescents’ retrospective recall poorest for: a) personal variables, such as the number of housing moves. b) physical variables, such as height prior to puberty. c) psychosocial variables, such as extent of familial conflict. d) all of the above. Answer: C Page: 203 Chapter 9: Assessment – Integration and Clinical Decision-Making Copyright 2018 © John Wiley & Sons Canada, Ltd.

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17. The tendency to take more personal credit for successes than for failures, by attributing success but not failure to internal, stable, and global causes is referred to as a) self-serving attributional bias. b) internally-focused heuristic. c) fundamental attribution. d) confirmatory bias. Answer: A Page: 203 18. Jonathan usually assumes that positive events have happened to him because of his hardwork and that negative events have happened because of bad luck. Jonathan’s thinking reflects: a) deluded thinking. b) a self-serving attributional bias. c) egocentricity. d) a fundamental self-serving bias. Answer: B Page: 203 19. Judgments that are systematically different from what a person should conclude based on logic or probability are known as _______, whereas mental shortcuts that make decisionmaking easier and faster but often lead to less accurate decisions are known as ________. a) heuristics; biases b) cognitive vulnerabilities; biases c) biases; heuristics d) biases; cognitive vulnerabilities Answer: C Page: 204 20. Maria is driving in traffic, when suddenly another car cuts her off. She mutters to herself “That driver is a nasty person, why can’t s/he learn to drive?” This overestimation of the influence of personality traits and underestimation of the influence of situational effects on another person’s behaviour is known as a) inferring causation from correlation. b) a fundamental attribution error. c) a hindsight bias. d) an affect heuristic. Answer: B Page: 204 21. Belief in the law of small numbers is a common decision-making bias that occurs when a psychologist trusts a) the results of a large research sample over a small sample. b) information obtained from a small sample of patients over larger research samples. c) information from colleagues over research results. d) the results of a small research sample as long as several studies have been conducted. Answer: B Page: 204 Chapter 9: Assessment – Integration and Clinical Decision-Making Copyright 2018 © John Wiley & Sons Canada, Ltd.

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22. A psychologist notices that many of his/her clients who are experiencing infertility report high levels of stress. S/he concludes that stress levels are interfering with their ability to conceive a child and recommends a program of relaxation. This is an example of decision-making that is affected by: a) inferring causation from correlation. b) a biopsychosocial model. c) a diathesis stress model. d) a self-serving bias. Answer: A Page: 204 23. A graduate student in clinical psychology hypothesizes that his/her client suffers from panic disorder. The graduate student asks in-depth questions about this diagnosis, but less detailed questions about other possibilities. By failing to gather information that could refute or temper the strength of this hypothesis, the graduate student is engaging in a(n): a) availability heuristic. b) hindsight bias. c) confirmatory bias. d) affect heuristic. Answer: C Page: 204 24. The process whereby a psychologist develops a clinical hunch and then gathers information to support his/her predictions is referred to as a(n) a) fundamental attribution error. b) case formulation. c) confirmatory bias. d) hindsight bias. Answer: C Page: 204 25. Camille obtains an extremely high score on the Beck Depression Inventory II (BDI-II) and then obtains a less extreme score when she takes the test two weeks later. This could potentially be explained by the a) hindsight bias. b) fundamental attribution error. c) anchoring and adjustment heuristic. d) regression to the mean. Answer: D Page: 204 26. Almost everyone believes that he/she is less likely to have their decisions affected by errors and biases. This could potentially be explained by the e) hindsight bias. f) fundamental attribution error. g) bias blind spot. h) regression to the mean. Answer: C Page: 204

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27. A psychologist who assumes that a particular pattern of responses on a test is indicative of a specific diagnosis, but does not take into account the probability of both the pattern of test responses and of the diagnosis, s/he is engaging in a(n) I a) anchoring and adjustment heuristic. b) hindsight bias. c) inattention to base rates. d) confirmatory bias. Answer: C Page: 204 28. Research on the use of biases and heuristics has shown that clinicians tend to over-predict the violence of a) black psychiatric inpatients and male patients. b) black prison inmates and female patients. c) white prison inmates and female patients. d) white prison inmates and male patients. Answer: A Page: 204 29. In their meta-analysis of 36 studies, Miller, Spengler, and Spengler (2015) found a small, but statistically significant link between ________________and accuracy of decisions about mental health. a) clinician confidence b) patient preconceptions. c) patient behavior. d) heuristics. Answer: A Page: 204 30. A psychologist who relies on psychological tests that are directly relevant to the assessment task that have strong psychometric qualities and uses normative data and base rate information whenever available, s/he is a) employing strategies to improve the accuracy of clinical judgment. b) contributing to the development of local norms. c) increasing her understanding of personal biases and preconceptions. d) using the anchoring and adjustment heuristic. Answer: A Page: 206 31. The advantage(s) of the written report following an assessment is that it a) provides integrated information to the agency, professional, or client that was the focus of the assessment. b) serves as a record of the assessment that can be referred to subsequently, potentially as a document used for legal purposes. c) provides a record of the client’s functioning prior to an intervention, which is crucial in accurately determining the impact of any intervention. d) all of the above. Answer: D Page: 207

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32. When completing the written report following an assessment, the psychologist ought to be mindful of a) the audience who will have access to reading the report. b) minimizing stigmatizing terms or descriptions. c) avoiding ambiguous and technical terms. d) all of the above. Answer: D Page: 207 - 208 33. Computer-based interpretations are a) minimally helpful as they are based on group data, and no part should be used in a report. b) possibly helpful, but no part should ever be used in a report. c) possibly helpful, but psychologists need to select narrative statements that accurately describe their client. d) usually very helpful to aid psychologists’ understanding of their clients, and can be appended to a psychological report. Answer: C Page: 208 34. When utilizing computer-based interpretations (CBIs) for scoring and interpreting assessments, a psychologist ought to a) rely on the computer’s interpretation for areas outside of their expertise. b) use it as a tool, but use judgment in interpreting the results. c) employ the interpretations of scores in full, but only cautiously use diagnostic impressions and case formulation, instead relying upon his/her clinical judgment. d) only use CBIs if the regulatory body in his/her jurisdiction has developed clear guidelines for their use. Answer: B Page: 208 35. In preparing a treatment plan, a psychologist must consider the a) reason for referral and problem identification. b) aims and goals of treatment. c) strategies for the planned treatment. d) all of the above. Answer: D Page: 208 36. In preparing an assessment report focused on treatment planning the psychologist should take into account: a. potential barriers to treatment. b. criteria for treatment termination or transfer to other service provider. c. the service provider responsible for treatment implementation and evaluation. d. all of the above. Answer: D Page: 208 37. Clinical psychologists typically provide_________________ to the client as the final stage in the assessment report. a. verification of treatment Chapter 9: Assessment – Integration and Clinical Decision-Making Copyright 2018 © John Wiley & Sons Canada, Ltd.

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b. referrals c. detailed feedback d. a variety of assessment exams Answer: C Page: 209 38. Changes in ethical codes and legislation since the 1970s have ______________ for clients to receive feedback regarding their assessment. a) made it more difficult. b) made it easier. c) not influenced how difficult it is. d) none of the above. Answer: B Page: 209 39. Providing assessment feedback to a client: a) helps the client identify situations that might exacerbate difficulties. b) allows verification of the general accuracy of the assessment results. c) promotes collaboration with the client in establishing therapeutic goals. d) all of the above. Answer: D Page: 209 40. Smith and colleagues’ (2007) survey of opinions regarding providing assessment feedback found that most psychologists, regardless of type of assessment, believed that feedback promoted clients’ a) improved understanding of their problems. b) enhanced motivation to follow recommendations that resulted from the assessment. c) feeling better. d) all of the above. Answer: D Page: 210 41. The approach to psychological assessment in which clients are actively encouraged to participate in discussions about the reasons for the assessment, the results of the testing, and how the assessment data should be integrated and interpreted is known as the: a) therapeutic model of assessment. b) collaborative model of evaluation. c) client-focused model of assessment. d) client-driven model of evaluation. Answer: A Page: 210

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Short Answer Questions 1. Why is it important for psychologists to be aware that data from multiple self-report tests and interviews are not independent sources? Suggested Answer: Page 197 a) All sources of self-report are only from one perspective – the client’s b) Additional assessment data from sources other than self-report (i.e., significant others, clinical observation, or archival records such as hospitalization data) have the potential to independently corroborate or nuance hypotheses c) If all sources of information are based on self-report data, then the apparent convergence of data can lead to misplaced confidence regarding the validity or accuracy of the hypotheses or conclusions 2. What is a case formulation? Describe two benefits of having a case formulation. Suggested answer: Pages 198 a) A case formulation is when psychologists (or other mental health professionals) describe a specific patient they have assessed and develop a set of hypotheses that provides a clinical overview of the individual. There should be enough information to enable the psychologist to make decisions regarding treatment options. b) Benefits: 1) Provides a way of understanding the connections between a patient’s various problems 2) Provides guidance on the type of treatment to consider (including whether the treatment should be conducted in an individual, couple, family, or group modality) 3) Predicts the patient’s future functioning if treatment is not sought and how this functioning will be different if treatment is successful. 4) Provides options to consider if difficulties are encountered in implementing and following through on treatment 5) Indicates options, outside of psychological services, for the patient to consider. 6) Provides alternative treatment options to consider if the initial treatment is unsuccessful. 3. List some of the components expert case formulations tend to focus on (Eells et al, 2011). Suggested answer: Page 198 a) Symptoms and problems b) Adult relationship history c) An explanation for the development and maintenance of the symptoms and problems. 4. What are the steps that psychologists can follow in developing a case formulation? Suggested Answer: Page 199

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Step 1. Develop a comprehensive problem list, including the patient’s stated problems and other problems indicated by referral agents or identified by other informants during the assessment. Step 2. Determine the nature of each problem, including its origin, current precipitants, and consequences. Step 3. Identify patterns or commonalities among the problems; this may yield an indication of previously unidentified factors that serve to maintain, exacerbate, or lessen the problem. Step 4. Develop working hypotheses to explain the problems. Step 5. Evaluate and refine the hypotheses, using all information gathered during the assessment and the patient’s feedback on the hypotheses. Step 6. If the psychologist moves from conducting an assessment to providing treatment, the hypotheses should be reconsidered, re-evaluated, and revised (as necessary) based on data gathered during treatment. 5. What is retrospective recall, and what has research generally shown regarding people`s abilities to engage in retrospective recall? Under what circumstances are the worst results likely to occur? Suggested Answer: Page 202 a) Retrospective recall: refers to people’s ability to accurately recall information regarding past incidents that have happened to them. b) Research: has shown that people are not particularly accurate at recalling past events. c) Circumstances affecting recall accuracy: i. Social desirability: research suggests that people are be worse at recalling events that put them in a negative light (due to a self-serving attributional bias). ii. Current mood or relationship quality can colour memory of past events (i.e., it can cause people to remember them as more negative than they actually were) iii. Psychosocial variables (e.g., family conflict) are likely to be poorly recalled (compared with isolated events such as housing moves, height and weight prior to puberty) 6. What is a self-serving attributional bias? Suggested Answer: Page 203 a) This bias involves making more internal, stable, and global attributions for positive events in your life, and blaming negative events on external factors that are out of your control. 7. Billy completed a test for his third year Clinical Psychology course and scored much below what he had expected. However, he found that he got one of the top marks on an essay that he had written for the same class. If Billy has a self-serving attributional bias, please provide concrete examples of the type of thinking he might engage in to explain these two conflicting results. Suggested Answer: Page 203 - 204 Chapter 9: Assessment – Integration and Clinical Decision-Making Copyright 2018 © John Wiley & Sons Canada, Ltd.

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a) Billy might explain the test result by reasoning that a neighbour’s dog had barked throughout the night keeping him awake so that he could not perform well on the test. Billy might also reason that he did not have enough time to study because of the demands of his part-time job. (Student answer should provide an example about an external factor beyond Billy’s control.) b) However, for his essay result Billy might explain his grade by thinking of all the hard work that he put into the paper, that he is a hard worker in general, or by thinking about how skilled he is at compiling information into a well-written essay. (Student answer should provide an example that makes more internal and global attributions.) 8. What is a heuristic? How can a heuristic facilitate bias? Suggested Answer: Pages 204 a) Heuristics are mental shortcuts that people often use to lessen the work that is required to make a decision. b) However, these tend to lead to an increase in errors in decision-making because, due to the shortcut, the person does not have to think critically. Heuristics do not always hold true, and a person who relies on them is susceptible to errors in thinking to the extent that exceptions occur. 9. To ensure more accurate decisions, in which two areas must clinicians have knowledge of base rates? Suggested Answer: Page 204 a) The clinician will need to have information regarding the base rate of the diagnosis and the base rate of the pattern of test responses before it is possible to determine the extent to which test responses accurately predict the diagnosis. 10. List and describe at least five of the common decision-making errors, biases, and heuristics as they relate to psychological assessment. Suggested Answer: Page 204 - 205 a) Fundamental attribution error – overestimating influence of personality traits and underestimating influence of situational factors (in the context of attempting to explain another’s behaviour) b) Inattention to base rates – not paying attention to the prevalence of the disorder, or the pattern of test responses, in the population c) Belief in the law of small numbers – attending to information gained from a few patients rather than the results of research on the disorder. d) Regression to the mean – a person who obtains an extreme score on a test at one point in time is likely to obtain a less extreme score when next taking the test. e) Inferring causation from correlation – inferring that one variable causes another (i.e., sexual abuse causing borderline personality disorder) when the variables only co-vary together (i.e., are related to a third variable) f) Hindsight bias – questioning or validating a decision based on data gathered after the fact g) Confirmatory bias – gathering confirming information to support a hypotheses, to the exclusion of disconfirming information Chapter 9: Assessment – Integration and Clinical Decision-Making Copyright 2018 © John Wiley & Sons Canada, Ltd.

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h) Bias Blind Spot – almost everyone believes that s/he is less likely than other people to have their decisions affected by errors i) Representativeness heuristic – relying on biases such as the belief in the law of small numbers to draw conclusions about the degree to which a symptom or behaviour is representative of an underlying disorder or condition j) Availability heuristic – making a decision based on easily recalled information k) Affect heuristic – allowing affective qualities (i.e., likeability, disgust, pleasure) to influence a clinical decision l) Anchoring and adjustment heuristic – first impressions may serve as a (possibly inaccurate) basis for considering and integrating subsequent information gathered about a person. 11. Describe four precautions that clinicians can take to improve the accuracy of their clinical judgement. Suggested Answer: Page 206 a) Use psychological tests that are directly relevant to the assessment task and that have strong psychometric properties b) Check for scoring errors when using test data c) Use computers as aids in the collection, scoring, and interpretation of clinical data whenever possible d) Use normative data and base rate information whenever available e) Use DSM criteria when making diagnostic decisions f) Use decision aids, such as decision trees or clinical guidelines g) In unstructured tasks, such as conducting interviews and reviewing assessment data, be as systematic, structured, and quantifiable as possible in order to obtain, consider, and use all relevant information h) Be aware of relevant research in psychological assessment, psychopathology, and prevention and intervention i) Be aware of personal biases and preconceptions j) Be self-critical: search for alternative explanations for hypotheses and challenge evolving case formulations k) Seek consultation from other professionals when unsure of the accuracy of conclusions l) Don’t rely on memory and don’t rush any conclusion or decision 12. Describe two advantages of reviewing assessment reports with clients? Suggested answer: Pages 209 a) Research suggests that assessment feedback can influence client emotional functioning b) Compared to assessment procedures focused solely on information gathering (i.e., little active collaboration with clients), clients receiving therapeutic assessment developed stronger working alliances with the therapist and were less likely to prematurely terminate treatment c) Can develop a stronger working alliance with client d) Can work collaboratively in defining the client`s goals e) Verify the general accuracy of assessment results Chapter 9: Assessment – Integration and Clinical Decision-Making Copyright 2018 © John Wiley & Sons Canada, Ltd.

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f) Refine the interpretation of results to ensure an optimal fit with the individual`s life circumstances g) Provide some psychological relief for the person by presenting an integrated picture that helps make sense of the person`s difficulties h) Help the individual identify stressful situations that exacerbate difficulties

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Chapter 10 Prevention Multiple Choice Questions 1. Health promotion refers to programs that are designed to increase a) an individual’s awareness of factors that contribute to his/her physical health problems. b) the integration of community-wide health-provider services. c) activities that are beneficial to many aspects of physical health. d) the impact of school-based education programs centring on health. Answer: C Page: 214 2. Which of the following best describes the involvement of clinical psychologists and community psychologists in prevention activities? a) Both have a long history of being involved in prevention activities. b) Until recently neither has been involved in prevention activities. c) Until recently clinical psychologists had very limited involvement in prevention activities. d) Until recently community psychologists had very limited involvement in prevention activities. Answer: C Page: 214 3. Child poverty rates in Canada a) have decreased dramatically in recent years. b) are comparable to rates in the USA. c) are much lower than rates of poverty in older adults. d) have not changed significantly since the 1990s. Answer: D Page: 214 - 215 4. Because children living in poverty are challenged across numerous life areas, prevention efforts must a) disentangle the effects of each life area’s stressful events and treat each area of stress individually. b) take into account the effects of a pile-up of stressors. c) prioritize teaching skills to cope with the most chronic of the stressors. d) focus on the most currently severe area of stress. Answer: B Page: 215 5. The most effective interventions to prevent negative outcomes for highly disadvantaged preschool age children are a) short-term and not intensive. b) long-term and not intensive. c) short-term and intensive. d) long-term and intensive. Chapter 10: Prevention Copyright 2018 © John Wiley & Sons Canada, Ltd.

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Answer: D

Introduction to Clinical Psychology 4e

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6. Meta-analytic data indicates that the positive effects of intensive preschool interventions for disadvantaged children are evident a) only in the short-term. b) in the short-term and medium-term, but not long-term. c) in the short-term, medium-term, and long-term. d) none of the above. Answer: C Page: 220 7. Research has found that the likelihood of drop out from parenting programs is higher among a) parents who argue a lot. b) depressed parents c) isolated parents. d) all of the above. Answer: D Page: 215 8. The World Economic Forum reported that in 2010, the global cost of mental disorders were a) impossible to estimate. b) equal to the GDP of some countries. c) highest in developing countries. d) approximately $2.5 trillion. Answer: D Page: 215 9. Experts agree that the only sustainable way to reduce the societal burden of mental disorders is through a) evidence-based assessment. b) prevention. c) evidence-based treatment via the internet. d) training more psychologists. Answer: B Page: 215 10. Universal preventive, selective preventive, and indicated preventive are three of the main types of: a) clinical research programs b) preventive programs c) mental disorders d) behavioural models. Answer: A Page: 215 - 216 11. Universal preventive intervention a) a prevention program that targets people who are at elevated risk of developing a particular disorder or problem.

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b) a prevention program that targets people who do not meet criteria for a disorder, but who have elevated risk and may show detectable, but subclinical, signs of the disorder c) a prevention program applied to an entire population, such as a media awareness campaign on the dangers of drinking and driving. d) occurs as soon as a disorder is evident, in order to prevent further deterioration. Answer: C Page: 217 12. Selective preventive intervention a) a prevention program that targets people who are at elevated risk of developing a particular disorder or problem. b) a prevention program that targets people who do not meet criteria for a disorder, but who have elevated risk and may show detectable, but subclinical, signs of the disorder c) a prevention program applied to an entire population, such as a media awareness campaign on the dangers of drinking and driving. d) occurs as soon as a disorder is evident, in order to prevent further deterioration. Answer: B Page: 217 13. Indicated prevention interventions a) have been demonstrated to be effective by research studies. b) have rarely been found to be effective c) are applied to everyone within a specific subgroup of the population. d) administered to everyone who is at elevated risk for a particular disorder. Answer: D Page: 217 Answer: B

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14. What type of preventive intervention targets people who do not necessarily meet the criteria for a disorder, but have elevated risk or show subclinical signs of the disorder? a) Specialized b) Selective c) Pre-emptive d) Indicated Answer: D Page: 217 15. According to the World Health Organization, mental health promotion activities are designed to increase a) awareness of mental health issues within the population and decrease stigma associated with mental health disorders. b) one’s understanding of his/her own mental health issues. c) well-being and resilience. d) the integration of community-wide mental health services. Answer: C Page: 218

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16. The characteristics of the individual or the environment that render a person less vulnerable to the development of a problem or a disorder are referred to as a) predictive factors. b) protective factors. c) risk factors. d) relapse factors. Answer: B Page: 218 17. The risk reduction model is an approach to prevention that a) promotes resilience factors. b) identifies and reduces risk factors. c) relies heavily on research to guide preventions. d) All of the above. Answer: D Page: 218 18. The characteristics of the individual or the environment that render a person more vulnerable to the development of a problem or a disorder are referred to as a) predictive factors. b) protective factors. c) risk factors. d) relapse factors. Answer: C Page: 218 19. The risk reduction model a) is an approach to prevention that increases risks and obstructs protective factors b) is an approach to prevention that reduces risks and promotes protective factors. c) is an approach to prevention that reduces risks and obstructs protective factors. d) is an approach to prevention that increases risks and promotes protective factors. Answer: B Page: 218 20. The number of new cases of a specific problem is referred to as the a) incidence rate. b) prevalence rate. c) number needed to treat. d) effectiveness rate. Answer: A Page: 220 21. Incidence rate is defined most accurately as the number of a) new cases of a specific problem. b) cases of a specific problem. c) cases not experiencing a specific problem. d) new cases not experiencing a specific problem. Answer: A Page: 220 22. What is the primary reason that relatively few studies have examined whether various prevention programs are effective in reducing incidence rates? Chapter 10: Prevention Copyright 2018 © John Wiley & Sons Canada, Ltd.

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a) Insufficient statistical power due to small sample sizes. b) Measurement issues. c) Sample representativeness issues. d) Accumulating samples from different studies has inadequate support as a methodology. Answer: A Page: 220 23. One reason why researchers rarely examine whether prevention programs reduce incidence rates is that a) there are no tools for measuring outcome. b) it is necessary to have a very large sample to detect a difference. c) it is unnecessary to conduct this type of research as long as high-risk samples are targeted. d) all of the above. Answer: B Page: 220 24. The “number needed to treat” refers to the number of a) districts needed for target in a given municipal area for the program to be effective at the population level. b) health care providers needed to treat the targeted disorder in a given area. c) individuals needed to receive the intervention in order to prevent one individual from developing the disorder. d) individuals needed to receive the intervention in order to determine effectiveness at a statistical level. Answer: C Page: 220 25. Research strategies used to examine the effect of prevention programs can a) target high-risk samples. b) offer the program at high intensity. c) rely on accumulating samples from various studies. d) all of the above. Answer: D Page: 220 26. The extent to which a prevention program achieves desired outcomes when used in an applied setting rather than in the original research conditions is known as a) the number needed to treat. b) effectiveness. c) the reduction of risk. d) efficacy. Answer: B Page: 220 27. There is strong evidence that children’s functioning is challenged by a) poor parenting. b) conflict in the family. c) parental psychopathology. d) all of the above. Chapter 10: Prevention Copyright 2018 © John Wiley & Sons Canada, Ltd.

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Answer: D

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28. The long-term effects of home-visiting programs, where nurses visit at-risk parents, include a) improving parental care. b) reducing child abuse and neglect. c) reducing the number of arrests of the children when they reached adolescence. d) all of the above. Answer: C Page: 221 29. The Incredible Years training program was developed to help a) children who had been identified as having conduct problems. b) youth who had been identified as having internalizing problems. c) elderly individuals who had been identified as having mental health issues. d) all of the above. Answer: A Page: 221 30. The Incredible Years parenting program uses various techniques that promote adult–child interactions to facilitate children’s a) development of academic abilities. b) development of social competence. c) emotional awareness. d) ability to be identify and cope with symptoms of depression and anxiety. Answer: B Page: 221 31. The efficacy of the Incredible Years training program has been a) questioned by many clinical psychologists. b) demonstrated for multi-ethnic families, but not for families that are disadvantaged socio-economically. c) demonstrated for both multi-ethnic and socio-economically disadvantaged families. d) questioned by many researchers. Answer: C Page: 221 32. The Triple P Positive Parenting Program is designed with the goal of: a) enhancing parents’ knowledge, skills, and confidence. b) promoting safe environments for young people. c) promoting children’s competence through positive parenting practices. d) all of the above. Answer: D Page: 222 33. The Triple P Positive Parenting Program is a __________ level system that provides interventions of _________________ intensity. a) single; increasing b) multi; decreasing c) single; decreasing Chapter 10: Prevention Copyright 2018 © John Wiley & Sons Canada, Ltd.

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d) multi; increasing Answer: D Page: 222 34. The first level in the Triple P Parenting program suite of programs is a universal prevention program that provides parents with a) individualized services by phone or face to face to address specific concerns. b) evidence-based information about parenting strategies. c) a group program to parents of children with mild to moderate problems. d) a group program to parents of children with more severe problems. Answer: B Page: 222 35. Parents’ use of physical punishment in both Canada and the United States is a) against the law. b) permitted only if the parent does not inflict physical harm. c) permitted only if the physical harm is justified by the seriousness of the misbehaviour. d) entirely at the parent’s discretion. Answer: B Page: 223 36. The risk of child abuse by poor, single teenage mothers who participated in a home visiting prevention program was _________ comparison mothers who did not participate. a) equal to b) 25% less than c) half that of d) 100% less than Answer: C Page: 223 37. Research has found that the risk of physical abuse can be modified by: a) home visiting programs. b) behavioural parent training programs. c) multi-modal programs. d) all of the above. Answer: D Page: 223 38. Research indicates that, at the community level, implementation of parenting programs is associated with a reduced number of: a) substantiated cases of child maltreatment. b) out-of-home placement for children due to maltreatment. c) child-maltreatment injuries requiring hospitalization. d) all of the above. Answer: D Page: 223 39. Children and youth are most commonly referred to mental health clinics for a) attention or concentration issues. b) internalizing problems, such as with depression or anxiety. c) externalizing problems, such as aggressive or non-compliant behaviour. Chapter 10: Prevention Copyright 2018 © John Wiley & Sons Canada, Ltd.

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d) bed-wetting. Answer: C Page: 223 40. Meta-analyses of the effects of school-based bullying prevention program revealed that: a) these programs can eliminate bullying. b) these programs have no effect on bullying. c) most effective programs involve both teachers and parents. d) programs are most effective in reducing bullying by boys. Answer: C Page: 224 41. Meta-analytic research indicates that anxiety prevention programs result in ________ effects in reduction of both anxiety symptoms and diagnoses, and are most effective when using _________ intervention programs. a) large; indicated/selected b) small but significant; universal c) small but significant; indicated/selected d) large; universal Answer: C Page: 224 42. Meta-analytic research examining depression prevention programs across the life-span indicate that preventive interventions reduce the incidence of depressive disorders by a) less than 5%. b) almost a quarter. c) half. d) 75%. Answer: B Page: 225 43. Tobler and colleagues (2000) found substance abuse prevention programs were most effective when they were a) non-interactive. b) lecture-based. c) interactive. d) taught by psychologists rather than by teachers. Answer: C Page: 227 44. Results of the meta-analysis conducted by Tobler and colleagues (2000) on the effectiveness of prevention programs for substance abuse indicate that a) interactive programs were less effective than non-interactive programs. b) interactive programs were more effective than non-interactive programs. c) interactive and non-interactive programs were both equally effective. d) interactive and non-interactive programs were both equally non-effective. Answer: B Page: 227

45. Critical Incident Stress Debriefing has been found to a) be very helpful to individuals experiencing or witnessing traumatic events. Chapter 10: Prevention Copyright 2018 © John Wiley & Sons Canada, Ltd.

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b) reduce the incidence of subsequent PTSD. c) be helpful for men but not for women d) sometimes be harmful. Answer: D Page: 228 46. Research has shown that _______________ can be effective for children exposed to traumatic events. a) psychodynamic therapy b) cognitive-behaviour therapy c) play therapy d) psychological debriefing Answer: B Page: 229

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Short Answer Questions 1. What is community psychology? Suggested Answer: Page 214 a) Community psychology is a branch of psychology that focuses on research and practice on the reciprocal relations between individuals and the community in which they live. 2. What is the main difference between universal and selective preventive interventions? Suggested answer: Pages 217 a) Universal preventive interventions are applied to an entire population, whereas selective preventive interventions target people who are at an elevated risk of developing a particular disorder or problem. 3. Which is Indicated preventive interventions? Suggested Answer: Page 217 a) A prevention program that targets people who do not meet criteria for a disorder but who have elevated risk and may show detectable, but subclinical, signs of the disorder. 4. What are risk factors and what are protective factors? Provide two examples of risk factors and two examples of protective factors for the development of psychopathology in children and youth. Suggested Answer: Page 218 a) Risk factors are characteristics of the individual or the environment that render a person more vulnerable to the development of a problem or a disorder, or that are associated with more severe symptoms. i. Examples: Refer to Exhibit 10.1 for a full list. Some risk factors include: poor social skills, peer rejection, large family size, frequent social changes, and poverty. b) Protective factors are characteristics of the individual or the environment that render a person less vulnerable to the development of a problem or disorder. i. Examples: Refer to Exhibit 10.2 for a full list. Some protective factors include: easy temperament, family harmony, sense of belonging, economic security, and attachment to networks within the community. 5. Imagine that you are tasked with designing a preventive intervention program. What are three of the steps that you must take when designing your program? Suggested Answer: Page 219 a) Identify the target: What do you want to prevent? b) Determine problem severity: How many people are affected? What are the costs of the problem? c) Review research evidence: What do you know about how the risk factors develop? d) Identify high-risk groups e) What is known about protective factors? What moderates risk? Chapter 10: Prevention Copyright 2018 © John Wiley & Sons Canada, Ltd.

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f) Design the intervention: How will the target condition be prevented? Is there an evidence-based prevention for this problem? If so, does it need to be modified for your community? g) Design the study: How will you know if the intervention is efficacious? 6. Describe critical incident stress debriefing. What has research demonstrated about its effectiveness? Suggested Answer: Page 228 a) CISD is a preventative strategy to ensure that survivors and witnesses to tragedies have assistance in processing the details of the traumatic event at the time in order to avoid the dangers of a delayed stress reaction. Outcome data does NOT suggest that it is effective and in some cases suggests that it might be a harmful procedure. 7. List at least three of the features of successful prevention programs. Suggested Answer: Page 229 Successful prevention programs: a) are evidence-based. b) work to promote the same relatively simple principles (such as providing adequate monitoring and supervision). c) are multifaceted. d) are developed as an expansion of an effective treatment intervention. e) are offered in a convenient context. f) all stress the process of program fidelity in adopting their interventions.

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Chapter 11 Intervention: Overview Multiple Choice Questions 1. A limitation of John Norcross’ definition of psychotherapy is that: a) it does not specify that psychologists must deliver the services. b) it does not focus adequately on feelings. c) it ignores the patient’s role in setting goals. d) it does not address whether the treatment is evidence-based. Answer: D Page: 232 2. Barlow (2004) suggested that the term psychological treatments be used to refer to evidence based treatments used to treat a) clinically significant problems. b) subclinical problems (e.g., relational problems). c) Axis II disorders. d) Axis I disorders. Answer: A Page: 232

3. In discussing treatment the psychologist should explain: a) his/her preferred method of treatment. b) evidence-based treatments s/he is competent to provide. c) the major evidence-based treatments for the client’s problem. d) treatments s/he has found helpful in treating people with similar problems. Answer: C Page: 233 4. To make an informed decision about treatment, clients must be informed of all of the evidence-based treatment options, which may include: a) medication options. b) psychological interventions the psychologist can provide. c) psychological interventions the psychologist does not have the training to provide, followed by a referral if needed. d) all of the above Answer: D Page: 233

5. The “Scared Straight” program has been shown to be: a) highly effective in preventing the development of conduct disorder among at risk youth b) ineffective in treating delinquent youth c) highly effective in treating anxiety disorders Chapter 11: Intervention: Overview Copyright 2018 © John Wiley & Sons Canada, Ltd.

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d) a good example of a stepped care approach Answer: B Page: 234 6. Evidence-based practice requires that treatments be based on: a) highly controlled, internally valid, replicated studies. b) highly controlled studies in real world environments. c) the best available evidence. d) randomized controlled studies. Answer: C Page: 234 7. Lilienfeld (2007) described the growing research base of psychological treatments that can cause harm. Two examples of this are: a) cognitive-behavioural therapy and “Scared Straight” programs. b) “Scared Straight” programs and rebirthing therapy. c) rebirthing therapy and short-term psychodynamic psychotherapy. d) short-term psychodynamic psychotherapy and cognitive-behavioural therapy. Answer: B Page: 234 8. Psychodynamic theories assume that individuals are prone to conflicts between the a) ego and transference. b) id and transference. c) id and ego. d) superego and countertransference. Answer: C Page: 236 9. Psychodynamic theorists propose that a client’s core interpersonal conflicts will be repeated in the relationship with the therapist through a process known as a) counter-transference. b) transference. c) projection. d) introjection. Answer: B Page: 236 10. The unconscious application of expectations and emotional experiences, based on important early relationships, to subsequent interpersonal relationships is known as: a) process-experience. b) introspection. c) transference. d) counter-transference. Answer: C Page: 237 11. Across different types of short term psychodynamic psychotherapies, therapy involves: a) helping the client to understand phases of psychological development. b) making unconscious processes conscious. c) re-enacting in the relationship with the therapist issues that have troubled the client in the past. Chapter 11: Intervention: Overview Copyright 2018 © John Wiley & Sons Canada, Ltd.

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d) all of the above. Answer: D Page: 237 12. Short-term psychodynamic treatment usually requires: a) weekly sessions over about a year. b) biweekly sessions for six months. c) weekly or biweekly sessions for 4-7 months. d) daily sessions. Answer: C Page: 237 13. Which of the following is the psychologist’s first task in short-term psychodynamic psychotherapy? To: a) develop a positive transference relationship. b) analyze the transference relationship. c) deal with loss. d) challenge the client to recognize his/her defence mechanisms that may impede progress in therapy. Answer: A Page: 237 14. A short-term psychodynamic psychotherapist would be most likely to use which of the following techniques? a) Challenging thoughts. b) Behavioural activation. c) Confrontation about defense mechanisms. d) Assignment of the sick role. Answer: C Page: 237 - 238 15. Within Short-Term Psychodynamic Psychotherapy, counter-transference is considered a) a breach in therapeutic neutrality caused by the therapist’s unconscious conflicts. b) useful, as it provides useful information about the way the client’s interpersonal behaviours affect others. c) particularly harmful to the therapeutic alliance. d) more useful in treating some disorders than others. Answer: B Page: 238 16. Sullivan (1953) suggested that psychological problems were often related to a) difficulties in relationships. b) unconscious impulses. c) faulty thinking. d) a lack of behavioural activation. Answer: A Page: 239 17. Therapeutic activities involved in Interpersonal Psychotherapy for Depression include a) dealing with grief. b) examining role disputes. c) assisting in role transitions. Chapter 11: Intervention: Overview Copyright 2018 © John Wiley & Sons Canada, Ltd.

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d) all of the above Answer: D Page: 239 18. ________ is designed to change relational functioning, whereas __________ is designed to alter intrapsychic variables using information about relationships. a) Interpersonal Psychotherapy; Short-Term Psychodynamic Psychotherapy b) Short-Term Psychodynamic Psychotherapy; Interpersonal Psychotherapy c) Cognitive-Behaviour Therapy; Interpersonal Psychotherapy d) Interpersonal Psychotherapy; Cognitive-Behaviour Therapy Answer: A Page: 239 19. The treatment approach emphasizing awareness of emotions, understanding and expressing emotions, and transforming maladaptive to adaptive emotions is known as: a) Interpersonal Psychotherapy. b) Process Experiential Therapy. c) Short-term Psychodynamic Psychotherapy. d) Emotion Regulation. Answer: B Page: 241 20. Process Experiential treatment includes a) enhancing clients’ emotion-regulation abilities. b) examining defense mechanisms. c) helping clients to transform maladaptive emotion into adaptive emotion. d) both A and C. Answer: D Page: 241 21. A central characteristic of process-experiential therapies is its emphasis on a) in-session experiencing of affect. b) the unconscious. c) interpersonal relationships. d) both A and B. Answer: A Page: 241 22. Behavioural interventions focus on a) reducing undesirable behaviours. b) reducing undesirable behaviours and increasing desirable behaviours. c) increasing desirable behaviours. d) classical conditioning responses. Answer: B Page: 242 23. Whose seminal findings demonstrated that learning can take place by observation and imitation? a) Albert Bandura b) Carl Rogers c) Albert Ellis d) B.F. Skinner Chapter 11: Intervention: Overview Copyright 2018 © John Wiley & Sons Canada, Ltd.

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Answer: A

Introduction to Clinical Psychology, 4e

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24. A person’s sense of competence to learn and perform new tasks is referred to as a) self-discovery. b) self-efficacy. c) self-efficiency. d) self-sufficiency. Answer: B Page: 242 25. Self-efficacy has been shown to predict a) the development of defense mechanisms. b) willingness to approach phobic stimuli. c) attempting new behaviours. d) both B and C. Answer: D Page: 242 26. Cognitive approaches to therapy are based on the assumption that a) events directly impact individual functioning. b) it is the perception of events that impacts individual functioning. c) catharsis is necessary for restructuring thoughts. d) negative thoughts arise beginning in early childhood. Answer: B Page: 242 27. In Cognitive-Behavioural Therapy, client and therapist develop strategies to a) facilitate the development of new relationships. b) re-enact emotional conflicts within sessions. c) examine the client’s defense mechanisms. d) test the client’s dysfunctional beliefs. Answer: D Page: 242 28. Cognitive-behavioural therapists a) play a very active role in service provision. b) use Socratic questioning to help clients. c) play a passive role in service provision. d) Both A and B. Answer: D Page: 242 - 243 29. In CBT the most important changes are presumed to take place a) in the first half of the session. b) in the second half of the session. c) in between sessions. d) after the completion of all the treatment sessions. Answer: C Page: 243 30. The termination phase in CBT

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a) is a time to use the therapeutic relationship to help clients process their emotions that will create new meaning for their emotional experiences. b) focuses primarily on coping with the end of the therapeutic relationship. c) is an opportunity for the client to examine the impact of childhood experiences upon his/her current functioning. d) is future-oriented, with an emphasis on consolidating skills and anticipating future challenges. Answer: D Page: 243 31. The increased number of people seeking treatments for psychological problems can largely be accounted for by a) increased use of psychopharmacological treatments. b) increased use of psychotherapy services. c) the increase in the variety of psychotherapy options. d) all of the above. Answer: A Page: 245 32. Research suggests that in the past few decades the overall use of mental health services has a) remained constant. b) increased significantly, both for psychotropic medication and psychotherapy. c) decreased significantly for psychotherapy. d) increased significantly for psychotropic medication, and less so for psychotherapy. Answer: D Page: 245 33. Psychotherapy clients are most likely to a) be male. b) be female. c) have a lower income. d) be older adults. Answer: B Page: 245 34. A Canadian receiving psychological services is most likely to be a) living in a rural area. b) living in a two parent family. c) male. d) university educated. Answer: D Page: 245 35. Saunders’ (1993) research found that the majority of those who eventually sought therapy reported that it took _____________ to move from recognizing that a significant problem existed to pursuing therapy. a) only days b) several months c) years d) none of the above Chapter 11: Intervention: Overview Copyright 2018 © John Wiley & Sons Canada, Ltd.

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Answer: B

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36. Psychotherapy is practised by a) psychologists. b) nurses. c) social workers. d) all of the above. Answer: D Page: 246 37. The vast majority of people who receive psychotherapy attend a) just one session. b) fewer than 10 sessions. c) at least 15 sessions. d) upwards of 20 sessions. Answer: B Page: 247 38. In Hansen, Lambert, and Forman’s (2002) examination of 6,000 adults who received routine psychotherapy, approximately ____ of clients experiences no change, whereas ____ of clients improved or recovered. a) 10%; 85% b) 25%; 60% c) 50%; 35% d) 85%; 10% Answer: C Page: 248 39. Most current psychological treatments are designed to range from approximately a) 1 to 3 sessions. b) 6 to 8 sessions. c) 10 to 30 sessions. d) 40 to 80 sessions. Answer: C Page: 248 40. Examination of randomized controlled trials of evidence-based treatments, summarized by Hansen et al. (2002), indicates that a) evidence-based treatments are more effective than treatment as usual. b) patients attended fewer sessions in evidence-based treatments. c) less half of patients recovered in evidence-based treatments. d) treatment as usual was just as effective as evidence-based treatments. Answer: A Page: 248 41. Evidence-based treatments perform _________ than routine psychotherapy services, and patients receiving the evidence-based treatments in randomized controlled trials are often _______ severely distressed. a) better ; less b) better ; more c) more poorly ; less Chapter 11: Intervention: Overview Copyright 2018 © John Wiley & Sons Canada, Ltd.

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d) more poorly ; more Answer: B Page: 249 42. The vast majority of psychological interventions are delivered in a) individual sessions. b) group sessions. c) couple therapy sessions. d) Both A and C Answer: A Page: 249 43. What type of group treatment is designed to capitalize on the dynamics of the group? a) Structured group approaches. b) Unstructured group approaches. c) Process group approaches. d) Dynamic procedural group approaches. Answer: C Page: 250 44. Which of the following can be both a positive and negative aspect of group therapy? a) Universality. b) Modelling of behaviour. c) Support. d) Cost-effectiveness. Answer: B Page: 250 45. A study by Dishion, McCord and Poulin (1999) found that youth with significant problem behaviours who received a peer-group intervention a) did better than youth who did not receive the group treatment. b) fared worse than youth who did not receive the group treatment. c) performed the same as youth who did not receive the group treatment. d) were unlikely to complete the group treatment. Answer: B Page: 250 46. There is currently ___________ that self-administered treatments _____ effective in treating various mental health issues such as depression. a) overwhelming evidence; are not b) evidence; can be c) no evidence; can be d) preliminary evidence; are not Answer: B Page: 250 47. A study by Proudfoot et al. (2004) examined the effectiveness of the computer-based treatment program Beating the Blues and found that a) it was less effective than treatment as usual. b) it was equally effective as treatment as usual. c) it was more effective than treatment as usual. d) it was less effective as many clients lose motivation to continue. Chapter 11: Intervention: Overview Copyright 2018 © John Wiley & Sons Canada, Ltd.

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Answer: C

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48. The use of information technology and telecommunications to provide health care services from a distance is known as a) Telehealth. b) Computer-mediated Psychotherapy. c) Healthcom. d) MedTech Answer: A Page: 252 49. Stepped care refers to the process of a) offering the type of intervention for which the treatment provider is most qualified. b) disregarding cost to provide the strongest evidence-based intervention to meet the client’s needs. c) offering the lowest cost interventions to those who do not have private health insurance coverage. d) only providing more intensive interventions to those for whom first line intervention is insufficient. Answer: D Page: 253

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Short Answer Questions 1. On what basis did Barlow (2004) suggest that the terms psychological treatments and psychotherapy be differentiated? Suggested Answer: Page 232 a. The term psychological treatment should be used to define the growing number of specific, evidence-based interventions designed to treat clinically significant — Axis I & II —disorders. b. Psychotherapy should be used to describe interventions that address difficulties of a subclinical intensity such as relationship problems. c. The reason for this distinction is the importance of clarifying boundaries between counselling, psychotherapy, and psychological services, and ensuring that the public can recognize the service they are seeking. In most jurisdictions, the term psychotherapist is not licensed or restricted. Anyone can advertise and offer psychotherapy.

2. List three questions that all clinical psychologists should be prepared to answer for potential clients about psychotherapy services. Suggested answer: Page: 234 a. What kind of training and experience do you have in dealing with problems like the ones I have? b. What type of treatment is most effective for the kinds of problems I have, and do you provide this treatment? c. Are there any disadvantages or side-effects associated with the most effective treatment? d. Are there other effective treatment options that I should consider? e. What is the hourly rate for sessions? f. Do you offer a sliding fee based on individual or family income? g. Will my private health insurance cover all or part of the fees? h. How many sessions will treatment likely take? How often will we need to meet? 3. What is transference? Suggested answer: Page: 237 a. It is a psychodynamic theory proposing that a client’s core interpersonal conflicts will be repeated in the relationship with the therapist; the unconscious application of expectations and emotional experiences, based on important early relationships, to subsequent interpersonal relationships. 4. Define self-efficacy. What can self-efficacy predict that is relevant to cognitive-behaviour therapy? Suggested Answer: Page 242 a. Self-efficacy refers to a person’s sense of competence to learn and perform new tasks. b. Self-efficacy has been found to be the best predictor of behaviour (e.g., approaching a phobic stimulus, or attempting a new behaviour), and it is Chapter 11: Intervention: Overview Copyright 2018 © John Wiley & Sons Canada, Ltd.

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important to recognize the importance of cognitions in mediating behavioural responses. 5. Discuss the rates of psychological problems in rural settings, as well as the access of individuals who live in these rural areas to psychological services. Suggested Answer: Page 235-236 a. There is no evidence that the rates of psychological problems are any less or more in rural settings as opposed to more urban settings. b. However, access in rural areas to mental health professionals is much lower. 6. List two reasons why research indicates that fewer clients receiving psychological services in routine practice experience improvement compared with clients receiving services in randomized controlled trials. Suggested answer: Page 248 a. most clients attend fewer sessions than is ideal (i.e., the dosage of psychotherapy is too low). b. psychotherapy provided by some therapists is not evidence-based, and may be less effective

7. Define stepped care. List an example of two steps of care as they might be applied to the provision of psychological services. Suggested Answer: Page 253 a. This is a model of treatment that attempts to offer lower cost interventions first, and only introduces more costly (or intensive) interventions if the lower cost interventions are ineffective. b. Stepped care models have long been practiced in the field of medicine. c. Step 1 – following a thorough assessment, self-help or computer-based treatments may be considered as a first step. Step 2 – if symptoms persist, consider individual therapy.

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Chapter 12 Intervention: Adults and Couples

Multiple Choice Questions 1. In a randomized controlled trial a) participants are randomly assigned to one of two or more treatment conditions. b) Participants are randomly assigned to two treatment conditions. c) participants are matched on demographic characteristics between the treatment and control groups. d) external validity is maximized. Answer: A Page: 257 2. In 1952, Hans Eysenck published a review from which he concluded that rates of improvement among clients receiving psychodynamic or eclectic psychotherapy were a) better than rates of remission of symptoms among untreated clients. b) comparable to rates of remission of symptoms among untreated clients. c) comparable to rates of remission of symptoms among clients treated with cognitivebehavioural therapy. d) better than rates of remission of symptoms among clients treated with cognitivebehavioural therapy. Answer: B Page: 257 3. Prior to Hans Eysenck’s controversial 1952 article challenging the efficacy of psychotherapy, a) the results of many previously-published randomized controlled trials were called into question. b) only a few randomized controlled trials had been published. c) proponents of various forms of psychotherapy based their claims on RCTs. d) proponents of various forms of psychotherapy based their claims on clinical experience and expert consensus. Answer: D Page: 257 4. The huge growth in empirical attention toward the effects of psychotherapy has been attributed to: a) Sigmund Freud b) Carl Jung c) Hans Eysenck d) Albert Bandura Answer: C Page: 257 5. What made it difficult to compare research conducted by behavioural therapists and traditional therapists in the mid-1900s? a) Each research group used different criteria for including studies in their review. b) Different criteria were used to evaluate whether therapy worked. c) Interpretation of results was influenced by each group’s biases. Chapter 12: Intervention: Adults and Couples Copyright 2018 © John Wiley & Sons Canada, Ltd.

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d) All of the above. Answer: D Page: 257 6. Mary Smith and Gene Glass are the authors of the first: a) meta-analysis of the adult psychotherapy literature. b) scientific article to strongly support the use of psychotherapy. c) article advocating for evidence-based psychotherapy. d) article to provide empirical support for psychoanalysis. Answer: A Page: 258 7. Meta analysis is a method for a) qualitatively reviewing research studies. b) quantitatively reviewing research studies. c) critiquing research studies. d) analyzing patients in the psychoanalytic tradition. Answer: B Page: 258 8. In order to integrate the results from multiple studies meta-analyses involve the calculation of: a) standard differences. b) levels of significance. c) effect sizes. d) the influence of outliers. Answer: C Page: 258 9. An effect size of d = .66 means that a) there is a difference of two-thirds of a standard deviation between groups. b) there is a standard score mean difference of .66 between groups. c) there is a difference of 66% between groups. d) the treated group is a third as likely as the control group to suffer from psychopathology after treatment. Answer: A Page: 258 10. Smith and Glass’s (1977) initial meta-analysis of the effect of psychotherapy suggested that a) psychotherapy can have a substantially positive impact. b) psychotherapy appeared to have no real impact. c) psychotherapy appeared to have a slightly negative impact. d) the effect of psychotherapy was unclear. Answer: A Page: 258 11. Three years after their initial publication, Smith, Glass, and Miller (1980) published a more extensive and sophisticated meta-analysis on the effect of psychotherapy. Results were a) substantially less positive than the original meta-analysis. b) slightly less positive than the original meta-analysis. c) identical to the original meta-analysis. d) even more positive than the original meta-analysis. Chapter 12: Intervention: Adults and Couples Copyright 2018 © John Wiley & Sons Canada, Ltd.

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Answer: D

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Page: 258

12. Smith, Glass, and Miller (1980) compared the efficacy of various types of treatment and found that the treatments with the largest to smallest effect sizes were, respectively, a) Psychodynamic, cognitive-behavioural, developmental, behavioural b) Cognitive-Behavioural, humanistic, behavioral, psychodynamic c) Psychodynamic, behavioural, cognitive-behavioural, psychodynamic d) Cognitive-Behavioural, behavioural, psychodynamic, humanistic Answer: D Page: 259 13. Smith, Glass, and Miller (1980) compared the effects of psychotherapy across different disorders and found that the largest effect sizes were found in the treatment of a) mood and anxiety problems. b) certain personality disorders. c) schizophrenia. d) eating disorders. Answer: A Page: 259 14. Unpublished research is also known “grey literature” research, and can include a) unpublished studies provided by researchers b) only materials controlled by commercial publishers c) peer-reviewed books d) peer-reviewed journals. Answer: A Page: 260 15. Clinical practice guidelines a) provide recommendations based on best available evidence. b) provide recommendations based on clinical experience. c) were first introduced by psychologists. d) are available only to trained healthcare professionals. Answer: A Page: 262 16. The first initiative to introduce clinical practice guidelines to the field of clinical psychology occurred in the early a) 1950s. b) 1970s c) 1990s. d) 2000s. Answer: C Page: 262 17. Motivation to develop clinical practice guidelines in clinical psychology came from a) cognitive-behavioural psychologists. b) psychodynamic therapists. c) increasing demands for health care practices to be demonstrably effective and costeffective. Chapter 12: Intervention: Adults and Couples Copyright 2018 © John Wiley & Sons Canada, Ltd.

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d) from mental health professions. Answer: C Page: 262

18. The APA Society of Clinical Psychology 1995 task force required which of the following conditions be met for a treatment to be designated as an empirically supported treatment? a) Evidence of symptom reduction. b) Improved functioning among participants. c) Data were derived from at least two independently conducted RCTs or from a large series of single-case studies. d) All of the above. Answer: D Page: 263 19. Evidence-based treatments vary in the extent and nature of their supporting data—so a treatment could have a modest evidence base but, because no independent RCTs have been conducted on the treatment, it would not meet the original criteria to be an EST. Therefore, the term evidence-based is ________________ the term EST. a) broader and more inclusive than b) exactly the same as c) limited and more exclusive than d) much more restricted than. Answer: A Page: 263 25. A treatment study in which no control group is used and, typically, few participant exclusion criteria are applied is known as a(n) a) unrandomized design. b) imperfect RCT. c) open trial. d) limited trial. Answer: C Page: 264 26. There are evidence-based psychological treatment for a) all affective disorders. b) the most commonly diagnosed mental disorders. c) most personality disorders. d) all ICD diagnoses. Answer: B Page: 266 27. The Canadian Psychological Association task force on evidence-based psychological services recommended that psychologists give the strongest weight to: a) syntheses of studies that balance internal and external validity. b) expert consensus. c) prior experience in treating a problem. d) primary research that is high in internal and external validity. Answer: A Page: 267

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28. The National Institute for Health and Care Excellence (NICE) stepped care model for the management of depression includes the following possible treatments except: a) electroconvulsive therapy. b) antidepressant medication. c) interpersonal psychotherapy. d) transcranial magnetic stimulation. Answer: D Page: 270

29. In cognitive-behavioural treatment of depression, behavioural activation tasks could include a) making a special meal. b) relaxing on the couch. c) disputing dysfunctional beliefs. d) reflecting on life goals. Answer: A Page: 271 30. Behavioural activation generally begins with a) setting treatment goals. b) time management training. c) challenging automatic thoughts. d) scheduling pleasurable activities. Answer: D Page: 271 31. Initial sessions of CBT tend to focus primarily on a) cognitive restructuring tasks. b) behavioural activation tasks. c) completing thought records. d) challenging schemas. Answer: B Page: 271 32. CBT for depression generally starts with a) self-monitoring of the link between activities and mood. b) prescribing pleasurable activities. c) research into pleasurable activities. d) thought challenging. Answer: A Page: 271 33. Thought monitoring requires recording the types of thoughts that typically occur around a) upsetting situations. b) positive situations. c) Both of the above d) None of the above Answer: A Page: 271 34. In the final stage of CBT the psychologist focuses on: Chapter 12: Intervention: Adults and Couples Copyright 2018 © John Wiley & Sons Canada, Ltd.

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a) challenging long-standing beliefs. b) challenging negative automatic thoughts. c) adopting a more positive activity schedule. d) relapse prevention. Answer: D Page: 273 35. The cognitive-behavioural approach to treating posttraumatic stress disorder includes __________, which is not included in CBT treatment for depression. a) behavioural activation b) cognitive restructuring c) prolonged exposure d) activity scheduling Answer: C Page: 273 36. Which of the following are the three main treatment components of CBT for posttraumatic stress disorder? a) Relaxation skills, imaginal exposure, in vivo exposure b) Imaginal exposure, in vivo exposure, hypnosis c) Relaxation skills, hypnosis, in vivo exposure d) Relaxation skills, in vivo exposure, behavioural activation Answer: A Page: 273 37. Which component of CBT for posttraumatic stress disorder involves having the client recount his/her traumatic experiences for an extended period in order to encourage the client to fully emotionally process the trauma? a) In vivo exposure b) Imaginal exposure c) Field exposure d) behavioural activation Answer: B Page: 273 38. The component of CBT for PTSD in which a psychologist develops a hierarchy of feared stimuli with the patient and encourages the patient to intentionally expose himself or herself to increasingly fearful stimuli is known as a) imaginal exposure. b) emotional processing. c) progressive fear desensitization. d) in vivo exposure. Answer: D Page: 273 39. Emotionally focused therapy is an intervention method used primarily for a) parent-child relationship problems. b) couples experiencing relationship problems. c) any type of relationship problems. d) behavioural problems in youth. Answer: B Page: 274 Chapter 12: Intervention: Adults and Couples Copyright 2018 © John Wiley & Sons Canada, Ltd.

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40. Emotionally focused couples therapy is a a) cognitive-behavioural treatment. b) interpersonal treatment. c) psychodynamic treatment. d) process-experiential treatment. Answer: D Page: 274 41. Emotionally focused couples therapy is designed to a) modify partners’ emotional responses. b) modify partners’ interactional patterns. c) foster or establish a secure emotional bond in the couple. d) all of the above. Answer: D Page: 274 42. One of the key issues addressed through the early steps of Emotionally Focused Couples Therapy is a) problem-solving and communication. b) faulty behaviour cycles. c) unrealistic expectations. d) attachment difficulties. Answer: D Page: 274 43. Efficacious treatments are treatments that have been demonstrated within a) a clinical setting. b) a controlled research study. c) Both A and B d) None of the above Answer: B Page: 275 44. Effectiveness trials indicate that efficacious treatments a) cannot be effectively transported to routine practice. b) can be transported to routine clinical practice, but with significant loss of treatment impact. c) can be transported to routine clinical practice, with moderate loss of treatment impact. d) can be transported to routine clinical practice, with little loss of treatment impact. Answer: D Page: 275 45. Effective treatments are treatments that have been demonstrated within a) a real-world clinical setting. b) a controlled research study. c) Both A and B d) None of the above Answer: A Page: 278 46. Benchmarking can be used to Chapter 12: Intervention: Adults and Couples Copyright 2018 © John Wiley & Sons Canada, Ltd.

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a) determine which intervention will be most effective for a specific mental health problem. b) compare the results of controlled research studies with clinical practice research results. c) compare various interventions for a mental health issue within a clinical setting. d) determine the type of treatment for which a given patient is suited. Answer: B Page: 275 47. The rapid introduction of new evidence-based psychological treatments is hindered by a) the inability to patent psychological treatments. b) training requirements for psychological treatments. c) ethical codes and professional guidelines usually prohibiting advertising psychological treatments to the public. d) all of the above. Answer: D Page: 276 48. A 2006 survey of accredited doctoral training programs found that _____ Ph.D. programs and _____ of Psy.D. programs did not require any training in evidence-based treatments. a) no; some b) very few; some c) many; some d) almost half; two-thirds Answer: D Page: 277

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Short Answer Questions 1. List two of the potential threats to internal validity of Hans Eysenck’s (1952) analysis of the effects of psychotherapy. Suggested Answer: Page 257 a) selection biases – without the use of appropriate control groups, in which participants are randomly assigned to treatment conditions, it is incorrect to compare the results from the different data sets b) untreated groups were patients in residential treatment settings and patients treated by general physicians. Therefore, the untreated patients would have received some psychological help and were not a true control group. c) some critics claim that Eysenck’s criteria for establishing clinical improvement were arbitrary and biased against finding therapeutic effects 2. What does conversion of data into effect sizes allow researchers to do? Suggested Answer: Page 258 a) Conversion of data into effect sizes allow researchers to integrate and make meaningful comparisons of data across various studies. 3. Define the term clinical practice guidelines. Suggested Answer: Page 262 a) Clinical practice guidelines are a common way in which empirical evidence is used to assist clinicians in making assessment and treatment decisions. b) Based on the best empirical evidence, clinical practice guidelines are a summary of scientific research, dealing with the diagnosis, assessment and or treatment of a disorder. 4. List two of Tolin et al’s recommendations to establish review panels when determining empirically supported treatment. Suggested Answer: Page 263 a) Review panel members should be individuals with a broad range of expertise in treatment provision and treatment research. a) Members must disclose potential conflicts of interest when reviewing treatments. b) Detailed procedures describing every aspect of the review process must be in place. 5. List two of Tolin et al’s recommendations for the review process when determining empirically supported treatment. Suggested Answer: Page 263 a) A treatment for a specific disorder or condition is nominated for review by an individual or an organization. b) Recent (within the past two years) systematic reviews and/or meta-analyses are examined to determine the impact of the treatment compared to no-treatment control conditions and alternative psychological treatments. c) Standardized tools are used to rate the quality of the research reported in the review/metaanalysis, as well as the quality of the review/meta-analysis itself. Standardized tools are

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used to rate the level of potential bias due to methodological limitations associated with the conclusions of the review/meta-analysis. 6. In reference to psychotherapy research, what is an open trial? Suggested Answer: Page 264 a) An open trial is a type of initial, exploratory treatment study in which no control group is used b) Few participant exclusion criteria are applied 7. What is the key difference between efficacious treatments and effective treatments? Suggested answer: Page 270 a) Efficacious treatments have demonstrated success within a controlled research study, while effective treatments have demonstrated success within a routine clinical practice. 8. Define benchmarking strategy. What is the main goal of this strategy? Suggested answer: Page 275 a) Benchmarking strategy refers to a process where the results of efficacy trials are used as a standard to compare the services provided by regular clinicians to regular patients. b) The main goal is to help evaluate the impact of treatment in routine practice. c) Failing to control for differences in sample size across studies or using all results from each study rather than an average of all results (thus weighting more heavily studies with a large number of analyses). 9. List three reasons why the adoption of evidence-based psychological treatments is slower than that of pharmaceutical interventions. Suggested Answer: Page 275 a) psychological interventions, unlike pharmaceutical interventions, cannot be patented – there is no comparable process, or financial reward, for rapidly disseminating evidencebased psychological treatments to health care professionals or advertising directly to the public. b) ethical codes prohibit most types of advertising of psychological services c) there is often much more to learning how to appropriately provide an efficacious psychological treatment than there is to learning how to prescribe a pharmalogical treatment. d) there are few structured opportunities for psychologists to engage in continuing education at an intensity necessary to become proficient at learning a new treatment e) many doctoral training programs do not train students in evidence-based interventions f) health care settings are under financial pressure to reduce wait times, and so clinician skill development is not a priority g) some clinicians are concerned about the feasibility of implementing manual-based treatments, lack of fit between client needs and EBT’s, the impact that EBT’s might have on the therapeutic relationship, and the possibility for decreased job satisfaction.

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Chapter 13 Intervention: Children and Adolescents Multiple Choice Questions 1. Data from an American study of 1,420 adolescents indicate that only ________ adolescents requiring services for psychopathology received them. a) one in ten b) one-third of c) half of d) seven in ten Answer: B Page: 281 2. Hawley and Weisz (2005) found that the youth-therapist alliance was related to _______, whereas the parent-therapist alliance was related to ________________. a) participation in therapy; symptom improvement. b) symptom improvement; participation in therapy. c) satisfaction with services; symptom improvement. d) participation in therapy; satisfaction with services. Answer: B Page: 281 3. Consent procedures for youth vary according to a) the chronological age of the youth. b) the jurisdiction and context in which services are offered. c) the nature of the presenting problem. d) the experience of the psychologist. Answer: B Page: 281 4. Research reviews in the 1950s and 1960s by Levitt concluded that there was ____________ evidence for the efficacy of child psychotherapy. a) no b) only some c) a moderate amount of d) overwhelming Answer: A Page: 284 5. The meta-analysis conducted by Kazdin and colleagues in 1990 found that treatment studies often used ________ samples and that they were treated in a(n) _________ format. a) referred; individual b) referred; group c) volunteer; individual d) volunteer; group Answer: D Page: 284 6. Kazdin and colleagues (1990) drew attention to the fact that clinical practice usually Chapter 13: Intervention: Children and Adolescents Copyright 2018 © John Wiley & Sons Canada, Ltd.

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involves________ samples treated in a(n) _________ format. a) referred; individual b) referred; group c) volunteer; individual d) volunteer; group Answer: A Page: 284 7. Data from larger samples have _______ error variance, and are therefore _______ population values. a) less; closer to b) less; further from c) more; closer to d) more; further from Answer: A Page: 284 8. The statistical procedure that accounts for error inherent when sampling data from a population by assigning less weight in a meta-analysis to studies with greater error variance and more heavily weighting those with less error variance is known as the a) standard deviation. b) regression to the mean. c) weighted least squares method. d) unweighted strategy. Answer: C Page: 284 9. Weisz et al. (1995) conducted the fourth major meta-analysis of the effects of child therapy and introduced a statistical technique known as the a) effect size. b) standard deviation method. c) weighted least squares method. d) deviation from the norm. Answer: C Page: 284 10. A study by McLeod and Weisz (2004) found that published studies reported ________ effect sizes compared to unpublished dissertations. a) smaller b) similar c) larger d) more variable Answer: C Page: 285 11. McLeod and Weisz (2004) found that unpublished dissertations studying child psychotherapy, compared with published studies, a) were more methodologically sound, and obtained lower effect sizes. b) were more methodologically sound, and obtained higher effect sizes. c) were less methodologically sound, and obtained lower effect sizes. d) were less methodologically sound, and obtained higher effect sizes. Chapter 13: Intervention: Children and Adolescents Copyright 2018 © John Wiley & Sons Canada, Ltd.

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Answer: A

Introduction to Clinical Psychology, 4e

Page: 285

12. One of the methodological considerations of meta-analyses of psychological treatments for children and adolescents has centred on whether to include a) behavioural and nonbehavioural variables. b) both published and unpublished studies. c) studies done on children under the age of 5. d) children with conduct disorder. Answer: B Page: 285 13. Psychotherapy researchers in various countries have developed psychosocial interventions that effectively help children and youth living with a) autism. b) depression and anxiety. c) ADHD and disr. d) all of the above. Answer: D Page: 285 14. A meta-analysis of 32 studies comparing evidence-based treatments to usual clinical care found that a) evidence-based treatments consistently outperformed usual clinical care. b) usual clinical care consistently outperformed evidence-based treatments. c) there were no significant differences between these treatment modalities. d) evidence-based treatments outperformed usually clinical care only for autism treatment. Answer: A Page: 477 15. Evidence-based treatments for disorders in children and youth include treatments for a) insufficiency of oxygen in the blood. b) gluten and casein intolerance. c) substance abuse. d) high bacteria levels in the stomach . Answer: C Page: 285 16. Huey and Polo’s (2008) meta-analysis of the efficacy of evidence-based treatments with ethnic minority youth found a) evidence that a number of treatments are probably efficacious in the treatment of minority youth. b) evidence that the majority of treatments examined were definitely efficacious in the treatment of minority youth. c) that treatments were equally effective for both minority and non-minority youth. d) that treatments were not effective for either non-minority or minority youth. Answer: A Page: 288 17. The current movement to develop interdisciplinary, evidence-based guidelines for the assessment and treatment of diverse childhood disorders is designed to a) inform policy-makers of mental health practices. Chapter 13: Intervention: Children and Adolescents Copyright 2018 © John Wiley & Sons Canada, Ltd.

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b) guide consumers (children and their families) of treatment options. c) help mental health professionals deliver services that are based on current research findings. d) all of the above. Answer: D Page: 289 18. What is the most common reason for which adults refer children and youth for mental health services? a) Internalizing problems. b) Disruptive behaviour. c) Depression. d) Anxiety. Answer: B Page: 289 19. Oppositional Defiant Disorder is based on a) a pattern of serious violation of the rights of others that is evident before age 8. b) a pattern of persistent negativistic and hostile behaviour usually evident before age 3. c) a pattern of persistent negativistic and hostile behaviour usually evident before age 8. d) a pattern of aggression, destructiveness, deceitfulness, and serious violation of rules. Answer: C Page: 289 20. Which of the following is most accurate regarding the progression of Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD)? a) ODD often precedes CD. b) CD often precedes ODD. c) ODD and CD generally are not typically related. d) ODD rarely progresses to CD. Answer: A Page: 289 21. There is evidence that if untreated, the problems associated with disruptive behaviour disorders in childhood a) generally dissipate before adolescence. b) persist into adolescence but generally fade by adulthood. c) naturally fade in adolescence. d) persist into adulthood. Answer: D Page: 289 22. Evidence-based parenting programs are based on the assumption that oppositional child behaviour can be changed by modifying the child’s social environment a) through family therapy. b) by role-playing with the child to teach him/her more appropriate conflict resolution skills. c) by having the child challenge the underlying schemas that influence his/her behaviour. d) by working with parents rather than by working directly with the child. Answer: D Page: 290 23. Evidence-based parenting programs involve reducing the child’s oppositional behaviour by Chapter 13: Intervention: Children and Adolescents Copyright 2018 © John Wiley & Sons Canada, Ltd.

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a) modifying the child’s social environment. b) working directly with the child. c) modifying parental expectation. d) promoting parents’ attachment behaviours. Answer: A Page: 290 24. Coercive exchanges between parents and their children are characterized by parents a) rewarding children for positive behaviour and children rewarding parents by engaging in positive behaviour. b) using authoritarian methods (e.g., shouting or spanking). c) rewarding children for aversive behaviour and children rewarding parents by ceasing the aversive behaviour. d) rewarding children for aversive behaviour and children punishing parents by continuing the aversive behaviour. Answer: C Page: 290 25. When a parent unintentionally rewards the child for inappropriate behaviour and the child rewards the parent for giving in to inappropriate behaviour, this is referred to as a(n) a) inappropriate exchange. b) accidental reinforcement. c) negative exchange. d) coercive exchange. Answer: D Page: 290 26. Core parenting skill(s) identified by Patterson and his colleagues (2005) include a) discipline. b) skill encouragement. c) problem-solving. d) all of the above. Answer: D Page: 290 27. Research has consistently demonstrated that ______ families engage in fewer positive interactions than _____ families. a) large; small b) distressed; nondistressed c) rural; urban d) busy; less busy Answer: B Page: 291 28. A consequence that increases the likelihood of a behaviour being repeated is known as a) bribery. b) differential reinforcement. c) positive reinforcement. d) non-compliance prevention. Answer: C Page: 291

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29. Over time, parents should strive to use ________ with their children to reinforce desired behaviours. a) material reinforcers b) social reinforcers c) bribery d) time out Answer: B Page: 291 30. When a child does not have access to reinforcers for a brief time following misbehaviour, this period is referred to as a) time penalty. b) quiet time. c) time out. d) negative reinforcement. Answer: C Page: 291 31. Parenting strategies are designed to be used by parents a) until undesirable child behaviours desist. b) to help children develop. c) intermittently, or on an “as needed” basis. d) as a “quick fix” for child behaviour problems. Answer: B Page: 291 32. Patterson (2005) found that that parent-child warmth is associated with a) parental punishment. b) parental monitoring. c) parental negative reinforcement. d) child monitoring. Answer: B Page: 292 33. Patterson (2005) found that adolescent-parent contempt is associated with ____________, which in turn is associated with ___________. a) delinquency; inconsistent and disrupted parental monitoring. b) inconsistent and disrupted parental monitoring; delinquency c) inconsistent and disrupted parental monitoring; school attendance. d) delinquency; school attendance. Answer: B Page: 292 34. Multisystemic Therapy (MST) is an approach to treat delinquent adolescents by a) combining CBT and family therapy. b) challenging youth about the long term effects of their behaviour. c) intervening in an integrated way in the multiple systems in which youth are involved. d) demanding as much effort from youth as from parents. Answer: C Page: 293 35. A theory of psychosocial functioning that examines a young person’s functioning within the Chapter 13: Intervention: Children and Adolescents Copyright 2018 © John Wiley & Sons Canada, Ltd.

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multiple contexts in which he or she lives is known as a) an ecological theory. b) a social-emotional framework. c) interpersonal psychotherapy. d) a multiple stakeholders approach. Answer: A Page: 293 36. Multisystemic Therapy (MST) involves a) emphasizing the positive and using systemic strengths as levers for change. b) developmentally appropriate interventions. c) targeting sequences of behaviour within and between multiple systems that maintain the identified problem. d) all of the above Answer: D Page: 293 37. Multisystemic therapists work ________ and treatment typically lasts for ____________. a) individually; 6-8 sessions b) individually; 3–5 months c) in small teams; 6 -8 sessions d) in small teams; 3-5 months Answer: D Page: 293 38. Research has demonstrated that although depression is _________ common in adolescence as in adulthood; research in adolescent depression has been _______ extensive than the research for depression in adults. a) less common; less b) almost as; less c) almost as; more d) less common; more Answer: B Page: 295 39. The NICE guidelines recommend, for treating children and youth with depression, a) antidepressants as a first line treatment. b) antidepressants as a second option to be used only when CBT does not work. c) that antidepressants should never be used without an accompanying psychological treatment. d) that it is up to the discretion of the prescribing physician whether or not to use antidepressants. Answer: C Page: 295 40. Tracking mood on a regular basis, usually using a chart is a) psychoeducation b) meta-analyses c) mood monitoring d) self-analysis Answer: C Page: 295 Chapter 13: Intervention: Children and Adolescents Copyright 2018 © John Wiley & Sons Canada, Ltd.

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41. Weisz et al (2013) conducted a meta-analysis of 52 randomized trials that compared an evidence-based treatment for children and adolescents to usual care. On average, youth receiving evidence-based psychotherapy had a) a lower outcome than either youth or adults receiving usual care. b) a similar outcome to youth receiving usual care. c) a lower outcome than 60% of youth receiving usual care. d) a better outcome than 60% of youth receiving usual care. Answer: D Page: 296 42. Lee, Horvath, and Hunsley (2013) found that evidence-based treatments for children and youth a) can be effective when used in routine practice settings. b) are slightly less effective in routine practice settings than in research settings. c) are much less effective in routine practice settings. d) cannot be transported to routine practice settings. Answer: A Page: 297 43. A modular approach in which practice elements are combined to meet the needs of diverse youth holds considerable promise. A modular approach requires a) the creation of new manuals based on meta-analyses and clinical studies b) a graduate education in evidence-based treatment. c) continuing education in evidence-based treatment. d) extensive training and support of the mental health workforce. e) . Answer: D Page: 300

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Short Answer Questions 1. Briefly describe Evidence-based Parenting Programs and Multisystemic Therapy (MST) programs. List one thing these programs have in common, and one way in which they are different. Suggested answer: Page 290 - 291 a) Evidence-based Parenting Programs: i) Based on social learning theory, and the idea that oppositional child behaviour can be changed by modifying the child’s social environment rather than by directly working with the child ii) According to this theory, maladaptive patterns of parent-child interaction inadvertently influence both parents and children to engage in inappropriate behaviours (i.e., coercive exchanges) iii) Program designed to help parents encourage appropriate behaviours and discourage unacceptable behaviours by teaching five parenting practices that are associated with the development of prosocial or deviant behaviour: skill encouragement, discipline, monitoring, problem-solving, and positive involvement (ie: teaching parents of children with behavioural problems to parent like parents of children without these problems. b) Multisystemic Therapy: i) Designed to treat seriously disturbed delinquent adolescents by intervening in an integrated way in the multiple systems in which they are involved ii) Grounded in an ecological theory of psychosocial functioning, MST works with these youth within the context of numerous systems, including the nuclear family, extended family, neighbourhood, school, peer, community, juvenile justice, child welfare, and mental health • This treatment approach is consistent with research findings that delinquent behaviour is not caused simply by one factor but, rather, is multiply determined. c) Similarity: Both are treatments for families with children with disruptive behaviours d) Difference: Evidence-based parenting programs work with parents only (not with the child), whereas MST works with everyone possible in child’s life (child/adolescent, parent/caretaker, teacher, etc) 2. What is a coercive exchange? Suggested answer: Page 290 a) Coercive exchanges are parent-child interactions in which the parent unintentionally rewards the child for whining or aggression by withdrawing a demand or providing attention, and the child rewards the parent for giving in to his or her complaints by ceasing the aversive behaviour. 3. In the context of parenting, what is positive reinforcement, and why is it important? Provide three examples of positive reinforcers. Suggested Answer: Page 291 a) Positive reinforcement is any consequence of a child’s behaviour that increases the likelihood of a behaviour being repeated b) Parents seeking mental health services for their children’s oppositional behaviours often Chapter 13: Intervention: Children and Adolescents Copyright 2018 © John Wiley & Sons Canada, Ltd.

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report that their interactions with their children are very negative, so it is very important for parents to learn ways to encourage positive behaviour, and engage in positive behaviour themselves. c) Examples: smiles, attention, verbal encouragement, touch, stickers, toys, TV time, etc. 4. What are the NICE guidelines for treatment of depression in youth? Suggested Answer: Page 295 a) Initial assessment: address risk and protective factors in the child’s social networks b) Consider treating parental psychopathology in parallel with services offered to the youth c) Young person should be advised of benefits of lifestyle factors (regular exercise, adequate sleep, good nutrition) d) Do not prescribe antidepressant medication for mild depression. Instead, monitor, and provide non-directive supportive therapy or group CBT e) For moderate to severe depression: individual CBT, IPT, or short-term family therapy f) Antidepressant is only to be used in combination with a psychological treatment 5. Define psychoeducation. Suggested Answer: Page 296 a) Teaching psychological concepts to clients in a manner that is accessible to them. 6. To roll out evidence-based services on a large scale requires coordination across researchers, policy-makers, and practitioners. It requires? Suggested Answer: Page 299 a) Development of manuals that allow flexible implementation b) Graduate education in evidence-based treatment c) Continuing education in evidence-based treatment d) Training protocols such as workshops, supervision, and consultation e) Increased research on effective dissemination strategies

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Chapter 14 Intervention: Identifying Key Elements of Change Multiple Choice Questions 1. Research that examines what happens within and across psychotherapy sessions is known as: a) process research. b) effectiveness research. c) outcome research. d) efficacy research. Answer: A Page: 302 2. Research that examines the elements of psychotherapy (such as the alliance between therapist and patient) and how these elements are related to the impact of treatment is referred to as: a) process research. b) process-outcome research. c) efficacy research. d) effectiveness research. Answer: B Page: 302 3. ___________ research addresses the question of which intervention is more efficacious, whereas ___________ research ask about how an intervention works. a) Process; process-outcome b) Process-outcome; process c) Treatment-outcome; process and process-outcome d) Process and process-outcome; treatment-outcome Answer: C Page: 303 4. Starting in the 1950s and 1960s, the development of process-outcome research was influenced by the use of ____________________ as sources of data. a) recordings of psychotherapy sessions and standardized measures for clients’ and therapists’ experience of the treatment process b) responses to projective measures following treatment c) standardized measures of experience of the treatment process reported by therapists and clients d) recordings of psychotherapy sessions and interviews with family members to assess changes in the client Answer: A Page: 303 5. Tang and colleagues demonstrated that if a patient makes sudden gains in therapy, it typically occurs a) after the first session. b) relatively early in therapy (around sessions 4 through 6). c) around the mid-point of therapy (sessions 8 through 12). d) near the end of therapy. Answer: B Page: 304 Chapter 14: Intervention: Identifying Key Elements of Change Copyright 2018 © John Wiley & Sons Canada, Ltd.

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6. Tang and colleagues found that sudden gains in therapy are a) evidence of a flight into health. b) short-lived and dissipate quickly. c) involve a significant reduction in symptoms. d) only evident in CBT. Answer: C Page: 304 7. Early treatment gains for individuals in treatment for major depressive disorders have been shown in individuals receiving a) cognitive therapy. b) placebo medication. c) short-term psychodynamic therapy. d) all of the above. Answer: D Page: 304 8. One of the difficulties in identifying how client variables influence treatment outcome is that a) most psychologists believe diagnosis determines treatment outcomes. b) very few empirical studies have examined this issue. c) psychologists are much more interested in comparing groups rather than in comparing individuals. d) it is difficult to detect patterns across studies that use different types of measures. Answer: D Page: 305 9. With a large body of research, we now have a _______________ understanding of how client variables affect treatment outcome. a) rudimentary b) moderate c) good d) highly developed Answer: A Page: 305 10. Socioeconomic status of the client variable can influence treatment outcome because ____________socioeconomic status is related to a greater likelihood of _______________. a) higher; staying in treatment b) higher; not staying in treatment c) lower; engaging with the therapist d) lower; staying in treatment Answer: A Page: 305 11. Which of the following client variables has been found to influence treatment outcome? a) Extraversion. b) Introversion. c) Age. d) Socioeconomic status. Answer: D Page: 305 Chapter 14: Intervention: Identifying Key Elements of Change Copyright 2018 © John Wiley & Sons Canada, Ltd.

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12. Which of the following therapist variables influences treatment outcome? a) Gender. b) Age. c) Ethnicity. d) Emotional well-being. Answer: D Page: 307 13. To be effective in delivering psychological services, the psychologist must have a) a large number of clients, interpersonal sensitivity, and tolerance for distress. b) knowledge, technical skills, interpersonal sensitivity, and tolerance for distress. c) knowledge, ability to put others first at all costs, technical skills, and tolerance for distress. d) a large number of clients, ability to put other first at all costs, interpersonal sensitivity, tolerance for distress. Answer: B Page: 307 14. Research conducted by Lafferty, Beutler, and Crago (1989) found that patients under the care of effective therapists a) experienced substantially more positive emotional adjustment. b) reported feeling more understood in treatment. c) experienced greater success with therapists who did not self-disclose. d) reported greater success with therapists from some mental health disciplines than from others. Answer: B Page: 307 15. Research indicates that differences in therapist effectiveness are most apparent when treating patients a) without comorbid disorders. b) with low levels of problem severity. c) with high levels of problem severity. d) who are of a different ethnicity than the therapist. Answer: C Page: 308 16. A therapist’s interpretations are most successful with clients who have a) good interpersonal skills. b) poor interpersonal skills. c) good self-examination skills. d) poor self-examination skills. Answer: A Page: 309 17. Psychological ___________ is the tendency to react against attempts to directly influence one’s behaviour. a) recoiling b) reconsideration c) oppositional defiance d) reactance Chapter 14: Intervention: Identifying Key Elements of Change Copyright 2018 © John Wiley & Sons Canada, Ltd.

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Answer: D

Introduction to Clinical Psychology, 4e

Page: 309

18. Psychological reactance is the tendency to react a) against attempts to directly influence one’s behaviour. b) favourably toward attempts to directly influence one’s behaviour. c) to emotional stimuli in the environment. d) to emotional stimuli in therapy. Answer: A Page: 309 19. In terms of psychological reactance, low-reactant clients usually experience greater therapeutic gains in ____ directive treatment, and high-reactant clients usually experience greater therapeutic gains in ____ directive treatment. a) more; less b) less; more c) less; less d) more; more Answer: A Page: 309 20. Focusing on enhancing patient self-awareness and understanding of their problems works best for patients who ________, whereas patients who ________ respond best to a focus on symptom alleviation. a) are undercontrolled; are introspective b) have an internalizing style; have an externalizing style c) are extroverted; are introverted d) have an externalizing style ; have an internalizing style Answer: B Page: 310 21. Research suggests that patient compliance in completing homework acts as a moderator of the relation between positive treatment expectations and a) therapist characteristics, such as empathy. b) relapse prevention following termination of therapy. c) initial improvement in functioning. d) increased therapeutic alliance. Answer: C Page: 310 22. Who is credited as being the first person to identify a common set of therapeutic factors that inform the effectiveness of all approaches to psychotherapy? a) Saul Rosenzweig. b) Lester Luborsky. c) John Norcross. d) Jerome Frank. Answer: A Page: 313 23. What was Rosenzweig’s (1936) assertion regarding the various types of therapies that were available to clinicians at the time? a) Some therapies are very effective and others are not effective. Chapter 14: Intervention: Identifying Key Elements of Change Copyright 2018 © John Wiley & Sons Canada, Ltd.

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b) Most therapies are not effective. c) Little is known about the effectiveness of therapy. d) All therapies are equivalent in treatment outcome. Answer: D Page: 313 24. Weinberger’s (1995) review of the literature on common factors found that a) there was little agreement on what the common factors actually are. b) all therapeutic success could be explained by these factors. c) most proponents of the common factors theory had been misinformed. d) there was very good agreement on particular common factors. Answer: A Page: 313 25. Lambert and Ogles (2004) categorized the most commonly suggested common factors in psychotherapy into the following main dimensions: a) psychoeducational, emotional, and cognitive factors. b) vulnerability, protective, and educational factors. c) support, learning, and action factors. d) internalized, externalized, and alliance factors. Answer: C Page: 313 26. The development of integrative treatment models for psychotherapy has been greatly influenced by a) process-outcome research. b) the common factors approach. c) interpersonal psychotherapy. d) cognitive-behavioural therapy. Answer: B Page: 313 27. Which of the following therapeutic elements would be considered a common factor to several psychotherapeutic approaches? a) Therapist disclosure. b) Therapeutic alliance. c) Corrective emotional experience. d) Homework. Answer: B Page: 314 28. Which of the hypothesized common factors in psychotherapy has received the most research attention? a) Empathy. b) Sense of mastery in the client. c) Therapeutic alliance. d) Confronting problems in therapy. Answer: C Page: 313 29. One of the problems in interpreting the research on the alliance-outcome link is the importance of not inferring Chapter 14: Intervention: Identifying Key Elements of Change Copyright 2018 © John Wiley & Sons Canada, Ltd.

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a) correlation from causation. b) significance from correlation. c) significance from causation. d) causation from correlation. Answer: D Page: 314 30. Studies that are controlled for the effects of early improvement have found that early therapeutic alliance a) no longer significantly predicts treatment outcome. b) still significantly predicts treatment outcome. c) only predicts treatment outcome for low reactant clients. d) only predicts treatment outcome for high reactant clients. Answer: B Page: 315 31. Rosenzweig’s (1936) hypothesis that all psychotherapies must be equivalent in their effects is referred to as the a) Tropical bird effect. b) Dodo bird verdict. c) Chameleon result. d) Common factors approach. Answer: B Page: 315

32. Luborsky and colleaguesÈ reviews of psychotherapy effectiveness have concluded that a) the nature of specific therapeutic effects is clear. b) all therapies are equal. c) all therapies are not equal. d) many current therapeutic techniques can be harmful to clients. Answer: B Page: 315 A design in which the differential impacts of at least two treatments are compared, and a notreatment control group may or may not be included is known as a(n) e) higher-order treatment outcome study. f) comparative treatment study. g) mixed design. h) effectiveness trial. Answer: B Page: 316 33. Smith, Glass, and Miller (1980) conducted a meta-analysis of treatment outcome studies and found that ________________treatments had the largest effect sizes. a) cognitive-behavioural b) psychodynamic c) humanistic d) vocational counseling Answer: A Page: 316

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34. Smith et al. (1980) conducted analyses on data from 56 comparative outcome studies of the behavioural and verbal classes of treatment and found that a) there were significant differences between the two classes of therapy. b) verbal classes of treatment were more effective. c) behavioural and verbal classes of treatment were equally effective. d) neither class of treatment was effective. Answer: A Page: 316 35. Meta-analyses of the child and adolescent treatment literature have found a) no differences between treatments. b) cognitive-behavioural treatments to be more efficacious than other treatments. c) psychodynamic treatments to be more effective than other treatments. d) humanistic (play therapy) treatments to be more effective than other treatments. Answer: B Page: 316 36. Bruce Wampold has been a vocal proponent a) of the psychotherapy equivalence position. b) against the psychotherapy equivalence position. c) against psychotherapy. d) both B and C. Answer: A Page: 316 37. The average effect size difference between therapies shown to be effective is approximately a) d = 0. b) d = .2. c) d = .4. d) d = .6 Answer: B Page: 316

38. Aspects of the therapeutic relationship associated with successful treatment are known as a) common factors of psychotherapy. b) integrated treatment. c) evidence-based psychotherapy relationships. d) therapeutic alliance. Answer: C Page: 318

39. Who developed an initiative to identify empirically based principles of therapeutic change? a) Castonguay and Beutler b) Orlinksy and Luborsky c) Orlinsky and Castonguay d) Luborsky and Wampold Answer: A Page: 320

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40. Among the empirically based principles of therapeutic change, greater pre-treatment impairment is a(n) a) client variable hypothesized to reduce likelihood of benefitting from therapy. b) client variable hypothesized to increase likelihood of benefitting from therapy. c) intervention target hypothesized to lead to therapeutic change. d) client variable that does not systematically impact degree of change. Answer: A Page: 320 41. Group cohesion refers to a) the relationship between the clients and the therapist. b) the relationship among the clients in the group. c) the extent of personality integration. d) both A & B Answer: D Page: 320

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Introduction to Clinical Psychology, 4e

Short Answer Questions 1. What differentiates process research from process-outcome research? Suggested answer: Page 303 a) Process research examines patterns (using therapist and/or client data) that are evident within and across therapy sessions. b) Process-outcome research examines these patterns (such as patterns in the alliance between therapist and client) and how they are related to the impact of treatment (i.e., client improvement in symptoms or functioning). 2. Define “common factors” in psychotherapy: Suggested Answer: Page 303 a) Common factors are therapeutic elements that occur in all or most treatments that are believed to be critical for successful client outcomes. 3. Provide two examples of variables that could be examined in process research and two examples of variables that could be examined in process-outcome research. Suggested Answer: Page 304 (Table 14.1) Process Research a) Facial expressions b) Shift in gaze c) Statements made by client or therapist d) Changes in direction of conversation e) Changes in dynamics across sessions f) Dealing with alliance problems g) Homework assignments h) Between-session experiences i) Development of alliance j) Phases of treatment k) Addressing recurrent themes in treatment l) Entire course of treatment m) Long-term treatment events

Process-Outcome Research a) Emergence of specific experiences, such as insight or catharsis b) Immediate improvements in mood or motivation c) Change in functioning, improved handling of problems d) Ongoing improvements in functioning and reduction of symptoms e) Changes in adaptation and identity f) Personality change

4. What are sudden treatment gains? At what point in therapy do they typically occur? Suggested Answer: Page 304 a) Sudden treatment gains refer to a phenomenon where patients demonstrate either abrupt gains in functioning or sudden large reductions in symptoms. b) Sudden treatment gains typically occur earlier in treatment, around sessions 4, 5, and 6. 5. List three client variables that influence treatment, and the manner in which they influence treatment. Suggested Answer: Page 306 (Exhibit 14.2) a) Socioeconomic status – associated with a higher likelihood of engaging in and staying in treatment Chapter 14: Intervention: Identifying Key Elements of Change Copyright 2018 © John Wiley & Sons Canada, Ltd.

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b) Ethnicity – Overall, client ethnicity is unrelated to treatment outcome. Similarity in client/therapist ethnicity is related to a greater likelihood of a client staying in treatment and making therapeutic change c) Gender – women are more likely to seek therapy than men d) Symptom severity – greater severity is related to poorer treatment outcome. e) Functional impairment – greater overall functional impairment is related to poorer treatment outcome. f) Personality disorders – presence is associated with premature termination, process problems, and less therapeutic change g) Ego strength – related to positive outcome h) Psychological mindedness – related to positive outcome i) Psychological reactance – low reactance is associated with greater gains in directive treatments, whereas higher reactance is associated with greater gains in less directive treatments j) Treatment expectations – positive expectations are associated with staying in treatment and better outcome 6. List two therapist variables that are unrelated to treatment outcome and two therapist variables that are likely to be related to treatment outcome. Suggested Answer: Page 307 (Table 14.3) a) Unrelated: • age of therapist • gender of therapist • personality traits also have little association. • Ethnicity of therapist • Values, attitudes, and beliefs b) Related • the amount of professional experience (more is generally better, although there is variability in the research) • Professional background – therapists trained in a mental health discipline have better outcomes than those trained in a health discipline (e.g., general practitioners) • Emotional well-being of therapist • Self-disclosure (judicious use of self-disclosure has been found to have a small and positive effect on treatment outcome. 7. How does psychological reactance influence the effectiveness of therapeutic directiveness? Suggested answer: Page 309 a) Low reactant clients usually experience greater therapeutic gains in more directive treatments b) High reactant clients tend to experience greater therapeutic gains in less directive treatments. 8. Describe Jerome Frank’s (1973, 1982) model to explain all treatment effects. Suggested Answer: Pages 313

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a) He suggested that a distressed and disillusioned individual will seek help from a healer working in a recognized health setting which would instill hope in the individual, and motivate the person to participate in healing rituals to resolve their problems. b) Frank proposed that his model applies to all mental health care treatments, irrespective of type of healer, setting, or type of ritual. 9. What are the important components of the e therapeutic alliance. Suggested Answer: Page 314 • positive affective bonds (e.g., mutual trust, liking, respect, and caring) • consensus about and commitment to the goals of therapy • a shared sense of partnership in the therapeutic process

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Chapter 15 Health Psychology, Clinical Neuropsychology, and Forensic Psychology Multiple Choice Questions 1. Which twentieth century advances set the stage for psychologists to play a significant role in health promotion, treatment of disease, and rehabilitation? a) Sanitation. b) Medicine. c) Medical technology. d) All of the above. Answer: D Page: 325 - 326 2. Within a medical model, disability is considered a _________ requiring treatment to correct the problem, whereas within a social model, disability is viewed as a ____________. a) characteristic of a person; function of both the physical and social environments b) function of the social environment; characteristic of a person c) function of the physical environment; a function of the way the person reacts to perceived limitations d) characteristic of a person; impairment associated with physical health problems Answer: A Page: 326 3. The World Health Organization (WHO) has adopted a ______________ model of disability. a) psychosocial b) social-contextual c) biosocial d) biopsychosocial Answer: D Page: 326 4. According to the WHO model of disability, an individual’s functioning or disability is determined by the interaction of a) pre-morbid functioning and supportiveness of the environment. b) the availability of integrated services and readiness to change. c) severity of impairment and motivation to change. d) health conditions and contextual variables. Answer: D Pages: 326 5. According to Canadian Disability Survey rates of disability ______________ with age. a) decrease b) remain constant c) increase d) can either decrease or increase Answer: C Page: 326 6. Canadian Disability Survey data from 2012 revealed a disability rate of Chapter 15: Health Psychology, Clinical Neuropsychology, and Forensic Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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a) 7%. b) 14%. c) 26%. d) 33%. Answer: B

Introduction to Clinical Psychology, 4e

Page: 326

7. Data from the Canadian Disability Survey show that among working-age adults, the most common type of disability was related to pain, followed by flexibility and mobility chronic pain and mobility limitations a) pain b) flexibility c) mobility d) agility Answer: A Page: 326 8. Data from the Canadian Disability Survey revealed that _____________was the most common disability in those aged over 65. a) flexibility b) mobility c) pain d) learning disability Answer: B Page: 326 9. ___________ refers to aspects of well-being for individuals living with diverse disorders, as well as for their caregivers. a) Quality-of-life b) Biosocial health c) Level of satisfaction d) Environmental contentment Answer: A Page: 326 10. In recent decades and many quality-of-life assessment tools have been developed for use with people suffering from mental and physical problems, for example, there is now considerable research on quality of life. a) primarily with very elderly patients. b) among children suffering from depression. c) among people with cancer. d) focusing on mental and not physical problems. Answer: C Page: 326 11. To conduct health psychology research a) it is not necessary to have clinical training. b) the researcher is strongly advised to obtain clinical training. c) it is mandatory that the individual have clinical training. d) it is mandatory to have clinical training for clinical (rather than empirical) research only. Answer: A Page: 327 Chapter 15: Health Psychology, Clinical Neuropsychology, and Forensic Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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12. When conducting assessments and interventions clinical health psychologists must a) be knowledgeable about the physical disorders from which their patients suffer. b) consider psychological issues, such as the applicability of a mental disorder diagnosis in addition to a physical disorder. c) consider the person’s social context. d) all of the above. Answer: D Page: 329 13. A pain that serves an unpleasant, but useful, function for an individual and lasts for a short duration is classified as _______ pain. a) acute b) prolonged c) chronic d) short-term Answer: A Page: 30 14. Pain is considered chronic when it persists for a) less than 6 weeks. b) 6 – 12 weeks. c) more than 3 months. d) more than 6 months. Answer: D Page: 330 15. ____________ is a helpful strategy for managing acute pain in children. a) Distraction b) Denying the pain c) Giving false reassurance d) Focusing on the pain Answer: A Page: 330 16. Using data from the Canadian Community Health Survey 2011/2012, Gilmour (2015) reported that ______ of Canadians aged 18 or older reported that they experienced chronic pain. a) 2% b) 12% c) 22%. d) 32%. Answer: C Page: 330 17. Psychological approaches to treatment for chronic pain management involve a) problem-solving. b) relaxation. c) contingency management. d) all of the above. Answer: D Page: 331 Chapter 15: Health Psychology, Clinical Neuropsychology, and Forensic Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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18. CBT treatment for insomnia includes: a) sleep hygiene, stimulus control, sleep restriction, cognitive restructuring. b) sleep hygiene, behavioural activation, sleep restriction, cognitive restructuring. c) behavioural activation, sleep hygiene, exposure, cognitive restructuring. d) exposure, cognitive restructuring, stimulus control, sleep restriction. Answer: A Page: 332 19. If Joanna avoids caffeine and other stimulants in the evening she is practising good a) sleep strategies. b) rest enhancers. c) sleep hygiene. d) self-care. Answer: C Page: 332 20. Principles of sleep hygiene include a) stimulus control. b) sleep restriction. c) avoiding caffeine, smoking, and exercise near bedtime. d) taking a hot bath or shower before going to bed. Answer: C Page: 332 21. Behavioural strategies to treat insomnia include a) getting out of bed when unable to sleep and returning only when sleepy. b) avoiding caffeine in the evening. c) changing dysfunctional beliefs about sleep. d) avoiding exercise late in the evening. Answer: A Page: 332 22. CBT treatments for insomnia a) can be delivered inexpensively and effectively. b) can be delivered only in individual therapy. c) are more expensive than pharmacotherapy. d) have only shown effectiveness in the short-term. Answer: A Page: 332 23. Neuropsychology is the study of ____________, whereas clinical neuropsychology is _____. a) neurological injury or disease; the application of this knowledge to assess and remediate effects of neurological injury or disease b) brain-behaviour relationships; the application of this knowledge to assess and remediate effects of neurological injury or disease c) neurological injury or disease; the study of brain-behaviour relationships d) brain-behaviour relationships; the study of neurological injury or disease Answer: B Page: 333 24. Which test is widely considered a useful tool in evaluating cognitive functioning? Chapter 15: Health Psychology, Clinical Neuropsychology, and Forensic Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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a) The Reitan-Luria battery. b) The Luria-Halstead battery. c) The Halstead-Morin battery. d) The Halstead-Reitan battery. Answer: D Page: 333 25. The ways that injuries and diseases affect the brain is referred to as a) neuroanatomy. b) neuropathology. c) neurology. d) neuropsychology. Answer: B Page: 333

30. In a neuropsychological assessment aimed at formulating a diagnosis, a relevant question could include: a) Does this child show signs of having been exposed to a toxic substance? b) To what extent will this child’s acquisition of language be affected by head injury? c) What is the extent of damage to this employee who sustained an electric shock? d) What can be done to help this person with mild memory loss? Answer: A Page: 336 31. In a neuropsychological assessment aimed at providing information for treatment planning and rehabilitation, a relevant question could include: a) Is there evidence of brain dysfunction that could be related to the person committing a violent act? b) What kind of special learning aids will this child with a learning disability require? c) To what extent will this child’s acquisition of language be affected by her head injury? d) Does this child show signs of having been exposed to a toxic substance? Answer: B Page: 336 32. Research has demonstrated that there is _______________ between performance on a neuropsychological test and performance of the activities of daily living. a) no simple correspondence b) a very strong causal link c) some relationship d) no relationship Answer: A Page: 336 33. Many norms for neuropsychological tests are based on samples that under-represent a) children. b) minorities. c) females. d) all of the above. Answer: B Page: 337

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34. Conducted by clinical neuropsychologists, _________ assessment is specifically designed to balance the need for autonomy with the need for protection, and requires an understanding of the ways in which functioning can be impaired by injury and degenerative processes. a) legal b) deterioration c) capacity d) traumatic brain injury Answer: C Page: 337 35. The history of treatment for individuals with neurocognitive impairment is _________ the history of treatment for mental disorders. a) comparable to b) much more extensive than c) relatively brief compared to d) controversial compared to Answer: C Page: 337 36. A survey of rehabilitation programs within the American Hospital Association (2003) revealed that _________ programs incorporated neuropsychological testing for individuals who had been hospitalized for a stroke or brain injury. a) no b) few c) most d) all Answer: B Page: 341 37. Treatment planning in rehabilitation based on the acronym SMART (Wilson, 2008) establishes goals that are a) specific, measurable, achievable, realistic and timely. b) short, measurable, achievable, realistic and timely. c) specific, measurable, active, reliable and timely. d) short, measurable, active, reliable and timely. Answer: A Page: 338 38. A meta-analysis of 26 studies of cognitive rehabilitation for individuals with acquired brain injury revealed a) evidence of significant improvements in working memory in both treated and untreated patients over time b) evidence of modest improvements in working memory in both treated and untreated patients over time c) evidence of minor improvements in working memory in both treated and untreated patients over time d) evidence of no improvements in working memory in both treated and untreated patients over time Answer: A Page: 338

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39. A meta-analysis of 16 studies conducted by Guàrdia-Olmos, Perŏ-Cebellero, & GudayolFerré (2015) found that rehabilitation produced ________________improvement in quality of life are methodologically sound. a) a permanent. b) a long-term. c) at least a temporary d) at least a complete Answer: C Page: 338 40. The College of Psychologists of Ontario requires that forensic psychologists have additional knowledge in a) criminal behaviour. b) risk management. c) risk assessment. d) all of the above. Answer: D Page: 340 41. Based on expert opinion on tests for forensic evaluations, the most highly recommended tool for assessing the risk of violence is the a) Violence Risk Appraisal Guide. b) MCMI-II. c) MMPI-2. d) Psychopathy Checklist-Revised. Answer: D Page: 342 42. The Psychopathy Checklist-Revised is ___________ assessing risk of violence. a) as effective as projective measures in b) one of many effective tools for c) the most highly recommended tool for d) the least highly recommended tool for Answer: C Page: 342 43. Viljoen, MacLachlan, and Vincent (2010) found that forensic psychologists routinely used standardized measures in assessing violence risk among youth and adults. Those working with ________ offenders were less likely to include measures of psychopathy than were those working with __________ offenders. a) young; repeat b) young; adult c) adult; young d) adult; repeat Answer: B Page: 342 44. The risk assessments conducted by forensic psychologists focus primarily on a) the risk of the individual re-engaging in violent criminal behaviour. b) the risks that individuals pose to themselves. c) ability to benefit from social skills group training. Chapter 15: Health Psychology, Clinical Neuropsychology, and Forensic Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

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d) suicidal risk. Answer: A Page: 342 45. Canadian researcher Robert Hare is primarily known for his ground-breaking work on a) antisocial personality disorder. b) psychopathy. c) neurological deficits. d) aging. Answer: B Page: 343 46. The PCL-R a) measures psychopathy. b) is considered to be the single best predictor of violent behaviour. c) is considered to be useful in diverse cultural contexts. d) all of the above. Answer: D Page: 343 47. What is the term used to describe the act of committing a crime after release from incarceration? a) Relapse b) Lapse c) Recidivism d) Recriminalization Answer: C Page: 343 48. Meta-analyses by Dowden and Andrews (2004) support the utility of ____________ interventions for offenders. a) CBT b) Experiential c) Psychodynamic d) Interpersonal Answer: A Page: 344 49. A meta-analysis by Wilson and colleagues (2005) found that offenders who had been treated had a recidivism rate of ________% whereas untreated offenders had a recidivism rate of ________%. a) 77; 25 b) 22; 50 c) 46; 54 d) 56; 56 Answer: C Page: 344

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Introduction to Clinical Psychology, 4e

Short Answer Questions 1. Define the conceptualization of disability within both a) a medical model and b) a social model. Suggested answer: Page 326 a) Disability is defined, by the World Health Organization, as impairment, activity limitation, and participation restriction. b) Within a medical model, disability is considered to be a characteristic of the person. c) Within a social model, disability is considered to be a function of both the physical and social environment. 2. Provide a definition for the biopsychosocial model. According to this model, an individual’s functioning or disability is determined by the interaction of which two factors? Suggested answer: Page: 326 a) A biopsychosocial model takes into account • biological factors • individual factors • social factors b) Functioning (or disability) is determined by considering an interaction between health conditions (diseases, disorders, injuries) and contextual factors (e.g., gender, age, coping style, climate, physical environment, legal and social structures). 3. Define the concept of quality-of-life, and explain why it is important to measure this (alongside measuring the extent of disability). Suggested answer: Page 326 a) Quality of life is a concept that has been used to assess various positive aspects of wellbeing for those living with diverse disorders, as well as for their caregivers. b) Many quality of life assessment tools have been developed. c) Although it is important to recognize the extent of disability, it is also important to consider the positive aspects of functioning. 4. What is the difference between acute pain and chronic pain? Suggested Answer: Page 330 a) Acute pain is short-term (less than six months) and serves an unpleasant but useful function. It can usually be relieved in different ways including the application of heat or cold, rest, distraction, or the administration of analgesics. b) Pain that persists for more than six months is considered to be chronic. Chronic pain is associated with a host of other problems, including sleep disturbances, depression, and anxiety. 5. List two helpful (either psychological or physical) and two unhelpful methods to manage children’s acute pain. Suggested Answer: Page 331 (see Exhibit 15.4) a) Helpful: • Presence of parent or other special person • Encouragement to ask questions and express feelings Chapter 15: Health Psychology, Clinical Neuropsychology, and Forensic Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

Test Bank to Accompany Lee/Hunsley

Introduction to Clinical Psychology, 4e

• Provision of simple, accurate information about a medical procedure • Provision of some control (e.g., sit on lap or chair) • Distraction: talking, video games, music, books • Imagination: thinking of activities associated with being relaxed and calm • Suggestion that the child let the pain slip away • Play and silliness • Encouragement that the child is doing well • Deep breathing • Comforting touch: stroking, swaddling, holding, rocking, cuddling • Medication b) Unhelpful: • Denying the pain • Ridiculing or shaming • Giving false reassurance • Focusing too much on pain 6. Are cognitive-behavioural interventions for reducing symptoms in those suffering from insomnia effective? Further, how does CBT compare to pharmacotherapy in the treatment of insomnia? Suggested Answers: Page 332 a) Cognitive-behavioural interventions are effective, yielding an average of 50 to 60% symptom reduction in those suffering from insomnia. b) Cognitive-behavioural interventions are directly comparable to the effectiveness obtained with pharmacotherapy, however, the effects of CBT are better maintained over time. A meta-analysis of studies comparing CBT with pharmacotherapy revealed that CBT produced better quality sleep, while pharmacotherapy produced superior sleep duration. 7. What is clinical neuropsychology? Suggested Answer: Page 333 a) Clinical neuropsychology is the application of knowledge regarding brain-behaviour relationships to the assessment and remediation of neurological injury or illness. 8. What is the difference between neuroanatomy and neuropathology? Suggested Answer: Page 333 a) Neuroanatomy refers to the understanding of normal brain functioning; while neuropathology concerns an understanding of the ways that injuries and diseases affect the brain. 9. Do neuropsychological tests reflect human functioning perfectly? Why or why not? Suggested Answer: Page 336 a) There is no simple correspondence between performance on a neuropsychological test and performance of the activities of daily living b) The context of neuropsychological testing may actually mask some types of deficits. For example, an individual may perform better in a brief, one on one environment of a testing session than in a home setting with multiple distractions and simultaneous attentional demands Chapter 15: Health Psychology, Clinical Neuropsychology, and Forensic Psychology Copyright 2018 © John Wiley & Sons Canada, Ltd.

Test Bank to Accompany Lee/Hunsley

Introduction to Clinical Psychology, 4e

c) Therefore, it is essential that data be gathered from both the individual and others who are knowledgeable about his/her functioning 10. What is forensic psychology? And how is treatment outcome most likely to be measured by psychologists in this field? Suggested Answer(s): Page 339, 343 a) Forensic psychology is any application of psychology in the legal and criminal justice systems. b) Treatment outcome is more likely to be measured in terms of recidivism (reoffending after release from incarceration) rather than a reduction in symptoms.