Major Approaches to Clinical Psychology: Obsessive-Compulsive Disorder

  

Slide 2:  A variety of approaches exist for the treatment of obsessive-compulsive disorder (OCD). Four major approaches include psychodynamic, cognitive-behavioral, humanistic, and family systems. Each approach perceives obsessive compulsive disorder as an intrusive condition characterized by unwanted repetitive and anxiety-producing thoughts accompanied by the compulsive act of rituals the individual believes will protect them from the anxiety (Hansell & Damour, 2008). The obsessions are thoughts or impulses over which the individual has no control except to apply the ritual for relief, and the compulsions make the individual feel driven to do something - usually the ritualistic practice for the purpose of relieving the anxiety (Hansell & Damour, 2008).

OCD has a well-established biological component similar to other anxiety disorders. According to the National Institutes of Health (2010) anxiety produces affective physical reactions in people, and the biological perspective views the activation or stimulation of the nervous system and its excesses or deficiencies. There may also be associated genetic predispositions, neuro-chemical, and hormonal malfunctions (Schimelpfening, 2009). Emotion components include underlying concerns or experiences that have not been openly addressed. From a psychodynamic perspective, there may be pain and sadness resulting from early childhood parental relations. Most psychologists consider underlying conditions as a prelude to OCD (Hansell & Damour, 2008).

The cognitive-behavioral components of OCD include cognitive distortions of oneself and one's environment. Anxiety is often the result of maladaptive thought processes and dysfunctional thought patterns. Misinterpreted situations, and the underestimation of emotional ability may contribute to the disorder. As mentioned previously, behavioral components include the obsessive thoughts or impulses which precedes the application of ritualistic practice (Hansell & Damour, 2008). Each approach has distinct perceptions of OCD and equally distinct methods of management.

Freud believed obsessive-compulsive symptoms are based on defense mechanisms that he called isolation of affect and undoing. These mechanisms help the affected individual manage anxiety-provoking impulses and thoughts. Using the isolation of affect, individuals treat unwanted thoughts as unconnected to their feelings and experience and more as intruding annoyances. Isolating relates to how individuals treat their obsessive thoughts. Undoing is the use of ritual as a magical treatment to rid oneself of the disturbing thought. The undoing relates to the compulsion side of OCD.

Freud also theorized the symptoms of OCD were caused by misunderstood punishment and rigid toilet training that led to internalized conflicts. Other psychodynamic theorists considered OCD the result of the cultural demand for cleanliness and neatness, as well as parental style and punishment tactics during childhood. According to Fraum (2011), "the fundamental issues that drive these symptoms include fear of rejection or abandonment, as well as interpersonal issues regarding intimacy, sex, control, power or other problems in their relationship" (para. 11). Freud published a case study on a patient he called Rat-man. He claimed he successfully treated the man for obsessive thoughts and compulsive behaviors which Freud thought began from sexual and punitive issues in his childhood (Wertz, 2003).

The goal of the psychodynamic interventions is to help clients understand the roots of their symptoms, gain greater self-acceptance, develop better solutions to emotional conflicts, and decrease needs for problematic defense mechanisms (Hansell & Damour, 2008). In the case of OCD by relieving individuals’ stress, they will cease to need to use the defense mechanism.

According to Abend (1996), psychodynamic therapy focuses on pathological anxiety that arises from unconscious emotional conflicts, so therapists in this discipline tend to use basic psychodynamic techniques to address most anxiety disorders (Abend, 1996). Through an established bond between the patient and the therapist, the patient is encouraged to speak freely to uncover the roots of the anxiety, and to recall dreams. Guided imagery and movement is also used in the psychodynamic approach. The therapist helps the client identify and understand problems as a reaction to present and past issues.

Since the psychodynamic approach seeks to uncover unconscious directives, the therapist must be capable of interpreting the patient's thoughts, feelings, and dreams and assisting the patient to identify the unconscious motives to help the patient resolve the conflicting emotions. A significant part of psychodynamic therapy is the ongoing bond built between the patient and the therapist and the trust within the relationship will allow the patient to thoroughly investigate the issues.

Uncovering the roots of anxiety is effective in any anxiety disorder and psychodynamic therapy has been successfully used in the development of treatment goals, as well as, especially in group treatment (Wells, Glickauf-Hughes, & Buzzell, 1990). The patients modify their character by “evolving autonomous functions and partly through evolving relationships with other individuals” (Wells, Glickauf-Hughes, & Buzzell, 1990, p. 375). According to Bram and Björgvinsson ( 2004), in severe cases of OCD cognitive behavioral therapy was more successful than psychodynamic therapy alone and relieved more symptoms of the OCD. Bram and Björgvinsson ( 2004) claim that training psychodynamic clinicians to accommodate cognitive-behavioral techniques will help successfully treat patients with OCD.

According to cognitive behavioral theory, in obsessive compulsive disorder, an association is made between a compulsive ritual that seems to reduce anxiety caused by a disturbing thought or impulse (Hansell & Damour, 2009). In effect, the reduction in anxiety negatively reinforces the ritual. Traditionally, cognitive-behavioral theory claims behavior is a product of one's environment and is either positively or negatively reinforced, or positively or negatively punished. Individuals learn to adjust behavior according to the response received from the environment.

In a cognitive behavioral intervention, the goal would be to change the way the individual responds to the stimulus in effect, changing the ritualistic response to the disturbing thoughts. For example, a client may be asked to allow themselves to think about the disturbing thoughts without engaging in the usual ritualistic behavior. According to Hansell and Damour (2009), the goal of cognitive-behavioral therapy would be to interrupt the ritualistic behavior to allow the client to experience the dissipation of the anxiety even without the application of the ritual. When the process of obsessive thoughts followed by ritualistic behavior is interrupted, the behavior ceases to negatively reinforce the anxiety, so the pattern is broken.

Cognitive therapists teach strategies and perspectives for responding to the challenges that life has to offer so that individuals can gain a greater sense of self-efficacy (i.e. developing faith in their abilities to achieve specified goals). Equally as important as knowledge, training, experience, and credentials on the part of the cognitive therapist are warmth, understanding, and compassion (Phillipson, n.d., para. 3).

Cognitive interventions for anxiety disorders are generally goal-oriented and highly structured; cognitive therapists take an active, directive stance toward the client and his or her problems (Beck, Emery, & Greenberg, 2005). The therapist will help the client identify the automatic responses to the disturbing thoughts, and the negativity associated with the thoughts. They might discuss the logic (or lack thereof) of the disturbing thoughts and identify the distortions involved in such thinking. Ultimately, the client will be taught how to challenge his or her typical thought processes.

Because the cognitive- behavioral perspective is based on the idea that people learn from reinforcement from the environment, the strategies in therapeutic application emphasize altering the pattern of reinforcement. If a response causes disordered patterns, a change in response is necessary (Phillipson, n.d.). The behaviorist approach claims all learning takes place by the organisms adaptability to change according to its environment, and changing that response alters the established pattern.

Research (Clark et al., 2003) finds cognitive-behavioral therapy effective in treating anxiety disorders. According to Phillipson (n.d.), cognitive behavioral treatment for obsessive-compulsive disorder provides the client with effective tools with which to continually manage anxiety and challenge internalized thinking. Rather than depending on a therapist for longer periods, the client can immediately learn to use the cognitive-behavioral tools. The behavioral tools are ultimately important in the client's ability to continue the management of the disturbing thoughts, and finally decrease the endless ritualizing. Nathan and Gorman (2002) found the interventions were as effective used alone as in combination with other behavioral techniques such as relaxation training.

The humanistic approach uses philosophy, existentialism, and the belief that humans are motivated toward fulfilling certain growth potential. Humanism is committed to a paradigm that emphasizes the human ability "to be consciously reflective and have the ability to experience self-determination and freedom" (Plante, 2011, p. 58). This perspective was strongly influenced by philosophy and an existential approach to psychotherapy, which became popular after World War I. Humanism embraced the human characteristic need to understand life's meaning. Thus, the individual is not considered a passive being who requires the intervention of an expert, but rather an active cognitively aware being. This notion reflects the fundamental underlying principle of humanism that states traditional schools of therapy see the approach as a treatment for illness, rather than seeing patients as active and responsible and participatory in creating and maintaining their mental and emotional states. The patient can chose to alter their mental state under appropriate conditions (Dombeck, 2006). Unlike Freud's psychoanalytic view, humanism views people as essentially good, rather than dysfunctional and bad by nature.

The goal of humanistic therapy for OCD is to create an appropriate environment by which the patient will be able to develop, mature, and evolve, and as a result continue the process in healthy development (Dombeck, 2006). I the humanistic view, psychological dysfunction is caused by an interruption in development because of social and emotional immaturity. By enabling natural development, the patient regains his or her natural ability to proceed in a healthier direction. By maintaining natural development, individuals continue along their personal life pathway, and meeting their psychological needs.

Because the humanistic approach sees the patient as an active participant, and an active cognitively aware party who has the inherent power to determine the course of life and mental disturbances, the patient is the center of the therapy. Several techniques include Rogerian humanistic therapy best known for its gentle engineering of the patients own determination of how they feel about certain topics. Alternatively, Gestalt therapists might use a more direct approach enabling patients to allow the emotional experience within the body rather than in a more limited cerebral experience (Dombeck, 2006).

One well-known Gestalt technique is known as the empty chair technique which is a visualization technique wherein the patient is directed to imagine a person in the empty chair that sits in the therapists office. By entering into a discussion with the imagined person, conflicts are more easily resolved. The goal is to allow the patient to work with the fears and emotions surrounding the issue, ultimately rendering the situation less scary whereby the patient no longer needs to avoid the other person or situation (Dombeck, 2006).

According to Whelton (2004), depth of experience in psychotherapy is positively related to outcome. In humanistic therapy, this depth is a normal expectation and one goal of its application. This indicates feelings and emotions are being processed and new more appropriate meanings are formed as well as finding solutions to problems that create fear and avoidance, and other issues that derail the natural human proclivity to evolve. There is, however, no empirical research clarifying the effective role of humanistic therapy in relieving the intrusive symptoms of obsessive -compulsive disorder.

According to Plante (2011), "prior to the 1950s most psychological treatment focused on the identified patient defined as the person regarded within the family as manifesting problematic symptoms, behaviors, or attitudes" (p. 60). Family members did not participate directly in the identified member's therapy. Neither were they considered an integral part of the recovery nor were they considered part of the problem. Later in the 1970s the family system approach became popular in clinical applications (Plante, 2011).

Family systems approaches differ from psychodynamic, behavioral, and humanistic approaches as they use the integration of the family in recognizing and treating disordered emotions and behavior. Rather than working with the individual having the specific problem, the whole family is involved in the therapy. Psychological insight provided a new platform for therapy that supported the family as an interrelated system, not a group composed of members with random, unrelated experiences. Rather than viewing the identified individual as affected by motivations exclusive of the family, this new systems saw the identified individual as a product of the family unit and "dysfunction resided in the family as an interrelated system" (Plante, 2011, p. 60).

The goal of family systems therapy is to treat the whole family and reduce the dysfunction affecting all the members, but more severely expressed by the identified family member. The issues of the identified individual are acknowledged and addressed, although within the scope of the family. As well as developing the identified individual, the system also develops each family member as autonomous and independent while re-establishing family solidarity (Plante, 2011). The system seeks a balance between the function of the group and the independent individual performance.

In family systems the therapist guides the family in assessing their needs and defining goals. Improving communication within the group is accomplished by several techniques including reframing or changing perceptions within the group, and paradoxical intention, which defines symptoms, especially those of OCD to alleviate resistance to the therapy. Joining or developing a rapport with the family allows the therapist to become more familiar with the mechanisms by which the OCD became symptomatic. Through establishing rapport with the family unit, the therapist can identify any anxiety producing relationships or psychological enmeshment between members (Plante, 2011). Furthermore, the therapist assists in the recognition of disengagement of one or more members whereby the individuals remove themselves from the family unit as a coping mechanism, in this case the symptoms of disturbed thoughts and ritualistic coping behavior. Alleviating the symptoms of OCD in one family member includes understanding the anxiety and psychological pressure the individual experiences. Identifying such issues will help to establishing new ways of relating within the family, disabling the individual's need for obsessive-compulsive behaviors.

The communication approach seeks to re-establish healthy communication within the family thereby eliminating unreasonable expectations, inappropriate rules, and inaccurate assumptions between the individuals, which may be causing the OCD symptoms. The structural approach aims to disengage dysfunctional family patterns and balance relationships, while the Milan approach establishes the therapist as an integral member of the family, providing a neutral position and garnering respect for the unit. The guidelines of all the specific techniques and strategies embrace the general assumption that the family unit contains the dysfunction causing the OCD, and issues are not exclusive to the identified individual (Plante, 2011).

Unlike the other three approaches addressed herein, family systems therapy addresses inadequacies in the family unit. Although addressing these relational issues, there is little evidence that family systems therapy is efficient as an exclusive therapy for treating OCD. Carr (2000) believes family therapy is an effective treatment "either alone or as part of a multimodal or multisystemic treatment program for child abuse and neglect, conduct problems, emotional problems, and psychosomatic problems" (p. 48) although severe symptoms of OCD requires adjunct therapy.

The major theoretical approaches are philosophies about human behavior that provide psychologists with a thematic conceptual understanding of mental health, illness, and disorder. The approaches also provide a consistent parameter by which to assess and treat the patient and a dependable plan of action in a variety of situations and patient needs. Whereas the psychodynamic perspective emphasizes the unconscious directives that influence the individual's ability to maintain normal functioning, the foundation of the cognitive-behavioral approach focuses on contemporary, measurable and observable behavior. It uses classical and operant conditioning as explanations for many types of behavior.

The humanistic approach emphasizes the natural human ability to evolve and develop and perceives people as "active, thinking, creative, and growth oriented" (Plante, 2011, p. 133) and crave self-actualization. The family systems approach views the unhealth of the individual as a consequence of dysfunction in the family, and only by creating health and solidarity within the family can the individual be freed from symptoms of mental illness.

Psychologist have become more integrating with their perspective preference and less rigid to one particular theoretical approach. Each approach has advantages for specific challenges, and some perspectives lend themselves to particular research whereas others do not. The integration of various theoretical perspectives in clinical psychology allows the therapist to afford the broadest potential for successful change within the individual. "Furthermore, as more research and clinical experience help to uncover the mysteries of human behavior, approaches need to be adapted and shaped in order to best accommodate these new discoveries and knowledge" (Plante, 2011, p. 132). The human psyche is a rich and complex maze of diverse needs and challenges, served most appropriately by an equally elaborate and divergent palette of treatments and interventions.

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Examination of Clinical Psychology

Clinical psychology's rich history spans from early Greek philosophers to Sigmund Freud, to modern psychology wherein lies a body of information drawn from science, philosophy, and other realms. Scientific exploration continues to evolve and transform clinical interventions as empirically based evidence supports the principles by which clinical psychologists treat human challenges. Although various distinctions exist between clinical psychologists and other psychological disciplines, all endure to promote a better quality of life from and for the human spirit (James & James, 1991).

The History of Clinical Psychology

Long before Lightner Witmer opened his clinic in 1896 and coined the term clinical psychology, history provided remarkable developments, each providing a steppingstone for new scientific and medical exploration. Greek history provided a rich background in the sciences when early Greek thinkers recognized the interconnectedness of the mind and body and the influence this relationship had on illness. Hippocrates, Plato, and Aristotle saw the "spirit or soul as being in charge of the body and that problems residing in the soul could result in physical illness" (Mora, 1985 as cited by Plante, 2011, p. 34). During the Middle Ages mental and physical ailments were considered a breach in character, and consequently healing disease and insanity became an issue of the spirit. Later the Renaissance brought a return of scientific exploration, rendering supernatural and religious viewpoints unscientific. Biomedical reductionism established illness was more accurately understood by scientific observation and experimentation rather than spiritual and metaphysical beliefs (Plante, 2011).

In the nineteenth century, Sigmund Freud and his colleagues began to have a more articulate understanding of the mind/body connection which "reawakened the notion that a more holistic view of health...was necessary for a fuller understanding of health, illness, and abnormal behavior" (Plante, 2011, p. 46). Freud theorized unconscious directives exert powerful influence on health and well-being, recalling the early Greek philosophy of the inextricable connection between the mind and body (Parsons, 1958). Freud's psychoanalytic thinking inspired the need to accommodate individual demands, which remains central to contemporary clinical psychology (Brown, 1940).

The birth of psychology came with the development of the first laboratory established by Wilhelm Wundt in Germany in 1879, and exerted into prominence with the 1890 publishing of William James' Principles of Psychology. Shortly thereafter, the newly founded APA elected G. Stanley Hall as its president. Although the new idea of applying psychological principles to human ailment was not initially well received by his professional colleagues, Witmer opened his clinic in 1896, and provided a venue for such application (Plante, 2011). Both World Wars played a significant role in the need for clinical psychologists, first in developing psychometric assessments, and later to provide services to more than 40,000 veterans hospitalized for psychiatric reasons. Conferences at Boulder, Colorado in 1947 and later at Vail Colorado in 1973, supported the development of new models of clinical training and guidelines for the education of clinical psychologists. In 1977, George Engel created the biopsychosocial model of treating mental illness, which suggested physical and psychological illnesses have biological, psychological, or social components that must be understood to provide effective treatment (Plante, 2011).

Clinical Psychology's Evolving Nature

Clinical psychology has an intrinsic mechanism that creates its ongoing evolving nature, defined by its association with modern medicine and its use of the scientific method (Kazdin, 2008). As the high-tech standards of modern medicine and neuroscience continue to unearth new discoveries about the human brain and its connection to thought and behavior, clinical psychology evolves its applications according to new empirical evidence. "Central to this evolution has been the titanic human struggle to understand abnormal behavior in the context of the mind and the body" (Plante, 2011, p. 31). Contemporary clinical psychology embodies the scientific advances of science while incorporating a deeper understanding of the human psyche, and even the spiritual nature of humanity, which is enveloped in the context of the evolving human condition. As research and practice unite to provide continued improvement to patient care, the relationship between the two is an essential component to its evolving nature (Kazdin, 2008). According to Kazdin (2008), one of the conundrums between clinical psychology and research is the clinician's best effort to "tailor treatment to meet the needs of individual patients" (p. 17) when such individuality has no defined protocol supported by empirical research.

The Role of Research and Statistics in Clinical Psychology

At the foundation of clinical psychology is research, which provides answers to questions by which the science continues to actively learn, and from where it derives its evolving nature. Statistics, as part of the scientific method allows researchers to determine whether information is significant and applicable to wider populations. Research is an essential component of clinical psychology because it augments therapeutic applications, improving the quality of life for many individuals and determines more effective ways to diagnose, treat, and understand human behavior (Plante, 2011). Using the scientific method and statistically significant evidence, clinical psychologists develop critical thinking skills, which benefit both research and clinical settings, and gain knowledge, which precedes the ability to design effective treatments. According to Plante (2011), "research is fundamental to both the science and practice of clinical psychology" (p. 106). Evidence substantiated by statistical significance allows clinicians to apply proven therapies and theories confidently, knowing their work is corroborated by the dependable and reputable methods of science (Plante, 2011).

Although there are different ways to design experiments and research, each method has unique advantages and disadvantages, but all seek to effectively and scientifically study important issues without bias. One of the most challenging goals in psychology is ethically studying issues that translate into practice in a clinical setting. Effective clinical psychologists maintain current knowledge of research in their work with patients, knowledge without which, relegates psychological practice to the common anecdote. The future will undoubtedly include higher technology and more refined answers pertaining to the connection between the mind and the body but will most likely continue to "integrate methods and knowledge from disciplines such as medicine, sociology, and epidemiology" (Plante, 2011, p. 106).

Clinical Psychology as it Differs from Other Disciplines

Differences between clinical psychology include specific training and focus, and may require different graduate degrees. School psychologists typically have master's degrees and work in elementary, secondary, or special education programs or maintain private practice, and their primary focus is working with students and their families (Plante, 2011). Social workers, like school psychologists typically have a master's degree and provide direct services to clients in clinical settings that may include schools, hospitals, clinics, and private practice. A common focus (but not necessarily the only one) for social workers is often following and managing individual case studies (Plante, 2011). Training for social work involves less emphasis on the biological components of illness and their influence on behavior as well as less attention paid to research.

Counseling psychology is similar to clinical psychology and many believe there is no need for the two separate branches (Kinderman, 2009). Psychiatrists are physicians with special training in psychiatric medicine usually during medical internship and have an extensive training in the biological basis of behavior and behavioral problems. Other mental health care professions such as psychiatric nursing, counseling specializations, and occupational therapy, offer clinical services similar to those offered by school psychologists, psychiatrists, and social workers. Although clinical psychologists differ in some respects from other mental health-related professions, each discipline aims to "use the principles of psychology and [the] understanding of human behavior to promote health, happiness, and enhanced quality of life" (Plante, 2011, p. 27-28).

Conclusion

Many factors contributed to the genesis of clinical psychology as an independent discipline. Its evolution has been continual with a constant influx of new scientific information in biology, chemistry, physics, and technology. The contributions of Freud and psychoanalytic thinking inspired the notion of individuality in therapeutic design, which continues as a fundamental underpinning to clinical psychology. Although clinical psychology maintains differences with other psychological disciplines, the existence of the mental health-related professions embrace a primary aim to accommodate the psychological needs of humankind and provide a realistic and enduring ability to thrive, tailored empirically for the human spirit.

References

Brown, J. F. (1940). Freud's contribution to psychology. American Journal of Orthopsychiatry, 10(4), 866-868. doi: 10.1111/j.1939-0025.1940.tb05757.x

James, J., & James, M. (1991). Passion for life: psychology and the human spirit. New York, N.Y.: Dutton.

Kazdin, A. E. (2008). Evidence-based treatment and practice: new opportunities to bridge clinical research and practice, enhance the knowledge base, and improve patient care. American Psychologist, 63(3), 146-159. doi: 10.1037/0003-066X.63.3.146

Kinderman, P. (2009). The future of counselling psychology: a view from outside. Counselling Psychology Review, 24(1), 16-21.

Parsons, T. (1958). Social Structure and the Development of Personality: Freud's Contribution to the Integration of Psychology and Sociology. Psychiatry: Journal for the Study of Interpersonal Processes, 21, 321-340. doi: 10.1037/11302-002

Plante, T. G. (2011). Contemporary clinical psychology. Hoboken, NJ: John Wiley & Sons.

Welwood, J. (2000). Toward a psychology of awakening: Buddhism, psychotherapy, and the path of personal and spiritual transformation. Boston: Shambhala.

Issues in Psychological Testing

What are at least two ethical issues associated with psychological testing? What impact do these issues have on the field of psychological testing?
One ethical issue is the use of informed consent. An essential component of psychological testing is obtaining voluntary consent to the assessment. The client must be informed about the purpose, expected duration, and any procedures used in the testing, and ascertain the client understands every aspect of giving consent (American Psychological Association, 2010). If the client is a child, or an individual of limited capacity, the parent or legal guardian must give consent for the client. The idea of informed consent is a continuing agreement, and clients may withdraw their consent at any time during the testing (Hogan, 2007). According to the American Medical Association (2011), informed consent is a process of communication between a patient and a health care professional that results in the patient's authorization or agreement to undergo testing. Furthermore, patients or clients have a right to full disclosure of test results, which must be accommodated in language reasonably understandable to them.

Maintaining confidentiality is another significant issue associated with psychological testing, and the psychologist is bound by ethical codes to refrain from referring to a patient's results outside of the appropriate context (Hogan, 2007). Furthermore, regarding confidentiality in record keeping, psychologists must maintain records efficiently, securely, and effectively so results are not prone to dissemination by other inappropriate parties. In most states, confidentiality is upheld by law. However, responsibility toward confidentiality is waived when harm to self or others is suspected (Hogan, 2007).

Both issues are of significant consequence to psychological testing. Without codes of, and specific adherence to ethical behavior, the science of psychology cannot be counted upon as a scientific discipline worthy of protecting and effectively supporting the myriad challenges of the human condition. Individuals and the whole of the human race depend upon ethical judgment, treatment, and applications formed by scientific exploration rather than the common anecdote. Because the rights of individuals should be a primary concern in any psychological discipline, equally consequential is maintaining confidentiality. Without protecting these fundamental rights, the science cannot present itself as adequately and fairly preserving and supporting the private attempt of every individual toward achieving and retaining a more positive quality of life.

2. What are at least two legal issues associated with psychological testing? How do these issues affect the field of psychological testing?
One major issue that continues to cause problems with psychological testing is discrimination and the idea that some testing infringes upon the rights of individuals of a particular race or ethnicity (Hogan, 2007). The EEOC guidelines were "intended to establish a uniform Federal position in the area of prohibiting discrimination in employment on grounds of race, religion, sex or national origin" (29 C.F.R. § 1607.18 as cited by Hogan, 2007, p. 606). By law, psychologists cannot apply tests or any other type of selection procedure that may result in unfair discrimination or adversely impacts a favorable ratio of the sexes, races, or ethnic groups. Psychologists may be called upon to support the use of specific testing, and demonstrate the test's validity and job relevance, and whether it is necessary to address the individual's capability for functioning as it supports the operation of the business (Hogan, 2007).

Another issue of legality concerns making appropriate accommodations for Americans with disabilities. According to the Americans with Disabilities Act of 1990, necessary accommodations must be made for any person who cannot conform to normal test-taking protocols (Hogan, 2007). Examples of such accommodations include effective ways to mitigate difficulties of the hearing impaired, or providing tests in large print editions for individuals with sight impairment. Making appropriate accommodations for disabilities is essential, although not to the extent of giving the disabled individual an unfair advantage over the other nondisabled applicants (Hogan, 2007). Ongoing efforts continue to provide a better understanding of how accommodations are best navigated and executed for the benefit of disabled and nondisabled Americans.

Both issues present difficult challenges to psychological testing. Leveling the playing field must account for fairness for both sides of the discrimination issues. Certainly it is neither fair nor ethical to treat one group less fairly than another. Laws regarding these issues are implemented for the protection of all citizens, and psychologists are mandated by law and expectedly their personal ethics, to continue to contribute higher order thinking to mitigate remaining issues of discrimination. The field of psychology and that of psychological testing must be held accountable for the highest level of ethics and legal fairness.

3. Which court case do you feel has had the largest impact on the field of psychological testing? Why?
One case that brought substantial change to psychological testing and gave influence to the recently formed Civil Rights Act of 1964 was the Griggs v Duke Power case in 1971 (Hogan, 2007). Even though this case was not unusual, it happened during a time when initial progress was being made in this country for African Americans. Although the Civil Rights Act had been enacted seven years prior, there was continued discrimination against the African American population. (Note: African Americans were still referred to as Negroes.) Also influential was this case transpired in the southeastern part of the United States where slavery was a significant problem with long-term ramifications extending further into contemporary conditions than experienced in other parts of the country. This case set a precedent for African Americans, women, and other minorities, for fairness in hiring, and established that the requirements of the job must reasonably associate with job performance (Hogan, 2007). This case designated legal standards, requiring the validation of tests, or in other words, must show "a relationship between the selection device and job performance" (Hogan, 2007, p. 610). In sum, the court ruled the requirements of the company did not pertain to performance ability, and even though unintentionally, the company had discriminated against African American employees (Tobler, 2005). Discrimination even as it continues in the United States must be addressed through legal means, if necessary. Discrimination negates the fundamental and inalienable rights and privileges of all people and the Constitution of the United States. It is essential for anyone in the psychological disciplines to uphold and support the continual fight against any form of discrimination.

References

American Medical Association. (2011). Informed consent. American Medical Association. Retrieved July 24, 2011, from http://www.ama-assn.org/ama/pub/physician- resources/legal-topics/patient-physician-relationship-topics/informed-consent.page

American Psychological Association. (2010). Ethical Principles of Psychologists and Code of Conduct. American Psychological Association (APA). Retrieved July 24, 2011, from http://www.apa.org/ethics/code/

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Psychological Measure: The BDI

The Beck Depression Inventory (BDI), the creation of Aaron T. Beck, is one of the most widely used tests for assessing depression. The BDI is a reliable multiple-choice self-report inventory, for the purpose of assessing the presence and severity of depression (Beck, Ward, Mendelson, Mock, & Erbaugh, 1061). The following articles address the use of the BDI in a variety of circumstances including alcohol dependency and with young girls between the ages of nine and 13. In both populations the BDI-II and the BDI-Y provided both valid and reliable results. The test is easy to use and can be administered by individuals with a minimal amount of training. Accounting for the complex nature of co-morbidities in any substance dependency, and for children between the ages of nine and 13, the BDI-II and the BDI-Y are assessments sufficient for the initial determination of depression and its severity for the two distinct populations measured.

Articles Discussing the Beck Depression Inventory

Using the BDI in Alcohol-dependent Populations

McPherson and Martin (2009) studied the use of the BDI in an alcohol-dependent population and found 80% of people with alcohol dependency experience clinical symptoms of depression. There is often confusion on how to treat someone who is depressed and dependent on alcohol, although the recommended treatment is a combination of pharmacology and psychotherapy as well as educating the individuals and their families (McPherson & Martin, 2009). The BDI was first created to assist in evaluating the progress of treatment, but later used to determine whether individuals were depressed or not depressed. McPherson and Martin (2009) claim “these characteristics and the recurring factors in a range of studies highlighted led to a conclusion that the BDI is a rational choice as a screening instrument for depression in an alcohol-dependent population” (p. 28).

Considering the reliability and validity of using the BDI, McPherson and Martin (2009) claim “an initial literature search carried out for this study shows research into its use with an alcohol-dependent population is scarce” (p. 20). Test-retest reliability shows stability of a test over time and the study by McPherson and Martin (2009) demonstrated reliability. Using internal consistency to confirm test items are consistent with each other, the internal correlation retained its consistency in an alcohol-dependent population. In sum, the BDI is a reliable and valid measure of depression in this population.

Using the BDI in a Sample of Girls

In 2007, the Beck’s Depression Inventory for Youth (BDI-Y) was used in a study involving girls ages nine to13. The ethnic background of the girls varied with roughly five different ethnicities included (Stapleton et al., 2007). The BDI-Y measured different domains of anxiety, depression, and self-concept. The depression inventory asks for responses about negative self perspective, generally negative world views, lack of hope, and average emotional and other symptoms of depression (Stapleton et al., 2007). The BDI includes 20 questions in the inventory and the questionnaire is formulated for the reading level of second graders. The questions have a negative connotation. The girls in the study answered each question with responses of never, sometimes, often, or always, depending on how closely the question related to them. Upon completion, tests were scored determining the presence and severity of depression.

The results of the study demonstrated the effectiveness of the BDI-Y. "Predictive validity of the BDI-Y was supported, as the mean score of girls eventually diagnosed with depression was higher than that of girls who did not receive a diagnosis of depression" (Stapleton et al., 2007, p. 232). Furthermore, it demonstrated the BDI-Y as both reliable and valid in a variety of ethnic backgrounds, as the results did not vary because of this variable. Reliability was slightly off in regard to age because the results of the BDI-Y varied marginally when compared the Children’s Depression Inventory, only for the nine-year-old girls, however. Because of this, further research is recommended to test the effectiveness of the BDI-Y for girls ages seven to eight. This test is designed for youth ages seven through 18. Another consideration is to include both positive and negative words on the test to determine if this would produce different responses (Stapleton et al., 2007). The Children's Depression Inventory makes use of both types of wording, which varies from the BDI.

Uses of Beck Depression Inventory

The BDI-II is designed for adults and adolescents over the age of 13. Beck designed the inventory as a screening tool, although it is used by many health care professionals to ascertain a more immediate diagnosis (Sharp & Lipsky, 2001). According to McPherson and Martin (2010), the BDI-II is both reliable and valid for use in detecting depression and changes in depression in a variety of populations, and furthermore, an effective screening tool for alcohol-dependent populations (McPherson & Martin, 2010). Research (Luty & O'Gara, 2006) suggests further study into the areas of addiction and dependency and the use of the BDI-II. Other research (Buckley, Parker & Heggie, 2001) has determined the BDI-II is valid in addiction research and research concerning alcohol-dependent individuals. McPherson and Martin (2010) claim depression can be "expressed as either a primary or secondary component" (p. 22) and central to primary depression are mood issues, although in secondary depression other problems such as alcohol dependence are of issue, and central to the depression. Understanding the issues associated with depression, and the multiple causalities contributing to this disorder, help to explain why the BDI-II can effectively be used in populations with depression even with a variety of causalities. The BDI-Y is a reliable and valid measure for young girls ages nine to 13 with more research suggested for the its application to seven and eight-year-olds (Stapleton, Sander, & Stark, 2007). As measured against the Children's Depression Inventory, the BDI is valid and reliable for the ages and ethnic backgrounds accounted for in the research.

Qualifications for Administration and Interpretation

The goal of Beck’s cognitive therapy is to help people develop realistic appraisals of the situations they encounter (Beck, 1991). The therapist acts as trainer and co-investigator, providing data to be examined, and guidance in understanding how cognition influences behavior (Beck & Weishaar, 1989). The BDI-II and the BDI-Y can be self-administered, although the scoring and measurements may not be as easy to interpret for self-administration. In a clinical setting the test can be administered and scored by a paraprofessional, although the interpretation of the final scores requires a professional with clinical training and experience (Smith & Erford, 2001). The scoring for both BDI assessments is dependent on those who have been diagnosed with depression and scores vary by population.

The interpretive ranges of the test are 0 to 13: minimal depression, 14 to 19: mild depression, 20 to 28: moderate depression, and 29 to 63: severe depression (Polgar, 2011). The BDI has been tested over time for its validity as it was constructed by clinicians and experts on depression among psychiatric patients. The BDI has been tested for reliability and has followed all testing standards for psychological testing since 1985. Internal consistency has been demonstrated in more than 25 studies in varied populations. The BDI has been shown to be valid and reliable and resulting in corresponding ratings of depression in more than 90% of cases (Polgar, 2011). The BDI would be appropriate to use for individuals already experiencing symptoms of depression and is best used in cases in which a patient is already undergoing counseling or treatment.

Populations for Valid and Invalid Use

The test served as a self-report assessment accurately demonstrating the severity of depression symptoms in each group. According to McPherson and Martin (2010), the test shows 80% of the alcohol-dependent population have co-morbidities including depression. The BDI-II is useable for alcohol-dependent populations with the caveat that more research on addictive and substance-dependent populations is necessary. Regarding the BDI-Y on the girl's group, the test is reliable and valid except for the group of seven to eight-year-old girls. Furthermore, the test was reliable and valid across the five ethnic groups represented in the study (Stapleton, Sander, & Stark, 2007). More research is necessary for the younger age group (ages seven to eight) to further examine reliability and validity. The BDI-II is a valid and reliable psychometric evaluation for measuring the presence and severity of depression and is designed for individuals over the age of 13. The BDI-Y is preferable for children under the age of 13, and as advised by Stapleton, Sander, & Stark (2007), caution should be used in children under the age of nine. Although more research is suggested for populations with substance dependency, the BDI-II is an accurate and reliable measure of depression's severity and its changes over time in a clinical setting.

According to Hersen (2004), there have not been adequate norms for diverse ethnic groups. The majority of psychometric studies on the BDI-II have used Caucasians. Although some population-specific norms have been created for the BDI, more appropriate norms for the variety of ethnic groups are needed (Hersen, 2004). Regarding the BDI-Y, Hersen (2004) claims there is insufficient published data on this inventory other than the reports contained in the test manual.

Conclusion

The BDI-II "has had an enduring legacy in psychiatry as a measure for depression" (McPherson & Martin, 2010, p. 27) and is effective for measuring depression and its changes over time (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961). Depression has a variety of co-morbidities, and the use of the BDI-II depends on contemporary empirical evidence supporting its use in a variety of populations. Research supports using the BDI in alcohol-dependent and other addictive groups (Buckley, Parker, & Heggie, 2001; McPherson & Martin, 2010; Sharp & Lipsky, 2001) and for young girls between the ages of nine and 13 from various ethnic backgrounds (Subramaniam, Harrell, & Huntley, 2009).


References

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Beck, A.T. & Weishaar, M. (1989). Cognitive Therapy. Comprehensive Handbook of Cognitive Therapy. New York: Plenum

Buckley T.C., Parker J.D. & Heggie J. (2001) A psychometric evaluation of the BDI-II in treatment-seeking substance abusers. Journal of Substance Abuse Treatment 20, 197– 204.

Hersen, M. (2004). Comprehensive handbook of psychological assessment. Hoboken, NJ: Wiley.

Luty, J., & O'Gara, C. (2006). Validation of the 13-Item Beck Depression Inventory in alcohol- dependent people. International Journal of Psychiatry in Clinical Practice, 10(1), 45-51. doi: 10.1080/13651500500410117

McPherson, A. A., & Martin, C. R. (2010). A narrative review of the Beck Depression Inventory and implications for its use in an alcohol-dependent population. Journal of Psychiatric & Mental Health Nursing, 17(1), 19-30. Doi:10.1111/j.1365-2850.2009.01469.x

Polgar, M. (2011). Beck Depression Inventory. In Encyclopedia of Mental Disorders. Retrieved July 30, 2011, from http://www.minddisorders.com/A-Br/Beck-Depression-Inventory.html

Sharp, L. K., & Lipsky, M. S. (2001). Screening for depression across the lifespan: a review of measures for use in primary care settings. American Family Physician, 66(6), 1001-1008.

Smith, C., & Erford, B. T. (2001). Test review: Beck depression inventory - II. Association for Assessment in Counseling. Retrieved July 30, 2011, from http://aac.ncat.edu/newsnotes/y98fall.html

Stapleton, L. M., Sander, J. B., & Stark, K. D. (2007). Psychometric properties of the Beck
depression inventory for youth in a sample of girls. Psychological Assessment, 19(2), 230-235. doi: 10.1037/1040-3590.19.2.230

Subramaniam, G., Harrell, P., Huntley, E., & Tracy, M. (2009). Beck depression inventory for
depression screening in substance-abusing adolescents. Journal of Substance Abuse Treatment, 37(1), 25-31. doi: 10.1016/j.jsat.2008.09.008