HD 3700 1st Edition Lecture 9 Outline of Last Lecture I Freud and the dynamic mind II Case Study Joe III Compromise formation in the formulation of Fat Lady Outline of Current Lecture I Projectives and Self Reports II Joe s Psych Testing Report III Shedler and Defensive Mental Health IV Class Data Current Lecture I Projectives and Self Reports A psychologist comes to do a testing what s in her bag o IQ test Weschsler Adult Intelligence Scale o MMPI yes no questions computer scored o Hamilton Depression Rating Scale structured interview o TAT projective pictures that prompt narratives o Rorschach Test projective series of inkblots o Why the objective wing hates projectives Patients don t answer them the same way Their data can t be easily quantified The data only captures one moment in time Data can be misinterpreted over interpreted by the tester Used by psychodynamic clinicians who rely on out moded ideas of the unconscious o Why the projective wing hates objectives Patients are forced to answer complex questions on a 4 or 7 point rating scale Patients can t refine the questions or qualify their answers The data doesn t convey anything idiosyncratic or personal about the patients That data relies on the patient to be truthful It is uses by cognitive behavioral clinicians who measure success by lower numbers on self report depression scores o The Rise of the Objective Wing 50 s and 60 s the projective wing ruled psychology Cognitive revolution in the 70s began to build an empirical understanding of the mind The rise of the objective wing has led to Rejecting the use of projective tests and not teaching them to new clinical students Leaving Freud out of the curriculum Emphasizing only objective tests Teaching only empirically validated manualized psychotherapy techniques An emphasis on the here and now as opposed to an interest in the childhood of patients and their unconscious II Joe s Psychological Testing Joe came to counseling complaining of an inability to study even though he insisted he was highly motivated Maintained excellent focus throughout the psychological testing o High IQ scores o Lower scores on Coding a subtest known to be sensitive to high levels of anxiety o Self reports indicate high levels of anxiety and low but significant levels of depressed mood o TAT three stores of character feeling guilty for making others feel inferior In one story a boy wins a race only to see his grandfather have a heart attack in the stands o These stories as well as his responses to several Rorschach cards as animals who were beaten up cause they lost a fight suggest that there may be some anticipated guilt for school success o Perhaps his anxiety has to do more with succeeding than with failing even though his fear of failure brought him to CAPS in the first place o Continuing psychotherapy is recommended with an emphasis on his selfconcept locus of control and his family relationships o It is possible that fear of success perhaps because of his fear of wounding member of his family by doing so is generating sufficient anxiety to inhibit his school work even if he is unaware of the reasons why o A supportive psychotherapy may well help Joe to become more aware of the factors contributing to his poor school performance as well as his general anxiety and depressed mood III Shedler and Defensive Mental Health His aim to show empirically the limits to self report depression measures specifically BDI Data o BDI score o Physiological measures of stress o Early Memories Test scored by clinicians then by students Main findings o For many subjects low BDI low stress positive memories o For some subjects high BDI high stress negative memories o For a subset low BDI high stress negative memories o This third group is displaying Defensive Mental Health Couldn t recognize their depression on BDI This is the group self report measures will miss o He found the limits of self report measures IV Class Assessment Data Here s what you filled out demographics CES D Early Memory Test one item from the Narrative Completion Test and an Early Life Events Checklist o A demographics form self report More females Mostly wealthy upper middle class o The CES D measuring depressive symptoms in the past week self report I felt as good as other people Rarely 45 Some or a little of the time 35 Occasionally 15 Most of the time 5 I thought my life had been a failure Rarely 75 Some or a little of the time 15 Occasionally 10 The class rarely reports feeling depressed even if their other answers clearly show depressed mood I felt depressed Rarely 60 Some or a little of the time 25 Occasionally 15 Most of the time 5 I felt lonely Rarely 40 Some or a little of the time 35 Occasionally 15 Most of the time 5 In a relationship 30 in a relationship 70 single CES D Summary Scores 31 of the class meets criteria for mild depression 23 of the class meets criteria for clinically relevant depression o Early Memory Test asking for your earliest memory of mother a projective 1 negative memory 2 neutral memory 3 positive memory Results 45 of the memories were negative 15 of the memories were neutral 40 of the memories were positive o One item from the Narrative Completion Test a projective 25 were negative 15 were neutral 60 were positive o Early Life Events Checklist a self report Nearly 33 of you have experienced one of the following Parents have marital problems Parents separate Parents divorce Parent loses job Parent dies Step parent dies Parent abuses substances Parent in trouble with the law Death of a sibling Friend ill or injured Friend dies But less than 17 of your parents have gotten divorced Regression Analysis o o To see which data predict overall depression summary scores the variables are put into a statistical model called a regression The regression allows us to measure mathematically the power of each of the variables to predict the overall depression the dependent variable The highlighted area shows you which variables predict depression at a significant level for significance look at the column on the right Results o Both projective measures significantly predicted CESD depression totals Early Memory of Mother and Narrative Completion Test predicted depression o If we add this year s assessment to the eleven previous years bringing the total number of students to 2 623 the more participants the more statistical power we find that both projectives predict self report depression with the Early Memory at 01