HD 3700 1st Edition Lecture 9 Outline of Last Lecture I. Freud and the dynamic mindII. Case Study: JoeIII. Compromise formation in the formulation of “Fat Lady”Outline of Current LectureI. Projectives and Self-ReportsII. “Joe’s” Psych Testing ReportIII. Shedler and Defensive Mental HealthIV. Class DataCurrent LectureI. Projectives and Self-Reports- A psychologist comes to do a testing…what’s in her bag?o IQ test—Weschsler Adult Intelligence Scaleo MMPI—yes/no questions, computer scoredo Hamilton Depression Rating Scale—structured interviewo TAT—projective, pictures that prompt narrativeso Rorschach Test—projective, series of inkblotso 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 unconsciouso 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 scoreso 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 testingo High IQ scoreso Lower scores on Coding, a subtest known to be sensitive to high levels of anxietyo Self reports: indicate high levels of anxiety and low but significant levels of depressed moodo 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 self-concept, locus of control, and his family relationships. o It is possible that fear of success, perhaps because of his fear of woundingmember 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- Datao BDI scoreo Physiological measures of stresso Early Memories Test, scored by clinicians/then by students- Main findingso For many subjects: low BDI/low stress/positive memorieso For some subjects: high BDI/high stress/negative memorieso For a subset: low BDI/high stress/negative memorieso This third group is displaying “Defensive Mental Health” Couldn’t recognize their depression on BDI This is the group self-report measures will misso He found the limits of self-report measuresIV. 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 Checklisto A demographics form (self-report) More females Mostly wealthy/upper middle classo 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 depressiono 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 positiveo 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 Analysiso 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.)o The highlighted area shows you which variables predict depression at a significant level (for significance, look at the column on the right)- Resultso Both projective measures significantly predicted CESD depression totals Early