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Testing and Therapy Concept Map (Testing (Tools in for Psychology…
Testing and Therapy Concept Map
Therapy
Outreach in Therapy
Cultural
Crossing Cultural Obstacles
Always the therapist's responsibility, never the client's
Matching Therapist to Client
Ms. R sought a feminist therapist
Many cultures have a stigma around mental health that makes people afraid to talk about their problems or feel to embarrassed to see a therapist
England is experimenting with No-Cost Talk Therapy, where people may call or email, and either recieve low-intensity talk therapy over the phone or come in for more extensive face to face therapy. Many people who were too ashamed to talk about their mental health did feel comfortable discussing it over the phone, and the program is overwhelmed with the number of people utilizing their service
Ethnic minorities underuse therapy and tend to drop out of treatment more
Economic
Lots of bias, psychologists don't want to work with poor
The impoverished actually do have just as much need for and interest in therapy as the other classes, saying otherwise seems like an excuse for biased psychologists
Psychology has been sloppy in objectively defining social classes
Classism is one way - the disenfranchised don't have the power to exert biases in the form of oppression
1960's: Saw the rise of the Community Mental Health Center (CMHC) movement. Promised get therapy for every social class. Research done at the time showed therapists saw the poor as hostile and accepted upper class into treatment far more often. They didn't think the poor could benefit from it and dropped out too much to be worth the effort.
70s: CMHCs opened, were new and more cuturally savvy, said that with therapists biases, of course the poor didn't want to come. But those biases were the therapists' problem, not a reason to not treat people.
Giving different treatments to poor open it up to bias and discrimination
Feminist psychology and family systems were the most accepting
Therapists afraid of relating to poor people, don't want to identify with them in the ways necessary for building alliance
The poor still have human needs, on top of trying to eat and shelter (contrary to popular belief) still need human compassion
Gender-related issues
Women may feel more pressure to sacrifice their self for harmonious relationships, leading to depression
Women economically unable to leave dysfunctional relationship, stay trapped in unhappiness, leads to female depression. Divorced women with dependent children may become impoverished
Success in Therapy
Alliance
Being tough on patients can be empowering - shows that you know they can handle it. Tiptoeing around them may make them feel like they can't
Emotional intimacy really sealed the deal for Yalom/Elva's alliance, when they went through her purse. He described it as the best hour of therapy he ever had.
Alliance may be most important factor in success of therapy
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Shown by teamwork in working toward common goals and building personal rapport between them
Counterargument that choosing the right therapeutic style may lead to better alliance, but the research supports effectiveness of alliance independent of treatment style
Cultural effects in alliance
Must be wary of cultural miscommunication/misunderstanding; may be that cultural differences can impede alliance if incorrectly handled
By APA Ethics, psychotherapists can only take on patients they are capable of working with - if it goes outside the realms of their competence, they don't take the client on. But, being unaware of cultural differences, may not recognize own incompetence
Therapist should give client opportunity to express negative feelings, otherwise they may hide them out of fear of rejection
POC are slighted so often they may be constantly editing how they respond
Research isn't unified, but clients tend to be more comfortable when therapist is the same ethnicity
Microaggressions happen, even from well-meaning therapist, must not abuse position of power
Stereotype threat happens, history of psychology mistreating PoC may lead client to pick up of negativity or rejection when therapist does not intend it
Modern racism is subtle - negative body language, less eye contact, therapists must be aware
Therapists may miss empathetic moments by not realizing the significance, happen more often when therapist and client are from different groups
No one exists outside of culture. All impacted
Culture and race may impact different treatment styles differently
Cognitive psych may need to account for cognitive effects of racism
Some cultures may be more comfortable with egalitarian vs. authoritarian styles, and vice versa
Nonracism in whites starts by accepting racism
Personal traits good for alliance: flexible, respectful, warm honest
Emotion
Vulnerability
Vulnerable Therapist
Therapist must be vulnerable and open to acknowledging their own feelings to be aware of countertransference, biases, and in psychoanalysis, understanding why the client makes them feel that way
Hindrances to vulnerability
Shame causes disconnect: if you're ashamed of something, you think that if others find out, you aren't worthy of that connection
When you feel ashamed of a thing, you talk about that thing less - leads to more shame. Predatory circle. Only way to break it is to open up about thing you are ashamed of - be vulnerable
Feling that you're not good enough for that connection
Elva's irrational 'specialness' from years of being taken care of by her husband and social class. Felt invulnerable
Ellis' explanation for underlying thought processes in REBT was that people think they must be terrible for not living up to perfect standards, then feel ashamed and hide that, so no one will know how imperfect they are, and that leads to their problems
Aids to Vulnerability
A sense of worthiness, being worth love and belonging.
Seeing vulnerability as a good thing
Vulnerable Client
Elva finally became emotionally vulnerable when Yalom pointed out that the purse snatching proved that her husband was reall gone, broke down crying instead of usual snapbacks.
Can't divide up the emotions - bring out good, suppress bad. Can't be happy and open while hiding vulnerability and shame
Counter transference
Yalom in Elva's case had to handle negative emotions about his mother brought up by Elva's mannerisms
Benefits of Emotion: A system of usefulness and meaning
Emotions aren't secondary to thinking, but are an important part of human functioning in their own right. They help functioning, don't impede it like we assume. Helps us make decisions
Help us adjust to circumstances that are always changing
Communicates to what extent our needs are being met
Network of memory, information for emotional stimuli and information related to that. Higher order.
Forms schemas, a framework to help us interpret the world
We actively form/interpret our reality, emotions guide that process
Can have adaptive visceral effects even in higher order, like a pit in your stomach when you see an ex.
Research supports using emotion-focused therapy as a treatment for depression
Types of Emotion:
Low Road: Instant and primal. Adaptive bc quick response. Initiated when amygdala is active
High Road: Slower, goes through cortex, more thought out
Theories on Emotional Change:
Dialectical Constructivist:
We construct our reality as we go, constantly changing orginization systems,
Two types of memory
1: Factual, explicit
Emotional, procedural
Transforming Emotion:
Can use emotion to change emotion
Experiencing joy can undo negative emotions
Using motor manipulation (like changing facial expression), can increase emotions that go with that action, or decrease those that go against it
Therapy can then change maladaptive emotions (shame) into adaptive emotions (anger)
Changing Emotion Schematic Memory
Somatic information: when the feelings are stored with the memory
Memory changes each time it is recalled, can be reconsolidated in a different form
Implications in Therapy:
First, bring up the emotion. Then can change it to be more adaptive. Two options:
Help clients feel their feelings
Seems best to encourage reflection
Distract clients while the feelings are brought up
Traits of Emotional Change
Awareness of emotion
Safe expression
Ability to regulate emotion
Reflect on emotions
Transform the emotion
Correct old feelings
Overcoming cultural differences
Success of Types of Therapy
Style may not matter as much as the intention to be therapeutic
The way ___ frames his clients problem may not matter as much as the fact that he and the client agree it is a plausible frame, and use that to get to the heart of the matter
Examples of diverse, successful healing practices
Peter: Native American man struggling with alcohol and suicidal thoughts does a sweat and forms a bond with the traditional healer. His symptoms are lessened and he can resume normal life.
Susan has abdominal pain, goes to see doctor, finds out she has an ulcer. She is treated with antibiotics and a proton pump, and feels better.
Serena has anxiety, goes to see a psychologists, they discuss the loss of her father and process her grief. She feels better.
Willhelm is hedonistic but lonely, goes to church, starts a connection with the minister and starts his life anew as an evanglical
James is lethargic and doesn't feel happy, is prescribed an SSRI, feels better.
Pat has PTSD, goes through cognitive behavioral treatment (CBT), does the relaxation, restructuring, and exposure, feels better
Three main systems of explanation:
Psychological
Cognitive-Behavioral Treatment
Experiential Treatment
Religious/Spiritual
Biological
Antidepressants
Philosophically materialist, only things with matter are important. Assumes underlying physical reasons for illness, like chemical imbalance in the brain
Antibiotics
Types of Therapy
Psychotherapy
Family Systems
Looks at problem in context of family structure
Useful in identifying family patterns holding women in place in dysfunctional families
Not focused an individual being the problem, but looks at whole system. In Ms. R case, made sure no one family member was blamed for overarching system
Behavioral Therapy
Covert Sensitization: Unwanted behavior paired with an unpleasant image, to prevent that behavior
Case of Reverend X
Used on Reverend X to get him to think about the negatives of his paraphilia that he had been rationalizing away or blocking out.
Involved visualization of his pedophilic urges paired with intensely unpleasant stimuli
Rather than explicitly tell client what they need to change, use visualizations and subtle questioning to get him to realize what is wrong
Cognitive-Behavioral Therapy (CBT)
Changed behavior based on the three cognitive perspectives: thoughts, feelings, and behaviors
Rational Emotive Behavior Therapy (REBT)
Seems more argumentative, but doesn't treat clients as weak or fragile (which may be empowering), and doesn't leave any stones unturned (like the case of simone)
Cuts straight to the core, underlying ideas and brings them up, challenges them. Aggressive but supportive
Makes a guess at what an underlying cause is, works as long as the client accepts it (regardless of being true), uses that to bring up the beliefs and what she tells herself. Unlike psychoanalysis, doesn't bother finding the truth in their childhood.
Discuss value systems, not symptoms
Gets client to accept themselves rather than condemn themselves
In Martha's case, very fast-acting. Made improvements after first session. A large minority make this quick response, but still not a majority.
Didn't take dream analysis very literally, just mentioned that it was only her muddled feelings. Prefer to avoid dreams.
No matter what is upsetting the client, REBT shows her there is nothing to be upset about, only absurd underlying beliefs
Psychoanalysis
Involves theory that symptoms appear after relationship conflict
Case of Simone - Therapist Safran used dream analysis of her dog dream to present the idea of himself as a nurturing figure, an idea which was scary to simone but she came to consider.
Tiptoed around some issues that seemed important, client still had binge eating issues four years later when she left but was significantly improved
Solution Focused Therapy
Looks for exceptions: when a problem behavior wasn't a problem
Uses exceptions to examine what happens when things go right, and encourage that
Clients come in expecting to talk about problems, surprised when asked about when things weren't a problem
Then make the exceptions concrete (Developmentally difficult for children that age to remember them, so added help)
Asked Rubin to draw a cartoon of himself behaving well
Got Rubin to role play how he would respond to people insulting him in ways that weren't fighting
Three Types of Clients
Customer
There by choice
Wants to make changes in themselves
Complainant
Wants someone else to change
Parent bringing child in
Therapist should make an alliance with them by listening to their complaints, aligning with their goals, finding out how they cope, find how they've tried to solve problem themselves in the past, get context, reframe complaints as positive behaviors in the present
If therapist makes them feel like complaints aren't valid, they will be less cooperative in finding solutions
Visitor
Not there by choice, someone else made them go
Child brought in by parent
Goal isn't to train, but be done with treatment
Therapist should let them be responsible for change, structure goals around why they were brought in, find out more about their relationships. Also align with their own goals - how to get parents off their back so they can end treatment, but direct goals toward improving behavior.
3 Responses to "I don't know" (how children often respond to therapist's questions
Silence: Client will feel awkward enough to talk. BUT if it goes on too long, may be a power struggle, block alliance
Rephrase the question so they can better understand
Use a relationship question, ask them to look at themselves from the perspective of another person
Trusts clients as the experts of their own lives
Instead of telling family what to do, finds their personal strengths and resources, encourage client find their own answers and solutions.
Uses reframing and normalizing
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Reframed arguments as propensity for being a lawyer, used that goal to focus him on accomplishments in school
Normalized his rebellious clothing as a developmental stage of adolescence
Looks at context of problem
Stage of development (Adolescence for Rubin)
Parent's Behavior: Asked his mother why his clothing was a problem for her, found her fear of him joining gangs but also let her realize that was something all the kids did
Existential Psychotherapy - Used by Yalom
In Elva's case, used talk therapy, focused on her human condition as a whole - achievements and limitations. He adapted to her style, at some points using the same dark humor shock value speech as her, uses it to build alliance and get her to open up.
Mantra was 'it's the relationship that heals'
First step in change is to assume responsibility - can't make a change if you don't think you have anything to do with your problems
Betty (like simone) had a fear of getting too dependent in therapy
Did go into dream interpretation a bit with Betty
Discusses that in the history of psychotherapy a preset termination date encourages people to go deeper in to the therapy with the short time they have
First done by psychiatrists, then clinical psychologists with a PhD, moving towards shifting it lower, to masters level psychologists, counselors, and social workers.
Aundria was treated by a social worker
Had to balance wanting to help this young person with the responsibility of truthfully reporting back to the court
Started with a one hour meeting for psychological assessment
Used nonjudgmental tone to ask about drug use
Nearly universal goal is to help patients master (improve self control and self understanding) their symptoms and interpersonal conflicts
Shown in Grenyer and Luborsky that Psychotherapy is successful in improving client's mastery, which in turn helped them overcome their symptoms
Very effective, but we don't know why. The mechanisms are unknown.
Essential aspect of giving patients a new and more helpful EXPLANATION for their problems when their own explanations are useless, such as thinking their problems are inevitable
Patients expect an explanation, will not be fulfilled or conviced without one. Unknown is scary and intolerable
Explanation gives context to treatment, and vice versa. Also must FIT the context, to be accepted. Sweat lodge may be unconvincing in medical setting
Having an explanation can show them their troubles can be fixed, remoralizes
MUST sound truthful or will not help. If patient accepts explanation, will help
Psychotherapy as an elaborate ritual for influencing patients. Shouldn't reduce the practice.
~75% of patients who receive treatment report feeling some benefit
Unique to humans, and wideespread among them (different cultures throughout history pretty much all had ritual healers, etc), explained via whatever metaphysical thing was popular at the time - the four elements, humors and biles, etc
Hard to ID one specific cultural lineage, a mix of Freudian, coming from Ashkenzi Jewish tradition, Gestalt, Humanism, etc
All types of psychotherapies seem to have roughly the same (high) effectiveness
Might be the therapist, not the type
Variation among therapists may really just be the alliance formed
Wampold suggests letting the client choose what treatment makes the most sense for them, while the therapist is chameleon adjusting the therapy to each individual client
Adlerian Psychotherapy
Treats the person as discouraged, not sick
Holistic, doesn't divide the person into body and mind, etc
The discouraged person uses self centered rather than prosocial paths to reach their goals
Two ways of movement: Useful or useless. All behavior looked at on the social field, not adaptive/maladaptive
Useless: Uncooperative and self centered
Useful: Coopoerative, prosocial
Doesn't incorporate diagnoses about the ways in which a person is sick, simply treats them as discouraged
Four Processes: (not steps because interpretation can happen any time, for example
Form a relationship with the client
Find out about their lifestyle
Give the client an interpretation of their lifestyle
Guide them to becoming prosocial by changing antisocial beliefs and helping them develop proscoial attitudes
Use, not posession - a person isn't inherently a thing, but they may use that thing to get something. Like Roger - not that he has anxiety, but that uses it to get people to do things like drive him around
Considers neuroses as avoiding the tasks of life. Roger narrowed life down to the places he felt secure
The Question: If all your symptoms magically dissapear, what would your life look like? Helps determine what the symptom is used for, what tasks are evaded
Motivational Interviewing (MI)
Listen seriously, summarize and repeat back, accepting - not judgemental
Good approach for social work, aligns with values of self determination and regulation
Not a trick, but an attitude
Develop Discrepancy
Tactic of MI that guides client to realize discrepancy between goals and current behavior
Change Talk:
MI Tactic to selectively pay attention to talk that will lead to positively changing behavior - what you pay attention to will grow
Client-Centered Therapy
Doesn't use specific diagnoses in treatment of problem, simply accepts that the person is maladjusted and seeks to fix that. May even refuse to look at diagnosis to come in unbiased. Treatment doesn't change based on 'disorder.' Diagnosis control the person and expectations of them, client centered doesn't want that, they should all be given equal opportunity and they are all unique, no blanket generalizations fit
The maladjustment is often seen as due in part to low self worth, maybe as a child getting the idea that they were bad, become alienated from the truth of how they feel. Child may be angry with those who wronged or disrespected her, but that goes against her idea that she is a loving child, so the split begins.
Client centered wants to rejoin to a whole being/experience after the split, not identify problems
Congruence - when the therapists genuinely wants to help client, and do so as their honest self, full transparency
Therapist should not have authority over the client, should be equal and working together
Nondirective, allows for flexibility to fit each therapist/client pairing
Humanist therapy and application to daily life
Emphasize human caring, being genuine, respectful
Should make you are more caring human being, better at communication etc. Sounds great but is also a burden to keep up, exhausting to self reflect all the time
Therapist as a therapist and as humanist (and as a person) are inseparable
Exhausting to be perfect humanist all day, but feel like a fraud if only a humanist at work
Can't leave humanism at work when it applies in every facet of life
Therapists fear both being abandoned and being engulfed, need balance, and must accept feelings they have toward clients, even sexual attractions
Negative aspects to therapy
80% have strong negative feelings towards clients
Work interferes with sleep and eating habita
Twice as likely to commit suicide as compared to other physicians
Have to balance wanting to sacrifice their needs to help others with being a person who also has needs that should be met, and on top of tht feel like they should be self-sufficient as therapists, and thus shouldn't need to ask for help
Assumes that the therapist starts with no prior knowledge/assumptions because each client is different
Professional training doesn't really talk about how to take care of yourself and make time for your family
Present time is not as welcoming for Humanistic therapy - people want to be cured instantly, are cynical, and drug companies tempt with quick cure and avoidance of the hard and uncomfortable work of facing therapy
Conclude that it should be practiced in life as it is in work
Shortcomings in Therapy
Field of psychology has many biases against poor communities and people, believe them to be hostile or a waste of time, unable to make use of therapy
Testing
Scientific or subjective?
2 Questions:
Does it matter?
The truth may not matter as long as the client accepts the new, more adaptive narrative
The truth may be good for detective work, but doesn't really change anything from a clinical perspective
Is it subjective?
Clients' accounts of what has happened and the causes of their problems aren't precise truth, but colorful narrations from their perspective
But, the objective truth could theoretically be discovered, and thus the interpretations
could
be shown as true or false
Even some value judgements can be empirical - like saying that someone who broke a world record in running is a great runner
Defective Desire Theory
Don't have to make decisions about universal/intrinsic goods
Instead, what is good for that individual person
The desire is defective if it will not actually benefit them, or does so only fleetingly
Different categories of defectiveness; futile, irrational, phobic aversions, etc
Doesn't sound scientific because still making value judgement in calling it defective for that person - but maybe could be empirical. Like woman wanting a lower score on depression scale because she assumes her depression will then be lessened. If validity of test is empirically shown to be low, that desire is defective
Neither question impedes therapy
Psychological Reports
Length
Varies from 1-54 pages, average 5-7
Can't really be standardized because length has to be appropriate for specific field/situation
Medical model is one concise page, wouldn't work for forensic where background, personal characteristics, etc need to be documented
Readability
Most are written at too high of a level for the average person to understand
Needs improvement
Should use shorter sentences, more common words, dividing it up with subheadings, etc
Acknowledge it if your measures were poorly validated
Computer-based interpretations
Computer can't consider client's history, do true clinical judgement
Computer can show symptoms and likely response to treatment
Sound very good, appear valid to those who don't know better, too easy to believe
About half its estimations are false
Can't assume computer interpretation really represents the client
Clinicians should put computer interpretation in the context of what they know about the client, and interpret from there - not blindly believe computer interpretation. It's a tool, not the answer
Including Test Scores (Or Not)
Include
Different people interpret scores differently, need the raw scores so they dont have to blindly follow the interpretation of one person
Holds researcher accountable for their conclusion if people can see the numbers to support/disprove it
More precise, gives more information for retesting, scientific
Don't Include
Control who can access personal data
APA Ethical Guidelines say personal data must stay between qualified professionals (not released to public in journals)
May be misinterpreted without context of behavior, environment, etc
Up to the client
APA is starting to lean more towards 'clients should have more control in what is done with their information
Integrate sources of information
Low Integration
Rely on individual test scores, exact numbers rather than implications, less context given. 'Scores indicate that..'
High Integration
Pulls together data from multiple tests/sources, gives context, uses clinical judgment rather than test scores alone
Include the Strengths of a client (or not)
Include
Humanize rather than pathologize
Positivity and hope
Clients are getting more access to reports, need to consider its impact on them. Make it positive
Don't Include
Comes from medical model
Only include relevant information
Keep report concise
May make clients feel worse if they read only negative, demoralize
Feedback
Can be hard to find time to give feedback, especially in settings like mental hospital
Clients who get feedback feel more satisfied and report less distress
Putting it in report makes it concrete for client, can answer questions
Put feedback the client would agree with first, disagree second
Makes sure client understands the results of the test
Tools in for Psychology
Modeling family relationships in family systems therapy
Physiological measures like penile strain gauge used in Reverend X case to test response to pedophilic stimuli
Visualization techniques in covert sensitization in Rev X's case
Used unrealistic but poignant embellishments (vomit rotting girl's flesh, maggots). Effective with some clients, but not others
Paired his erotic stimuli with aversion imagery, as therapy progresses move the aversion closer and closer to beginning, until the first sign of it is aversive
Physical action - Yalom used Elva's purse as a metaphor for her, the physical act of opening up the purse and accepting everything inside aligned with her opening up emotionally and accepting it all.
Core Conflictual Relationship Theme (CCRT) measure: Used in Psychotherapy to document what the patient wants, how others react, and how they react
Mastery Scale: Used in Psychotherapy to evaluate clients' levels of emotional mastery as therapy goes on (self control, self understanding, impulse control, etc). Can be used to evaluate effectiveness of therapy for clients.
Life Style Assessment: Used by Adlerians to look into past and present situation to understand their schemas and beliefs
Reframing in Solution-Focused Therapy: Finding the silver lining - each problem shows a certain strength that can be reframed as good.
Praises the positive part rather than punishing the negative
Rather than punish Rubin for arguing, asked if he had thought about becoming a lawyer - he had, was positive
Reversed negative cycle of arguing
Normalizing in Solution-Focused Therapy
Looks at problems as everyday life obstacles, not illness
Scaling Questions in Solution-Focused Therapy
Track progress on goals using a ten point scale, like Rubin and his mother ranking his behavior
Who is most at risk/in need?
Women face risk of depression when economically dependent on unhappy relationships
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Impoverished communities and people
History and uses of psychological testing
Currently, schools do the most psychological testing, finding the slow vs. fast learners
Started off as a way to identify people with mental deficiencies, which is a still a big part of its use today
Then expanded to testing of mental disorders, behavioral problems, and intelligence
Also use for employee selection
Traits of Psychological Testing
A Behavior Sample
Can ONLY measure behavior. If a test says it measures capacity - it does not. Just predicts how well you will be able to learn that foreign language based on the behavior sample.
A sample of behavior that we then use to predict future behaviors (Even a diagnosis, because it relies on current behavioral state to predict how the person will act, respond to treatment, etc
Standardized
Has to be done the same way, for everyone, so it is a valid measure.
Scores interpreted by norms
Objective Measure
Same person should get the same score regardless of who is scoring/administering the test
Judge item difficulty empirically - based on which items people get wrong the most, etc
Reliability
Like if the bathroom scale measures the same weight if you step on it twice in the same day
Can only be tested by empirical trial
Consistency of scores
Validity (Most important)
Does it measure what you want it to measure?
Can be tested against other constructs (If you made a test to find good employee traits, then compare it to how well they do on the job)
Can even tell us exactly what the test is measuring, not just if its measures what we want it to
Qualified Examiner
If it's not administered or scored correctly, then no validity, test useless
Test User (not the test taker)
Makes decisions based off the test scores
Must not be misused, short cut, etc
Secure Test Content
If test answers get out, not a valid test of whatever, just of memorizing leaked answers
Might be leaked with good intentions, like using them as practice problems so children will be prepared. BAD idea - no validity. Useless.
Communicating Information
Security fears should NOT impede on communicating proper info to test takers and public
Prevents misconceptions, mystery, allows test takers to familiarize themselves with the process
New York Law made them give out all questions and answers to public for tests for college admissions. Meant they had to make a new one every year
What Makes a Test Good?
How good a test is depends on how well the behavior sample it collects accurately predict future behavior. MUST be empirically shown to be connected
Administering Tests
Train Examiners Before Test
Memorize and standardize script, question responses, etc
Train in working with materials, where to put them, etc
Testing Conditions
No noise, good lighting and ventilation, controlled environment
Subtle changes ca nmake a difference - in young children, having a separate answer sheet lowers their score. Offhand comments by examiner can change score. Etc
Rapport and Orientation
Interest and encourage participants in test
Shy children may need time to settle into room, tests should be kept short
Examiner and Situation
Warm vs cold examiner, appearance, race, sex, can impact scores on one on one intelligence tests
Examiner's Expectations can impact score
Test Taker
Test Anxiety
On a bell curve: A little helps, a lot hurts
Training and Test Performance
Coaching
Overall seems to improve scores, but also factor in the coachee's prior knowledge and ability in how successful the coaching was
Closer it is to real test material, better
Test Sophistication
How many times you've taken a test
Get better when taking it a second time, without any studying in between
Being taught generalizable Cognitive Skills
Should improve in many areas, but only if it transfers