Clinical Psychology Exam 1
Assessment of Personality: Objective tests soon followed projectives
A. Objective tests soon followed projectives - Typically paper-and-pencil, self-report, and more scientifically sound - MMPI (1943)—comprehensive personality test measuring various pathologies - MMPI-2 (1989)—revised and restandardized - MMPI-A (1992)—for adolescents
The NEO Personality Inventory (NEO-PI)
and its successors, has risen to some degree of prominence in more recent decades as a personality measure less geared toward psychopathology than is the MMPI.
Miller and wonpo suggest that
the relationship between patient and psychologist is the single best indicator if patient will get better. Recent definitions
Assessment: Diagnostic Issues ( dates)
1. DSM: 1952 2. DS- II: 1968 3. DSM-III: 1980 - introduced specific diagnostic criteria and a multiaxial diagnostic system. (More discussion on major chang es in subsequent slides) 4. DSM-III-R: 1987 5. DSM-IV: 1994 6. DSM-IV-TR: 2000 7. DSM-5:2013
Contemporary Ethical Issues: Technology
"Psychological tests" on Internet -Many have questionable reliability and validity -Other issues include 1. Identity of client 2. Testing conditions 3. Inability to observe behavior during testing Similar concerns about online therapy When therapy is done via computer, the clinical psychologist and client may not be able to fully appreciate all aspects of communication (e.g., nonverbals). Moreover, online therapy gives rise to concerns about confidentiality and client identity that don't exist when the clinical psychologist works with the client in person.
As a consistent trend, as the DSM has been revised, it has expanded to include a greater number of disorders
"Scientific discovery" or "social invention?"
APA Division 12 Definition of Clinical Psychology
"The field of Clinical Psychology integrates science, theory, and practice to understand, predict, and alleviate maladjustment, disability, and discomfort as well as to promote human adaptation, adjustment, and personal development. Clinical Psychology focuses on the intellectual, emotional, biological, psychological, social, and behavioral aspects of human functioning across the life span, in varying cultures, and at all socioeconomic levels." (APA, 2012) - An accurate, comprehensive, contemporary definition of clinical psychology needs to be more inclusive and descriptive, such as that provided by the APA. - The field and practitioners of clinical psychology continue to outgrow classical definitions.
Assessment: Diagnostic Issues and Kraepelin
- Diagnosis and categorization of mental illness has been central to clinical psychology from the start A. Emil Kraepelin (1855-1926) is considered a pioneer of diagnosis - Differentiated between exogenous and endogenous disorders - Coined some of the earliest terms to categorize mental illness Kraepelin differentiated exogenous disorders (caused by external factors) from endogenous disorders (caused by internal factors) and suggested that exogenous disorders were the far more treatable type. Kraepelin also assigned names to specific examples of disorders in the broad exogenous or endogenous categories. For example, Kraepelin put forth the term dementia praecox to describe one endogenous disorder with some similarity to what is now known as schizophrenia. Later, he also proposed terms such as paranoia, manic depressive psychosis, involutional melancholia, cyclothymic personality, and autistic personality—terms that had not been coined previously. - Kraepelin's work set the stage for the Diagnostic and Statistical Manual (DSM), which continues to dominate diagnosis today - First DSM published by American Psychiatric Association in 1952
Training Psychologists in Cultural Issues
- Educational alternatives •Courses •Readings •Real-world experiences •Encourage cultural self-knowledge, curiosity, and humility
Currently, numerous disorders are under consideration for inclusion in next DSM
- Internet gaming disorder - Attenuated psychosis syndrome - Persistent complex bereavement - Nonsuicidal self-injury - Others A section of the current edition of the DSM (DSM-5) lists numerous proposed disorders that were considered for inclusion but rejected by DSM authors. They are included as unofficial "proposed criteria sets" with the hope that additional research will inform future decisions to include or exclude them as official disorders.
Getting In: What Do Graduate Programs Prefer?
- Know your professional options -Take, and earn high grades in, the appropriate undergraduate courses - Get to know your professors - Get research experience - Get clinically relevant experience - Maximize your GRE score - Select graduate programs wisely - Write effective personal statements - Prepare well for admissions interviews -Consider your long-term goals On average, PhD programs in clinical psychology receive 270 applications and admit only 6% of them.
Assessment of Personality
- Projective tests were among the first to emerge—clients "project" personality onto ambiguous stimuli * Rorschach Inkblot Method—1921 * Clients respond to ambiguous inkblot - Thematic Apperception Test (TAT)—1935 * Clients respond to ambiguous interpersonal scenes
More Recent Definitions of Clinical psychology
- Tremendous growth has resulted in a very broad, hard-to-define field A.Brief definitions emphasize the study, assessment, and treatment of people with psychological problems B. More detailed definitions (e.g., Division 12 of APA) are more inclusive and descriptive Concise definitions fall short of capturing the field in its entirety. Contemporary clinical psychologists do many different things, with many different goals, for many different people.
Contemporary Ethical Issues: Managed Care
-Managed care companies' emphasis on financial bottom line can cause ethical conflicts -Perhaps include info about managed care in the informed consent process -Diagnostic decisions can be influenced by managed care companies' requirements
Contemporary Ethical Issues:Small Communities
-Small communities can be rural areas or defined by ethnicity, religion, or other variables -Multiple relationships can be unavoidable * Discuss up front with clients * Clarify boundaries * Avoid impaired judgment and exploitation
Evolution of Clinical Psychology
-The emergence of clinical psychology around the turn of the 20th century was preceded by numerous important historical events -These events "set the stage" for clinical psychology -Some pioneers in the treatment of the mentally ill made important contributions in the 1700s and 1800s
APA Ethical Principles
1. Beneficence and Nonmaleficence 2. Fidelity and Responsibility 3. Integrity 4. Justice 5. Respect for People's Rights and Dignity
Overexpansion of Mental Disorders
1. Do today's disorders describe normal life experiences? - Size and scope of the DSM increases with each new edition -With each edition of the DSM, the scope of mental illness has expanded, along with the controversy surrounding it. -In a 2014 survey of over 500 therapists from 8 countries around the world, over 60% of participants identified at least one disorder that should be completely removed from DSM, and the most common reasons for their choice were unclear boundaries between the disorder and either another disorder or normalcy (Robles et al., 2014).
Emerging Professional Issues for Use of Technology
1. Obtain -Obtain informed consent about the technology 2. Follow -Follow relevant telehealth laws 3. Follow -Follow APA ethics code 4. Ensure - Ensure confidentiality via encryption 5. Obtain - Obtain relevant training 6. Know - Know client's local emergency resources 7. Monitor - Monitor changes in laws, ethical codes, technology * As the technology-based practice of clinical psychology evolves, those providing it should follow some fundamental suggestions. Main suggestions are provided in the slide.
Current Controversies Overview
1. Prescription Privileges: Historically, prescribing has distinguished psychiatrists from psychologists - However, in recent decades, clinical psychologists have actively pursued prescription privileges. A. Three states have granted prescription privileges to appropriately trained psychologists 1. New Mexico (2002) 2. Louisiana (2004) 3. Illinois (2014) 4. Other states have considered similar legislation and may pass it soon. - Other significant steps in the movement toward prescription privileges include the creation of APA Division 55 in 2000, as well as the psychopharmacology training programs available for psychologists in the U.S. military. -Key proponents of prescription privileges for clinical psychologists are Patrick H. DeLeon, Morgan T. Sammons, and Robert McGrath.
Categories of Ethical Standards
1. Resolving Ethical Issues 2. Competence 3. Human Relations 4. Privacy and Confidentiality 5. Advertising and Other Public Statements 6. Record Keeping and Fees 7. Education and Training 8. Research and Publication 9. Assessment 10. Therapy
Advantages of Evidence-Based Practice/Manualized Therapy
1. Scientific legitimacy 2. Establishing minimal levels of competence 3. Training improvements 4. Decreased reliance on clinical judgment
Three Models of Training
1. Scientist-practitioner model (or Boulder model):Created in 1949 in boulder Colorado at a conference.Emphasized both practice and research.Balances Clinical practice with scientific research. a. Graduate students would need to receive training and display competence in the application of clinical methods (assessment, psychotherapy, etc.) and the research methods necessary to scientifically study and evaluate the field. - These graduate programs would continue to be housed in departments of psychology at universities, and graduates would be awarded the PhD degree. 2. Practitioner-scholar model (or Vail model): Created in 1973 at a conference in Vail, CO. This Spends more time doing clinical work with patients rather than clinical work and research. Leans towards clinical practice. Higher acceptance rates and larger classes. Proliferated in recent years- Come with a PsyD rather than a PHD. a. PsyD - Clinical focused internships doesn't care about APA- accredited internships. They are not research focused. * In the 1988 to 2001 time period alone, the number of PsyD degrees awarded increased by more than 160%. 3. Clinical scientist model:- Emerged in the 1990's. Reaction to Vail Model. Leans towards research. Trains researchers rather than practitioners A. Richard McFall's 1991 "Manifesto for a Science of Clinical Psychology" sparked this movement: The Academy of Psychological Clinical Science was founded at a conference at Indiana University. Graduate programs who are members of the Academy endorse McFall's views. For examples of graduate programs that adhere to each of the three training models. Examples are also provided in subsequent slides. - A subset of PhD institutions who strongly endorse empiricism and science
Why psychologists should prescribe:
1. Shortage of psychiatrists - Especially in rural areas -Important factor in NM and LA decisions 2. CPs more expert than primary care docs 3. Other non physicians have privileges Dentists, podiatrists, optometrists, and some nurses, among others 4. Convenience for clients 5. Professional autonomy 6. Professional identification 7. Evolution of the profession 8. Revenue for the profession
Disadvantages of Evidence-Based Practice/Manualized Therapy
1. Threats to the psychotherapy relationship 2. Diagnostic complications - "Textbook" cases vs. "real world" cases 3. Restrictions on practice - Mandated manuals vs. creatively customized treatments 4. Debatable criteria for empirical evidence - Some studies have actually found that therapists who demonstrate flexibility while using a manual are more successful in terms of getting clients engaged in therapy and ultimately producing better outcomes.
Why psychologists should not prescribe
1. Training issues - Which courses? When? Taught by whom? 2. Threats to psychotherapy -Would medication replace talk therapy? 3.Identity confusion -Especially when only some CPs prescribe 4.Influence of pharmaceutical industry
Applications of Technology in Clinical Psychology: Examples
1. Videoconferencing to interview or treat 2. Email or text psychotherapy 3. Interactive Internet sites 4. Online psychotherapy programs 5. Virtual reality therapeutic experiences 6. Computer-based self-instruction 7. Therapist/client interaction via hand-held devices - Ex. www.fearfighter.com can be used to treat individuals with panic disorder or specific phobias.
Early Pioneers
1. William Tuke 1732-1822 - Lived in England - Appalled by deplorable conditions in "asylums" where mentally ill lived - Devoted much of his life to improving their treatment - Raised funds to open the York Retreat, a model of humane treatment. * At the York Retreat, patients received good food, frequent exercise, and friendly interactions with staff. The York Retreat became an example of humane treatment, and soon similar institutions opened throughout Europe and the United States. 2. Phillippe Pinel 1745-1826 - Lived in France - Advocated for more humane and compassionate treatment of the mentally ill in France - Also introduced ideas of a case history, treatment notes, and illness classification, indicating care about their well-being * Pinel convinced his contemporaries that the mentally ill were not possessed by devils, and that they deserved compassion. He created new institutions in which patients were given healthy food and benevolent treatment. Pinel advocated for the staff to include in their treatment of each patient a case history, ongoing treatment notes, and an illness classification of some kind—components that suggested he was genuinely interested in improving these individuals rather than locking them away. 3. Eli Todd 1762-1832 - A physician in Connecticut - At the time, there were very few hospitals for the mentally ill - Burden for their care fell on families - Using Pinel's efforts as a model, he opened humane treatment centers in US * Todd emphasized patients' strengths rather than weaknesses and allowed patients to have significant input in their own treatment decisions. 4. Dorothea Dix 1802-1887 - Worked in a prison in Boston and observed that many inmates were mentally ill rather than criminals - Traveled to various cities to persuade leaders to build facilities for humane treatment of mentally ill - Resulted in over 30 state institutions in US and other countries
What do Clinical Psychologists Do?
A. A variety of activities, but psychotherapy is most common -True since 1970s B. Other common professional activities include: Diagnosis/assessment Teaching/supervision Research/writing Other activities
Where Do Clinical Psychologists Work?
A. A variety of settings, but private practice is most common -True since 1980s B. Other common work settings include -Universities -Psychiatric and general hospitals -Community mental health centers -Other settings
APA Code of Ethics: Aspirational and Enforceable
A. Aspirational •General Principles section describes an ideal level of ethical functioning, or what to strive for B. Enforceable •Ethical Standards section includes rules of conduct that can mandate minimal levels of behavior and can be specifically violated
Development of the Profession
A. At the historic Boulder conference in 1949, directors of graduate training programs agreed on a dual emphasis on practice and research B. In the 1950s, 1960s, and 1970s, -Therapy approaches proliferated -PsyD/Vail model programs emerged - Insurance companies began reimbursing for clinical psychologists' services c. In the 1980s, - Psychotherapy thrived, in part due to increasing respect from medical professionals and insurance companies - The number of training programs and new clinical psychologists increased D. In the 1990s and 2000s, - The size and scope of the field continues to grow - Multiple training model options are available - Empirical support of clinical techniques, prescription privileges, and new technologies are among major contemporary issues *In the late 1950s, only 14% of the U.S. population had ever received any kind of psychological treatment; by 2010, that number had climbed to 50%. See Box 2.3 Timeline of Key Historical Events in Clinical Psychology in your textbook.
Payment Methods:Third-Party vs. Self-Pay: Effective
A. Effect on therapy 1. Negative impact on quality 2. Too little control over clinical decisions 3. Ethical problems, including confidentiality 4. Confusion about informed consent (what to tell clients about payment method) 5. Greater affordability for many clients B. Effect on diagnosis - Increased likelihood of being diagnosed with a mental disorder Certain diagnostic categories being used more or less often. C. Effect on psychologists' experience - Lower pay Time required for paperwork, phone calls, etc. Frustration due to denial of care psychologist believes to be necessary
Evidence-Based Practice/Manualized Therapy
A. Hans Eysenck (1952) claimed therapy wasn't beneficial When researchers measure therapy outcome, they often use therapy manuals -To ensure uniformity across therapists -To minimize variability When outcome data support the use of a manualized therapy, the treatment is known as "evidence based" Hans Eysenck's 1952 statement that psychotherapy had no positive outcome for patients was a major catalyst in beginning what is today known as evidence-based practice research. * Evidence-based practice is defined as the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences.
Recent Professional Efforts to Emphasize Culture
A. Journals and books on cultural topics •New APA divisions -Division 35—Society for the Psychology of Women -Division 36—Psychology of Religion -Division 44—Society for the Psychological Study of Lesbian, Gay, and Bisexual Issues -Division 45—Society for the Study of Ethnic Minority Issues -Division 51—Society for the Psychological Study of Men and Masculinity B. Revisions to APA ethical code -Competence -Discrimination -Interpreting assessment results -Others C. APA accreditation standards D. Revisions to recent editions of DSM •Text describing cultural variations of disorders •culture-bound syndromes - Not disorders per se, but troubling experiences of people within a particular culture - Some related to DSM disorders; others unique - E.g., Susto, maladi moun Examples of culture-bound syndromes include sutso, in which a frightening event is thought to cause the soul to leave the body, resulting in depressive symptoms (found in some Latino/Latina/Hispanic cultures); taijin kyofusho, in which a person anxiously avoids interpersonal situations because he believes his appearance, actions, or odor will offend others; and maladi moun, in which one person can "send" psychological problems to another.
Boundaries and Multiple Relationships
A. Knowing someone professionally and in some other way ´Romantic/sexual, friendship, business, etc. B. Unethical when: ´Psychologist's objectivity, competence, or judgment can be impaired ´Exploitation or harm could result C. Boundary crossings (minor, often harmless) can lead to boundary violations (major, often harmful) -Multiple relationships can form not only when a psychologist knows one person both professionally and nonprofessionally but also when a psychologist has a relationship with someone closely associated with or related to someone the psychologist knows professionally. -Not every multiple relationship is, by definition, unethical. To be unethical, a multiple relationship must impair the judgment of the psychologist and exploit or harm the client.
Evidence-Based Practice/Manualized Therapy: Treatment
A. Lists of validated treatments published in articles and A Guide to Treatments That Work - Examples 1. Exposure plus response prevention for OCD 2. Dialectical behavior therapy for BPD -The first list of empirically validated treatments was published in 1995, and updates appeared in 1996 and 1998. A Guide to Treatments That Work was also published around this time, with more detailed information about these therapies. - Numerous websites now provide continuously updated lists of treatments that work to both therapists and prospective clients. Examples include psychologicaltreatments.org and effectivechildtherapy.org.
Comparison of PsyD and PhD
A. PhD - Emphasize practice and research - Smaller classes - Lower acceptance rate -Typically in university departments -Offer more funding to students - Greater success in placing students in APA-accredited internships B. PsyD - Emphasize practice over research -Larger classes -Greater acceptance rate -Often in free-standing professional schools -Offer less funding to students -Less success in placing students in APA-accredited internships
Internships: Predoc and Postdoc
A. Predoctoral internship -Takes place at the end of doctoral training programs (before PhD or PsyD is awarded) -A full year of supervised clinical experience in an applied setting -An apprenticeship of sorts, to transition from student to professional - In WV 1800-hour internship before graduating. In some years, the number of graduate students seeking predoctoral internships has either approached or exceeded the number of available slots. The shortage has worsened considerably since roughly 2002, as the number of students who applied but were not successfully placed at an internship has increased dramatically, to hundreds per year. One factor that appears to contribute is the drastic increase in the number of PsyD applicants without a corresponding increase in internship sites B. Postdoctoral internship -Takes place after the doctoral degree is awarded -Typically lasts 1-2 years -Still supervised, but more independence -Often specialized training -Often required for state licensure
How Are Clinical Psychologists Different From Professional Counselors?
A. Professional Counselors: -Earn a master's degree -Complete training in 2 years -Little emphasis on psychological testing or research -May specialized in career, school, college counseling Every state in the US has some version of professional counselor licensure, but the name may vary slightly, with common alternatives including licensed professional mental health counselor, licensed clinical professional counselor, and licensed counselor of mental health.
How Are Clinical Psychologists Different From Psychiatrists?
A. Psychiatrists: -Go to medical school and are physicians -Have prescription privileges (clinical psychologists now have these same privileges in some states) -Increasingly emphasize biological/pharmaceutical rather than "talk therapy" intervention
How Are Clinical Psychologists Different From School Psychologists?
A. School Psychologists: -Tend to work in schools -Tend to have a more limited professional focus than clinical psychologists (student wellness and learning) -Frequently conduct school-related testing and determine LD and ADHD diagnoses -Consult with adults in children's lives (e.g., teachers, staff, parents)
How Are Clinical Psychologists Different From Social Workers?
A. Social Workers -Tend to emphasize social factors in clients' problems -Earn a master's degree rather than a doctorate -Training emphasizes treatment and fieldwork over research or formalized assessment
Emerging Trends in Training
A. Technology •Use of webcams for supervision •Computer-based assessment (MMPI) B.Competencies (outcome-based skills) •Skills that a student must demonstrate •E.g., Intervention, assessment, research, etc. (Multicultural, Group theory competencies). *Emphasizing competencies ensures that the students who graduate from clinical psychology programs will not only have earned good grades on exams, papers, and other academic tasks, but will be able to apply what they have learned as well.
Psychotherapy recent decades
A. When psychotherapy became a more common activity in the mid 1900s, the psychodynamic approach dominated B. In the decades that followed, numerous other approaches arose: 1. Behaviorism 2. Humanism 3. Family Therapy 4. Most recently, cognitive therapy has risen to become the most widely endorsed singular orientation * Recent decades have witnessed a movement toward combining individual therapy types in either eclectic or integrative ways.
How Are Clinical Psychologists Different From Counseling Psychologists?
A.Counseling Psychologists: -Tend to see less seriously disturbed clients -Are less likely to work in settings like inpatient hospitals -Tend to endorse humanism more and behaviorism less -Tend to be more interested in vocational and career counseling
Psychotherapy
A.Psychotherapy is the most common activity of clinical psychologists today, but before the 1940s/1950s, it was not a significant professional activity - Treatment was by medical doctors, not psychologists B. World War II created a demand for treatment of psychologically affected soldiers - Wars have had many other influences on the evolution of assessment and psychotherapy *Without the demand created by psychological consequences of World War II on U.S. soldiers, psychotherapy might have remained an uncommon activity of clinical psychologists. See Box 2.2 The Influence of War on Clinical Psychology.
How Well Does Cybertherapy Work?
Appears to work about as well as in-person psychotherapy A. Examples include - CBT for anxiety disorders - Internet-based therapy for PTSD - Internet-based depression treatments
Education and Training in Clinical Psychology
Commonalities among most training programs oDoctoral degree- going into a program with a bachelor's degree. oMost enter with bachelor's, some with master's degree oRequired coursework oThesis/dissertation oPredoctoral internship (more information in later slides) - WV: Licensed master's in psychology. - About 3,000 doctoral degrees in clinical psychology are awarded each year.
Assessment: Diagnostic Issues- Pages and disorders
Each revision of the DSM has included more disorders than the version it replaced, with the jump between DSM-II and DSM-III being the largest. In the time between the original DSM (in 1952) and DSM-IV (in 1994), the number of disorders increased by more than 300% to a total of 368 distinct diagnoses. The current DSM-5 is 947 pages long. Note: Estimates of the number of DSM-5 disorders often list "300+." 300 is not an exact number.
Payment Methods:Third-Party vs. Self-Pay
Early in the history of clinical psychology, clients paid for services directly out of pocket With time, health insurance companies began covering mental health Today, many clients use health insurance/managed care benefits to pay for services Often called "third-party payers"
Overexpansion of Mental Disorders: Influence of the pharmaceutical industry?
Financial ties - 57% of DSM-IV panel members - 69% of DSM-5 panel members Cosgrove and Wheeler (2013) have argued that the pharmaceutical industry is trying to "colonize" psychiatry—that is, attempting to control the mental health field, beginning with a deep connection between its core diagnostic manual and their financial interests.
Education and Training: Specialty Tracks
In recent decades, specialty tracks have emerged, including: oChild oHealth oForensic oFamily oNeuropsychology - More than half of APA-accredited doctoral programs offer (but may not require) training within a specialty track. * Get a degree that allows you to get a license (go broad and then specialize).
The Influence of Technology: Cybertherapy and More
In recent years, clinical psychologists have increasingly used technology in the direct delivery of psychological services 1. Assessment 2. Treatment - Cybertherapy can replace or supplement face-to-face meetings. - Benefits can include accessibility, affordability, and more * Cybertherapy is also called telehealth and telemental health, among other labels.
Lightner Witmer and the Creation of Clinical Psychology
Lightner Witmer 1867-1956 - Received doctorate in 1892 in Germany - Psychology was essentially academic; no practice, just study - In 1896, Witmer founded the first psychological clinic at the U. of Pennsylvania * Witmer studied under Wilhelm Wundt, who many view as the founder of experimenal psychology. - At the 1896 convention of the American Psychological Association, Witmer (1897) spoke to his colleagues and fellow members about his clinic and encouraged them to open their own—to "throw light upon the problems that confront humanity" (p. 116)—but they were largely unenthusiastic (Reisman, 1991). - By 1914, there were about 20 clinics in US - By 1935, there were over 150 - Witmer also founded the first scholarly clinical psychology journal, The Psychological Clinic, in 1907
Overexpansion of Mental Disorders ( New disorders)
New disorders and new definitions of old disorders - Introduction of new disorders to capture experiences once considered normal - "Lowering the bar" for existing disorders As examples of "lowering the bar," critics point to changing the age by which symptoms of attention-deficit/hyperactivity disorder must appear from 7 to 12, or changing the required frequency of binges in bulimia nervosa from twice per week to once per week, both of which are DSM-5 changes.
Three Models of Training Example
R T P - Theory drives both research and practice. Research to test theories. - Theories inform our practice. - Research influences theory and practice. - As we research, we revise theories. - Research also informs practice. - Practice influences theory and research. - Practice informs theory and research Will lean to one part of the triangle, all three are important.
Sample MMPI and Rorschach Stimuli
Stimuli are approximations; they are not actual test items.
Diversification of U.S. Population
The U.S. population is increasingly diverse, particularly in certain areas/cities •20% of U.S. schoolchildren speak a language other than English at home •In Miami, Detroit, and Washington DC, a single ethnic minority group represents over half of the population -In a single decade (1990-2000), the Asian American/Pacific Islander population and the Latino/Latina/Hispanic population each grew by about 50%. In 2000, there were 28 million first-generation immigrants in the United States, representing about 10% of the entire U.S. population.
Evidence-Based Practice/Manualized Therapy: Treatments
Treatments formerly called "empirically validated" and "empirically supported" - "Evidence-based practice" includes the treatment and factors related to people providing and receiving the treatment - Evidence-based practice is defined as the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences. -Hans Eysenck's 1952 statement that psychotherapy had no positive outcome for patients was a major catalyst in beginning what is today known as evidence-based practice research.
Reality of mental health professions
You need to have a degree and a license A. psychology- testing and assessment as well as evaluation- make more money. B. Social work - psychotherapy C. Professional counseling - doing psychotherapy- you will be doing some of the same things (a lot) - No difference really in the fields of work.
In a study by Pope, Tabachnick, and Keith-Spiegel (1987),
more than 450 members of APA Division 29 (Psychotherapy) rated the ethicality of 83 separate behaviors that a psychologist might perform. Results indicated that a few behaviors—sex with clients or former clients, socializing with current clients, and disclosing confidential information without cause or permission—are viewed as blatantly unethical. A few other behaviors—shaking hands with clients, addressing clients by first name, and breaking confidentiality if clients are suicidal or homicidal—are viewed as unquestionably ethical. But most of the 83 behaviors fell in the gray area between ethical and unethical.
Witmer was the first
operate a psychological clinic. a. the first clients were - children with behavioral or educational problems. B. According to Witmer's definition, a clinical psychologist was a person - whose work with others involved aspects of 1. treatment: method 2. education: Psych. education ( educate that person about diagnosis). 3. interpersonal issues: The relationship between the psychologist and person is very important. It is critical for the relationship.
Ethical Issues in Clinical Psychology
´APA Code of Ethics guides the behavior of clinical psychologists ´Relevant issues include 1. Confidentiality 2. Informed consent 3. Multiple relationships 4. Competence 5. Others (sex with client, major one).
APA Code of Ethics
´First published in 1953 ´Revised 9 times ´Most recent edition was published in 2002 ´Two amendments in 2010: emphasizing the fact that psychologists cannot use particular ethical standards to justify or defend the violation of human rights.
Ethical Decision Making
´Fisher's (2017) model 1.Prior to any ethical dilemma arising, make a commitment to doing what is ethically appropriate. 2.Become familiar with the APA ethical code. 3.Consult any law or professional guidelines relevant to the situation at hand. 4.Try to understand the perspectives of various parties affected by the actions you may take. Consult with colleagues (always protecting confidentiality) for additional input and discussion. 5.Generate and evaluate your alternatives. 6.Select and implement the course of action that seems most ethically appropriate. 7.Monitor and evaluate the effectiveness of your course of action. Modify and continue to evaluate the ethical plan as necessary
Confidentiality: When the Client is a Child or Adolescent
´Often, children will confide more if they can be assured that psychologists will not repeat everything to their parents ´Parents, of course, have a right to be informed ´Psychologists often make arrangements by discussing this with families up front ´Some issues, such as child abuse, require breaking of confidentiality to protect the child Every state has laws requiring mental health professionals to break confidentiality to report known or suspected child abuse.
Ethics in Clinical Research
´Psychotherapy efficacy research -What should control group receive? ´No treatment ("wait-list" control) ´Placebo treatment ´Alternate treatment ´What ethical issues arise when any of these three options are used?
informed consent
´Required for research, assessment, therapy, and other professional activities ´For therapy, informed consent is an ongoing process rather than a one-time event ´As psychologist learns more about client, more information can be shared ´Informed consent for therapy must allow client the opportunity to ask questions and receive answers ´Informed consent process can be an early part of a strong therapeutic relationship informed consent to therapy—unlike informed consent to research or assessment—may be best understood as an ongoing process rather than a one-time event.
Psychologists' Ethical Beliefs
´Some behaviors are viewed as absolutely unethical (e.g., sex with clients) ´Some behaviors are views as absolutely ethical (e.g., addressing clients by first name) ´Many behaviors fall in "gray area" in between ´Lots of difficult judgment calls
Competence
´Sufficiently capable, skilled, experienced, and expert to complete the professional tasks they undertake ´Boundaries of competence ´Psychologists should know their limits and seek additional training or supervision when necessary ´Continuing education can maintain competence ´Importance of cultural competence ´Burnout can impair competence -Burnout can be minimized by efforts by the psychologist to keep job varied, keep life balanced, keep expectations reasonable, and keep self healthy Most state licensing boards have continuing education regulations. That is, to be eligible to renew their licenses, psychologists in many states must attend lectures, participate in workshops, complete readings, or demonstrate in some other way that they are keeping their knowledge of the field current. Burnout refers to a state of exhaustion that relates to engaging continually in emotionally demanding work that exceeds the normal stresses or psychological "wear and tear" of the job.
Confidentiality: Tarasoff and the Duty to Warn
´Tarasoff is a court case regarding a college student client who told his therapist he was going to kill his girlfriend (Tatiana Tarasoff) ´Therapist contacted campus police who detained him, but after he was released, he killed her ´Her family sued and won ´Tarasoff v. The Regents of the University of California ´The finding was that the therapist had the "duty to warn" the potential victim ´This finding now sets a precedent for all therapists for breaking confidentiality
Ethics in Clinical Assessment
´Test selection -Consider competence, culture, test's reliability and validity ´Test security -Don't allow test materials to enter public domain ´Test data -Raw data collected during assessment -Should generally be shared at client's request
"Clinical psychology" first used
•1907 by Lightner Witmer •Originally defined as similar to medicine, education, and sociology
Assessment of Intelligence
•Assessment of intelligence characterized the profession in early years •Early debates about the definition of intelligence focused on Spearman's "g" (a single, general intelligence) vs. multiple intelligences (e.g., Thorndike) •Alfred Binet's early intelligence test (1905) later became the Stanford-Binet Intelligence Scales, which is still widely used today * The Binet-Simon scale (the precursor to the Stanford-Binet) yielded a single overall score, endorsing the concept of "g." It was the first to incorporate a comparison of mental age to chronological age as a measure of intelligence. This comparison, when expressed as a division problem, yielded the "intelligence quotient," or IQ.
Assessment of Intelligence: Binet's test to Wechsler's
•Binet's test was intended for children •David Wechsler published the Wechsler-Bellevue in 1939, which was designed for adults •Wechsler later created tests for school-age and preschool children •Revisions of Wechsler's tests are among the most commonly used today * Today, Wechsler's tests have expanded to include the Wechsler Adult Intelligence Scale, Wechsler Intelligence Scale for Children, and Wechsler Preschool and Primary Scale of Intelligence.
Cultural Competence:Knowledge of Diverse Cultures
•Can gain knowledge by -Reading, especially regarding history -Direct experiences -Relationships with people of various cultures -Asking client to explain cultural meaning (to a limited extent) •Remember that there are exceptions to cultural trends - heterogeneity - Metaphor—Asian men tend to be relatively short, but Yao Ming is 7′ 6″
Technology: Additional Potential Issues
•Confirming the identity of the client •Confidentiality across the electronic transmission •Making interpretations in the absence of nonverbal cues that would be present face-to-face •Competence in technical as well as clinical skills •Current research suggests that it can work •Success depends on many factors: 1. Which cybertherapy, disorder, device? 2. What setting? 3. How clients found or were referred to cybertherapy? 4. Live support available?
Multiculturalism as the "Fourth Force: Client
•Culture shapes how clients understand their problems •Questions to assess client understanding: -What do you call your problem (illness, distress)? -What do you think your problem does to you? -What do you think the natural cause of your problem is? -How do you think this problem should be treated? -Who else (e.g., family, religious leaders) do you turn to for help? Culture shapes the way that the client understands the very problem for which he or she is seeking help. It is this understanding—this worldview, applied to psychological problems—that the therapist should appreciate as he or she devises an approach to helping the client.
Confidentiality
•In general, psychologists are ethically obligated to maintain confidentiality •Some situations can arise in which breaking confidentiality is appropriate
Most drastic change in DSMs is from DSM-II to DSM-III
•Larger, including more disorders •Specific diagnostic criteria •Multiaxial system
Cultural Competence:Self-Awareness
•Learning about one's own culture -Values, assumptions, biases -By doing so, become less egocentric -Realize that differences are not deficiencies Psychologists will inevitably encounter clients whose cultural background differs—sometimes slightly, sometimes considerably—from their own.
Getting Licensed
•Licensure enables independent practice and identification as a member of the profession •Requires appropriate graduate coursework, postdoctoral internship, and licensing exams (e.g., EPPP) •Each state has its own licensing requirements •To stay licensed, most states require continuing education units (CEUs) - States typically require successful completion of the Examination for Professional Practice in Psychology (EPPP) and a state-specific exam on laws and ethics for licensure. * 1. Licensure enables independent practice 2. EPPP- examination in professional practice in Psychology ' - In WV it's an oral examination. 3. 30 hours every year in WV for continuing education.
Measuring the Outcome of Culture-Based Training Efforts
•Many questions remain -How can we measure a baseline of cultural competence? -How can we measure change after training? -Whose opinion should we seek? Psychologist, client, supervisor, others? -How can we infer cause? At the moment, measuring the outcome of culture-based efforts is at a very early stage of empirical investigation.
Interacting Cultural Variables
•Multiple cultural factors can combine to create a unique culture for a particular individual -Two people of the same ethnicity can differ on many other variables, and can have very different life experiences as a result
What Constitutes a Culture?
•Narrow vs. broad definitions -Some argue that ethnicity and race are the defining characteristics of culture - Others argue that many other variables can define a culture, such as •Socioeconomic status, religion, gender, age, geography/region, political affiliation, disability status Those who argue for a more narrow definition of culture typically point to ethnicity and race as the defining cultural characteristics. Some argue that culture can be defined by a much broader range of variables, including any and all potentially salient ethnographic, demographic, status, or affiliation identities.
Acculturation
•Response to new cultural environment •Balance between adopting new and retaining original culture •Specific strategies: 1. Assimilation (high new and low original): ake new information and experiences and incorporate them into our pre-existing ideas or worldview 2. Separation (low new and high original): The individual maintains his or her own cultural identity and rejects involvement with the host culture. 3. Marginalization (low new and original): The individual does not identify with or participate in either his or her own culture or the host culture 4. Integration (high new and original): when individuals maintain their cultures and are able to accept and adapt to the host's cultures.
Multiculturalism as the "Fourth Force"
•Some argue that multiculturalism is the defining issue of the current generation of psychology •Defining paradigms of previous generations have included -Psychoanalysis (1st) -Behaviorism (2nd) -Humanism/person-centered (3rd) -Multiculturalism can enhance any of previous "forces"
Cultural Competence
•The counselor's acquisition of awareness, knowledge, and skills needed to function effectively in a pluralistic democratic society •Three main components: 1. Awareness 2. Knowledge 3. Skills
Tripartite Model of Personal Identity
•Three levels of identity 1. Individual level - Every person is totally unique 2. Group level -Every person is like some others 3. Universal level - Every person is like all others •Clinical psychologists can recognize all three levels for any client
