Clinical Psychology Exam 1
Scientific legitimacy - Prior to evidence-based treatments, clinical psychology could be considered a "cottage industry"—every psychologist puts their own spin on treatment Establishing minimal levels of competence - Reducing client harm/use of ineffective approaches Training improvements - Training can be very different between different graduate programs Decreased reliance on clinical judgment - Clinical judgment is often flawed (and subjective to bias)
What are the advantages of evidence-based practice/manualized therapy
Training issues - What kind of education should clinical psychologists receive before prescribing? How in depth should it be? When should it occur? - Should psychologists be trained regardless to promote understanding/communication? Threats to psychotherapy - The way psychologists understand and intervene with their clients may shift from behavioral, cognitive, and emotional processes to symptom reduction via psychotropic medications Identity confusion - Could lead to client confusion - maybe confused between psychologist and psychiatrist Potential influence of the pharmaceutical company - What if clinical psychologists are pressured by pharmaceutical companies to consider factors other than client welfare?
What are the arguments against granting prescription privileges to clinical psychologists?
Justice
"...fairness and justice entitle all persons to access and benefit from the contributions of psychology and to equal quality in the processes, procedures, and services being conducted by psychologists.
Fidelity and Responsibility
"Psychologists establish relationships of trust with those with whom they work" You're responsible for knowing the ethics code and abiding by it.
Integrity
"Psychologists seek to promote accuracy, honesty, and trustfulness in the processes, procedures, and services being conducted by psychologists. Don't lie.
Beneficence and Nonmaleficence
"phycologists strive to benefit those with whom they work and take care to do no harm"
Humanistic approach
("client-centered") popular in 1960s Emphasized relationships, personal growth
World War 2
Created demand for more practicing clinical psychologists Many US veterans returned home with "shell shock" and were in need of psychological treatment Prior to WWII, very few graduate programs offering training in clinical psychology The government and VA (US Department of Veterans Affairs) requested formalized training to help meet demands Also led to accreditation of programs
broad definition of culture
Culture can be composed of any group that shares a theme or issues We can also consider socioeconomic class, gender, geography/region, age, sexual orientation, religion/spirituality, disability/ability status
difference between C.P. and psychiatry
Differences in training Spend little time engaging in psychotherapy Primarily prescribe psychotropic medication
cultural self-awareness
First step in being culturally competent is learning about one's own culture Everyone's viewpoint is unique, everyone has had unique experiences Cultural self-awareness may help us - Realize that differences between people are not necessarily deficiencies - Explore our own personal reactions to differences and address any discomfort - Becoming self-aware can be difficult, unpleasant
difference between C.P. and counseling psychology
Historically, tended to treat problems of adjustment or minor forms of maladjustment Differences are shrinking
Beneficence and Nonmaleficence Fidelity and Responsibility Integrity Justice Respect for People's Rights and Dignity
List the general ethical principles
difference between C.P. and professional counselor
Master's degree; focus on psychotherapy (not assessment, research)
objective personality tests
More scientifically sound Scoring and interpretation more straightforward Typically self-directed paper and pencil instruments based on empirical data Example: MMPI
knowledge of diverse cultures
Need to be familiar with a client's culture - An ongoing process Psychologists can't know everything about every culture - What steps can you take then? What should cultural knowledge include? - Current lifestyle of members of the culture, the group's history (especially regarding social and political issues) We also can't assume that a member of a cultural group will exhibit all of the characteristics common to that group - Heterogeneity - different people are different, even if they have some group identity in common Differences in acculturation—(four common strategies)
People may receive treatment they don't actually need
Potential consequences of over-expansion
differences between C.P and school psychology
Primarily conduct psychological testing to diagnose learning disabilities, ADHD, and developmental disabilities Conduct assessments
Lightner Witner
Prior to Witmer, psychology was an academic discipline only—focused on research, not on application Opened the world's first psychological clinic in 1896 Primarily treated children who had difficulty learning in schools Proposed that psychologists should continue to function as scientists, but also apply what they learn to address practical problems First to formally propose the profession of clinical psychology
Respect for People's Rights and Dignity
Psychologists respect the dignity and worth of all people and the rights of individuals to privacy, confidentiality, and self-determination.
subcultures
Relatively small groups within a society that may not fully constitute cultural groups but whose members may nonetheless possess typical and culturally meaningful characteristics
Duty to Warn
The duty to warn resulted from the Tarasoff case - Set a legal precedent for psychologists - Duty to warn people toward whom their clients make credible, serious threats - "The protective privilege ends where the public peril begins"
assimilation
The individual adopts much of the new culture and abandons much of the original
integration
The individual adopts much of the new culture and retains much of the old culture
marginalization
The individual rejects both the new and original culture
separation
The individual rejects much of the new culture and retains much of their original culture
general principles
These items are aspirational—broader descriptions of ethical behavior
ethical standards
These items are enforceable—rules of conduct Psychologists can be found guilty of an ethical violation if they break these rules
difference between C.P. and social worker
Traditionally have connected individuals with social resources (e.g., disability benefits, food stamps) and arranged vocational and residential placements Can become a clinical social worker and provide therapy with one extra year of school
narrow definition of culture
Typically point to ethnicity and race as defining cultural characteristics
Shortage of psychiatrists - Underserved populations may benefit Clinical psychologists are more expert than primary care physicians - ~80% of prescriptions written for psychotropic medications come from primary care physicians Other non-physician professionals already have prescription privileges - E.g., dentists, podiatrists, optometrists, and advanced practice nurses Convenience for clients - Many clients are treated with both psychotherapy and psychotropic medication Streamlines the process Professional autonomy - Able to treat clients without having to rely on other professionals Professional identification - Would further differentiate clinical psychology from other mental health professionals Evolution of the profession - Some argue that impeding prescription privileges is standing in the way of the field progressing Revenue for the profession - Could help offset salary decreases seen by many Clinical Psychologists over the past few decades Strong opposition from psychiatric organizations - During the 1990s, people receiving an antidepressant increased from 37% to 74%
What are the arguments in favor of granting prescription privileges to clinical psychologists?
Threats to the psychotherapy relationship - Much of whether or not therapy is successful tends on the quality of the therapeutic alliance Diagnostic complications - Each evidence-based treatment manual targets a specific disorder Restrictions on practice - Some professionals are very dismissive of any treatments that are not empirically supported Debatable criteria for empirical evidence - More difficult to measure outcomes with certain techniques (e.g., psychodynamic therapy)
What are the disadvantages of evidence-based practice/manualized therapy
Assimilation Separation Marginalization Integration
What are the four common strategies of acculturation?
Select tests that are appropriate for the purpose of the assessment and the population being tested Test security is another focus -May produce invalid results
What are the major ethical issues specific to clinical assessment?
Cultural self-awareness Knowledge of diverse cultures Culturally appropriate clinical skills
What are the primary components involved in acquiring cultural competence?
general principles ethical standards
What are the two sections of the APA code of ethics?
Those psychiatrists who had received at least $5000 in compensation from pharmaceutical companies wrote three times as many prescriptions antipsychotic medications (compared to doctors who had no financial ties to the pharmaceutical industry)
What did the results of the Carey and Harris (2008) study suggest about the potential impact of the pharmaceutical industry on the prescribing habits of psychiatrists?
Exogenous Disorders
caused by external factors
endogenous disorders
caused by internal factors
microaggressions
comments or actions made in a cross-cultural context that convey prejudicial, negative, or stereotypical belief and may suggest dominance or superiority of one group over another - Can involve a variety of differences between people (e.g., gender, SES, age, religion/spirituality, sexual orientation)
Cognitive therapy
currently very popular Emphasis on logical thinking
scholar-practitioner model (Vail Model)
emphasis on psychological services, not research training. led to the development of the Psy.D. program
clinical scientist model
emphasis on scientific training, even more than the Boulder model
predoctoral internship
full year of supervised clinical experience in an applied setting. This must be completed before a doctoral degree is rewarded.
Psychodynamic approach
initially dominated was challenged as time passed, different approaches were developed
scientist-practitioner model (Boulder Model)
integration of science and practice. Graduate students should be competent in clinical and research methods most common training model
psychotherapy
most prominent engaged in activity most common setting is in a private practice.
post-doctoral requirements
most states require a one or two year clinical to get a license. requirements for getting licensed vary state-by-state. There is a national licensure exam.
Behavioral approach
popular in 1950s, 1960s Emphasized empirical method Measure problems and progress in observable, quantifiable terms
Emil Kraepelin
published first textbook on psychiatry (considered the "father of descriptive psychiatry" Dementia praecox as a predecessor of schizophrenia Came up with a two-category system of mental illness: Exogenous Disorders Caused by external factors Endogenous Disorders Caused by internal factors Set a precedent for the creation of diagnostic terms
Moral Treatment Movement
significant efforts were made to reform mental health treatment William Tuke (1732-1822)—founded the York Retreat in England Basically a big farm house. He created a different environment that allowed people with mental illnesses to have freedom. He encouraged his staff to treat people with dignity Philippe Pinel (1745-1826)—worked to reform mental health care in France He took over an asylum. He saw how awful the conditions were. He wanted to change and reform the system. He gave patients freedom, the ability to make choices, and told staff to treat them with dignity Also encouraged record keeping Any treatments they did try and whether or not it works He tried some basic classification of disorders Eli Todd (1762-1832)—advocated for the humane treatment of the mentally ill in the US. Opened The Retreat in Hartford, Connecticut in 1824 Dorothea Dix (1802-1887)—her efforts resulted in the establishment of more than 30 state institutions for the mentally ill in the US She started out volunteering in jails She found that many inmates weren't criminals, but many were mentally ill
cybertherapy
the use of technology including the internet, videoconferencing, smartphones, and text-based services, in the application of clinical psychology Examples: - Use of email/skype to provide psychotherapy or supplement it - Computer-based self-instructional programs - Smartphone apps to monitor symptoms, complete activities - Virtual reality techniques in which clients undergo therapeutic experiences (e.g., exposure)
learning about one's own culture
what is the first step of cultural self-awareness?`
multiple relationships
when a psychologist is in a professional role with a person and: (1) at the same time is in another role with the same person, (2) at the same time is in a relationship with a person closely associated with or related to the person with whom the psychologist has the professional relationship, or (3) promises to enter into another relationship in the future with the person or a person closely associated with or related to the person
Albert Binet's assessment of intelligence
Also interested in helping children with learning difficulties Established a test to help the Parisian public school system identify students who would not benefit from instruction in a regular classroom Binet-Simon Scale - one of the earliest measures of intellectual abilities. This was actually a norm referenced test, which is impressive. First norm-referenced test of intelligence Adapted by researchers and clinicians interested in intelligence and classifying children with learning difficulties Predecessor of modern intelligence testing Now referred to as the Stanford-Binet Intelligence Scales
culturally appropriate clinical skills
Approaches and techniques used by a psychologist should be consistent with the values and life experiences of that client Awareness of microaggressions Cultural adaption of treatments with empirical evidence - Evidence-based practice We can't assume that just because a treatment works with one group, it will work with clients from all backgrounds - E.g., Guided imagery script
Tarasoff Case
August 1969—a student at the University of California at Berkley (Prosenjit Poddar) Became romantically interested in another student (Tatiana Tarasoff) Sought therapy—disclosed he intended to kill Tatiana Psychologist broke confidentiality Police involvement—did not hold the student Student never returned to therapy October 1969—Poddar killed Tarasoff by stabbing and shooting her Tarasoff's parents sued the psychologist and others involved in the case for wrongful death Court found the psychologist liable This is the basis for Duty to Warn
Increase of specialized journals and books Emergence of APA Divisions - E.g., Society for the Psychological Study of Lesbian, Gay, and Bisexual Issues (Division 44); Society for the Study of Ethnic Minority Issues (Division 45) APA's ethical code compels psychologists to work with cultural sensitivity and competence - Principle E: Respect for People's Rights and Dignity - This states that psychologists need to be aware of and respect cultural, individual, and role differences Standard 2.01 Boundaries of Competence APA accreditation standards for graduate programs - "Cultural and Individual Differences and Diversity" is one of 8 domains that a program must address DSM-5 changes in light of multiculturalism - General guidance to help with cultural competence (e.g., suggests aspects of culture to assess in clients) - Glossary listing of cultural concepts of distress - Includes 9 terms that represent psychological problems observed in groups in various parts of the world (e.g., taijin kyofusho—found in Japanese culture as well as some other cultures) Revisions of prominent assessment methods - E.g., When the Minnesota Multiphasic Personality Inventory (MMPI) was revised and became the MMPI-2
What efforts have been made to emphasize issues of culture within the field of psychology?
clinical psychologists
What field (within psychology—e.g., clinical, social, developmental, etc.) do most members of the American Psychological Association belong to?
A PhD is a doctor of philosophy in psychology. These programs tend to have a stronger emphasis on research, smaller class sizes, more full-time faculty, and higher admissions standards. A PsyD is a clinical doctor program, which focuses more heavily on psychological practices. These are more likely to be housed in independent schools. They have lower admissions standards and allow much larger class sizes, but offer less fundings. They have lower success at placing students in APA accredited internships.
What is the difference between a PhD and a PsyD?
Introducing new disorders that capture experiences once considered "normal" - E.g., premenstrual dysphoric disorder, binge-eating disorder "Lowering the bar" for diagnosing existing disorders - E.g., changing the age that symptoms of ADHD must be present by from 7 to 12 years
What might lead to the overexpansion of psychological disorders?
69%
What percentage of work group members involved in the development of the DSM-5 had financial ties to major pharmaceutical companies?
It was the first addition to include diagnostic criteria
What was the biggest change presented with the DSM-III
if there is a credible threat against someone's life if someone is considering taking their own life if the client has been abused if the client is an abuser in certain cases with minors, it may be necessary to break confidentiality to inform parents
When is it appropriate to break client confidentiality?
sexual multiple relationships
Which type of multiple relationship is thought to be most damaging to clients?
You want to retain the trust of the client, but it also may be in the best interest of the client to inform the parents if their life or safety is at risk
Why is confidentiality more of a challenge with child and adolescent clients?
projective assessments of personality
a personality test in which individuals are assumed to project their personality characteristics via responses to ambiguous or vague stimuli. Heavily influenced by psychodynamic theory Examples: Inkblot test, thematic appreciation test
professional activity of supervision
a special type of teaching graduate students. Takes many forms (e.g., direct observation, reviewing audio or video-taped sessions) Potential ethical issues: Doing what's best for the client and doing what's best for the graduate student can sometimes be at odds. It can also be difficult to evaluate the performance of a supervisee
burnout
a state of exhaustion that relates to engaging continually in emotionally demanding work 1/3 psychologists have reported they have experienced burnout
