psy 370
etic perspective
outsider perspective -Emphasizes similarities between all people -Assumes universality -Downplays culture-based differences
What is cybertherapy?
- CPs can perform assessments and treatments via computer instead of in person meetings • Benefitscanincludeaccessibility, affordability, and more
What methods are used to teach cultural competency in graduate programs
- Courses - Readings -Real-world experiences -Encourage cultural self-knowledge, curiosity, and humility
What are current prescription privileges, and who holds those privileges
- Historically, prescribing has distinguished psychiatrists from psychologists - However, in recent decades, clinical psychologists have actively pursued prescription privileges • Three states have granted prescription privileges to appropriately trained psychologists -New Mexico (2002) -Louisiana (2004) -Illinois (2014)
LPCC
- Masters in Counseling - the application of counseling interventions and psychotherapeutic techniques to identify and remediate cognitive, mental, and emotional issues, including personal growth, adjustment to disability, crisis intervention, and psychosocial and environmental problems, and the use, application, and integration of the coursework and training - The scope of practice for LPCCs does not include the assessment or treatment of couples or families unless the LPCC meets specific qualifications mandated by California law.
Why psychologists should not prescribe
- Training issues • Which courses? When? Taught by whom? - Threats to psychotherapy • Would medication replace talk therapy? people may expect quick fix from CPs -Identity confusion • Especially when only some CPs prescribe -Influence of pharmaceutical industry - CPs may feel pressure to prescribe
how is competence seen
- competent Cps are those who are sufficiently capable, skilled, experienced, and expert to complete the professional tasks they undertake - boundaries of competence: only working in scope of practice, based on education, trying and experience - must remain competence by continuing to educate themselves, renew licenses - cultural competence - burnouts can impair competence - personal problems start to interfere with work, not as emotionally engaged - Burnout can be minimized by efforts by the psychologist to keep job varied, keep life balanced, keep expectations reasonable, and keep self healthy
Advantages of Evidence-Based Practice/Manualized Therapy
- scientific legitimacy of treatment methods - establishing minimal levels of competence for CPs as they follow manulaized treatments - training improvements by teaching evidence based therapies - Decreased reliance on clinical judgment, which can be susceptible to bias, evidence based therapies are objective
Reporting guidelines for child abuse and/or neglect
- separate confidentiality issue for child abuse, must break confidentiality to report, same rationale are tarasoff - responsibility shift to the immediate prevention of harm when to report: knows or reasonably suspects abuse includes: neglect, physical harm, sexual abuse, endangerment applies to: minors where to report: local law enforcement timeframe: immediate telephone report, follow up with written report within 36 hours
Know and apply the four parts of Acculturation
- some heterogeneity within a culture stems from differences in acculturation - when people find themselves in a new cultural env, they may respond in a variety of ways - balance between adopting new and retaining original culture Specific strategies: • Assimilation (high new and low original) • Separation (low new and high original) • Marginalization (low new and original) • Integration/ bicultural (high new and original)
LMFT
-Masters of Science, Psychology -Service performed with individuals, couples, or groups wherein interpersonal relationships are examined for the purpose of achieving more adequate, satisfying, and productive marriage and family adjustments. This practice includes relationship and premarriage counseling. - the use of applied psychotherapeutic techniques, to enable individuals to mature and grow within marriage and the family, the provision of explanations and interpretations of the psychosexual and psychosocial aspects of relationships, and the use, application, and integration of the coursework and training required
why psychologists should prescribe
1)Shortage of psychiatrists -Especially in rural areas (get paid less) -Important factor in NM and LA decisions 2) CPs more expert than primary care docs - CP have more extensive training on mental health, could better diagnose and prescribe than GP 3) Other non-physicians have privileges -Dentists, podiatrists, optometrists, and some nurses, among others 4) Convenience for clients - increase in time and money to have to see a CP and psychiatrist - miscommunication between professionals 5) Professional autonomy - capable of providing more services, not feeling restricted by relying on psychiatrists 6) Professional identification - would set psychologists more apart from non phd or psyd 7) Evolution of the profession - prescription authority could open doors to opportunities for CPS 8) Revenue for the profession - more prescriptions prescribed, more sales
APA Ethical Principles
1. Beneficence and nonmaleficence - psychologists strive to benefit and do no harm 2. Fidelity and responsibility - establish relationships of trust, aware of responsibilities to society 3. Integrity - knowing your scope of practice and only seeing specific people to your license 4. Justice - equal quality of process and fairness 5. respect for people's rights and duties
Fisher's model for ethical decision making
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. 8. Modify and continue to evaluate the ethical plan as necessary.
What is the percentage of GP vs Psychiatrist who prescribe
80% of prescriptions written for psychoactive medications come from primary care physicians
Postdoctoral Internship
A 1- or 2-year internship occurring after the doctoral degree in clinical psychology is granted that consists of supervised clinical experience in an applied setting, often with a specialized focus Required for licensure as a psychologist Last 1-2 years by gaining supervised hours opporutnity for specialized training
psychiatrist
A medical doctor who has specialized in the diagnosis and treatment of psychological disorders (MD) ➤ Go to medical school and are physicians (Training in psychiatry does not happen until the end Medical School) ➤ Have prescription privileges (clinical psychologists now have these same privileges in some states) ➤ Increasingly emphasize biological/pharmaceutical rather than "talk therapy" intervention Typical meeting with a Psychiatrist: 90min intake 30 min follow up after 2-3 weeks on being on medication 15-30 min check in appointments every 2-3 months
Tripartite Model
A model that describes three roles that parents can play in their children's development: interactive partner, direct instructor, and provider of opportunities. - individual level: uniqueness to individual - group level similarities and differences: ways individuals are like some others - universal level: ways all humans are the same
predoctoral internship and requirements
A year-long internship occurring near the end of doctoral programs in clinical psychology that consists primarily of supervised clinical experience in an applied setting - before psd or phd is awarded - similar to applying to grad school, very extensive - must be in doctoral program - apply to 15-20
Dates of APA code of Ethics, and current revision
APA first code of ethics published in 1953 nine revisions current revision: 2002
What are the "Major Forces" in Clinical Psychology
psychoanalysis behaviorism humanism/ person-centered psychology multiculturalism - can enhance previous forces
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) - must make continual efforts
licenses available in the field of Clinical Psychology
Clinical psychologist Psychiatrist Counseling psychologist Licensed marriage and family therapist (LMFT) Licensed clinical social worker (LCSW) Psych technician
Know the critiques of the DSM
DSM = diagnostic and statistical manual of mental disorders - DSM grows with each new edition - do not limit which disorders are published, leads to overdiagnosis - no real epidemic of mental illness, just a looser definition of illness - problems that used to be an expected and tolerated part of life and now treated as mental disorder - the danger of DSM-5 is that it extends the scope of mental disorder to a point where almost anyone can be diagnosed - Introduction of new disorders to capture experiences once considered normal Influence of the pharmaceutical industry? - more disorder, more diagnoses, more customers o Financial ties to DSM authors • 57% of DSM-IV panel members • 69% of DSM-5 panel members
How do Third Party Payers influence the practice of care
Effect on therapy -Negative impact on quality -Too little control over clinical decisions -Ethical problems, including confidentiality -Confusion about informed consent (what to tell clients about payment method) -Greater affordability for many clients Effect on diagnosis - Increased likelihood of being diagnosed with a mental disorder because health insurance requires DSM diagnosis for treatment - Certain diagnostic categories being used more or less often Effect on psychologists' experience - Lower pay than those who pay directly - Time required for paperwork, phone calls, etc. to. third party - Frustration due to denial of care psychologist believes to be necessary
Scientist-Pracitioner Model (Bolder) PhD
Emphasis on both research/science and practice More programs in the U.S., smaller cohort
APA Ethical Standards
Enforceable -Ethical Standards section includes rules of conduct that can mandate minimal levels of behavior and can be specifically violated 1. resolving ethical issues 2. competence - keeping up on training, getting most out of program, full understanding population you are seeing 3. human relations 4. privacy and confidentiality 5. advertising and other public statements- must be what you actually do not just trying to get patients 6. record keeping - must document everything, clearly state fees of service 7. education and training - keep it up to date 8. assessment are you using proper testing for patients, some are not appropriate, what are assessments used for 9. Therapy 10. Research and publication - are you accurately presenting research
LCSW
Masters of Social Work - service in which a special knowledge of social resources, human capabilities, and the part that unconscious motivation plays in determining behavior, is directed at helping people to achieve more adequate, satisfying, and productive social adjustments. - counseling and using applied psychotherapy of a nonmedical nature with individuals, families, or groups; providing information and referral services; providing or arranging for the provision of social services; explaining or interpreting the psychosocial aspects in the situations of individuals, families, or groups; helping communities to organize, to provide, or to improve social or health services; or doing research related to social work
The Clinical Science Model (Indiana) PhD
Heavy science is the "only" clinical psychology Tend to train researchers vs. clinicians stressed the scientific side of clinical psych more than boulder
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
Practitioner-Scholoar Model (Vail) PsyD
Practice over Research Less programs in the U.S., larger cohort
becoming licensed
Supervised hours in both pre and postdoc for PhD Registered Associates for LCSW, LMFT, LPCC State Licensing Board Exams Continuing Education Units
Know the changes to demographics in the United States, what groups are increasing and which are declining.
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 • As stated by McGoldrick, Giordano, and Garcia-Preto (2005), "[we] must incorporate cultural acknowledgment into our theories and into our therapies, so that clients not of the dominant culture will not have to feel lost, displaced, or mystified" (p. 4)
multicultural counseling competence
The counselor's acquisition of awareness, knowledge, and skills needed to function effectively in a pluralistic democratic society • Three main components: - Awareness - Knowledge - Skills
definition and application of Clinical Psychology
This field 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
mulitculturalism
culture is a powerful force because it shapes the way the client understands 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?
integration
embrace both cultures
What is Homogeneity and Heterogeneity
heterogeneity - there are exceptions to cultural group norms ex. average Chinese man is 5'7, but Yao Ming is 7'6 shouldn't generalize
assimilation
individual adopts much f the new culture and abandons much of original
seperation
individual rejects new culture and retains original
Confidentiality: how it is and isn't used
maintaining confidentiality is a primary obligation but confidentiality is not absolute, sometimes psychologists are obligated to break it for the sake of their clients or others - Tarasoff
marginalization
rejects both
emic perspective
the perspective of the insider, the one belonging to the cultural group in question -Emphasizes culture-specific norms -Appreciate clients in the context of their own culture
cultural self awareness
when a CP comes to understand that their viewpoint is unique - recognize that differences between people are not necessarily deficiencies, must consider one's culture - can be difficult because may involved coming to terms with some isms
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
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
issues of multiple relationships
• Knowing someone professionally and in some other way -Romantic/sexual, friendship, business, etc. Unethical when: -Psychologist's objectivity, competence, or judgment can be impaired -Exploitation or harm could result • Boundary crossings (minor, often harmless) can lead to boundary violations (major, often harmful)
Issues with cybertherapy
• Obtain informed consent about the technology • Follow relevant telehealth laws • Follow APA ethics code • Ensure confidentiality via encryption • Obtain relevant training • Know client's local emergency resources • Monitor changes in laws, ethical codes, technology • Confirming the identity of the client • Confidentiality across 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
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 - info includes payment and confidentiality policies and outset of therapy - more details about length, goals, and substance of psychotherapy will come later -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
Recent Professional Efforts to Emphasize Culture
• Revisions to ethical code - Competence - Discrimination - Interpreting assessment results - Others • Accreditation standards 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
ethics in a small town
• 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
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 • How credible are clients' threats? • What kinds of threats merit warnings? - How should the unsafe behavior of clients with HIV/AIDS be understood in terms of threat?
Culturally Appropriate Clinical Skills
• Techniques should be consistent with the values and life experiences of each client • "Talk therapy" may work better for some cultural groups than for others • Some cultural groups may respond more positively to "action" than "insight"
disadvantages of evidence based practice
• Threats to the psychotherapy relationship • Diagnostic complications - "Textbook" cases vs. "real world" cases - clients may mislead you or have multiple disorders • Restrictions on practice - if a therapy is not listed - limits autonomy of CP - Mandated manuals vs. creatively customized treatments • Debatable criteria for empirical evidence
What is Evidenced Based Practice (Manualized therapy) and what does it consist of?
• 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"
How does one apply for a Doctoral Program, and what are the requirements
➤ Know your professional options ➤ Take, and earn high grades in, the appropriate undergraduate courses ➤ Get to know your professors ➤ Get research experience (mainly for PhD) ➤ 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
licensed educational psychologist
➤ Masters Degree (Usually within the School of Education) The practice of educational psychology is the performance of any of the following professional functions pertaining to academic learning processes or the education system or both: (a) Educational evaluation. (b) Diagnosis of psychological disorders related to academic learning processes. (c) Administration of diagnostic tests related to academic learning processes including tests of academic ability, learning patterns, achievement, motivation, and personality factors. (d) Interpretation of diagnostic tests related to academic learning processes including tests of academic ability, learning patterns, achievement, motivation, and personality factors. (e) Providing psychological counseling for individuals, groups, and families. (f) Consultation with other educators and parents on issues of social development and behavioral and academic difficulties. (g) Conducting psychoeducational assessments for the purposes of identifying special needs. (h) Developing treatment programs and strategies to address problems of adjustment. (i) Coordinating intervention strategies for management of individual crises.
Doctoral degree
➤ Most enter with bachelor's, some with master's degree ➤ Required coursework ➤ Thesis/dissertation ➤ Predoctoral internship ➤ Postdoctoral work Time frame ➤ 4 years of intense coursework ➤ 1 year of predoctoral ➤ 2 years of post doctoral work