stanford clinical psychology — ch 1-6

Malleus Maleficarum

"The Witch's Hammer;" Christian duty to recognize witches led to "you believed in them or were one," confirming their existence; description of clinical symptoms (birthmarks=devil's pact); to destroy a witch you had to burn/drown the host

ambulatory assessment

"how do you feel right now?" then picking a face to send to clinician while going about your day

Post WWII impact

'battle fatigue' was the new name for soon to be PTSD; Veteran's Association (VA) was the largest employer of clinical psychologists (and still is up there); MMPI introduced; treatment overrode assessment

DSM 5 definition of mental disorder

'syndrome' characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental phrases underlying mental functioning

Duty to Warn conditions

1) patient has communicated to the psychologist a threat of physical violence, 2) the threat is serious, and 3) the victim is reasonably identifiable

three dominant training models

1) science practitioner (boulder), 2) clinical science, and 3) professional schools (PsyD)

Witmer's important ideas

1) scientific psychology can help people, 2) this help should be a specific profession trained in psychology, and 3) it must be based in research-oriented science

Regulation of Profession

1) supervised/specialized predoctoral and postdoctoral internships (PAID) and 2) after degree, must achieve licensure

When and where was the first psychiatric hospital opened?

1848 New Jersey

John Watson

1920s; Little Albert and observable focus; showed that learning could create abnormal behavior (behaviorist)

The Boulder Conference

1949; from here came dominant training model for clinical psychology (equal weight to science and practice); PhD as required degree

Rise of Behaviorism

1950s and 1960s; B.F. Skinner and observable focus

Hans Eysenck

1952; insisted there was no evidence that psychotherapy was more effective than no treatment; said clinical psychology should not involve training in therapy; "therapy doesn't work!"

DSM I

1952; vague terms and emphasized psychodynamic contributions

Paul Meehl

1954; statistical prediction better than clinical judgment; provided empirical support for the advantage of mechanical modes of combination over clinical judgment/insight; distressed clinical psychologists; "assessment doesn't work!"

Chicago Conference

1968; developed 1st PsyD program; the first proposal to establish purely professional training programs is made due to the need for more psychological service providers

DSM II

1968; was less psychodynamically focused, emphasis on behaviorism

Rise of Cognitive Behavioral Approach

1970s; belief that internal factors could influence our behavior; Ellis, Beck, Bandura

DSM III

1980; guided by Robert Spitzer, was atheoretical; more complex descriptions of diagnostic criteria, multiracial, increased focus on reliability; personality disorders on Axis II; dropped terms like "neurosis"

DSM IV

1994; further focused on reliability; 'working groups' worked on clusters of disorders

DSM 5

2013; current version; no longer Roman numerals because becoming real book w updates (similar to software updates like 12.1); Non Axial, environmental problems checklist, dysfunction measured by scale developed by W.H.O., cross-cutting symptom assessment measures for youth and adults (same assessments regardless of age)

what percentage of colleagues at PhD programs call themselves psychodynamic?

7%

what percentage of colleagues at PhD programs call themselves cognitive behavioral?

80%

Famous early mental health advocates

America: Dorothea Dix and Clifford Beers (who wrote a famous book about his own experience in a mental institution); France: Philippe Pinel (stopped use of torture on psychiatric patience in France, and shared his ideas about case history, treatment notes, and illness classification)

ABAB Design

An experimental design, often involving a single subject, wherein a baseline period (A) is followed by a treatment (B). To confirm that the treatment resulted in a change in behavior, the treatment is then withdrawn (A) and reinstated (B).

Anton Mesmer

Beginning of one-to-one treatment; focused in mesmerism/hypnosis, which a group of scientists inc Ben Franklin later deemed useless

Father of Psychiatry

Benjamin Rush; believed mental illness was a disease of the mind and not related to possession, and wrote first psychiatric textbook published in US

Why must we depend on clinical science?

Candace case study where "Attachment theorists" suffocated girl to try to simulate womb; science/empirical research shows us what is true and what works

James Cattell

Columbia; believed in individual differences, meaning simply that people are different/have dimensions; sensory motor functioning and ways to measure reaction times

The California School of Psychology

Developed by California Psychological Association in late 60s to train practicing clinicians; independent schools and not university depts, very few full-time faculty, and large classes with little financial assistance

Association for Psychological Science (APS)

Formed by people who thought practitioners controlled APA; much more focused on science than practice; 1988 Rift

potential problems with epidemiological data

How do we define mental illness? How do we locate these cases How do we handle less serious forms of the illness? Sampling issues/Issues of social desirability

1800s conceptualization/treatment

Humanistic movement/Mental Health; better placement and no killings; moral treatment/help/personal relationships

Case Studies for Fabricating Data

Marc Hauser (Harvard): Harvard found Hauser guilty of scientific misconduct and he resigned, but the US Office of Research Integrity also had to open an investigation because his research was financed by government grants; Diederick Stapel (Tilburg University, the Netherlands): social psychologist who committed academic fraud by making up studies that told the world what it wanted to hear about human nature, and he was suspended

assessment

ONGOING evaluation of individual strengths and weaknesses, conceptualization of problems/etiological factors, and recommendation for alleviating the problem

Alfred Binet

Paris; believed in improvement (esp of intelligence in young children)

Tarasoff Case

Psychologist did not report boyfriend's threats to girlfriend's family, but only police, who interviewed and then released Poddar; he later killed his girlfriend

Lewis Terman

Stanford; Stanford-Binet test (now in revised 5th edition); eugenicist

probability sampling

a method used by pollsters to select a representative sample in which every individual in the population has an equal probability of being selected as a respondent; every 10th participant

technological signs of depression

about a month before people are diagnosed with clinical depression, their locomotion diminishes and some even look up pictures of bridges before admitting suicidal thoughts/tendencies

repercussions of prescription privileges

additional course requirements (basic pharmacology training), screening out of applicants who don't have good foundation in undergrad physical science courses, and changing nature of clinical psychology profession

roles of research in clinical psychology

allows us to avoid speculation, informs clinical practice, develops new tests/interventions, evaluates effectiveness of existing tests/interventions, and provides a way for researchers to extend and modify existing theories

APA Ethics 2002 Code

approval via IRB, obtained informed consent, no coercion, use deception only when justified and necessary, minimize harm to participants, don't fabricate/falsify data, assign authorship immediately, and share data with other researchers for verification

what is clinical psychology?

based in science practice, with the goals of understanding maladaptive behavior, promoting healing, and alleviating discomfort

"ships of fools"

boats full of lunatics sent from towns and refused docking privileges anywhere; people died on the boats

pros of psychologists being able to prescribe meds

can provide a wider range of treatment to a wider range of clients, increase in efficacy and cost-effectiveness of care, will give clinical psychologists a competitive advantage in the health care marketplace, and important step in being full health care professino

single case design

case study in which a persons serves as their own control subject; similar to both experimental and case study methods; person's behavior is measured under several conditions, can establish causal relationships, do not have to withhold treatment, and can be useful for rare clinical conditions

When Privileged Communication does not apply

client is suicidal, client needs hospitalization, counselor is conducting court-ordered evaluation, client sues counselor, client uses mental disorder as legal defense, underage child being abused, or client threatens another person

goals of a classification system

communication (among clinicians, between science&practice), clinical (facilitate identification, treatment, and prevention of mental disorders), research (understand etiology and test treatment efficacy), education (teach about psychopathology), information management (measure and pay for care)

Sir Francis Galton

cousin of Darwin; work led to the notion that mental illness can be inherited; promoted enforced sterilization to eliminate unwanted genes

assessment trends 60s-70s

decline in interest; new roles for clinical psychologists, some new approaches did not require psychological testing

McFall's Manifesto

exact service should be described clearly, claimed benefits stated explicitly + validated scientifically, positive effects of service must be proven/quantified; anything not focused on science=pseudoscience

multiple baseline design

experiment begins with the concurrent measurement of two or more behaviors in a baseline condition, followed by the application of the treatment variable to one of the behaviors while baseline conditions remain in effect for the other behavior(s); after maximum change has been noted in the first behavior, the treatment variable is applied in sequential fashion to each of the other behaviors in the design (no reversal)

Emil Kraeplin

famous for classifying schizophrenia (he initially called it "dementia praecox"); claimed certain groups of symptoms often occur together, thus allowing us to call them diseases or syndromes

Abraham Flexner

first person appointed (by Carnegie Foundation) to try to get medical training; led to massive reform in medical schools, muck-raking investigation

Lightner Witmer

first to use the term "clinical psychology;" studied under Wilhelm Wundt and opened first psychiatric facility to treat children at UPenn

placebo

has no active agent

problems with DSM approach

heterogeneity within syndromes (even people with same symptoms may differ in important ways) and the resultant dividing of syndromes into smaller categories that narrow diagnostic criteria and excessively complicate taxonomy

Major Differences PhD and PsyD

higher acceptance rate into PsyD programs; much more money to do PsyD because less financial support; PhD students often paid; PhD ends with dissertation, while PsyD ends with clinical assessment

Richard (Dick) McFall

insists that there is only one legitimate form of clinical psychology rooted in empirical science

preferred methods for ensuring reliability

interrater reliability is better than test-retest because it depends on structured diagnostic interviews and sick people change, so inconsistencies can be due to person rather than the test

culturally sensitive mental health services

make a commitment to cultural awareness as well as knowledge of self and others as cultural beings; recognize the importance of multicultural sensitivity; integrate multiculturalism and diversity into education and training; recognize the importance of culture in psychological research and clinical work

cons of psychologists being able to prescribe meds

may lead to de-emphasis of "psychological" forms of treatment, may damage the relationship of clinical psychology to psychiatry and general medicine, will lead to increases in malpractice liability costs

what do clinical psychologists do?

mostly therapy/intervention, 50% in research

Early 15th century conceptualization/treatment

move toward voluntary possession (all possessed were responsible); resulted in over 200,000 "witch" executions; witches blamed for floods, lame horses, miscarriages

trends in health care since 1990s

movement towards managed care; fewer client sessions and more clients per year; therapist functions as catalyst, and most changes occur outside of treatment; group therapy more common than one-on-one

APA Code of (Aspirational and Enforcable) Ethics

must be followed by members of APA; 1) beneficence and nonmaleficence (strive to benefit those they serve and not harm) 2) fidelity and responsibility (professional and scientific responsibilities to society and relationships built on trust), 3) integrity (accurate, honest, truthful), 4) justice (recognize their biases and boundaries of competence), and 5) respect for people's rights and dignity

states who've granted prescription privileges

new mexico, iowa, idaho, illinois, and louisiana

three most common control groups

no treatment/"waitlist," placebo treatment, or alternate treatment

controlled observation (pros/cons)

observer establishes the situation gain more clinical insight into nature of problem cost-effective (highly controlled but low ecological validity because patient knows they are being watched)

telehealth

offering CBT online is sometimes just as effective as in-person; research supports this, as number of people and speed increases w technological therapy

categorical approach issues

only a few mental disorders have been shown to have distinct etiologies, genetic and environmental factors underlying syndromes are non-specific, little empirical evidence for "natural boundaries" between disorders, researchers have not yet identified a "neural signature" for specific disorders, and similar treatments are effective for different DSM disorders

prevalence

overall rate of cases (new or old) in given population

categorical system

presence/absence of a disorder; you either have anxiety or you don't

who prescribes the majority of psychotropics?

primary care phyisicians (95%); psychiatrists only 5%

where do clinical psychologists mostly work?

private practice and universities; <5% at psychiatric hospitals

"statistical infrequency" as "abnormal" pros/cons

pros: cut offs make it easier to diagnose (so insurance can cover); cons: abnormal does not necessarily mean maladaptive (geniuses like Einstein)

naturalistic observation pros/cons

pros: gather information that can be the basis of more formal study and ecologically valid; cons: subject to participant-observer biases and lack of experimental control

unsystematic observation pros/cons

pros: gather information that can be the basis of more formal study; cons: little methodological rigor, can be case-specific, lack of experimental control, subject to clinician's interpretation (high potential for false conclusions)

case study pros/cons

pros: individualized, can describe rare circumstances, wealth of information; cons: non-generalizability of findings

"disability/dysfunction" as "abnormal" pros/cons

pros: relatively little influence required; often prompts people to seek treatment cons: who sets standard for dysfunction? in how many domains must we see issues?

"subjective distress" as "abnormal" pros/cons

pros: seems reasonable that people can assess their own distress cons: not everyone who is abnormal feels distressed (hoarders), and can actually feel comfort from their abnormality

dimensional system

rank on a continuous quantitative dimension; degree to which a symptom is present; how anxious are you on a scale of 1-10?

incidence

rate of new cases of a disease or disorder that develop within a given time

non-probability

recruit as many as possible, like through MTurk

reliability

refers to consistency; tests produce same results

validity

refers to whether the category reflects what it is supposed to reflect, often assessed by examining whether it correlates with what would be expected (convergent validity)

Middle Ages/Renaissance conceptualization/treatment

return to demonology; mass hysteria including around two major conditions: tarantism (nervous disorder characterized by uncontrollable urge to dance, likely influenced by spider bite+hysteria) and lycanthropy (lunatics, acting like werewolves)

cultural impacts on mental illness

risk factors, types of symptoms experienced, willingness to seek help, and availability of treatments

300-460 B.C. conceptualization/treatment

somatogenesis; Hippocrates first suggested that illness is biological and not spiritual; based in the balance of four humours (phlegm=indifference, blood=mood shifts, black bile=melancholy, yellow bile=irritability)

statistical significance vs clinical (practical) significance

statistical significance is the probability that observed findings did not occur by chance (p<.05 is a scientific tradition); clinical significance asks if results are meaningful in terms of clinical practice (the practical importance of a treatment effect—whether it has a real genuine, palpable, noticeable effect on daily life)

epidemiology

study of the incidence, prevalence, and distribution of an illness in a given population; survey and interview based; most commonly associated with medicine or public health

three ethics in clinical assessment

test selection (consider competence, culture, reliability, and validity of tests), test security (don't allow test materials to enter public domain), and test data (raw data collected during assessment and can be shared at client's request)

Post WWI impact

testing development boomed; Rorschach, discovered things about "shell shock," now known as PTSD

Sigmund Freud

therapist whose ideas from one-on-one therapy are still influential (late 1800s-early 1900s)

when we say someone has a mental disorder, we mean:

they meet the diagnostic criteria, not necessarily that we understand the cause

unique issues for clinical studies

treatment may have adverse effects, treatment may not work, participant may not fully understand what the study entails, use of a placebo in clinical trials, conducting trials with children

6500 B.C. conceptualization/treatment

trephining—came from conceptualization of abnormal behavior as possession by demons/spirits, and that opening the skull would allow the spirits to be released (sometimes effective in reducing headaches with released pressure)

Shakow Report

written by APA in 1947; established how clinical psychologists should be trained; training expected to produce pros in research, assessment, and therapy; approximately a four/five-year program

"crisis of reproducability'

~40% of findings from decades ago could actually be replicated; most important in social psychology; pre-registering a study takes away the ability to morph hypothesis after findings