Clinical Review Exam #1
boundaries of competence
"Psychologists provide services, teach, and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study, or professional experience"
Tarasoff v. The Regents of the University of California, 1974
"The confidential character of patient psychotherapist communications must yield to the extent to which disclosure is essential to avert danger to others. The protective privilege ends where the public peril begins"
the process of cultural self-awareness can be difficult or unpleasant for psychologists, because it may require admitting/ coming to terms with some undesirable "isms"
"isms"—racism, sexism, heterosexism, classism, ethnocentrism, or similar prejudicial or discriminatory belief systems
Burnout
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
cultural competence
an understanding of factors associated with age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, or socioeconomic status is essential for effective implementation of their services or research, psychologists have or obtain the training, experience, consultation, or supervision necessary to ensure the competence of their services.
Name the first three "Forces" in order-
psychoanalysis as the first force, behaviorism as the second force, and humanism/person-centered psychology as the third force
Emil Kraepelin (1855-1926)
"Father of Descriptive Psychiatry" Offered a two category system of mental illness: Differentiated exogenous disorders (caused by external factors) from endogenous disorder (caused by internal factors) and suggested that exogenous disorders were the far more treatable type. He also assigned names to specific examples of disorders in the broad exogenous or endogenous categories.Later, he also proposed terms such as paranoia, manic depressive psychosis, involutional melancholia, cyclothymic personality, and autistic personality—terms that had not yet been coined. Most of his specific terms have long since been replaced, but by offering such specific terminology, he set a precedent for the creation of diagnostic terms that eventually led to the Diagnostic and Statistical Manual of Mental Disorders (DSM) It eventually leads to DSM.
sexual multiple relationships
"Psychologists do not engage in sexual intimacies with current therapy clients/patients". Such behavior represents a fundamental breach of the healthy therapist/client relationship and often results in significant psychological or emotional damage for the client
confidentiality
"Psychologists have a primary obligation and take reasonable precautions to protect confidential information"
Know how multicultural competence is defined and how the field is attempting to measure it
"the counselor's acquisition of awareness, knowledge, and skills needed to function effectively in a pluralistic democratic society" • Cultural self awareness by learning your own culture, knowing your values, assumptions, biases, becoming less egocentric, exploring your own prejudices in order to minimize them • Differences are not deficiencies • Gaining knowledge by reading, direct experiences, relationships with people of various cultures • Techniques should be consistent with the values and life experiences of each client (some clients may respond better to action vs. insight)
Clinical-Scientist Model
-1990's primarily a reaction against the trend toward practice represented by Vail Model. -Richard McFall's 1991 "Manifesto for a Science if Clinical Psychology" sparked this movement -A subset of PhD institutions who strongly endorse empiricism and science -Tend to train researchers rather than practitioners -Most money and grants
Lightner Witmer (1867-1956) Germany
-Received doctorate in 1892 in Germany- studied under both Wundt (father of psych)and Cattell (father of experimental psych) -Coined the phrase Clinical Psychology -Psychology was essentially academic; no practice, just study -In 1896, Witmer founded the first Psychological CLinic at the U of Penn. -1914, there were about 20 clinics in US -1935, there were over 150 clinics -Founded the first scholarly clinical psychology journal, The Psychological Clinic, in 1907 -Made 3 lasting impressions on clinical psychology: 1. experimental psych can be helpful in helping people. 2. this can best be provided through a special profession that is independent of both medicine and education. 3. a commitment that clinical psychology should be highly research oriented and be closely allied with basic psych.
Cons Prescription Privileges
-Training issues -Treats to Psychological Treatment -Identity Confusion for the profession -Influence from Big Pharm
What to do to get into programs:
-know your professional options -take, and earn high grades in the appropriate undergrad coursework -get to know your professors -get research experience -get clinical relevance experience -Maximize your GRE scores -Select your program wisely -write effective personal statement -prepare well for admissions interviews -consider your long term goals
** Eight-step 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 American Psychological Association ethical code. Chapter 5 | Ethical Issues in Clinical Psychology 107 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.
William Tuke (1732-1822) England
1732-1822, lived in England, appalled by conditions in asylums, devoted most of his life to improving treatment, raised funds to open York Retreat where patients were treated with kindness, dignity & decency; they were given good food, frequent exercise, and friendly interactions with staff.
Philippe Pinel (1745-1826) France
1745-1826, lived in France, advocated for more humane treatment of mentally ill in France, also introduced ideas of a case history, treatment notes, illness classification, indicating care about their well-being. He wrote the Treatise on Insanity 1806 and encouraged healthy food and benevolent treatment.
Dr. Eli Todd (1762-1832) Connecticut
1762-1832: a physician in Connecticut, there were very few hospitals for the mentally ill, and the burden fell on the families of the ill, he used Pinel's efforts as a model. By raising money and awareness for the mentally ill he opened a facility called The Retreat. Similar facilities were soon opened because of his efforts.
Dorothea Dix (1802-1887) USA
1841, she was a Sunday school teacher in a jail in Boston. She would travel to a city, collect data on its treatment of the mentally ill, present her data to local community leaders, and persuade them to treat the mentally ill more humanely and adequately. She devoted the rest of her life to the the rest of her life to improving the lives and treatment of the mentally ill. Typically, she would travel to a city, collect data on its treatment of the mentally ill, present her data to local community leaders, and persuade them to treat the mentally ill more humanely and adequately. She repeated this pattern again and again, in city after city, with remarkable success. Her efforts resulted in the establishment of more than 30 state institutions for the mentally ill throughout the United States (and even more in Europe and Asia), providing more decent, compassionate treatment for the mentally ill than they might have otherwise received.
David Wechsler
1937, created the Wechsler-Bellevue for adults. Wechsler Adult Intelligence Scale WAIS 1955, WAIS-R 1981, WAIS-III 1997. -Wechsler Intelligence Scale for Children (WISC) 1949 -inclusion of specific of specific subtests, verbal, and performance scales. -Wechsler Preschool and Primary Scale of Intelligence (WPPSI)
Be familiar with the history of prescription privileges debate in the US
1st Postdoc prescription training program was at the School of Psychology Fairleigh Dickinson University (NJ) after the American Society for the Advancement of Pharmacotherapy, APA Division 55 was created. Pharmacy trained Psychologist passed in Illinois in 2014, Louisiana in 2004, and New Mexico in 2002.
Have a thorough understanding of the advantages of using technology in clinical psychology
Advantages • Provide service to underserved, people in poverty or in rural areas, more affordable, anonymity
Be familiar with some of the advantages of evidence based/manualized approaches to therapy
Advantages • Scientific legitimacy • Establishing minimal levels of competence • Training improvements • Decreased reliance on clinical judgment (wisdom)- rely on steps not your clinical judgement. • Bias that is not science
More testing...
Charles Spearman - General intelligence (g) Edward Lee Thorndike - promoted the idea that each person posses separate, independent intelligences. NEO Personality Inventory tests NEO-P-I Beck Depression Inventory Beck Anxiety Inventory
informed consent
It assures the person with whom the psychologist is working the opportunity to become knowledgeable about the activities in which they may participate, and it facilitates an educated decision. Moreover, it affords individuals the opportunity to refuse to consent if they so choose.
Have a thorough understanding of the disadvantages of using technology in clinical psychology
Disadvantages • Differences in informed consent, ethical codes, client confidentiality, cultural differences, relevant training needed, knowing local clients emergency resources
Be familiar with some of the disadvantages of evidence based/manualized approaches to therapy
Disadvantages • Threats to psychotherapy relationship (preventing a connection from forming between the client and therapist) • Diagnostic complications (if you have a manual, are you trying to fit people into a diagnosis? Missed Diagnosis? Trying to put people into categories?) • Restrictions on practice (most people don't want to be told to use a specific treatment) • Debatable criteria for empirical evidence (talking to clients about why/how/why not the treatment is working, How is this quantifiable? How do we evaluate the treatment?)
General Ethics Description: it's important to remember that the ethical code should be understood not only as a list of rules to follow and mistakes to avoid but also as a source of inspiration for ethical behavior of the highest order.
Ethical Principle Sample Sentence From Description in Ethical Code A. Beneficence and Nonmaleficence "Psychologists strive to benefit those with whom they work and take care to do no harm." B. Fidelity and Responsibility "Psychologists establish relationships of trust with those with whom they work. They are aware of their professional and scientific responsibilities to society and to the specific communities in which they work." C. Integrity "Psychologists seek to promote accuracy, honesty, and truthfulness in the science, teaching, and practice of psychology." D. Justice "Psychologists recognize that 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." E. 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
child abuse
Every state has laws requiring mental health professionals to break confidentiality to report known or suspected child abuse
acculturation
Four separate acculturation strategies have been identified : assimilation, in which the individual adopts much of the new culture and abandons much of the original; separation, in which the individual rejects much of the new culture and retains much of the original; marginalization, in which the individual rejects both the new and the original culture; and integration, in which the individual adopts much of the new culture and retains much of the original.
Measuring the Outcome of Culture-Based Training Efforts
How should we reliably and validly measure the outcome of culture-based training efforts? • How can we reliably and validly establish a baseline for the level of cultural competence of a psychologist or trainee before the training takes place? • When we assess the cultural competence component of psychotherapy, whose opinion should we seek? The client's? The psychologist's? The supervisor's? Another interested party's? • How can we make a causal connection between particular culture-based training efforts and particular outcomes? How can we be sure that confounding or unexamined variables aren't responsible for the outcomes we observe?
Tarasoff and the Duty to Warn
In 1969, Prosenjit Poddar was a student at the University of California at Berkeley. He became romantically interested in Tatiana Tarasoff, and when their relationship did not advance as he would have preferred, his mental state worsened and he sought psychotherapy at the university counseling center from a psychologist, Dr. Lawrence Moore. During a session in August 1969, Poddar told Dr. Moore that he intended to kill Tarasoff. Dr. Moore believed that Poddar's comment was credible, so he broke therapist- client confidentiality and contacted campus police. The campus police interviewed Poddar but did not hold him, because he promised to avoid Tarasoff and seemed rational at the time of the interview. Poddar never returned to therapy. On October 27, 1969, Poddar killed Tarasoff by stabbing and shooting her. Tarasoff's parents later sued Dr. Moore and the others involved in the case for wrongful death. The court found that the psychologist was liable for failure to warn Tarasoff of the danger (Knapp & VandeCreek, 2006). In other words, although Dr. Moore broke confidentiality and contacted campus police, the Chapter 5 | Ethical Issues in Clinical Psychology 109 court decided that his actions were insufficient—he should have made efforts to contact Tarasoff directly to warn her that she was in harm's way.
What the DSM 5 i doing to work towards being more Multicultural.
In addition to information on cultural variation embedded in the descriptions of specific disorders, it provides more general guidance for clinicians to help with overall cultural competence. For example, it offers an "Outline for Cultural Formulation," which instructs clinicians in various aspects of culture to assess in clients, such as cultural identity, cultural conceptualization of distress, and cultural features of the relationship with the mental health professional. It also offers a "Cultural Formulation Interview," a series of 16 specific questions that can guide a clinician toward a culturally informed interview. All of these efforts support the growing body of research suggesting that culture influences the experience or expression of a variety of psychological problems, including anxiety disorders, eating disorders, substance use, and many others
What Is Cultural Competence?
Multicultural counseling competence is defined as the counselor's acquisition of awareness, knowledge, and skills needed to function effectively in a pluralistic democratic society . . . and on an organizational/societal level, advocating effectively to develop new theories, practices, policies, and organizational structures that are more responsive to all groups.
Have an understanding of the impact of managed care/third party payment has had on the practice of clinical psychology
Negative impact on quality (limited to certain # of sessions), too little control over clinical decisions, ethical problems including confidentiality, confusion about informed consent (what to tell clients about the payment method), greater affordability for many clients, choice of only 4-5 diagnoses, increased likelihood of being diagnosed with a mental disorder, Expectation of a certain result. Insurance Fraud if you diagnose with a particular diagnosis or if you under diagnosis.
Treating a client via Technology- things to be concerned with:
Obtain informed consent from clients about the services they may receive, the technologies that may be used to provide them, and the confidentiality of the communication. • Know and follow any applicable laws on telehealth and telemedicine. • Know and follow the most recent version of the American Psychological Association ethical code, especially the portions that address technological issues. • Ensure client confidentiality as much as possible by using encryption or similar methods. Keep updated on ways clinical information could be accessed by "hackers" and techniques for stopping them. • Appreciate how issues of culture may be involved. As technological tools replace faceto-face meetings, psychologists may need to make special efforts to assess the cultural backgrounds of the clients they serve. • Do not practice outside the scope of your expertise. Merely having a license may not be enough. Advanced training—either clinical or technological—may be necessary to use a particular technique. Chapter 3 | Current Controversies in Clinical Psychology 71 • Be knowledgeable about emergency resources in any community from which your clients may seek services. A crisis related to suicide or psychosis, for example, may require an immediate face-to-face intervention that the psychologist is simply too far away to provide. • Stay abreast of changes to the laws, ethical codes, or technology relevant to your practice.
Be familiar with the tripartite model of personal identity
One level in this model is the individual level. Here, the premise is that "all individuals are, in some respects, like no other individuals." A second level is the group level, where the premise is that "all individuals are, in some respects, like some other individuals." The final level is the universal level, based on the premise that "all individuals are, in some respects, like all other individuals" A psychologist who can appreciate a client on all three levels will be able to recognize characteristics that are entirely unique to the client, others that are common within the client's cultural group, and still others that are common to everyone.
PhD vs. Psy D
PhD PsyD -Emphasize practice & -Emphasize practice over research research -Smaller classes -Larger classes -Lower acceptance rate -Greater acceptance rate -In University Depts. -Free standing professional schools - 6-8 year programs - 4-6 year programs -more funding to PhD programs/students **Postdoctoral internship still necessary for all three, takes place after the doctoral degree is awarded. Typically lasts 1-2 years. Still supervised but more independent , more specialized and often required for state licensure. In addition to the EPPP (a 240 question exam)
Test security
Psychologists should make efforts to protect the security and integrity of the test materials they use; When psychologists allow test materials to be taken home by clients, photocopied, or posted on Internet sites, not only might they be violating copyright laws, but they might also be allowing prospective test takers inappropriate access to tests. This could lead to preparation or coaching for psychological tests, which could, in turn, produce invalid test results. depending on the test in question, such invalid test results could place a nongifted student in a school's gifted program, a psychologically unstable police officer on the streets, or a child in the custody of an emotionally unfit parent.
Categories of American Psychological Association Ethical Standards
Resolving Ethical Issues -Competence -Human Relations -Privacy and Confidentiality -Advertising and Other Public Statements -Record Keeping and Fees -Education and Training -Research and Publication -Assessment -Therapy
Be familiar with multicultural psychology and the reason some believe it is the "fourth force" in the field
Some argue that multiculturalism is the defining issue of the current generation of psychology • 1st force- psychoanalysis (Freud) • 2nd force- behaviorism (Skinner) • 3rd force- humanism/person centered (Rodgers) • 4th force- multiculturalism can enhance all of these Multiculturalism underlies all psychological issues and efforts- if we do not address it we are actually missing an huge population.
two criteria for impropriety in a multiple relationship
The first involves impairment in the psychologist; if the dual role with the client makes it difficult for the psychologist to remain objective, competent, or effective, then it should be avoided. The second involves exploitation or harm to the client. Psychologists must always remember that the therapist-client relationship is characterized by unequal power, such that the therapist's role involves more authority and the client's role involves more vulnerability, especially as a consequence of some clients' presenting problems
cultural concepts of distress (many of which were called "culture-bound syndromes" in DSM-IV)
The glossary of cultural concepts of distress includes nine terms that represent psychological problems observed in groups from various parts of the world. Examples include taijin kyofusho, in which a person anxiously avoids interpersonal situations because he or she believes that his or her appearance, actions, or odor will offend other people (found in Japanese and some other cultures); 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); and maladi moun, in which one person can "send" psychological problems like depression and psychosis to another, usually as a result of envy or hatred toward the other person's success (found in some Haitian communities; similar experiences called the "evil eye" are more common in other parts of the world)
American Psychological Association (2002) ethical code has two distinct sections- one is the General Principles section and is Aspirational-
The items in the General Principles section are aspirational. In other words, they describe an ideal level of ethical functioning or how psychologists should strive to conduct themselves. They don't include specific definitions of ethical violations; instead, they offer more broad descriptions of exemplary ethical behavior
Why multiculturalism matters to clinicians...
The number of people of minority ethnicities, as well as the proportion of the U.S. population they represent, has increased dramatically. For example, in a single decade (1990-2000), the Asian American/Pacific Islander population and the Latino/Latina/Hispanic population each grew by about 50% (U.S. Census Bureau, 2001). Also, in 2000, there were 28 million first-generation immigrants in the United States, representing about 10% of the entire U.S. population (Martinez, 2004). One in five U.S. schoolchildren speaks a language other than English at home (Roberts, 2004). And by 2050, about half the country's population will identify at least partially as African American, American Indian, Asian American, or Latino/ Latina (U.S. Census Bureau, 2008).
Multiculturalism encourages therapist to ask the following questions from a cultural perspective:
What do you call your problem (or illness or distress)? • What do you think your problem does to you? • What do you think the natural cause of your problem is? • Why do you think this problem has occurred? • How do you think this problem should be treated? • How do you want me to help you? • Who else (e.g., family, friends, religious leader) do you turn to for help? • Who (e.g., family, friends, religious leader) should be involved in decision making about this problem?
Know when psychotherapy started to play a more prominent role in clinical psychology
World War II created a demand for treatment of psychologically affected soldiers Psychotherapy became a more common activity in the mid 1900s and the psychodynamic approach dominated • Then came behaviorism, humanism, family therapy, cognitive therapy
Microaggressions
are comments or actions made in a cross-cultural context that convey prejudicial, negative, or stereotypical beliefs and may suggest dominance or superiority of one group over another. Microaggressions often center on ethnicity or race but can involve any number of differences between people, such as age, gender, socioeconomic status, religion/spirituality, or sexual orientation.
cultural self-awareness
comes to understand that his or her viewpoint is (like everyone's) unique and idiosyncratic. For example, the psychologist may adopt a viewpoint toward clients that is less egocentric and more appreciative of the varying experiences of life. Also, the psychologist may come to recognize that differences between people are not necessarily deficiencies, especially if the difference demonstrated by the client is common or valued in his or her own cultural group. Rather than glossing over differences between themselves and their clients, psychologists should explore their own personal reactions to these differences and address any discomfort they may initially feel about them
competence
competent clinical psychologists are those who are sufficiently capable, skilled, experienced, and expert to adequately complete the professional tasks they undertake
Boulder Model
created in 1949 in Boulder, also known as scientist-practitioner model, emphasizes both practice and research, balanced approach -PhD program 6-8 years in length held at Universities with funding available to students. 6-7 students per program/yearly. Smaller classes. Dissertations.
Vail Model
created in 1979 in Vail, also known as practitioner-scholar model, emphasizes practice over research, yields Psy.D 40-50 students per class with lower GRE scores and lower GPA scores, 4-6 years long in stand a long schools these programs are similar to lit reviews with no real research.
multiple relationships
occurs 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.
heterogeneity
diversity
Signs/ causes of Burnout
emotional exhaustion, over-committed to clients, having a low sense of control over the therapy, and earning a relatively low salary.
etic perspective
emphasizes the similarities between all people. It assumes universality among all people and generally does not attach importance to differences between cultural groups. This perspective was more dominant in the early days of psychology, when most of the people teaching and practicing psychology were male, of European descent, and of middle-class or higher socioeconomic standing. Generally, their viewpoint was put forth as the normative viewpoint on issues such as defining psychological health, identifying and labeling psychological disorders, and developing therapy approaches
nonsexual multiple relationships
friendships, business or financial relationships, coworker or supervisory relationships, affiliations through religious activities, and many others. An essential task for clinical psychologists is to appropriately recognize the overlapping nature of these relationships as well as their potential to cause problems for the client.
Test selection
including the psychologist's competence; the client's culture, language, and age; and the test's reliability and validity. Additionally, psychologists must not select tests that have become obsolete or have been replaced by revised editions that are better suited to the assessment questions being addressed.
American Psychological Association's (2002) ethical code instructs psychologists to inform prospective participants about...
inform prospective participants about numerous aspects of the study, including its purpose, procedures, and length of time it may require; any predictable risks or adverse effects; incentives for participation; and the right to decline or withdraw from participation. If the study is an investigation of a treatment method, psychologists should also inform clients that the treatment is experimental in nature, that some clients may be assigned to groups that receive no treatment (control groups), and of available alternative treatments outside the scope of the current study
phonetic and phonemic.
linguists have used the term phonetics for sounds that are common to all languages and the term phonemics for sounds that are specific to a particular language
small communities encounter-
multiple relationships are preceded by "a slow process of boundary erosion" seemingly harmless, innocuous behavior that doesn't exactly fall within the professional relationship—labeled by some as a "boundary crossing" —and although this behavior is not itself grossly unethical, it can set the stage for future behavior that is. These harmful behaviors are often called "boundary violations" and can cause serious harm to clients, regardless of their initial intentions
cultural adaptation of treatments
now that clinical psychology has generated lists of treatments that work, an important subsequent step is to determine how those treatments might need to be adapted for members of diverse cultures
Ethical Standard 10.01 ("Informed Consent to Therapy") explains that
psychologists inform clients/patients as early as is feasible in the therapeutic relationship about the nature and anticipated course of therapy, fees, involvement of third parties, and limits of confidentiality and provide sufficient opportunity for the client/patient to ask questions and receive answers.
emic perspective
recognizes and emphasizes culture-specific norms. A psychologist employing the emic perspective—which has grown in prominence along with the rise in multiculturalism—considers a client's behaviors, thoughts, and feelings within the context of the client's own culture rather than imposing norms of another culture on the client. Compared with the etic perspective, the emic perspective allows psychologists more opportunity to appreciate and understand how the client might be viewed by members of his or her own cultural group. In short, the emic approach stresses that individuals from various cultural groups "must be understood on their own terms"
Test data
refers to the raw data the client provided during the assessment—responses, answers, and other notes the psychologist may have made. Although previous editions of the ethical code instructed psychologists not to release test data to clients, the current edition instructs psychologists to release test data unless there is reason to believe that the data will be misused or will harm the client. This revision reflects the more global shift toward patient autonomy in the health care field
continuing education
regulations of many state licensing boards. 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 sharpening their professional skills and keeping their knowledge of the field current.
Pro Prescription Privileges
shortage of psychiatrists in rural areas -other "non-MD's" write Scripts -one stop shopping for clients -professional autonomy without relying on other professionals -professional identity -evolution of profession -revenue for profession
How to counteract Burnout
varying one's work responsibilities, keeping one's expectations reasonable, consulting with other professionals, maintaining a balanced and healthy personal life, or seeking psychotherapy as necessary
First IQ test
was developed in 1905 by Alfred Binet, originally for children. Test yielded a single overall score, "g" -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" (IQ). Revised by Terman 1937, called the Stanford-Binet Intelligence Scales (child focused)
Know the history of the APA code of ethics and the two current "sections" of the code as discussed in class and in your book
• Aspirational: general principles section describes an ideal level of ethical functioning, or what to strive for • Enforceable: ethical standards section includes rules of conduct that can mandate minimal levels of behavior and can be specifically violated ** It was first published in 1953, and has been revised 9 times, most recently in 2002
Be familiar with what leaders in the field are saying graduate programs should do to improve cultural competencies
• Explicitly state a commitment to diversity • Actively make an effort to recruit graduate students from diverse populations • Actively make an effort to recruit and retain a diverse faculty • Make efforts to make the admissions process fair and equitable • Ensure that students gain awareness of their own cultural values and biases, knowledge of other groups, and skills to work with diverse populations • Examine all courses for an infusion of a culture-centered approach throughout curriculum • Evaluate students on their cultural competence on a regular basis
Objective tests were?
• MMPI (1943)- comprehensive personality test measuring various pathologies- 200 separate scales consisting of combinations of personality items • MMIP-2 (1989)- revised and restandardized -more appropriate for minorities and individuals from various regions of the country. • MMPI-A (1992)- for adolescents • Higher reliability and validity • High face validity- you know what they are getting at (my soul sometimes leaves my body) • Important to look at context of scores
Influence of War on Clinical Psychology
• Robert Yerkes chaired the Committee on the Psychological Examination of Recruits that created the Army Alpha and Beta intelligence tests during World War I. These tests, which were used to measure the intelligence of recruits and soldiers, are considered precursors to today's most widely used measures of intelligence (McGuire, 1994). • David Wechsler's creation of the Wechsler-Bellevue, his first intelligence test, stemmed from his clinical experiences during World War I measuring intellectual capacities of military personnel. This test led to the WAIS, and ultimately the WISC and WPPSI, the revisions of which are currently the most widely used measures of adult and child intelligence in the United States (Boake, 2002; Reisman, 1991) In the aftermath of World War II, many U.S. veterans returned home with "shell shock," as it was called at the time, and other psychological effects of battle. (Posttraumatic stress disorder later replaced shell shock as the accepted diagnostic label.) The U.S. government (specifically, the Veterans Administration—now the Department of Veterans Affairs) responded by requesting that the American Psychological Association formalize the training of clinical psychologists and provided significant funding to ensure the availability of such training opportunities. These efforts led to accreditation of clinical psychology doctoral training programs and ultimately to the scientist-practitioner (i.e., Boulder) model of training. This training model continues to dominate the field, and the strong relationship between Veterans Affairs and clinical psychology training, including a large number of internships at various levels, continues as well. • The Nazi presence in Eastern Europe in the 1930s forced many influential figures in clinical psychology—most notably, Sigmund Freud and other Jewish psychodynamic leaders—to flee their home countries. This forced relocation facilitated the spread of their theories and clinical approaches to England and, ultimately, to the United States. • Recent U.S. military events, including efforts in Iraq and Afghanistan, have illustrated the crucial role that clinical psychologists continue to play for soldiers and veterans. In fact, Veterans Affairs is one of the country's largest providers of mental health services, with almost 1 million veterans receiving such services within a recent 1-year period.
Projective tests were the first personality tests/ what were they?
• Rorschach Inkblot Method- 1921- 10 ink blot tests where you are projecting from your subconscious • Thematic Appreciation Test (TAT)- 1935- clients respond to ambiguous interpersonal scenes.
Have a thorough understanding of the four exceptions to client confidentiality as discussed in class
• Suicidality: must threaten to kill themselves, threat is imminent, must have access to the plan, must have a clear plan • Homcidality: clear plan, access to that plan, plan is imminent **Duty to warn** • Child abuse/neglect: if it leaves a mark you must report it, abuse must be happening now • Grossly unable to care for themselves: if someone is disconnected with reality
