Clinical Psychology: Profession and History

Chapter 1: Being a Clinical Psychologist - Profession and History

• Clinical psychologists assess clients, conduct psychotherapy, perform research, consult, and educate.
• Scientist-Practitioners actively research clinical practice questions, using clinical experience to inform research.
• Psychologists are scientists or clinicians specializing in psychology.
• Clinical psychologists provide health care, assessments, and psychological therapy; they require expertise in both science and practice.
• Master's level providers are less likely to work in hospitals, treat psychosis, and conduct assessments.
• Counselling psychologists are similar to clinical psychologists but have less training, less expertise in formal psychodiagnostic assessments, and are less likely to work with populations with psychoses or severe personality disorders; they often become service providers at the Master's degree level.
• Psychiatrists are physicians certified in treating mental illness through a biological approach.
• Psychiatrists complete medical school and specialize through residency, with the ability to prescribe medication.
• Professional Social Workers are focused on case management, medical social work, counselling, human services management, social welfare policy analysis, community organizing, advocacy, teaching, and social science research.
• Some social workers offer one-on-one clinical services, particularly in child and family areas.

Chapter 3: Methods for Research and Evaluation

• Professions that can demonstrate cost-effectiveness are more protected against budget cuts.
• Observational methods involve carefully watching a patient in session or in natural environments.
• Surveys and questionnaires are frequently used in research and clinical assessments as self-report tools for personality and psychopathology.
• Standardized tools have limitations and may not work for all people or problems.
• Single case studies are useful when therapists evaluate new methods or types of clients and their response to experimental interventions.
• Therapy outcome studies document the value and reasons for clinical interventions.
• Randomized, controlled clinical trials are considered the gold standard for creating knowledge that can be trusted to drive clinical practice.

Reliability and Validity

• Reliability measures the ability to produce the same results with a test multiple times.
• Reliability is measured on a scale of 0 to 1.00, with higher scores indicating better reliability.
• Inter-rater reliability is the extent to which two or more raters agree, which can be impacted by cultural grounds.
• Kappa coefficient represents agreement between raters, considering instances where one rater notices a behavior while another does not.
• A negative Kappa score means that there is no agreement between the two rates.
• Rater training aims for an inter-rater reliability of at least 0.8.
• Recording behaviors ensures they are not missed and is cost-effective.
• Improvements to inter-rater reliability can be time-consuming and expensive, yet less of a problem in self-evaluations.
• Test makers should strive to make tests as short and comprehensive as possible.
• Internal consistency, also known as Cronbach's alpha, determines how useful each item is for measuring the overall construct.
• Split-half reliability involves comparing similar items split into two equal groups for similar scores.
• High test-retest variability involves retaking a test after a period of time and yielding similar results.
• Validity measures whether the test is measuring what it's supposed to.

Face, Content, Concurrent, Construct, and Criterion Validity

• High face validity makes it obvious what a test is trying to measure and it facilitates biased responses.
• Content validity taps into what experts think the construct is all about.
• Concurrent validity assesses whether the test produces similar results to other studies measuring similar psychological constructs.
• Construct validity explores whether the variables reveal meaningful connections to other variables around the same theme.
• Criterion validity assesses whether the test helps with real-world decision-making.

Predictive Variability

• Predictive variability is the most desirable subtype of criterion validity and assesses whether a test can predict a behavior correctly.

Measuring Change in Therapy

• Psychologists are interested in patient improvement and critical interventions.
• Researchers test interventions to see what works and benefits patients.
• Case studies can present interesting cases like stories or treat a single patient as an experiment.
• Behavioral therapies often conduct experiments, and therapists may apply successful techniques to multiple patients with similar problems.
• Observation of individual patients/systematic case studies often innovate psychotherapy research.
• Testing treatment effects with a single case design involves a four-phase protocol with baseline recordings and treatment phases alternating twice (ABAB design).
• Simplest form of learning about treatment-induced change is through a single-group, pre-post treatment design.

Chapter 4: Ethical Decision Making

• Ethical behavior and decision making is rarely straightforward.
• Clinical psychologists must learn the process of ethical decision making and be familiar with ethical principles.
• Ethical decision making is derived from religion and philosophy, focusing on respect and dignity, which aligns with the medical principle of "above all, do no harm."
• Knowing when doing the right thing: a continuum exists from criminal behavior to selfless giving.
• Mandated behaviors are easiest to understand; breaking them may not be outright criminal, but still border felonious behavior.
• Behavior like treating clients with respect is harder to understand because ways of showing respect are subjective.
• The ethical continuum spans from bare minimum (do no harm) to aspirational goals.
• Most ethics violations are obvious, but subtler skills are needed to prevent future problems.
• Problems arise when two ethical principles clash.

Commitment to Ethical Standards

• Licensed psychologists must pass an exam with an ethics section and local legislation knowledge.
• Three common ethical complaints: inappropriate assessment procedures, lack of competence, and boundary violations.
• It is important to know the laws of your country, state, or province
• The most vital legislation to know involve mandatory reporting of child neglect and abuse, even if it violates confidentiality.
• Knowing limitations of confidentiality requires understanding when courts may ask for patient files.
• Best practice involves asking clients about legal proceedings in assessment or therapy.
• Another widespread requirement involves reporting impaired driving due to senility or brain injury.

Practice Guidelines and Codes of Conduct

• Practice guidelines help handle predictable professional responsibilities
• Following these guidelines makes it more difficult to challenge psychologists in court
• These guidelines are clustered with the code of conduct.
• Psychologists should be very familiar to it or have ready access to in.
• Basic principles of ethics are are there, as practice guidelines do not always cover individual circumstances.
• An ethical dilemma means there is no available answer, and the psychologist must strive to minimize damage, while realising that one or another principle has to suffer.
• Codes of ethics offer very general listings of prescriptions for professional behavior with a high moral standard.
• Codes of ethics are regularly revised and expanded.

Basic and Overarching Principles of Ethics

• Beneficence and non-maleficence mean striving to benefit others while taking care to do no harm, including awareness of one's own limitations.
• Fidelity and responsibility require awareness of professional and scientific responsibilities to society and specific communities.
• Integrity involves promoting accuracy, honesty, and truthfulness, keeping promises, and avoiding unwise commitments.
• Justice means ensuring fairness and equal access to services and benefits for all persons.
• Psychologists must respect people's rights and dignity, including privacy, confidentiality, and self-determination.
• Safeguards may be needed to protect vulnerable individuals' decision making.
• Psychologists should show awareness of cultural, individual, and role differences; these general principles apply to 10 ethical standards which include: resolving ethical issues, competence, human relations, privacy and confidentiality, advertising, record-keeping and fees, education and training, research, assessment, therapy.
• The Canadian code of ethics differs from the APA code, with nine core features including an analysis of existing codes, inclusion of the social contract, revision based on feedback, organization around four major principles weighed for importance, integration of a 10-step decision-making processes, consideration of society, minimal and aspirational standards, considering the APA and CPA codes as umbrella documents.

Chapter 5: The Nature of Psychopathology

• Defining Psychological Problems focuses on defining psychological problems
• Three major approaches applied in research involve Statistical or Normative Approach, Subjective Interpretation (Psychological Pain), and Judgements of Maladapttive Functioning.
• Statistical or Normative Approach involves conforming behavior to standards, expectations, or norms.
• Though these standards may be different across cultures, all cultures have standards for appropriate behavior.
• If behavior falls outside the norm it is considered abnormal, problematic, and in need of improvement.

Subjective Interpretation and Maladapttive Functioning

• Subjective Interpretation (Psychological Pain) is when individuals make judgments about abnormal or maladjusted behaviors.
• Subjective Interpretation does not necessarily use norms of a society or culture
• In Judgements of Maladapttive Functioning, an expert judges if a person's behavior is abnormal or maladaptive.
• This depends on a person's ability to work and/or develop and maintain relationships.
• Judgements of Maladapttive Functioning does not rely on statistics or personal judgements
• Many problems coming to clinical psychologists are better labeled as problems in living, rather than diagnoses.
• Clinical psychologists don't only tackle formal psychological disorders, they also treat problems that may not constitute formal diagnostic entities.

Focus of Seek Issues

• Issues people will seek are Relationship problems, Personal difficulties, and Achievement problems.
• Relationship problems include intimate relationship difficulties, relationship breakdown, problematic work-related relationships, family problems)
• Personal difficulties include self-esteem problems, identity-related problems, or lack of general satisfaction in life.
• Achievement problems include feelings of stagnation and dissatisfaction with work, test anxiety, job or life transition)
• Physical problems include weight control, reduction of blood pressure, sleep problems
• Problems that reflect normal but distressing processes include grieving losses arising from death, divorce.
• Abnormal behavior does not always equal negative or pathological or in need of elimination.

Key Concepts in Defining Psychological Problems

• A sign is a problem or abnormality observed by a clinician.
• "An objective manifestation of a pathological condition”
• A symptom is an abnormality or complaint perceived by a patient
• "Subjective manifestations of a pathological condition”
• A syndrome represents a group of signs and/or symptoms that reflect a health-related condition.
• A psychological disorder is normally described as a term used to imply the existence of a clinically recognizable set of signs, symptoms, or behaviors that often produce distress and interference with personal functions.
• The authors of the DSM recognize the lack of a definition, though they suggest that a disorder constitutes a manifestation of a behavioral, psychological, or biological dysfunction in an individual.
• Psychopathology has often been described as problems or difficulties involving processes in person's functioning
• Long-standing anger/hostility problems are examples where these difficulties are seen as part of the person's personality make-up
• Someone else may develop debilitating anxiety related to a discrete entity, such as the presence of snakes, and it is seen as distinct from personality and more situation-specific.

Emotions, Thoughts, and Perceptions

• Emotion or affect is a major domain that is affected in psychopathology and is a focus of much research and clinical work.
• Anxiety, depression, and anger: most predominant emotions reflective of disorders.
• Emotional regulation means ability to control the experience and expression of negative emotions.
• Reduced emotional expression or an absence of emotions are indicative of some psychological problem.
• Thoughts/Cognitions, Intellectual Functioning, Information Processing states that many forms of distress, psychological problems, and mental disorders have compromized cognitive features.
• Delusions in serious psychopathology are examples of problems involving Thoughts/Cognitions.
• Some disorders present with processing difficulties, whereby individuals interpret and focus on only negative aspects of the world, the self, and the future or on potential sources of threat.
• Rumination can be seen in numerous disorders, which reflects a lack of ability to control thoughts or in extreme cases can be debilitating to people (e.g., OCD).
• Also, cognitive processing and intellectual functioning problems are seen in many neuropsychological issues involving brain damage in addition to other disorders.
• Perceptual processess involve cognitive processess that give rise to perceptual experiences
• Hallucinations in schizophrenia are examples of extreme perception
• Object relations means the schemas or representations of others that individuals develop.

Self-Esteem, Behavior, and Development

• Numerous kinds of psychopathology also have characteristics of unrealistically low/high or reactive views of self-esteem and self-regard.
• Regulatory or Coping Behavior assesses the ability to cope and the way in which an individual does so, and whether it is effective.
• Inflexible coping or defending can have a decided effect on psychopathology.
• It is important to consider when determining abnormality, but these issues are most commonly focused on with children or adolescents
• descriptive psychopathology means that which is normal for a child of one age, may be indicative of psychopathology for a child of a different age
• Abnormality should be determined within the environmental context and issues that can influence psychological problems.

Conceptualizations of of Psychological Problems

• Understanding of psychopathology has shifted between demonological models and more "scientific” models or natural perspectives over the past centuries.
• Current conceptualizations aren't necessarily uniform or static, nor are components necessarily generally agreed upon.
• Something seen as a disturbance today, may not be seen as such tomorrow
• Clinical psychologists work is influenced by their theoretical orientation and that the field of clinical psychology is not necessarily a unified whole with only one or two theoretical orientations.
• Those working from a behavioral or cognitive-behavioral perspective will conduct interventions in a different manner, and will also have different fundamental beliefs in the nature of a person's problems, which differs substantially from psychodynamic psychologists.
• An observation can be obtrusive and not reactive:
• Perspective determines what information is viewed as relevant, what information is sought and focused upon, the particular assessment procedures and protocols used to obtain information, the focus and type of treatment.

Problems

• Conceptualizes problems as groups of symptoms or observable behaviors, and the presence of difficulty is a presence of those symptoms.
• The orientation of the psychodynamic, interpersonal, cognitive schools, and the PDM.
• A good indication is the current diagnostic schemes that are in use
• The ICD and DSM are in use.
• Diagnostic Classification Systems represent current conceptualizations of psychopathology
• Classification systems provide good descriptions of disorders such that they can be identified reliably and validly
• Diagnostic Classification Systems provide a common language for concepts and terms
• The International Classification of Diseases (ICD-10), the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5), and the Psychodynamic Diagnostic Manual (PDM) assist with the above
• Specific signs, symptoms, and behaviors reflect the diagnostic criteria for clinical diagnoses.

Diagnostic

• Diagnostic features are the type and number of criteria necessary for diagnosis
• Associated features support behaviors or characteristics that that often accompany the disorder Diagnostic includes findings from a variety of tests that aid in definitive diagnosis
• Culture-related, gender-related, features can be based on age, culture, and gender.
• The PDM focuses on three components to a person's functioning for the healthy functioning, expressions, symptom patterns, and judgements
• The major difference, between all three, of DSM and ICD as the beginning point of thinking personality
• All in concern, what problems and concerns are involved in assessing the features of problems
• The patients can do a test by doing what things are happening during this test

Tests, Interviews, and Examination

• Most surveys have focused on American samples
• Clinical interviews are a means of gathering clinical data and information on the difficulties the individual has.
• Has to gather information from multiple sources
• Information include age, sex, marital status, people in family, religion, race, occupation, contact information, etc. Usually test using an engagement with the patient and is able to obtain information
• In depth exams must be looked down for the patients utterances
• The Mental Status Exam (MSE) may contain psychological functioning
• Assessment involves expressive functions to know speaking or writing

Test Assessments

• Tests that have more validity will get an invalid test result
• Clinical interviews assess for a good range of things such as depression
• One of the most often used test is the MMPI
• All measures of distressed patients correlate so that its hard to figure a tool that doesn't “re-invent the wheel"
• Neuro assessments is the only way that a brain could get a test due to injury!
• Tests should be as clear as one and other

Neuro and Physiological Testing

• A Neuropsychology is a specialty area of clinical psychology that is a brain damage area
• A medical brain injury usually involves functional due to specific brain damage
• Patients, is the only way to help improve those who have been affected from brain damage
• A brain should be examined and tests should get the most clear and equal way for all tests.
• A behavioral and the only test to get an improvement

Chapter 9; Behavioral and Biological Assessment

• Rationale and base principles assess for the behavioral under certain circumstances.
• The patient, should observe that the only requirement for behavioral assessment is than an observable behavior is informative and quantifiable.
• Observing that all behaviors should be observed and if the self is not right.
• Monitoring behavior means for patients whom have a reactive punishment; is to protect themselves.
• You still must have accurate results and all need to be measured.
• You can show that the person can get what needs to be done using test results
• To help and be good as a doctor takes hard studies and work to observe.
• You can then provide recording booklets for patients and must take the correct tools for better results.