Defining Clinical Psychology

Defining Clinical Psychology

• Clinical psychology is a broad field of practice and research within psychology
• It applies psychological principles to assessment, prevention, amelioration, and rehabilitation of psychological distress
• It addresses disability, dysfunctional behavior, health-risk behavior, and the enhancement of psychological and physical well-being
• Clinical psychology encompasses scientific research, focusing on general principles, and clinical service, concentrating on client care
• Information from these activities influences practice and research
• Traditional definitions emphasized assessment, evaluation, and diagnosis
• Recently the focus has shifted to intervention, and prevention
• There is a significant emphasis on research and evidence-based practice presently
• Clinical psychologists apply psychological knowledge through prevention, assessment, intervention, research, consultation, teaching, and supervision
• Clinical psychologists cater to diverse clients in various settings and work in forensics, neuropsychology, and health, including services for children & adolescents

Clinical Psychology vs Other Mental Health Professions

• There is not much difference between Clinical and counseling psychology currently
• Populations, settings, and activities may vary based on training opportunities
• School psychologists work at the intersection of psychology and education, diagnosing childhood disorders and creating programs for schools and families
• A degree in education and/or experience with children and adolescents is required for school psychologists
• Psychiatrists hold a doctorate, while clinical psychologists may practice with a master’s degree
• Psychiatry emphasizes physiology, biological functioning, and pharmacology related to psychological abnormalities, with less training in assessment, psychotherapy, and research
• Clinical social work emphasizes clients' well-being (individuals, families, groups, communities)
• Clinical Social workers are involved in policy development, social program planning, case management, counselling, and client advocacy

Cognitive Behavioral Therapy (CBT) in Clinical Psychology

• CBT focuses on the relationship between thoughts, feelings, and behaviors

Pros of CBT

• It has more empirical support than other therapies, such as short-term psychodynamic psychotherapy
• Emphasis on CBT allows for more time and resources spent on empirical research for its effectiveness, including cross-cultural considerations

Cons of CBT

• Lack of diversity in the mental health field and differing views is important
• It can be difficult for clients to find therapists specializing in something other than CBT
• There is a lack of funding and research for therapies not based on CBT

Psychologist's Expertise in Diagnosis

Benefits of Diagnosis

• Suggests clinical psychologists are more privy to the severe side effects of taking/suddenly ending various psychopharmaceuticals, including benzodiazepines like lorazepam
• Allowing psychologists to diagnose and prescribe psychopharmaceuticals could be more efficient
• Positive framework is created for those involved in the mental health system
• General doctors have many patients, shifting responsibility among mental health providers could provide better patient care

Risks of Diagnosis

• Psychiatrists and other professionals with a medical background concentrate more on pharmaceuticals and the body in their training
• Clinical psychologists receive therapeutic and counseling training, not all have a background in science

Client Populations and Personal Biases

• Precluding work with domestic violence perpetrators
• Ethical code requires suspending judgment to give everyone a fair chance
• There is bias against domestic violence perpetrators
• Belief that therapy can help the individual

Psychotherapy vs Talking to a Friend

• Psychotherapy differs due to ethical code of conduct
• Includes conflict of interest
• Personal investment
• Bias due to close relationships
• Lack of structure or mutually agreed-upon goals
• Providing advice without accountability
• Talking to a friend is not a norm-referenced or empirically supported form of psychotherapy

Clinical Psychologist as a Generalist

• Being a generalist is possible but necessitates referring clients to specialists, similar to general practitioners

Challenges of Being a Generalist

• Extended schooling and training to understand populations while risking being “in over your head”
• Difficult to handle and getting small amounts of practice in each therapy

Disillusioning Clinical Psychology Path

• Masters programs in Alberta are not accredited, only PhD programs
• Without an accredited Ph.D., every class taken needs approval from the College of Alberta Psychologists
• Accredited programs are very competitive
• Finding and paying for a supervisor is a necessity
• Multiple applications to graduate programs may be decline
• Minimum bachelor degree requirements, research, and publications are needed
• You may be expected to move for your graduate program, and more than once when pursuing a PhD
• One must apply for their own tri-council funding and additional costs exist after grad school (time and study materials)

Cognitive Behavioral Therapy

• Cognitive Behavioral Therapy treats generalized anxiety disorder, OCD, and social anxiety disorder

CBT Theory of Change

• CBT posits that emotions and behaviors influence perception
• How events are processed determines feelings, not the actual event
• The CBT psychologist combines client experiences within a cognitive model through Socratic dialogue, challenging negative beliefs, dysfunctional assumptions, and negative automatic thoughts

CBT Strengths and Weaknesses

• Strengths include empirical evidence, structured format, usefulness for various diagnoses, accessibility, and cost-effectiveness
• Weaknesses include being better for some disorders (like anxiety disorders), being uncomfortable for some clients, and potential focus on individual without addressing underlying issues

Collateral Information in Assessment

• Psychologists use this information to understand behaviors, relationships, and habits and can interview family/friends with consent about observable actions, emotional states, and behaviors
• Though not part of every assessment, it is critical for children, forensic/high-stakes assessments, and when clients lack insight

Resolving Conflicting Information

• Look for common threads in common behaviors
• Follow up to understand conflicting info, and discuss it with the client for clarification

Reasons for Differing Information

• Individuals see the client in different settings, therefore reporting different information
• Different experiences and impressions of the client are created (i.e., friends vs. mother)

Interpersonal Therapy (IPT)

• IPT is best suited for regulating routines and social rhythms to prevent mood episodes, especially in Bipolar 1 and Depression patients
• However, others may not need such assistance, may have severe cases, or lack insight into triggers/disruptions
• Clients undergoing CBT may have proven more effective at treatment for anxiety disorders
• IPT relies on strong therapist-client trust to role-play interactions using psychoeducation, goal-oriented, and cognitive-behavioral elements
• Clients have to abide by daily tracking and be committed to the therapy
• Some therapists might have biases and therefore be specialized toward different therapies