Clinical Psychology PDF

Summary of Terms in Clinical Psychology (Pasado at Mataas na score cutieee) Division of the American Psychological Association devoted to clinical psychology The Division of Clinical...

Summary of Terms in Clinical Psychology (Pasado at Mataas na score cutieee) Division of the American Psychological Association devoted to clinical psychology The Division of Clinical Psychology (Division 12) of the American Psychological Association (APA) defines clinical psychology as follows: The field of Clinical Psychology integrates Part I Introducing Clinical Psychology science, theory, and practice to understand, predict, and alleviate maladjustment, disability, and Chapter 1 Definition and Training discomfort as well as to promote human adaptation, adjustment, and personal development. Clinical Psychology focuses on the intellectual, emotional, biological, psychological, social, Clinical psychology and behavioral aspects of human functioning across the life span, in varying cultures, and at Rigorous study and applied practice directed toward understanding and improving the all socioeconomic levels. (APA, 2012a) psychological facets of the human experience, including but not limited to issues or problems Boulder model of behavior, emotions, or intellect Alternate name for the scientist-practitioner model of graduate training stemming from the Clinical psychology is the psychological specialty that provides continuing and comprehensive historic 1949 conference of directors of training in Boulder, Colorado mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. Reflect the dual emphasis: Graduate students would (under supervision) conduct both clinical work and their own empirical research (thesis and dissertation). The term scientist- It is a specialty that is broadly inclusive of severe psychopathology - and marked by practitioner model was used to label this two-pronged approach to training comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. Practitioner-scholar (vail) model The scope of clinical psychology encompasses all ages, multiple diversities and varied A model of graduate training in clinical psychology that emphasizes practice over empirical systems; having advanced scientific and theoretical knowledge germane to the specialty and research understanding of psychopathology and diagnostic/intervention considerations. Includes mental Clinical psychologists sought a doctoral-level degree with less extensive training in research health issues across the lifespan based on a solid understanding of psychopathology. and more extensive training in the development of applied clinical skills. So, the practitioner- Lightner Witmer scholar model of training was born, along with a new type of doctoral degree, the PsyD. The founder of the field of clinical psychology, the first psychological clinic, and the first Vail model journal devoted to clinical psychology Alternate name for the practitioner-scholar model of graduate training stemming from a 1973 The term clinical psychology was first used in print by Lightner Witmer in 1907. Witmer was professional conference in Vail, Colorado also the first to operate a psychological clinic (L. T. Benjamin, 1996, 2005). The growth of the PsyD (or practitioner-scholar or Vail model) approach to training in clinical Division of Clinical Psychology (Division 12) of American Psychological Association psychology has influenced the field tremendously. (APA) Clinical scientist model APA – Prominent professional organization for psychologists of which many clinical A model of graduate training in clinical psychology that emphasizes empirical research over psychologists are members practice Division of Clinical Psychology (Division 12) Stressed the scientific side of clinical psychology more strongly than did the Boulder model. Postdoctoral internship A PhD from a clinical scientist program implies a very strong emphasis on the scientific A 1- or 2-year internship occurring after the doctoral degree in clinical psychology is granted method and evidence-based clinical methods. that consists of supervised clinical experience in an applied setting, often with a specialized Richard McFall focus Author of the “manifesto” that served as the foundation for the clinical scientist model of Most states require a postdoctoral internship (or postdoc) for licensure as a psychologist. The graduate training in clinical psychology postdoc typically lasts 1 to 2 years (Vaughn, 2006), and it is essentially a step up from the predoctoral internship. Postdocs take on more responsibilities than they did as predoctoral In 1991, Richard McFall, at the time a professor of psychology at Indiana University, published interns, but they remain under supervision – postdoc often provides an opportunity for an article that served as a rallying call for the clinical scientist movement – “Manifesto for a specialized training. Science of Clinical Psychology,” McFall (1991) argued that “scientific clinical psychology is the only legitimate and acceptable form of clinical psychology... after all, what is the Examination for Professional Practice in Psychology (EPPP) alternative?... Does anyone seriously believe that a reliance on intuition and other unscientific A standardized exam used by states and provinces as a criterion for licensure methods is going to hasten advances in knowledge?” Becoming licensed also requires passing licensure exams—typically, the Examination for Academy of Psychological Clinical Science Professional Practice in Psychology (EPPP) and a state-specific exam on laws and ethics. An organization of graduate programs subscribing to the clinical scientist model of graduate The EPPP is a standardized multiple-choice exam on a broad range of psychology topics; all training in clinical psychology U.S. states and most provinces of Canada establish a minimum score for licensure. A few years later, a conference of prominent leaders of select clinical psychology graduate Licensure programs took place at Indiana University. The purpose of the conference was to unite in an effort to promote clinical science. From this conference, the Academy of Psychological Status granted by states to clinical psychologists–– once they have met educational, Clinical Science was founded. experiential, and exam-related requirements––that allows them to identify themselves as members of the profession and to practice independently Predoctoral internship Once all the training requirements are met— graduate coursework, predoctoral internship, A year-long internship occurring near the end of graduate training in clinical psychology that postdoctoral internship—licensure appears on the horizon. consists primarily of supervised clinical experience in an applied setting Becoming licensed gives professionals, the right to identify as members of the profession—to All clinical psychology doctoral programs culminate in the predoctoral internship. present themselves as psychologists. Typically, this internship consists of a full year of supervised clinical experience in an applied It also authorizes the psychologist to practice independently setting. Continuing education units (CEUs) This internship year takes place before the PhD or the PsyD is awarded. Educational credits earned by licensed clinical psychologists by attending workshops, taking It is generally considered a year of transition, a sort of advanced apprenticeship in which the courses, reading selected material, or similar means; often required by states for license individual begins to outgrow the role of “student” and grow into the role of “professional.” renewal Once licensed, clinical psychologists in many states must accumulate continuing education Professional counselors units (CEUs) to renew the license from year to year. Professionals with some similarities to clinical psychologists but who attend master’s programs Counseling psychologists in professional counseling that typically have relatively high admissions rates, and whose activities emphasize counseling and deemphasize assessment and research Professionals with some similarities to clinical psychologists but whose work tends to emphasize less seriously disturbed clients, vocational testing, and career counseling Professional counselors (often called licensed professional counselors, or LPCs) earn a master’s (rather than a doctoral) degree and often complete their training within 2 years. Historically, they have differed primarily in terms of their clients’ characteristics: Clinical psychologists were more likely to work with seriously disturbed individuals, whereas Professional counselors’ work generally involves counseling of people with problems in living counseling psychologists were more likely to work with (“counsel”) less pathological clients. or mild mental illness (as opposed to serious mental illness). Psychiatrists School psychologists Professionals with some similarities to clinical psychologists but who are medically trained, Professionals with some similarities to clinical psychologists but who work primarily in able to prescribe medication, and emphasize the biological aspects of clients’ problems schools and often perform psychological and educational testing and conduct interventions with students Unlike clinical (or counseling) psychologists, psychiatrists go to medical school and are licensed as physicians. As the name implies, school psychologists usually work in schools, but some may work in other settings such as day-care centers or correctional facilities. As physicians, they are allowed to prescribe medication. The difference between psychiatrists and clinical psychologists is more than just the ability to prescribe medication. Their primary function is to enhance the intellectual, emotional, social, and developmental lives of students. Social workers Traditionally, social workers have focused their work on the interaction between an individual and the components of society that may contribute to or alleviate the individual’s problems. They saw many of their clients’ problems as products of social ills— racism, oppressive gender roles, poverty, abuse, and so on. They also helped their clients by connecting them with social services, such as welfare agencies, disability offices, or job-training sites Marriage and family therapists (MFTs) Professionals with some similarities to clinical psychologists but who typically obtain a master’s degree and focus on clinical work with couples and families Marriage and family therapists (MFTs) earn master’s degrees. Their training focuses on working with couples and families, but sometimes they also see individuals struggling with issues related to their partners or families. Chapter 2 Evolution of Clinical Psychology Was working as a Sunday school teacher in a jail in Boston, where she saw firsthand that many of the inmates were there as a result of mental illness or retardation rather than crime. Dix devoted the rest of her life to improving the lives and treatment of the mentally ill. William Tuke Her efforts resulted in the establishment of more than 30 state institutions for the mentally ill A pioneer of reform in the treatment of the mentally ill in England in the late 1700s and early throughout the United States (and even more in Europe and Asia), providing more decent, 1800s compassionate treatment for the mentally ill than they might have otherwise received. Heard about the deplorable conditions in which the mentally ill lived. He visited asylums to Lightner Witmer get a firsthand look, and he was appalled by what he saw. Tuke devoted much of his life to improving these conditions. Lightner Witmer (1867–1956), who created the term clinical psychology and founded the first psychological clinic. He raised funds to open the York Retreat, a residential treatment center where the mentally ill would always be cared for with kindness, dignity, and decency. neurosis Philippe Pinel Along with psychosis, one of the two broad categories of mental illness used in Europe in the 1800s; refers to disorders such as anxiety and depression in which the individual maintains an A pioneer of reform in the treatment of the mentally ill in France in the late 1700s and early intact grasp on reality 1800s The Psychological Clinic a liberator of the mentally ill; Pinel worked successfully to move mentally ill individuals out of dungeons in Paris, where they were held as inmates rather than treated as patients. The first scholarly journal in the field of clinical psychology, founded by Lightner Witmer in 1907 Eli Todd Witmer also founded the first scholarly journal in the field (called The Psychological Clinic) A pioneer of reform in the treatment of the mentally ill in the United States in the late 1700s in 1907. and early 1800s psychosis Eli Todd made sure that the chorus of voices for humane treatment of the mentally ill was also heard on the other side of the Atlantic Ocean. Along with neurosis, one of the two broad categories of mental illness used in Europe in the 1800s; refers to disorders in which the individual demonstrates a break from reality in the Todd had learned about Pinel’s efforts in France, and he spread the word among his own form of hallucinations, delusions, or grossly disorganized thinking medical colleagues in the United States. They supported Todd’s ideals both ideologically and financially, such that Todd was able to raise funds to open The Retreat in Hartford, Emil Kraepelin Connecticut, in 1824. A pioneer of diagnostic categorization in mental health who was one of the first to assign Dorothea Dix formal labels to particular clusters of symptoms A pioneer of reform in the treatment of the mentally ill in the United States and elsewhere in considered the “father of descriptive psychiatry,” offered a different two-category system of the 1800s mental illness. exogenous disorders Stanford-Binet Intelligence Scales Kraepelin differentiated exogenous disorders (caused by external factors); far more treatable A widely accepted test of intelligence originally developed by Alfred Binet and Theodore type Simon endogenous disorders Terman’s revision was called the Stanford-Binet Intelligence Scales, the name by which the test is currently known. caused by internal factors Wechsler-Bellevue multiaxial system The first intelligence scale created by David Wechsler in 1939, designed for adults An assessment system used by recent editions of the DSM that allows mental health professionals to provide diagnostic information on each of five distinct axes or domains In 1939, David Wechsler filled the need for a test of intelligence designed specifically for adults with the publication of his Wechsler-Bellevue test. DSM III, a way of cataloguing problems of different kinds on different axes, which remained for multiple editions before being taken out of the most recent. Wechsler Adult Intelligence Scale (WAIS) dementia praecox A prominent scale of intelligence for adults Emil Kraepelin’s term for a cluster of psychological symptoms similar to what is currently Since its creation, Wechsler’s adult intelligence scale has been revised and re-standardized known as schizophrenia numerous times: the Wechsler Adult Intelligence Scale (WAIS) in 1955. describe one endogenous disorder similar to what is now known as schizophrenia. Wechsler Intelligence Scale for Children (WISC) diagnostic criteria A prominent scale of intelligence for children Specific lists of symptoms used to define mental disorders In 1949, Wechsler released a children’s version of his intelligence test (a more direct competitor for the Stanford-Binet). DSM III, lists indicating exactly what symptoms constitute each disorder The WISC distinguished itself from the StanfordBinet by the inclusion of specific subtests as Alfred Binet well as verbal and performance scales (in addition to overall IQ). A pioneer in the assessment of intelligence who co-created the Binet-Simon scale in the early Wechsler Preschool and Primary Scale of Intelligence (WPPSI) 1900s, which evolved into the Stanford-Binet Intelligence Scales A prominent scale of intelligence for preschoolers When the French government sought help in determining which public-school students should qualify for special services. In response to this request, Alfred Binet (along with Theodore In 1967, Wechsler added an intelligence test designed for very young children called the Simon) created the first Binet-Simon scale in 1905. Wechsler Preschool and Primary Scale of Intelligence (WPPSI). This test yielded a single overall score, endorsing the concept of “g.” It was the first to Edward Lee Thorndike incorporate a comparison of mental age to chronological age as a measure of intelligence. A pioneer in the study of intelligence who promoted the idea that each person possesses separate, independent intelligences; also, a leading researcher in the area of operant conditioning and the law of effect Was among those who promoted the idea that each person possesses separate, independent The Minnesota Multiphasic Personality Inventory (MMPI), written by Starke Hathaway and intelligences. J. C. McKinley, is perhaps the best example of a comprehensive personality measure. When it was originally published in 1943, it consisted of 550 true/false statements. Charles Spearman The MMPI had a built-in system to detect random responding or intentionally misleading A pioneer in the study of intelligence who argued for the existence of “g,” a general intelligence responses. thought to overlap with many particular abilities Psychodynamic Hermann Rorschach An approach to clinical psychology deriving from the theories of Sigmund Freud and Swiss psychiatrist who created the Rorschach Inkblot Method, a popular projective personality emphasizing the goal of making the unconscious conscious test In the mid-20th century, when psychotherapy rose to a more prominent place in clinical In 1921, Hermann Rorschach published a test that had significant impact for many years to psychology, the psychodynamic approach to therapy dominated. come. behavioral Rorschach, a Swiss psychiatrist, released his now-famous set of 10 inkblots, which rose quickly in popularity (despite the fact that in the early years, several different competing Rorschach An approach to clinical psychology emphasizing empiricism, observable and quantifiable scoring systems existed). problems and progress, and a lack of speculation about internal mental processes As a projective personality test, the Rorschach Inkblot Method was based on the assumption Emphasizes an empirical method, with problems and progress measured in observable, that people will “project” their personalities onto ambiguous or vague stimuli; hence, the way quantifiable terms. This emphasis was in part a reaction to the lack of empiricism evident in individuals perceive and make sense of the blots corresponds to the way they perceive and psychodynamic psychotherapy. make sense of the world around them. cognitive Christiana Morgan and Henry Murray An approach to clinical psychology emphasizing illogical thought as the foundation of Christiana Morgan and Henry Murray published the Thematic Apperception Test (TAT) in psychopathology and logical thought as the foundation of psychological wellness 1935. with its emphasis on logical thinking as the foundation of psychological wellness, has The TAT was similar to the Rorschach in that the test taker responded to cards featuring intensified to the point that it has become the most popular singular orientation among clinical ambiguous stimuli. However, instead of inkblots, the TAT cards depicted people in scenes or psychologists. situations that could be interpreted in a wide variety of ways. Instead of identifying objects in humanistic the card (as they might with Rorschach’s inkblots), clients were asked to tell stories to go along with the interpersonal situations presented in the TAT cards. An approach to clinical psychology deriving primarily from the theories of Carl Rogers and Abraham Maslow emphasizing the tendency toward healthy growth within each individual Minnesota Multiphasic Personality Inventory (MMPI) (or “client-centered”) therapy also flourished in the 1960s, as Carl Rogers’s relationship- and A popular and empirically sound objective personality test for adults, originally published in growth-oriented approach to therapy offered an alternative to both psychodynamic and 1943 behavioral approaches that many therapists and clients found attractive. Boulder conference And in 1949, the historic Boulder conference took place, at which training directors from around the country agreed that both practice and research were essential facets of PhD clinical psychology training. Chapter 3 Current Controversies and Directions in Clinical Psychology Like the prescription privilege movement, the movement in favor of evidence-based practice and manualized therapy has intensified in recent decades, as has the reaction to it. evidence-based practice Several outspoken and prominent individuals have also promoted the movement toward prescribing The practice of clinical psychology based on empirical research evidence in combination with clinical expertise and client characteristics, culture, and preferences Patrick H. DeLeon therapy manual A prominent proponent of prescription privileges for clinical psychologists and a former president of the American Psychological Association A manual that provides detailed instructions for all phases of the treatment of a specific disorder; typically used in treatment outcome studies Morgan T. Sammons So, rather than broadly instructing the study’s therapists to practice therapy, or providing a A prominent proponent of prescription privileges for clinical psychologists and a widely vague description of the category of therapy to practice, you would provide much more detailed recognized expert on psychopharmacology instructions. In short, you would provide a therapy manual. a widely recognized expert on psychopharmacology and 1 of 10 psychologists who took part manualized therapy in the first experimental pilot program of psychologists prescribing medication. Forms of psychotherapy that follow a therapy manual, which provides detailed instructions for Robert McGrath all phases of the treatment of a specific disorder; typically used in outcome studies supporting A prominent proponent of prescription privileges for clinical psychologists and former evidence-based treatments president of the American Society for the Advancement of Pharmacology (Division 55 of the Psychologists should only apply the therapies listed in the manual as it is tested already and American Psychological Association) proven to be effective, but not all agreed because there are a lot of therapies not listed which training director of the Psychopharmacology Postdoctoral Training Program in the School of can be effective as well; the one who may used unlisted therapy may sound like it is a Psychology at Fairleigh Dickinson University and former president of the American Society malpractice. for the Advancement of Pharmacotherapy (American Psychological Association, Division health insurance/ managed care 55) A method of payment for psychological services involving a third-party payer, in contrast to American Society for the Advancement of Pharmacotherapy (American Psychological client self-pay Association, Division 55) third-party payer A division of the American Psychological Association devoted to issues related to prescription privileges for psychologists Typically, health insurance or managedcare companies that pay some or all of a client’s mental health expenses prescription privileges Telepsychology The ability to prescribe medication to clients, which constitutes a controversy among contemporary clinical psychologists The use of technology, including the Internet, videoconferencing, smartphones, and text-based services, in the application of clinical psychology Chapter 4 Diversity and Cultural Issues in Clinical Psychology editions; Alarcón, 2015). 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 cultural diversity because they believe that their appearance, actions, or odor will offend other people (found in Heterogeneity in the cultural background of members of a society Japanese and some other cultures); Clinical psychologists have recognized that the people who might seek their professional susto, in which a frightening event is thought to cause the soul to leave the body, resulting in services represent a growing variety of cultural backgrounds. As individuals and as a depressive symptoms (found in some Latino/Latina/Hispanic cultures); profession, clinical psychologists are making efforts to address issues of culture sensitively and and maladi moun, in which one person can “send” psychological problems like depression competently. and psychosis to another, usually as a result of envy or hatred toward the other person’s success One reason cultural diversity is such a powerful force in the clinical and counseling fields is (found in some Haitian communities; similar experiences called the “evil eye” are more that it shapes the way the client understands the very problem for which he or she is seeking common in other parts of the world). help. This understanding—this worldview, applied to psychological problems—is what the cultural competence therapist should appreciate as he or she devises an approach to helping the client. For clinical psychologists, the ability to work sensitively and expertly with culturally diverse multiculturalism members of a heterogeneous society An approach in clinical psychology emphasizing the appreciation of cultural diversity and Clinical psychologists should strive for cultural competence, indeed, when clients perceive awareness of how techniques can be best applied to individuals of various cultural backgrounds their therapists as culturally competent, they are more likely to form strong working Multiculturalism as the “Fourth Force,” as a defining issue of the current era of psychology. relationships with them, which leads to fewer therapy drop-outs and better therapy outcomes. psychoanalysis as the first force, behaviorism as the second force, and humanism/person- A key phrase in D. W. Sue and Sue’s (2008) definition of cultural competence is “awareness, centered psychology as the third force. knowledge, and skills”; these are the three primary components to multicultural competence as applied to clinical/counseling work. Let’s examine each one in detail. It represents a fundamental change of emphasis but one unlike the previous three in terms of its method of impact. Whereas behaviorism and humanism emerged as challenges to the cultural self-awareness incumbent first force of psychoanalysis, multiculturalism does not necessarily aim to dethrone An important component of cultural competence by which the clinical psychologist recognizes any of the first three forces. Instead, it enhances and strengthens existing models by infusing the uniqueness of his or her own cultural perspective them with sensitivity and awareness of how they can be best applied to individuals of various cultural backgrounds begins with learning about one’s own culture—not only basic facts such as where one’s parents or ancestors came from but also the values, assumptions, and biases that one has developed as cultural concepts of distress a result of all cultural influences. As listed in DSM-5, psychological problems observed in cultural groups from various parts of When a clinical psychologist attains cultural self-awareness—that is, comes to understand that the world their viewpoint is (like everyone’s) unique and idiosyncratic—several conclusions are within Another effort toward cultural awareness incorporated into DSM-5 is a glossary listing cultural reach. concepts of distress (many of which were called “culture-bound syndromes” in previous DSM heterogeneity etic In the context of cultural diversity, the variety of cultural backgrounds among members of a In contrast to emic, a perspective held by some psychologists emphasizing the similarities society, both between and within particular cultural groups between all people and deemphasizing differences between cultural groups Clinical psychologists should aspire to understand the norms of the cultures with which they emic work, but if they rigidly assume that every person in that culture fits those norms, they are The emic perspective differs from the etic perspective in that it recognizes and emphasizes guilty of unfair and often inaccurate prejudice. To some extent, generalizing is inevitable when culture-specific norms. discussing cultural groups (McGoldrick et al., 2005a), but our generalizations should be “guidelines for our behaviors, to be tentatively applied in new situations, and they should be tripartite model of personal identity open to change and challenge. It is exactly at this stage that generalizations remain generalizations or become stereotypes” A three-level model of personal identity in which each individual is recognized as being entirely unique, similar to some other individuals, and similar to all other individuals acculturation D. W. Sue and Sue (2008) offer a three-level model called the tripartite model of personal Response or adaptation to a new cultural environment, particularly with regard to adopting identity in which all levels hold some degree of importance. elements of the new culture or retaining elements of the original culture individual level when people find themselves in a new cultural environment, they may respond in a variety of ways, especially with regard to adopting elements of the new culture or retaining elements of One level in this model is the individual level. Here, the premise is that “all individuals are, in their original culture some respects, like no other individuals.” Four separate acculturation strategies have been identified (Berry, 2003; Rivera, 2008): group level assimilation, in which the individual adopts much of the new culture and abandons much of A second level is the group level, where the premise is that “all individuals are, in some the original; respects, like some other individuals.” separation, in which the individual rejects much of the new culture and retains much of the universal level original; The final level is the universal level, based on the premise that “all individuals are, in some marginalization, in which the individual rejects both the new and the original culture; respects, like all other individuals” and integration, in which the individual adopts much of the new culture and retains much of subcultures the original. Relatively small groups within a society that may not fully constitute cultural groups but whose microaggressions members may nonetheless possess typical and culturally meaningful characteristics for the clinical psychologist 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. some subsections of society—subcultures (prison culture and military prison, for instance) Chapter 5 Ethical and Professional Issues in Clinical Psychology confidentiality As mandated by the code of ethics of the American Psychological Association, upholding the privacy of clinical information code of ethics Confidentiality is specifically mentioned among the general principles (in Principle E: Respect Ethical guidelines for psychologists, originally published by the American Psychological for People’s Rights and Dignity) and in numerous specific ethical standards—including Association in 1953 and most recently updated in 2002 Standard 4.01, “Maintaining Confidentiality,” which begins, “Psychologists have a primary aspirational obligation and take reasonable precautions to protect confidential information” In contrast to enforceable, an approach to psychology ethics that emphasizes aspirational ideals duty to warn describing how psychologists should strive to conduct themselves Stemming from the Tarasoff case, the obligation of clinical psychologists to alert people toward The items in the General Principles section are aspirational. In other words, they describe an whom their clients have made credible, serious threats ideal level of ethical functioning or how psychologists should strive to conduct themselves. The duty to warn is an exception to the normal standards of client confidentiality that mandates They don’t include specific definitions of ethical violations; instead, they offer more broad that mental health professionals must warn third parties whom they believe their client may descriptions of exemplary ethical behavior. harm. This obligation may also be referred to as the duty to protect. enforceable Tarasoff case In contrast to aspirational, an approach to psychology ethics that emphasizes specific rules of A landmark legal case resulting in clinical psychologists’ duty to warn potential victims of conduct that can be violated dangerous or harmful acts whose identity is revealed by clients during psychological services ethical decision making From the Tarasoff case, the duty to warn (and duty to protect) was born. Since the Tarasoff case A process by which psychologists make decisions in ethically challenging situations set the legal precedent, clinical psychologists (and other therapists) have understood that there are limits to their confidentiality agreements with clients and that they have a duty to warn or When any ethical issue arises, a clinical psychologist should be equipped with a process by protect people toward whom their clients make credible, serious threats. which to make the most ethical decision possible. As stated in the first Tarasoff ruling, “The confidential character of patient-psychotherapist Celia Fisher communications must yield to the extent to which disclosure is essential to avert danger to A leading figure in psychology ethics who served as chair of the committee responsible for others. The protective privilege ends where the public peril begins” creating the 2002 revision of the code of ethics of the American Psychological Association child abuse One such expert is Celia Fisher, who served as chair of the American Psychological In the context of clinical psychology, a condition that mandates the clinical psychologist to Association’s Ethics Code Task Force, the committee responsible for creating the 2002 revision break confidentiality (per state laws) in an attempt to protect the welfare of the child at risk of the ethical code. In her book Decoding the Ethics Code, Fisher (2017) proposes a model for ethical decision making. A separate confidentiality issue for clients who are minors involves child abuse. Every state has laws requiring mental health professionals to break confidentiality to report known or suspected child abuse. The rationale behind such laws is similar to the rationale behind the Tarasoff ruling; namely, nonsexual multiple relationships some situations demand that the clinical psychologist’s primary responsibility shift to the A type of multiple relationship in which a clinical psychologist has a professional relationship immediate prevention of harm. with an individual and also has another nonsexual relationship (e.g., friendship, business informed consent relationship) with the same person The ethically mandated process of informing an individual about proposed activities (e.g., as a sexual multiple relationships therapy client or research participant) and obtaining the individual’s voluntary consent before A type of multiple relationship in which a clinical psychologist has a professional relationship proceeding with the activities with an individual and also has a sexual relationship with the same person It ensures the person with whom the psychologist is working the opportunity to become in which the clinical psychologist becomes a sexual partner of the client 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 competence multiple relationships Sufficient capability, skill, experience, and expertise to complete particular professional tasks adequately A circumstance in which a clinical psychologist has a professional relationship with an individual and also has another type of relationship with the same person or has a relationship In general, competent clinical psychologists are those who are sufficiently capable, skilled, with someone closely associated with the person experienced, and expert to adequately complete the professional tasks they undertake. In general, it can be problematic for clinical psychologists to know someone professionally— boundaries of competence as, say, a therapy client or student—and also to know that person in another way—as, say, a friend, business partner, or romantic partner. The term used to describe such situations is The limits of competence that a clinical psychologist has an ethical obligation not to overstep multiple relationships (although the term dual relationships has also been used). One specific ethical standard in the section on competence (2.01a) addresses the boundaries of occurs when a psychologist is in a professional role with a person and (1) at the same time is competence: “Psychologists provide services, teach, and conduct research with populations in another role with the same person, (2) at the same time is in a relationship with a person and in areas only within the boundaries of their competence, based on their education, training, closely associated with or related to the person with whom the psychologist has the supervised experience, consultation, study, or professional experience” professional relationship, or (3) promises to enter into another relationship in the future with continuing education the person or a person closely associated with or related to the person. Learning experiences by which clinical psychologists maintain their competence throughout Multiple relationships can form not only when a psychologist knows one person both their careers; often required by state licensing boards for license renewal professionally and nonprofessionally but also when a psychologist has a relationship with someone “closely associated with or related to” someone the psychologist knows Psychologists not only need to become competent, but they must also remain competent: professionally. “Psychologists undertake ongoing efforts to develop and maintain their competence” This standard is consistent with the 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. burnout Burnout refers to 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 test selection For a clinical psychologist conducting an assessment, the selection of tests that are appropriate in terms of the psychologist’s competence; the client’s culture, language, and age; and the test’s reliability and validity, among other factors Test selection should entail a number of factors, 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. test security Protection of the integrity of psychological test materials by preventing them from entering the public domain Test security represents another specific area of focus of the American Psychological Association’s (2002) ethical code. Psychologists should make efforts to protect the security and integrity of the test materials they use. In other words, psychologists should prevent the questions, items, and other stimuli included in psychological tests from entering the public domain. Test data refers to the raw data the client provided during the assessment—responses, answers, and other notes the psychologist may have made. Chapter 6 Conducting Research in Clinical Psychology experimental method A research process that follows a number of discrete, sequential steps including observation of events, hypothesis development, definition of independent and dependent variables, empirical treatment outcome testing of the hypothesis, and altering the hypothesis according to results obtained how well their therapies work; A common area of research for clinical psychologists focusing dependent variables on the assessment of the benefits of psychological treatments Variables in an experiment that are expected to change as a result of changes in the independent Research on treatment outcome has a rather extensive history, with Hans Eysenck’s (1952) variables unfavorable review of psychotherapy outcome serving as a landmark study and a catalyst for additional investigations on the subject. In the decades subsequent to Eysenck’s review, are those variables that are expected to change as a result of changes in the independent researchers established that psychotherapy is indeed effective and ultimately moved on to variables. exploring which particular therapies are most successful at treating which particular disorders. independent variables Efficacy are those variables in the study that are manipulated by the experimenter refers to the success of a particular therapy in a controlled study conducted with clients who randomized clinical trials (RCTs) were chosen according to particular study criteria. In short, the efficacy of a form of therapy is how well it works “in the lab,” where it is practiced according to manualized methods and A research method for assessing the efficacy of a manualized therapy in which participants where outcome for treated individuals is compared via clinical trial with outcome for who meet criteria for a particular diagnosis are randomly assigned to a group that receives the individuals who receive alternate or no treatment. therapy or a group that does not receive the therapy Effectiveness quasi-experimental design Refers to the success of a therapy in actual clinical settings in which client problems span a A type of research design used when truly experimental design is not feasible wider range, and clients are not chosen as a result of meeting certain diagnostic criteria. In short, the effectiveness of psychotherapy is how well it works “in the real world,” or how Research in clinical psychology often involves variables that the researcher is not entirely able well it translates from the lab to the clinics, agencies, hospitals, private practices, and other to control. Ethical, practical, or other constraints often limit the researcher’s ability to assign settings where clinical psychologists conduct therapy. people randomly to certain conditions, make particular manipulations, or otherwise experimentally test certain hypotheses. In such cases, clinical psychologists may use a quasi- internal validity experimental design rather than a true experimental design. Internal validity refers to the extent to which the change in the dependent variable is due solely Quasi-experimental designs are less scientifically sound than experimental designs; to the change in the independent variable. nonetheless, they are frequently used in clinical psychology and have often yielded very meaningful and important results external validity between-group design refers to the generalizability of the result—to what extent is the same finding valid for different settings and populations A research design in which participants in different conditions, one of which is often a control group, receive different treatments When clinical psychologists conduct a study with a between-group design, participants in Typically, they include descriptive observations of an individual’s behavior and an attempt by different conditions receive entirely different treatments. Often, such studies involve two the researcher to interpret it. conditions or groups: One (the experimental condition) receives the experimental treatment, The researcher may speculate about how explanations about the target individual may also whereas the other (the control group) does not receive the experimental treatment. apply to others who are similar in some way. Control Group correlational methods The condition or group in a between-subject design that receives no treatment Research methods that examine the relationship that exists between two or more variables and within-group design in which causality is not implied By contrast, a within-group design involves comparisons of participants in a single condition idiographic approach to themselves at various points in time. Essentially, all participants experience the same emphasizing or revealing the unique qualities of each person condition or conditions. nomothetic approach mixed-group design determining similarities or common qualities among people At times, clinical psychology researchers will combine aspects of between-group and within- group designs, creating a mixed-group design – at the end of the study, the researchers would ABAB design be able to compare the two groups with each other, and they would also be able to compare each group with itself at various points in time. A particular type of research design for case studies in which a treatment is alternately applied and removed analogue design ABAB design (also known as a reversal design), in which a treatment is alternately applied A research design that involves an approximation of the target client or situation as a substitute and removed (with A and B each representing the presence or absence of the treatment). for the actual clients or situations A variation of this design, called the alternating treatments design, involves two treatments A study of this type involves an approximation of the target client or situation as a substitute alternating rather than a single treatment alternating with no treatment. Although case studies for the “real thing.” At times, it can involve using participants whose characteristics resemble such as these may have limited generalizability on their own, they can be a relatively (but don’t exactly match) those of the target population, or asking participants to remember or inexpensive and convenient way to do research with direct clinical relevance. imagine themselves in a certain situation. meta-analysis analogue direct observation A statistical method of combining results of separate studies (translated into effect sizes) to In contrast to naturalistic direct observation, a type of behavioral observation that typically create a summation (or, statistically, an overall effect size) of the findings takes place in the clinic room, where the real-life situation is simulated A meta-analysis is a statistical method of combining results of separate studies (translated into case studies effect sizes) to create a summation (or, statistically, an overall effect size) of the findings. As its label implies, a meta-analysis is a study of studies, a quantitative analysis in which the full case studies involve a thorough and detailed examination of one person or situation. results of previous studies each represent a small part of a larger pool of data. cross-sectional designs In contrast to longitudinal designs, research designs that assess or compare a participant or group of participants at one particular point in time assess or compare a participant or group of participants at one particular point in time, tend to be easier and more efficient, may not provide valid approximations for changes that take place or evolve over time. longitudinal designs Emphasize changes across time, often making within-group comparisons from one point in time to another, require much longer periods of time, provide valid approximations for changes that take place or evolve over time. Part II Assessment come as no surprise that the DSM reflects a medical model of psychopathology in which each disorder is an entity defined categorically and features a list of specific symptoms Chapter 7 Diagnosis and Classification Issues proposed criteria set abnormality A set of symptoms described in Section III of DSM-5 and under consideration for inclusion as Forms of behavior that are outside the normal range; often labeled mental disorders, psychiatric an official disorder in a future edition of the DSM diagnoses, or psychopathology Currently, attenuated psychosis syndrome is not an official diagnostic category. Instead, it is In the 1990s, Jerome Wakefield, a renowned scholar in the field of abnormal psychology, listed as a proposed criteria set in the “Emerging Measures and Models” section of DSM-5 offered a theory that put forth a more simplified (in comparison with the multifaceted criteria above) definition of mental disorders DSM-I Wakefield (1992) explains his harmful dysfunction theory of mental disorders proposes that DSM-I was published by the American Psychiatric Association in 1952. ICD 6 in our efforts to determine what is abnormal, we consider both scientific (e.g., evolutionary) 106 diagnoses data and the social values in the context of which the behavior takes place. DSM-II Diagnostic and Statistical Manual of Mental Disorders (DSM) DSM-II followed as a revision in 1968. ICD 8 The prevailing diagnostic guide for mental health professionals, containing the definitions of all mental disorders, published by the American Psychiatric Association 185 diagnoses the prevailing diagnostic guide for mental health professionals— every day as they perform DSM-III assessments, conduct therapy, and design and execute research studies DSM-III, published in 1980. ICD 9 In DSM-5, mental disorder is defined as a “clinically significant disturbance” in “cognition, emotion regulation, or behavior” that indicates a “dysfunction” in “mental functioning” that is 265 diagnoses “usually associated with significant distress or disability” in work, relationships, or other areas DSM-III-R of functioning. 1987, 292 diagnoses In addition, the definition states that expectable reactions to common stressors are not mental disorders. DSM-IV medical model of psychopathology 1994, 297 diagnoses. ICD 10 A method of defining mental disorders in which each disorder is an entity defined categorically DSM-IV-TR and features a list of specific symptoms 2000, 297 diagnoses Thus, although the DSM has been used extensively by clinical psychologists and a wide range DSM-5 of other nonmedical mental health professionals (social workers, counselors, etc.), the authors who have had the most significant impact on its contents are medical doctors. So, it should May 2013, 298 diagnoses multiaxial assessment The word categorical refers to the basic view that an individual “has” or “does not have” the disorder—that is, the individual can be placed definitively in the “yes” or “no” category An approach to assessment introduced in DSM-III by which mental health professionals can regarding a particular form of psychopathology. provide diagnostic information on each of five distinct axes or domains dimensional approach When multiaxial assessment was in place, the psychiatric problems were described on each of five distinct axes. In contrast to the categorical approach, an approach to diagnosis based on the issue of severity of an individual’s symptoms on a continuum or dimension, rather than the presence or absence Axis I included disorders thought to be more episodic (likely to have beginning and ending of disorder points), and According to a dimensional approach, the issue isn’t the presence or absence of a disorder; Axis II included disorders thought to be more stable or long-lasting. instead, the issue is where on a continuum (or “dimension”) a client’s symptoms fall. Axes III and IV offered clinicians a place to list medical conditions and proponents of the dimensional approach to abnormality suggest that all of us—the normal and psychosocial/environmental problems, respectively, relevant to the mental health issues at the abnormal—share the same fundamental characteristics but that we differ in the amounts of hand. these characteristics that we each possess. What makes some of us abnormal is an unusually And Axis V, known as the Global Assessment of Functioning (GAF) scale, provided clinicians high or low level of one or more of these characteristics. an opportunity to place the client on a 100-point continuum describing the overall level of functioning. premenstrual dysphoric disorder (PMDD) A provisional or proposed mental disorder characterized by severe premenstrual symptoms, possibly including depressed mood, anxiety, affective lability, and decreased interest in activities It falls within the Depressive Disorders category, according to its description, PMDD should not be equated with premenstrual syndrome (PMS), which is more common and less severe than PMDD. The controversy over premenstrual dysphoric disorder (PMDD), which had been rejected from previous editions of DSM but is now included as a disorder in DSM-5, has renewed this criticism of DSM authors categorical approach In contrast to the dimensional approach, an approach to diagnosis based on the notion that an individual either has or does not have a particular disorder Chapter 8 The Clinical Interview conclusion assessment A clinical interview technique that may involve summarization, an initial conceptualization, a diagnosis, or recommendations In contrast to enforceable, an approach to psychology ethics that emphasizes aspirational ideals describing how psychologists should strive to conduct themselves confrontation attending behaviors A clinical interview technique used when the interviewer notices discrepancies or inconsistencies in the client’s comments Fundamental aspects of listening, including eye contact, body language, vocal qualities, and verbal tracking crisis interview being self-aware A type of clinical interview designed not only to assess a problem demanding urgent attention (most often, clients actively considering suicide or another act of harm toward self or others) A general skill for clinical interviewers involving the ability to know how the interviewer might but also to provide immediate and effective intervention for that problem affect others interpersonally and how others tend to relate to him or her developing positive working relationships body language A general skill for clinical interviewers often facilitated by attentive listening, appropriate In the context of the clinical interview, a behavior that can communicate strong nonverbal empathy, genuine respect, and cultural sensitivity messages diagnostic interview clarification A type of clinical interview in which the primary purpose is to diagnose the client’s problems A clinical interview technique designed to make sure the interviewer has an accurate understanding of the client’s comments directive clinical interview In the context of the clinical interview, an approach by which interviewers obtain the information they need by asking clients specifically for it A common assessment technique used by clinical psychologists involving a purposeful conversation with clients characterized by questions and answers intake interview clinical utility A type of clinical interview in which the primary purpose is essentially to determine whether to “intake” the client to the setting where the interview is taking place In psychological assessment, the extent to which a technique benefits the clinician and ultimately the client in a meaningful way listening closed-ended question A simple yet vital task for the clinical psychologist, especially in the context of the clinical interview In contrast to an open-ended question, an interview question that allows for far less elaboration and self-expression by the client but yields a quick and precise answer mental status exam Structured Clinical Interview for DSM-5 Disorders (SCID) A type of clinical interview often used in medical settings, the primary purpose of which is to A prominent structured interview technique appropriate for a wide range of DSM-5 disorders assess quickly how the client is functioning at the time of the evaluation structured interview nondirective In contrast to an unstructured interview, an interview with a predetermined, planned sequence In the context of the clinical interview, an approach by which interviewers allow clients to of questions that an interviewer asks a client determine the course of the interview summarizing open-ended question A clinical interview technique that usually involves tying together various topics that may have In contrast to a closed-ended question, an interview question that allows for individualized and been discussed, connecting statements that may have been made at different points, and spontaneous responses from clients identifying themes that have recurred during the interview paraphrasing technique A clinical interview technique used simply to assure clients that they are being accurately heard In the context of the clinical interview, the procedures and methods (e.g., types of questions) used by the interviewer quieting yourself unstructured interview A general skill for clinical interviewers involving the minimization of internal, self-directed thoughts that can preoccupy or distract the interviewer In contrast to a structured interview, an interview that involves no predetermined or planned questions and in which interviewers determine the course of the interview as it takes place rapport validity A positive, comfortable relationship between clinician and client, especially important in the context of the clinical interview In psychological assessment, the extent to which a technique measures what it claims to measure reflection of feeling verbal tracking A clinical interview technique intended to make clients feel that their emotions are recognized, even if their comments did not explicitly include labels of their feelings In the context of the clinical interview, the ability to repeat key words and phrases back to clients to assure the clients that they have been accurately heard reliability vocal qualities In psychological assessment, the extent to which a technique yields consistent, repeatable results In the context of the clinical interview, pitch, tone, volume, and fluctuation of voice that are important to appreciate and use effectively semi-structured interview Also known as a partially structured interview, a clinical interview that has some characteristics of structured interviews as well as some characteristics of unstructured interviews Chapter 9 Intellectual and Neuropsychological Assessment fluid reasoning The ability to solve novel problems; also one of five factor scores of the Stanford-Binet Intelligence Scales— Fifth Edition achievement full-scale intelligence score In contrast to intelligence (what a person can accomplish intellectually), what a person has accomplished, especially in academic subjects A feature of most contemporary tests of intelligence indicating overall or general level of intelligence achievement tests “g” Type of standardized tests used to measure how much students have learned in specific, clearly defined content areas, including but not limited to reading, mathematics, science, and social An abbreviation for general intelligence, as posited to exist by Charles Spearman and others studies (in contrast to “s,” or specific intelligences) Bender Visual-Motor Gestalt Test—Second Edition (Bender-Gestalt-II) Halstead-Reitan Neuropsychological Battery (HRB) The current edition of a brief neuropsychological screen in which clients are asked to copy A relatively popular, comprehensive battery of eight standardized neuropsychological tests simple geometric designs hierarchical model of intelligence John Carroll A model of intelligence in which specific abilities (“s”) play an important role but are all at A contemporary leader in the study of intelligence who has proposed the three-stratum theory least somewhat related to one another and to a global, overall, general intelligence (“g”) of intelligence index scores James Cattell A feature of most contemporary tests of intelligence indicating intellectual ability in one of a A leading figure in the study of intelligence who proposed separate fluid and crystallized small number of broad areas intelligences intelligence crystallized intelligence Aptitude or intellect; the exact definition has long been a subject of debate among The body of knowledge one has accumulated as a result of life experiences psychologists and may or may not include speed of mental processing, sensory capacity, abstract thinking, imagination, adaptability, capacity to learn through experience, memory, cultural fairness reasoning, or inhibition of instinct The extent to which an intelligence test is based on universal rather than culture-specific intelligence tests concepts or methods Psychological tests that measure a client’s intellectual abilities fluid intelligence The ability to reason when faced with novel problems knowledge Rey-Osterrieth Complex Figure Test General information accumulated over time via personal experiences, including education, A neuropsychological screen involving the reproduction of a single, complex geometric figure home, and environment; also one of five factor scores of the Stanford-Binet Intelligence “s” Scales—Fifth Edition An abbreviation for specific intelligences that may not correlate with one another (in contrast Luria-Nebraska Neuropsychological Battery (LNNB) to “g,” or general intelligence) A relatively popular, comprehensive battery of 12 standardized neuropsychological scales Charles Spearman NEPSY-II A pioneer in the study of intelligence who argued for the existence of “g,” a general intelligence A battery of neuropsychological tests designed specifically for children thought to overlap with many particular abilities neuropsychological tests specific learning disorder Psychological tests that focus on issues of cognitive or brain dysfunction, including the effects A diagnosis based primarily on the level of academic achievement falling significantly below of brain injuries and illnesses expected levels of achievement for people of the same age normative data Stanford-Binet Intelligence Scales—Fifth Edition (SB5) A sample of test-result data gathered by creators of a psychological test and typically designed The current edition of a prominent test of intelligence for individuals across the life span to accompany the test that constitutes a basis for comparison for individuals who take the test subtest scores in clinical settings A feature of most contemporary tests of intelligence indicating intellectual ability in one of Perceptual Reasoning Index many specifically defined areas A measure of fluid reasoning, spatial processing, and visual-motor integration; also one of four three-stratum theory of intelligence index scores yielded by the Wechsler intelligence tests A contemporary theory that intelligence operates at three levels: a single “g” at the top, eight Processing Speed Index broad factors immediately beneath “g,” and more than 60 highly specific abilities beneath these A measure of the ability to process simple or rote information rapidly and accurately; also one broad factors of four index scores yielded by the Wechsler intelligence tests Louis Thurstone quantitative reasoning A pioneer in the study of intelligence who argued that intelligence should not be understood as The ability to solve numerical problems; also one of five factor scores of the Stanford-Binet a single, unified ability but as numerous distinct abilities that have little relationship to one Intelligence Scales—Fifth Edition another Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Universal Nonverbal Intelligence Test-2 (UNIT-2) A neuropsychological screen that focuses on a range of abilities, including visuomotor A recently published intelligence test that was designed as entirely language-free in an attempt abilities, verbal skills, attention, and visual memory to maximize cultural fairness Verbal Comprehension Index Working Memory Index A measure of verbal concept formation and verbal reasoning; also one of four index scores A measure of the capacity to store, transform, and recall incoming information and data in yielded by the Wechsler intelligence tests short-term memory; also one of four index scores yielded by the Wechsler intelligence tests visual-spatial processing The ability to analyze visually presented information, including relationships between objects, spatial orientation, assembling pieces to make a whole, and detecting visual patterns; also one of five factor scores of the Stanford-Binet Intelligence Scales—Fifth Edition David Wechsler A pioneer in the assessment of intelligence for various age groups, including adults, children, and preschoolers Wechsler Adult Intelligence Scale—Fourth Edition (WAIS-IV) The current edition of a prominent intelligence test for adults Wechsler Individual Achie