Clinical Psychology PDF

1 Clinical Psychology Lecture 1-2: Foundations of clinical psychology Clinical Psychology Clinical Psychology - the study of individuals, by observation or experimentation, with the intention of promoting cha...

1 Clinical Psychology Lecture 1-2: Foundations of clinical psychology Clinical Psychology Clinical Psychology - the study of individuals, by observation or experimentation, with the intention of promoting change (Lightner Witmer 1907). The field of clinical psychology integrates science, theory, and practice to understand, predict, and alleviate maladjustment, disability, and discomfort as well as to promote human adaptation, adjustment, and personal development. Clinicians combine knowledge from research on human responses and mental processes with assessment in order to understand and treat the individual. Clinical psychology is a subfield of psychology that examines the study and treatment of human behavior and mental processes. The focus is on examining human behavior, personality characteristics, and psychopathology. Clinical psychology focuses on the cognitive, emotional, social, behavioral and biological contributors to human functioning across the life span, in varying cultures, and at all socioeconomic levels. Increasing interdisciplinary and collaborative nature to science. Clinicians differ from other psychologists in their approach to human beings. There are different theoretical orientations used in clinical psychology. They have different ideas about what causes psychological disorders to develop. Most of them are caused by multiple factors - the Bio-psycho-social model. Treatment is shaped by one’s understanding of the causes of the problem. Treatment is shaped by one’s understanding of the causes of the problem. Eclectic approaches combine ideas from the different approaches within psychology Clinical Psychology vs. Psychiatry Clinical Psychology Psychiatry How they see Learn to think as Researchers to evaluate findings and Are physicians - Learn facts and use this knowledge their subject defend their views by citing data to understand and treat patients Nature of the View the nature of client’s problems in a multivariate way Focus on biological aspects of client’s problem subject Approach to Clinical psychologists typically receive little training in Psychiatry regards psychopathology as a mental subject medicine. However, clinical psychologists do receive more “illness” with discrete (often biologically based) extensive training in the psychological principles causes that can best be remedied with a medical governing human behavior, in formal assessment of treatment, such as psychotropic medication. psychological functioning, and in scientific research methods. Psychiatrists make extensive use of a variety of Clinical psychologists also receive more extensive training medications in treating their patients’ psychological in psychotherapy (i.e., “talk” therapy as opposed to difficulties. medications) and are more likely to view psychopathology  2 as a consequence of interactions between individuals’ Many psychiatrists do not conduct extensive biological/psychological/ social predispositions and their psychotherapy with their patients experiences within the environment. Opportunities to work in depth with individuals experiencing psychological symptoms or to help teach behavioral skills that may reduce and prevent symptoms are more limited in psychiatry than in clinical psychology. Requirements Psychiatrists, like all medical doctors, complete a general medical school curriculum early in their training. Following completion of the medical degree and the general medical internship required of all physicians, the typical psychiatrist-to-be receives psychiatric training during a four-year residency. This apprenticeship period involves supervised work with patients in an outpatient or hospital setting, accompanied by seminars, reading, discussion, and related activities. The amount of formal psychiatric coursework varies, but the core training experience is the treatment of patients under the supervision of a more experienced psychiatrist. Qualified to Assessment and diagnosis, intervention or treatment, Psychiatrists are qualified to assess both the mental consultation, research, and the application of ethical and and physical aspects of psychological disturbance. professional principles. major battleground for the profession of psychiatry is Psychologists are trained in psychological assessment, that of prescription privileges for non-medical health therapy, and counseling. They focus on understanding care professionals, including clinical psychologists human behavior and mental processes, and they use therapeutic techniques to help patients manage mental Psychiatrists are medical doctors who specialize in health conditions. mental health. They can diagnose mental illnesses, prescribe medications, and provide other medical treatments. Only Clinical psychologist can conduct psychological assessment. Psychiatrists can prescribe medications But! Both: Diagnose and Treat using therapy (although training in psychotherapy is more heavily emphasized for clinical psychologists) Distinguishing Clinical Psychology from Related Professions Psychotherapy, coaching In contrast to clinical psychology, both are unregulated titles (anyone can offer services suing them) Different training – for psychotherapy and coaching there are no educational requirements, only licensing. Only Clinical psychologist can conduct psychological assessment. Provide psychological help in a form of psychotherapy or personality development to people with mental health/well-being problems Counseling Psychology Most similar to clinical psychology. Training about the same Counseling psychologists tend to deal with problems of adjustment in healthy individuals. Historically counseling psychologists worked within university counseling centers In last few decades, they have expanded their work  3 setting to include private practice Traditionally, counseling psychologists work with normal or moderately maladjusted individuals. Social Work M.S.W. (2 years of post B.A. training) emphasizing clinical work Typically focus on working with the poor and disenfranchised segments of the population. Work in settings dealing with many aspects of a patient’s life and care such as social security, housing, food stamps, Medicare, arrangements for nursing homes, and foster care placement Emphasis on therapy, but not diagnostic training or emphasis on research Other Mental Health ​ Clinical Social Workers: Professional social workers assist individuals, groups, or Professionals communities to restore or enhance their capacity for social functioning, while creating societal conditions favorable to their goals. ​ School Psychologists ​ Health and Rehabilitation Psychologists: many health and rehabilitation psychologists have doctoral degrees in clinical psychology, there is no requirement for this. Health psychologists are those who, through their research or practice, contribute to the promotion and maintenance of good health. ​ Adult disorders ​ Diagnosis ​ Psychotherapy ​ Rehabilitation ​ Substance abuse ​ Child and adolescents ​ Health psychology ​ Neuropsychology ​ Geropsychology ​ Community Psychology ​ Forensic Psychology ​ Psychoanalysis What do Clinical Psychologists do? 1.​ Conduct Research on human behavior and mental processes The range of research projects carried out by clinicians is enormous. Studies include searching for the causes of mental disorders, development and validation of assessment devices, evaluation of therapy techniques, and so on. 2.​ Use therapy/intervention to treat mental problems & disorders 3.​ Provide consultation In consultation and in teaching, the goal is to increase the effectiveness of those to whom one’s efforts are directed by imparting to them some degree of expertise. Consultation takes innumerable forms in many different settings.  4 Consultation can run the gamut from clinical cases to matters of business, personnel, and profit. It can deal with individuals or entire organizations. Sometimes it is remedial; other times it is oriented toward prevention. 4.​ Develop/engage in/direct health promotion programs 5.​ Make Psychological Assessments 6.​ Teach as Faculty 7.​ Work in administration 8.​ Develop/engage in/direct prevention programs Research Methods in Clinical Psychology Unsystematic Observation Casual observation does little by itself to establish a strong base of knowledge. In fact, unsystematic observation can lead people to erroneous conclusions. However, it is through such observation that we develop hypotheses that can eventually be tested more systematically. Naturalistic Observation. Although carried out in real-life settings, naturalistic observation is more systematic and rigorous than unsystematic observation. An example of a study using the naturalistic observation method might be an investigation of children’s playground behavior to understand the association between aggression and friendship. Investigators committed to more rigorous experimental methods sometimes condemn naturalistic observation as too uncontrolled. Controlled Observation. Controlled observation can also be used to assess communication patterns between couples or spouses. Instead of relying on distressed couples’ self-reports of their communication problems, researchers may choose to actually observe communication styles in a controlled setting. Case Studies. The great value of case studies resides in their richness as potential sources of understanding and as hypothesis generators. They can serve as excellent preludes to scientific investigation As Allport (1961) so compellingly argued, individuals must be studied individually. Case studies have been especially useful for (a) providing descriptions of rare or unusual phenomena or novel, distinctive methods of interviewing, assessing, or treating patients; (b) disconfirming “universally” known or accepted information; and (c) generating testable hypotheses Epidemiological Methods Incidence, prevalence, and distribution of illness or disease in a given population. Much epidemiological research is based on surveys or interviews. However, survey and interview data present a number of issues and potential problems. Correlational Methods We have seen that epidemiology often relies on correlational methods; that is, it assesses the correlates (risk factors) of an illness or disorder. We now focus more specifically on correlational methods. Significance of research 1/3  5 Psychology hasn’t always been acknowledged as a purely scientific discipline. Its clinical branch has been frequently referred to as a kind of art. Although psychology has become increasingly associated with cognitive sciences and scientific methods of research became prevalent, not all psychologists appreciate its scientific part, adopting a more humanistic approach. Thus it is still considered by many as a ‘soft’ science. Conflict between researchers and practicing clinicians. Why to consider the notion of pseudoscience in the context of psychology? ​ As psychology has been applied to various occupations and fields, many psychological concepts and theories have been not properly used and abused not only by professionals outside the field, but also among psychologists themselves. As a result the field is full of assessment methods and interventions that deserve a status of pseudoscientific. Thus it is frequently hard to differentiate psychological methods from pseudo-psychological ones and so-called pop psychology, especially if one is a layman. Significance of research 2/3 Psychological disorders are real problems that affect real people. Research into the causes and treatment of psychological disorders is critically important. need to distinguish science from pseudoscience. Many popular books and websites claim that adult children of alcoholics have a distinct personality profile (low self-esteem, feelings of powerlessness, difficulties with intimacy.) -> research showed that adult children of alcoholics are no more likely to have these problems than anybody else (Lilienfeld et al., 2010). What can we say about one's personality based on a person’s handwriting? Handwriting analysis or graphology is sometimes claimed to be a psychological assessment technique. However, actually it is not. There is no evidence for its validity (Eysenck & Gudjonsson, 1986; Greasley, 2000). The use of psychiatric medication has increased dramatically relative to the provision of psychological interventions. building evidence for insurance companies and policy makers that particular psychological interventions are effective. Cathartic technique in psychological practice (Trzebińska & Gabińska, 2015) Significance of research 3/3 Catharsis – releasing emotions, venting anger. Many mental health professionals consider it as a core technique to achieve positive therapeutic change. But growing evidence that intensified expression of negative emotions may be harmful because, paradoxically, it causes an intensification of these feelings (Lohr, Olatunji, Baumeister, & Bushman, 2007). Limitations of cathartic technique People having personality dispositions to experience negative emotional states (Kennedy- Moore & Watson, 2001) Expressing anger (Bushman, 2002) Bereavement (Bonanno, Keltner, Holen, & Horowitz, 1995; Bonanno & Keltner, 1997)  6 Debriefing which takes place immediately after the traumatic event (Devilly, Gist, & Cotton, 2006; McNally, Bryant, & Ehlers, 2003): for victims of sudden violence (Rose, Brewin, Andrews, & Kirk, 1999) victims of burns and car crashes (Mayou, Ehlers, & Hobbs, 2000) The Scientist-Practitioner Model Call for clinical psychologists to be scientists goes back to the earliest days of the field. Witmer (1907) argued that the pure and applied sciences advance as one – what retards or fosters progress in one, retards or fosters progress in the other. The Boulder Conference (1949) Formulated the “Boulder Model” Scientist-Practitioner Model Main reasons for “joint” training as scientists and practitioners: So students could develop interests in both research and practice, despite the fact that most would concentrate on one or the other in their careers. Underlying assumptions: Specialization in either research or practice was seen as likely to contribute to narrowness of thinking and rigidity of action. Direct involvement in clinical work by researchers would foster their knowledge of important clinical issues so they would be more likely to study them. Why are clinical psychologists required to engage in research to earn their degrees? Clinical psychologists need to be trained to critically evaluate published research on assessment methods and treatment options to determine which have been validated. Research training will help clinicians objectively evaluate their own treatment methods. A strong research background will aid clinicians who work with community mental health centers in assessing the effectiveness of the agency’s programs. Clinical psychologists who work as faculty members at a university need to supervise and mentor students in research programs. Evidence-Based Practices - Interventions that show consistent scientific evidence of being related to preferred client outcomes. Are an alternative to authority-based practice (Gambrill, 2005). Appeals to: A famous person, Popularity, Tradition, Consensus “If Freud said it, it must be true.” “Eighty percent of social workers use...I’m going to use it too.” “That’s the way we have always done it.” “We all believe that ____”  7 EBP Evidence Based Practice → practice based on empirical research The EBP Model – Best Available Research Evidence. Adopt a scientific view of clinical psychology, Knowledge of clinical research design and methods Strategies for accessing best available research, Ability to evaluate relevant evidence EBM Evidence Based Medicine → medicine based on empirical research EBPP Evidence-Based Practice in Psychology → psychological practice based on empirical research EBA Evidence Based Assessment → diagnosis based on empirical research APA Policy Statement adopted in August 2005 “Evidence-based practice in psychology is the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences.” To provide a rational basis for deciding which treatments to fund (e.g. which medications to prescribe). Multiple Types of Research Evidence Clinical observation - A research method similar to naturalistic observation in which carefully planned observations are made in real-life settings, except that the investigator exerts a degree of control over the events being observed. Qualitative research - Systematic case studies - Single-case experimental designs Public health and ethnographic research Process-outcome studies Effectiveness research in naturalistic settings RCTs and their logical equivalents Meta-analysis