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Division of Clinical Psychology (Division 12) of the American Psychological SUMMARIZE Association (APA) CHAPTERS 1-7 - Clinical Psycholo...

Division of Clinical Psychology (Division 12) of the American Psychological SUMMARIZE Association (APA) CHAPTERS 1-7 - Clinical Psychology integrates science, theory, and practice to (APSY 4-4) understand, predict, and alleviate maladjustment, disability, and discomfort as well as to promote CHAPTER 1: CLINICAL human adaptation, adjustment, and PSYCHOLOGY: DEFINITION AND personal development. TRAINING - Clinical Psychology focuses on the intellectual, emotional, biological, What is Clinical Psychology? psychological, social, and behavioral aspects of human ORIGINAL DEFINITION: functioning across the life span, in varying cultures, and at all Lightner Witmer - first used in print the socioeconomic levels. term clinical psychology in 1907; first to operate a psychological clinic - His first clients were children with Education and Training in Clinical behavioral or educational Psychology problems. - He foresaw clinical psychology as The basic components of clinical applicable to people of all ages and psychology training are common across with a variety of presenting programs and are well established. problems. Overview of Clinical Psychology Clinical Psychology - a discipline with Training: similarities to a variety of other fields, specifically medicine, education, and Clinical psychology education and sociology. training include obtaining a doctoral degree in Clinical Clinical Psychologists - a person whose Psychology, with approximately work with others involved aspects of 3,000 degrees awarded annually. treatment, education, and interpersonal Students typically enter doctoral issues. programs with a bachelor’s degree, though some enter with a master’s MORE RECENT DEFINITIONS: degree, often earned from a “terminal” master’s program in Introductory Psychology Textbooks and Clinical Psychology. Dictionaries of Psychology Training involves at least 4 years of - clinical psychology is essentially intensive coursework, including the branch of psychology that psychotherapy, assessment, studies, assesses, and treats people statistics, research design and with psychological problems or methodology, biological, disorders cognitive-affective, and social  bases of behavior, individual Developed in 1973 in response to differences, and other subjects. the discontentment with the Students must complete a master’s Scientist-Practitioner Model. thesis, doctoral dissertation, and a Focuses more on developing practicum for supervised clinical applied clinical skills, with less experience. emphasis on research training. After the completion of This led to the creation of a PsyD coursework, students undertake a degree, aimed at those focused on 1-year full-time predoctoral clinical practice. internship, followed by a postdoctoral internship. There are multiple paths to becoming a Clinical Psychologist, with specialties like clinical child, clinical health, forensic, family, and neuropsychology. Clinical psychology training follows three main models: Scientist-Practitioner (Boulder), Practitioner-Scholar (Vail), and Clinical Scientist. Balancing Practice and Science: The PsyD programs grew rapidly, with Scientist-Practitioner (Boulder) Model a significant increase in the number of degrees awarded in the 1970s. Established in 1949, this model PsyD programs tend to accept and emphasizes clinical practice and graduate more than PhD programs, research training. with roughly 1,500 students Graduate students are expected to graduating with each degree be competent in applying clinical annually. methods and conducting empirical research. Leaning Toward Science: The Clinical Graduate programs are typically Scientist Model housed in universities’ psychology departments, and graduates earn a PhD degree. The Scientist-Practitioner (Boulder) Model was the dominant approach for decades, though alternative models have emerged over time. Leaning Toward Practice: The Practitioner-Scholar (Vail) Model Emerged in the 1990s, advocating for a more research-oriented  approach to clinical psychology training. This model places greater emphasis on empirical methods and evidence-based clinical practice. Graduates still earn a PhD, but training focuses heavily on scientific research and less on clinical practice. Two key events propelled this model: Richard McFall’s 1991 Clinical psychology programs now article, “Manifesto for a Science of vary significantly, ranging from Clinical Psychology,” and the practice-oriented to founding of the Academy of research-oriented models, Psychological Clinical Science. providing a wide range of training Programs within the Academy experiences. emphasize research more than Recent trends include a shift practice, but the PhD remains the toward cognitive and degree awarded. cognitive-behavioral orientations and greater diversity among doctoral students. Training increasingly incorporates technology and outcome-based competencies to ensure the practical application of skills. Getting In: What Do Graduate Programs Prefer? Graduate programs in clinical psychology are highly competitive. APA-accredited PhD programs admit 7% to 16% of applicants, while APA-accredited PsyD programs admit 40% to 50%. Hence, early preparation is crucial for applicants. Key Suggestions/Recommendations: Know your professional options: Research different paths to becoming a clinical psychologist and overlapping professions to make informed decisions about your career. Take, and earn high grades in, the appropriate undergraduate courses: High grades in courses  like statistics, of the program and faculty research research/experimental methods, areas. psychopathology, biopsychology, Consider your long-term goals: and personality are essential. Reflect on whether you want to be Get to know your professors: a clinician or researcher, your Good letters of recommendation theoretical orientation, and the from professors or supervisors are areas of work you're most crucial. Having strong working passionate about. relationships through research or advising with them ensures they In addition, research has shown can write meaningful and that PhD programs place more persuasive letters. importance on research matches Get research experience: Engage and research assistance, while in research beyond classroom PsyD programs are more likely to methods. Research with professors admit applicants with a master's can lead to publications or degree. presentations, boosting your application. Get clinically relevant experience: Seek exposure to clinical settings such as community mental health centers, psychiatric centers, crisis hotlines, or internships. Maximize your GRE score: Along with GPA, GRE scores are key admission factors, so prepare thoroughly for the GRE through Internships: Predoc and Postdoc studying and practice tests. Select graduate programs wisely: Clinical psychology doctoral Research training models, faculty programs culminate in a orientations, specializations, and predoctoral internship, typically clinical opportunities. Consider involving a full year of supervised also personal factors such as clinical experience in settings such location and finances. as psychiatric hospitals, Veterans Write effective personal Affairs medical centers, university statements: Personal statements counseling centers, community must convey your career goals, mental health centers, or medical research, and clinical interests schools. while aligning with the program. This is a transition from the student Ensure the writing is professional role to a professional role, often and well-organized. with specialized training Prepare well for admissions opportunities. interviews: In-person interviews Many internships are allow faculty to learn about you. APA-accredited; Arrive prepared, with knowledge non-APA-accredited ones may be  less favored by state licensing Licensure requires passing the boards. Examination for Professional The application process mirrors Practice in Psychology (EPPP) that of applying to graduate school, and a state-specific exam on laws including researching sites, and ethics. applying, interviewing, and The EPPP is a standardized possibly relocating. multiple-choice exam on various Some students apply to 10-15 sites, psychology topics, with each state but stress is increased due to an and most Canadian provinces internship shortage, especially after setting minimum scores for 2002, when PsyD applicants licensure. increased without a rise in State exams often focus on legal internship placements. issues relevant to psychology Strategies are being developed to practice and may be written or oral. address this crisis, but most Once licensed, clinical applicants are successful if they are psychologists must accumulate flexible in applications and Continuing Education Units geographic range. (CEUs) to renew their license, A postdoctoral internship is ensuring they stay current in the typically required for licensure, field. lasting 1-2 years. Postdocs take on CEU requirements can be met by more responsibilities but remain attending workshops, courses, under supervision. specialized training, or exams on Postdoc offers specialized training, professional reading material. and after accumulating supervised hours and passing licensing exams, Professional Activities and Employment one becomes licensed to practice Settings independently. A growing number of states are WHERE DO CLINICAL dropping postdoc requirements, PSYCHOLOGISTS WORK? arguing that current graduate training offers sufficient clinical Clinical psychologists work in a wide experience. variety of settings, with private practice being the most common. Getting Licensed - Private practice has been the primary employment site for 30% After completing graduate to 41% of clinical psychologists coursework, predoctoral since the 1980s. internships, and postdoctoral - The second most common internships, licensure is on the workplace is university psychology horizon. departments, but this percentage Licensing allows individuals to has not exceeded 19%. present themselves as psychologists or clinical - 2% to 9% of clinical psychologists psychologists and practice work in settings such as: independently. Psychiatric hospitals General hospitals  Community mental - tend to be more interested in health centers vocational testing and career Medical schools counseling Veterans Affairs medical centers BOTH - The “other” category (e.g., - see the same types of clients, government agencies, public sometimes as colleagues working schools, substance abuse centers, side by side corporations, university counseling - their graduate students occupy the centers) has consistently ranked same internship sites, often earn third, with 15% listing it in 2003. the same degree (the PhD), and - Clinical psychologists are finding obtain the same licensure status employment in an expanding range - endorse the eclectic orientation of settings. more than any other How Are Clinical Psychologists Different From… COUNSELING PSYCHOLOGISTS: Clinical Psychologists - more likely to work with seriously disturbed individuals - tend to work with more seriously disturbed populations and, correspondingly, tend to work and complete internships more often in settings such as hospitals and inpatient psychiatric units - tend to endorse behaviorism more PSYCHIATRISTS: strongly - tend to be more interested in Clinical Psychologists applications of psychology to - trained to appreciate the biological medical settings aspects of their clients’ problems - biological aspects of clients’ Counseling Psychologists - more likely to problems may not be their defining work with (“counsel”) less pathological characteristic; nor is pharmacology clients the first line of defense - tend to work with less seriously - view clients’ problems as disturbed populations and, behavioral, cognitive, correspondingly, tend to work and emotional—still stemming from complete internships more often in brain activity, of course, but university counseling centers amenable to change via - tend to endorse nonpharmacological methods humanistic/client-centered approaches more strongly Psychiatrists - were likely to get into the - go to medical school and are “nitty-gritty” of their clients’ licensed as physicians; are allowed worlds by visiting their homes or to prescribe medication workplaces, or by making contacts - emphasizes biology to such an on their behalf with organizations extent that disorders—depression, that might prove beneficial anxiety disorders, - their theories of psychopathology attention-deficit/hyperactivity and therapy continue to emphasize disorder (ADHD), borderline social and environmental factors. personality disorder, and so on—are viewed first and foremost When working with psychologists and as physiological abnormalities of psychiatrists: the brain; tend to fix the brain by - they usually focused on issues such prescribing medication as arranging for clients to transition successfully to the community after BOX 1.3 leaving an inpatient unit by making sure that needs such as those for housing, employment, and outpatient mental health services were being met Training of Social Workers: - remains quite different from the training of clinical psychologists - typically earn a master’s degree rather than a doctorate - although their training includes a strong emphasis on supervised fieldwork, it includes very little on research methods, psychological testing, or physiological psychology SOCIAL WORKERS: SCHOOL PSYCHOLOGISTS: - have focused their work on the interaction between an individual - usually work in schools, but some and the components of society that may work in other settings such as may contribute to and alleviate the day-care centers or correctional individual’s problems. facilities - saw many of their clients’ - primary function is to enhance the problems as products of social intellectual, emotional, social, and ills—racism, oppressive gender developmental lives of students. roles, poverty, abuse, and so on - frequently conduct psychological - helped their clients by connecting testing (especially intelligence and them with social services, such as achievement tests) to determine welfare agencies, disability offices, diagnoses such as learning or job-training sites disorders and ADHD.  - use or develop programs designed to meet the educational and Training: emotional needs of students - compared with that of clinical - consult with adults involved in psychologists, typically includes students’ lives—teachers, school very little emphasis on administrators, school staff, psychological testing or conducting parents—and are involved, to a research. limited degree, in direct counseling - include few if any courses on these with students topics, focusing instead on - title of school psychologist: providing services to clients requires only a master’s degree rather than a doctorate MARRIAGE AND FAMILY THERAPISTS: PROFESSIONAL COUNSELORS: - earn master’s degrees - often called licensed professional - About half of MFTs work in counselors, or LPCs private practice, and most of the - earn a master’s (rather than a others practice in other types of doctoral) degree and often work settings like clinics or complete their training within 2 agencies years - attend graduate programs in Training: counseling or professional - focuses on working with couples counseling, which should not be and families, but sometimes they confused with doctoral programs in also see individuals struggling with counseling psychology issues related to their partners or - their work generally involves families. counseling of people with - Compared to the training of clinical problems in living or mild mental psychologists, the training of MFTs illness (as opposed to serious places relatively little emphasis on mental illness) research and assessment. - are among the clinicians who serve wide varieties of clients in CHAPTER 2: EVOLUTION OF community agencies; often enter CLINICAL PSYCHOLOGY private practice as well - often specialize in such areas as career, school, addiction, couple/ ORIGINS OF THE FIELD family, or college counseling Psychology, as we know, has a long, rich history, with roots winding back to Every state has some version of some of the great thinkers of prior professional counselor licensure, but the millennia, such as Socrates, Plato, and name may vary slightly, with common Aristotle (L. T. Benjamin, 2007; alternatives including mental health Ehrenwald, 1991). counselor, licensed professional mental When many people hear of a health counselor, licensed clinical “psychologist,” they immediately think professional counselor, and licensed of a “clinical psychologist” practicing counselor of mental health. psychotherapy or assessment. This  assumption regarding psychology was The facility provided kindness, dignity, inaccurate until at least the early and decency, with patients receiving 1900s. good food, frequent exercise, and The discipline of clinical psychology friendly staff interactions. simply didn’t exist until around the This humane approach led to similar turn of the 20th century, and it didn’t institutions in Europe and the United rise to prominence for decades after States. Tuke's family members that continued to be involved in the York Retreat and the movement to improve EARLY PIONEERS mental health care. In the 1700s and 1800s, the mentally ill were generally viewed and treated Philippe Pinel (1745–1826) much more unfavorably than they are What William Tuke was to England, today. Philippe Pinel was to France—a In many parts of the world, including liberator of the mentally ill. much of the Western Hemisphere, they Like Tuke, Pinel worked to move were understood to be possessed by mentally ill individuals out of evil spirits. Or they were seen as dungeons in Paris, where they were deserving of their symptoms as a held as inmates rather than treated as consequence of some reprehensible patients. action or characteristic. They were He convinced his contemporaries that frequently shunned by society and the mentally ill were not possessed by were “treated” in institutions that devils and deserved compassion and resembled prisons more than they did hope rather than maltreatment and hospitals (Reisman, 1991). scorn. Numerous individuals of various Pinel created new institutions where professional backgrounds from Europe patients were not kept in chains or and North America assumed the beaten but were given healthy food and challenge of improving the way people benevolent treatment. with psychological problems were Pinel advocated for staff to include regarded and treated. case histories, ongoing treatment notes, and an illness classification in the care William Tuke (1732–1822) of each patient. William Tuke, a prominent figure in Pinel’s Treatise on Insanity in 1806, England, was deeply concerned about Pinel's goal was empathy rather than the conditions of the mentally ill. He cruelty: “To rule [the mentally ill] with visited asylums and witnessed the a rod of iron, as if to shorten the term terrible conditions they faced. of an existence considered miserable, Tuke dedicated his life to improving is a system of superintendence, more these conditions and opened the York distinguished for its convenience than Retreat, a residential treatment center for its humanity or success” for the mentally ill. Pinel turned down the offer to join The simple act of labeling his facility a Napoleon as a personal physician, “retreat” suggests a fundamentally choosing to stay with his patients. different approach to the mentally ill The voices of Pinel and Tuke compared with the dominant approach contributed to a growing movement at the time.  advocating individual rights and social Dix devoted the rest of her life to responsibility for the mentally ill. improving the lives and treatment of the mentally ill. Eli Todd (1769–1833) She would travel to a city, collect data Eli Todd made sure that the chorus of on its treatment of the mentally ill, voices for humane treatment of the present her data to local community mentally ill was also heard on the other leaders, and persuade them to treat the side of the Atlantic Ocean. mentally ill more humanely and Todd was a physician in Connecticut in adequately. 1800, a time when only three states She repeated this pattern again and had hospitals for the mentally ill. again, in city after city, with The burden for treating the mentally ill remarkable success. typically fell on their families, who Her efforts resulted in the often hid their mentally ill relatives out establishment of more than 30 state of shame and embarrassment. institutions for the mentally ill Todd had learned about Pinel’s efforts throughout the United States (and even in France, and he spread the word more in Europe and Asia). among his own medical colleagues in Tuke, Pinel, Todd, and Dix did not create the United States. clinical psychology. Their efforts do, Todd was able to raise funds to open however, represent a movement prevalent The Retreat in Hartford, through much of the Western world in the Connecticut, in 1824. 1700s and 1800s that promoted the Todd ensured that patients at The fundamental message that people with Retreat were always treated in a mental illness deserve respect, humane and dignified way. understanding, and help rather than His staff emphasized patients’ contempt, fear, and punishment. strengths rather than weaknesses, and they allowed patients to have LIGHTNER WITMER AND THE significant input in their own treatment CREATION OF CLINICAL decisions. PSYCHOLOGY Similar institutions were soon opened Lightner Witmer (1867–1956) was in other U.S. states as leaders born in Philadelphia and earned an elsewhere learned of Todd’s successful undergraduate degree in business at the treatment of the mentally ill University of Pennsylvania. He received his doctorate in Dorothea Dix (1802–1887) psychology in 1892 in Germany under Despite Todd’s efforts, there were Wilhelm Wundt, who many view as simply not enough hospitals in the the founder of experimental United States to treat the mentally ill, psychology. and as a result, these individuals were He also studied under James McKeen too often sent to prisons or jails. Cattell, another pioneer of In 1841, Dorothea Dix was working as experimental psychology (Reisman, a Sunday school teacher in a jail in 1991; Routh, 2015c). At the time Boston, where she saw firsthand that Witmer received his doctorate, many of the inmates were there as a psychology was essentially an result of mental illness or retardation academic discipline, a field of rather than crime. research.  In the late 1800s, psychologists didn’t By the late 1800s, the work of Tuke, practice psychology, they studied it Pinel, Todd, and Dix set the stage for (Vasquez & Kelly, 2016). the birth of clinical psychology, and Witmer founded the first psychological Witmer proudly announced its arrival. clinic at the University of Pennsylvania in 1896. ASSESSMENT This was the first time the science of psychology was systematically and Diagnostic Issues intentionally applied to people’s problems. Historical Context and Early At the 1896 convention of the Classification Systems American Psychological Association, Witmer encouraged his colleagues to The classification of mental open their own clinics, but they were illnesses has been a central debate largely unenthusiastic. in clinical psychology since the By 1914, there were about 20 19th century, evolving significantly psychological clinics in the United over time. States, most modeled on Witmer’s. By Early Classification: 1935, the number had soared to more ○ Neurosis: Describes than 150. individuals with symptoms In his clinic, Witmer and his associates such as anxiety or worked with children whose problems depression who maintain an arose in school settings and were intact reality. related to learning or behavior. ○ Psychosis: Refers to Witmer emphasized that clinical individuals with a break psychology could be applied to adults from reality, characterized as well as children. by hallucinations, In 1907, Witmer founded the first delusions, or disorganized scholarly journal in the field, The thinking (Reisman, 1991). Psychological Clinic, and authored the first article titled “Clinical Emil Kraepelin's Impact on Modern Psychology.” Psychiatry Witmer defined clinical psychology as Emil Kraepelin, known as the related to medicine, education, and "father of descriptive psychiatry," social work but stated that physicians, advanced the categorization of teachers, and social workers would not mental illnesses. be qualified to practice clinical ○ Two-Category System: psychology. Exogenous This new field required a specially Disorders: Caused trained professional who would work by external factors collaboratively with members of (e.g., trauma) and related fields. considered more Witmer’s definition of clinical treatable. psychology was uninfluenced by Endogenous Freud, and he did not mention Disorders: Caused psychotherapy or empirically by internal factors evaluating treatments.  (e.g., biological or of symptoms genetic origins). required for each ○ Key Contributions: diagnosis. Introduced terms Multiaxial System: such as dementia A method for praecox (early term categorizing for schizophrenia), different types of manic-depressive problems (e.g., psychosis, paranoia, clinical disorders, and more. personality Established a disorders, medical foundation for conditions) on modern diagnostic separate axes. systems, leading to Subsequent Editions: the development of ○ DSM-III-R (1987), the DSM (Millon & DSM-IV (1994), Simonsen, 2010). DSM-IV-TR (2000), and DSM-5 (2013): Continued Development and Evolution of the DSM expansion of disorders and refinement of criteria. The Diagnostic and Statistical ○ Increase in the number of Manual of Mental Disorders disorders by over 300% (DSM) has evolved significantly, from DSM-I to DSM-IV, with numerous revisions reflecting growing the manual to 947 changes in psychiatric pages by DSM-5 (Houts, understanding. 2002). Early Efforts in Classification: ○ 1840 Census: Included a Key Debates and Controversies single category for "idiocy/insanity." Expansion of Disorders: ○ 1880 Census: Expanded to ○ Growth in the number of seven categories, followed disorders raises questions: by efforts from the Are these new American Medical diagnoses a result of Association and the U.S. scientific discovery, Army. identifying First DSM (1952): Published by previously the American Psychiatric unrecognized Association to provide a disorders? standardized approach to mental Or do they represent health diagnoses. a social invention, ○ DSM-II (1968): Made only where normal minor updates from DSM-I. variations of human ○ DSM-III (1980): Major behavior are revision introducing: increasingly Specific Diagnostic medicalized? Criteria: Clear lists  Influence of Non-Scientific Decision-Making Process for DSM Factors: Inclusion ○ Critics argue that social, political, and economic DSM Authors' Responsibilities: factors may play a role in Before each edition of the DSM is what is included or published, its authors undertake an excluded from the DSM (Caplan, 1995; Kutchins & extensive decision-making Kirk, 1997). process to determine which Balancing Empirical Evidence experiences or sets of symptoms and Social Considerations: should be classified as official ○ The expansion of the DSM diagnoses. These decisions have reflects both advances in substantial implications for: understanding mental ○ Clients: Who may receive health and challenges in defining what constitutes a diagnoses that can affect mental disorder. their treatment options, social standing, and Highlighted Information: personal identity. ○ Mental Health The DSM has evolved from a basic tool to a comprehensive manual Professionals: Who rely on with over 300% more disorders DSM classifications to since its inception. guide treatment plans and Kraepelin's work laid the interventions. groundwork for modern diagnostic ○ Health Insurance systems by categorizing disorders Companies: Which often based on external versus internal causes. base their coverage Ongoing debates focus on whether decisions on DSM the DSM’s expansion reflects classifications, influencing genuine scientific progress or a what treatments are tendency to over-pathologize reimbursed. normal behavior. ○ Researchers: Who use the The DSM's evolution illustrates the DSM as a standard intersection of scientific research, clinical utility, and social reference to study, influences in defining mental understand, and develop illness. treatments for various mental health conditions. Is it a DSM Disorder? Decisions to Examples of DSM Inclusion and Include or Exclude Potential Exclusion Disorders New Disorders Added to DSM-III (1980):  ○ Borderline Personality consensus on its Disorder: Characterized by distinctiveness and validity. unstable moods, behaviors, Reversal of Inclusion Decisions: and relationships; a ○ Homosexuality: Originally significant addition that listed in DSM-I and reflected a growing DSM-II as a mental understanding of complex disorder, it was removed in personality disorders. DSM-III following ○ Narcissistic Personality significant social advocacy Disorder: Involves a and research demonstrating pervasive pattern of that it is not inherently grandiosity, need for pathological. admiration, and lack of ○ Other Disorders empathy; its inclusion Removed: Disorders like acknowledged its distinct Inadequate Personality clinical presentation. Disorder and Asthenic ○ Social Phobia (now Social Personality Disorder were Anxiety Disorder): also removed in subsequent Describes intense fear of editions due to lack of social situations; clarity and overlapping recognized as a common symptoms with other and debilitating condition, diagnoses. deserving of its own category. Proposed Disorders in DSM-5 Disorders Considered but The current edition of DSM (DSM-5) Excluded: includes a section on "proposed criteria ○ Sadistic Personality sets," which lists disorders considered for Disorder: Involved a inclusion but ultimately rejected. These pattern of cruel, demeaning, disorders may be included in future and aggressive behavior, editions, pending further research. but was excluded due to insufficient empirical Examples of Proposed Disorders: support and concerns about ○ Internet Gaming misuse. Disorder: Characterized by ○ Self-Defeating Personality excessive gaming behavior Disorder: Described that results in significant individuals who habitually impairment or distress, engage in self-destructive including symptoms like behaviors, but was not preoccupation with included due to a lack of gaming, inability to control gaming behavior,  withdrawal symptoms, to consider self-injury as a relationship problems, and primary diagnosis, not just reduced functioning in a symptom of other daily life. It reflects conditions. growing concerns over the impact of digital addiction. Ongoing Debate: Mental Illness or ○ Attenuated Psychosis Normal Human Experience? Syndrome: Involves mild Criteria for Inclusion: The key or brief psychotic-like question remains whether the symptoms, such as phenomena listed in the "proposed delusions, hallucinations, criteria set" should be classified or disorganized thinking, as mental illnesses or considered but with less severity than part of normal human full-blown psychotic experiences. This debate centers disorders like on balancing clinical need and the schizophrenia. This risk of over-pathologizing normal category aims to identify behavior. and treat at-risk individuals Future Decisions: The inclusion early. of these disorders in future DSM ○ Persistent Complex editions will depend on decisions Bereavement: Refers to by the DSM authors, influenced by prolonged, intense grief ongoing research, clinical after the loss of a loved one, feedback, and social with symptoms persisting considerations. for over 12 months (or 6 months for children), Important Points to Note: including preoccupation, yearning, and intense The DSM's evolving nature sorrow. It acknowledges reflects changes in how mental that for some individuals, health conditions are understood, the grieving process may categorized, and treated. require clinical attention. Controversies around including or ○ Nonsuicidal Self-Injury: excluding certain disorders Describes deliberate, highlight the complexity of self-inflicted harm (such as defining mental illness, where cutting, burning, or other clinical, social, and ethical injury) without any perspectives intersect. suicidal intent, occurring on Proposed disorders are often five or more days in the reflective of emerging trends in past year. This proposed mental health, but their formal disorder highlights the need recognition depends on further  study and consensus among “intelligence quotient” (IQ) professionals. (Ferrand & Nicolas, 2015). Lewis Terman revised Binet’s test Assessment of Intelligence in 1937, naming it the Stanford-Binet Intelligence The field of clinical psychology emerged Scales, which remains in use today. around the turn of the 20th century, The Stanford-Binet was pivotal in coinciding with a significant dispute formalizing the measurement of among psychology's pioneers about the intelligence (G. Goldstein, 2008; nature of intelligence. Two main theories Reisman, 1991). were at the center of this debate: Wechsler's Contributions to Intelligence Edward Lee Thorndike promoted Testing the idea that each person possesses separate, independent While Binet's test focused on intelligences. children, David Wechsler Charles Spearman argued for the recognized the need for an existence of "g," or general adult-focused intelligence test and intelligence, a single overarching published the Wechsler Bellevue ability that overlaps with many test in 1939. This test quickly specific skills (Reisman, 1991). became popular and has undergone several updates: This debate profoundly influenced how ○ Wechsler Adult clinical psychologists assessed intellectual Intelligence Scale (WAIS): abilities, making it a defining activity in Introduced in 1955. the early years of the profession (L. T. ○ WAIS-R: Revised in 1981. Benjamin, 2007). ○ WAIS-III: Revised in Development of Intelligence Testing 1997. ○ WAIS-IV: Latest revision In the early 1900s, the French in 2008 (G. Goldstein, government needed a way to 2008; Reisman, 1991; identify public-school students who Wasserman & Kaufman, would benefit from special 2015). services. In response, Alfred Binet In 1949, Wechsler released the and Theodore Simon developed Wechsler Intelligence Scale for the first Binet-Simon scale in Children (WISC), a direct 1905. This test introduced the competitor to the Stanford-Binet. concept of “g” and was the first to The WISC introduced subtests compare mental age to and verbal and performance chronological age to derive an scales, offering a more comprehensive assessment of  intelligence. It has been revised Mental Tests and Their Evolution multiple times: ○ WISC-R: Revised in 1974. James McKeen Cattell first introduced the term "mental test" in 1890 in his article ○ WISC-III: Revised in Mental Tests and Measurements. Initially, 1991. the tests measured basic abilities like ○ WISC-IV: Revised in reaction time, memory, and perception. 2003. Over time, mental tests expanded to ○ WISC-V: Latest revision in include intelligence and personality 2014. assessments. Wechsler also developed a test for The Rise of Personality Testing very young children, the Wechsler Preschool and Primary Scale of Early 20th century: The first efforts to Intelligence (WPPSI), first measure personality empirically began, but released in 1967. It has seen only a few had a lasting impact. several revisions: 1921: Hermann Rorschach introduced ○ WPPSI-R: Revised in the Rorschach Inkblot Test, which became 1989. a well-known projective personality test. Based on the theory of "projection," this ○ WPPSI-III: Revised in test was widely used by psychodynamic 2002. practitioners in the early and mid-1900s. ○ WPPSI-IV: Latest revision in 2012. Development of Projective Techniques Establishment of Standards in Following the Rorschach test's success, Intelligence Testing other projective tests emerged: ○ 1935: Thematic Apperception Test The Stanford-Binet and Wechsler (TAT) by Christiana Morgan and Henry tests have become the standard Murray involved interpreting ambiguous scenes of people, allowing for a variety of measures of intelligence narrative responses. assessment in clinical psychology. ○ Other examples include the Both tests have undergone Draw-a-Person test and Incomplete continuous revision and Sentence Blank, each aiming to infer refinement, responding to personality traits from responses. advancements in psychological theory and testing technology. Shift to Objective Personality Testing They are seen as competitors in Objective personality tests, which were the marketplace, with each new more structured and scientifically edition reflecting advancements or grounded, appeared after projective responses to developments in the methods: other test. ○ These tests used multiple-choice or Assessment of Personality true/false questions, making scoring and interpretation clearer and more reliable.  Broader Uses of Personality Tests ○ Minnesota Multiphasic Personality Inventory (MMPI), created by Starke Personality assessments have expanded Hathaway and J.C. McKinley in 1943, is a into areas like job screenings and forensic notable example. It consists of 550 purposes, though these applications have true/false statements and helps classify stirred controversy due to concerns over clients using clinical and validity scales. validity and reliability, emphasizing the importance of these qualities in Minnesota Multiphasic Personality psychological testing. Inventory (MMPI) and Its Evolution PSYCHOTHERAPY The MMPI included a built-in system to detect random or misleading responses, The Role of Psychotherapy in Clinical ensuring the validity of test results. Psychology By 1959, there were over 200 scales derived from MMPI items. Early 20th Century: Psychotherapy was not the primary In 1989, the MMPI-2 was introduced, focus of clinical psychologists. offering updated norms that were more ○ In 1930, most clinical representative of minorities and various psychologists worked in regions. It also refined outdated language. academia, not in practice. ○ Psychologists focused more The MMPI-Adolescent (MMPI-A) was on psychological testing launched in 1992 for younger individuals. rather than treatment, which was considered the domain Hallmarks of MMPI of medical doctors. All versions of the MMPI are known Emergence of Psychotherapy in the for: 1940s-1950s ○ Ease of administration and scoring ○ Reliability and validity It wasn’t until the 1940s and 1950s ○ Clinical utility that psychotherapy became a central activity in clinical Other Personality Tests psychology. ○ Clinical psychologists had While other tests have emerged, none limited roles in treatment match the lasting impact of the MMPI. strategies, as medical ○ The NEO Personality Inventory practitioners dominated the (NEO-PI), NEO-PI-R, and NEO-PI-3 field. focus on The transition towards universal personality traits rather than psychotherapy began with psychopathology, as seen in the MMPI. increased demand for mental health ○ Specific trait-based instruments like the services due to World War II. Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) are also Impact of World War II widely used.  The psychological consequences also gained popularity, with of World War II on soldiers played Carl Rogers promoting a a crucial role in making therapy centered on growth psychotherapy a common practice and therapist-client among clinical psychologists. relationships. ○ Post-war, there was an ○ Family Therapy emerged, increased need for mental emphasizing that an health treatment, prompting individual’s mental health a shift in the profession. problems could be a ○ Without this demand, reflection of issues within clinical psychology might their family system. have continued focusing on academic and testing roles Rise of Cognitive Therapy for much longer. Cognitive Therapy: In recent The Evolution of Psychotherapy decades, this approach became the Approaches in Clinical Psychology most popular, focusing on logical thinking and its role in Mid-20th Century: psychological well-being. ○ Psychotherapy became Cognitive therapists aim to correct more prominent in clinical irrational or distorted thinking psychology, with the patterns. psychodynamic approach dominating early on. Variety and Integration in Modern ○ This approach, heavily Therapy influenced by Freudian theories, focused on Today, the range of therapy unconscious processes and approaches is vast, with modern early life experiences as the graduate textbooks covering at source of psychological least a dozen distinct methods. problems. Therapists increasingly combine approaches through eclectic or Challengers to Psychodynamic integrative therapy models. Therapy Cultural competence has also become essential in modern 1950s-1960s: therapy, influencing how therapists ○ Behaviorism emerged as apply various methods to clients an alternative, focusing on from diverse backgrounds. observable behaviors and emphasizing empirical, Conclusion measurable outcomes. This approach reacted against The multitude of therapy the lack of scientific approaches available today did not evidence in psychodynamic always exist; they evolved over therapy. time, often emerging as reactions ○ Humanistic Therapy (or to previous methods. The client-centered therapy) development of psychotherapy  reflects a continuous expansion and Origins: David Wechsler refinement of techniques to meet developed the Wechsler-Bellevue the needs of clients. intelligence test based on his experiences measuring military Influence of War on Clinical personnel’s intellectual capacities Psychology during World War I. Legacy: This test evolved into the Wars' Impact: World Wars WAIS (Wechsler Adult significantly shaped clinical Intelligence Scale) and later into psychology, particularly in the WISC (Wechsler Intelligence therapy, assessment, and Scale for Children) and WPPSI training. (Wechsler Preschool and Primary Military Needs: Governments Scale of Intelligence). needed ways to select soldiers and Current Use: The WAIS, WISC, treat them post-service, driving and WPPSI are now among the advancements in psychological most widely used intelligence tests testing and mental health for adults and children in the treatments. United States (Boake, 2002; Key Figures: Robert Yerkes Reisman, 1991). chaired the Committee on Psychological Testing, leading to Post-World War II and Modern large-scale use of psychological Influences on Clinical Psychology assessments for military personnel. Post-War Growth: WWII created Veterans and Psychological demand for psychotherapy to treat Effects: veterans, solidifying its role in ○ After World War II, many clinical psychology. VA hospitals U.S. veterans suffered from also became key in training new what was then called "shell psychologists. shock," now known as Posttraumatic Stress Army Alpha and Beta Intelligence Disorder (PTSD) (L. T. Tests Benjamin, 2005; J. G. Miller, 1946). World War I: The Army Alpha ○ The Veterans and Beta intelligence tests were Administration (now the developed to assess the Department of Veterans intelligence of recruits and Affairs) requested the soldiers. American Psychological Significance: These tests are Association to formalize considered precursors to modern clinical psychology intelligence measures, influencing training, leading to the today's widely used intelligence development of the tests (McGuire, 1994). scientist-practitioner (Boulder) model (R. R. David Wechsler’s Intelligence Tests Baker & Pickren, 2011). Training and Impact:  ○ This model continues to Psychological Association in 1919. dominate, with strong ties The Psychological Corporation was between the Department of established in 1921, marking the Veterans Affairs and beginning of commercial clinical psychology training psychological testing. programs. ○ By 2014, there were In the 1940s, clinical psychology approximately 4,700 training became more standardized psychologists working with increased training sites and within the Department of the American Psychological Veterans Affairs (Zeiss, Association accrediting graduate Zeiss, & Carroll, 2016). programs. Veterans Affairs Influence of World War II and hospitals supported graduate Nazi Persecution: training and internships, and the ○ The rise of the Nazis in the 1949 Boulder conference 1930s forced prominent emphasized the importance of both psychodynamic theorists, practice and research in PhD including Sigmund Freud, training. to relocate, spreading their theories to England and the The 1950s saw a proliferation of U.S. (Reisman, 1991). therapy approaches, including new Current and Future Roles: behavioral and ○ Recent military operations humanistic/existential methods. in Iraq and Afghanistan Eysenck’s 1952 analysis spurred highlight the ongoing need interest in the effectiveness of for clinical psychologists to psychotherapy, and the American support soldiers and Psychological Association veterans (Lorber & Garcia, published its first ethical code in 2010; Maguen et al., 2010). 1953. ○ The Department of Veterans Affairs remains a major During the 1960s and 1970s, the provider of mental health field diversified with increased services, with nearly 1 recruitment of females and million veterans receiving minorities. The introduction of care annually (M. G. Hunt PsyD programs focused on clinical & Rosenheck, 2011). skills, and insurance companies began covering psychotherapy services. DEVELOPMENT OF PROFESSION In the 1980s, clinical psychologists The profession of clinical gained respect from the medical psychology has evolved establishment, with hospital significantly since its early years. admitting and Medicare payment In 1917, the American Association privileges. Training institutions of Clinical Psychologists was expanded, and nearly half of founded and transitioned into the American Psychological Clinical Section of the American Association members were  clinicians. The use of intelligence and personality testing decreased, though the profession continued to grow. By the 1990s and 2000s, the profession expanded in size and scope to meet the demand for psychotherapy. By 2010, 50% of the U.S. population had received psychological treatment. Training options increased, including PhD programs, PsyD programs, and specialized clinical scientist programs. Specializations like forensic and health psychology flourished, and new professional developments included empirical support for clinical techniques, prescription privileges, and new technologies. CHAPTER 3: CURRENT whether psychologists should be CONTROVERSIES AND allowed to prescribe medication. DIRECTIONS IN CLINICAL PSYCHOLOGY Why Clinical Psychologists Should Prescribe: Prescription Privileges Shortage of Psychiatrists: Many Historically, the primary distinction regions, especially rural areas, lack between psychiatrists and enough psychiatrists to meet the psychologists has been the ability demand for mental health care. to prescribe medication. Granting prescription privileges to However, in recent decades, some psychologists could address this clinical psychologists have sought gap and provide better access to prescription privileges, leading to a care in underserved areas. high-profile debate. More Expertise than Primary Care Physicians: While This movement gained momentum psychiatrists specialize in mental in the 1980s and 1990s, with health, most psychoactive support from the American medication prescriptions come Psychological Association (APA), from primary care physicians. which advocated for training Psychologists, with their psychologists in specialized training in mental psychopharmacology. Key figures, health, could provide more such as Patrick H. DeLeon, accurate diagnoses and appropriate Morgan T. Sammons, and prescriptions. Robert McGrath, played a Precedent of Nonphysician prominent role in pushing for this Professionals Prescribing: Other change. non physician professionals, such NEW MEXICO and as dentists, podiatrists, LOUISIANA- was the first state to optometrists, and advanced grant prescription privileges to practice nurses, already have trained psychologists in the years prescription privileges. This 2002 and 2004. precedent supports the argument for clinical psychologists to do the Followed by Illinois, Iowa, and same, especially considering the Idaho in subsequent years. limited mental health training of general physicians. The establishment of APA Division 55 and psychopharmacology Convenience for Clients: training programs in the military Psychologists with prescription also advanced this cause privileges could offer both therapy and medication management, Despite this the issue remains simplifying treatment for clients by controversial, with strong reducing the need for multiple arguments on both sides regarding  appointments and communication training similar to that of between different professionals. physicians, while others suggest Professional Autonomy: basic psychopharmacology training Prescription privileges would is sufficient. The logistics of this enhance psychologists' ability to training—such as when and how it independently treat their clients' should occur—are unresolved. mental health issues, allowing them Adding pharmacology to graduate to offer a more comprehensive programs could significantly range of services without relying extend the length of education, and on psychiatrists. many psychology programs Professional Distinction: The currently lack qualified faculty to ability to prescribe would set teach these courses. psychologists apart from other non Threats to Psychotherapy: prescribing mental health Prescription privileges could lead professionals, such as counselors to a shift away from psychotherapy and social workers, potentially toward pharmacological elevating their professional status. intervention. Psychologists may Evolution of the Profession: prioritize medication due to its Prescription privileges are seen as a profitability, potentially altering natural progression in the field of their focus from behavioral and clinical psychology, allowing the emotional processes to symptom profession to evolve and open new reduction via drugs. This mirrors a opportunities, such as consulting similar trend seen in psychiatry, with physicians on raising concerns that clinical psychopharmacology. psychology could lose its core Revenue Increase: Prescription essence. privileges could lead to increased Identity Confusion: If only some income for psychologists, psychologists gain prescription offsetting salary decreases from privileges, the profession may face managed care. Opposition from an identity crisis. Clients could psychiatrists stems in part from the become confused about whether potential financial impact, as their psychologist can prescribe psychologists would become medications, leading to potential competitors in the prescription of misunderstandings and inconsistent medications expectations within the field. Influence of the Pharmaceutical Why Clinical Psychologists Should Not Industry: There is concern that Prescribe: psychologists who prescribe will be influenced by the Training Issues: There is ongoing pharmaceutical industry, as has debate about the level of education been reported with other healthcare clinical psychologists should providers. The risk of being receive before prescribing. Some swayed by financial incentives or argue they need extensive medical pressure from drug companies  could compromise psychologists' psychotherapy. Research shows that ability to prioritize client welfare accommodating client preferences when making prescription improves treatment outcomes and reduces decisions. dropout rates. Evidence-Based Practice/Manualized Although EBP and manualized therapy Therapy have been praised for advancing clinical psychology, legitimizing it as a scientific The debate around evidence-based practice field, they have also sparked concerns. (EBP) and manualized therapy in mental Critics argue that rigid manualization may health has grown over recent decades. The limit the therapist's flexibility to tailor movement stems from research seeking to treatments to individual clients, raising understand whether therapy works, which questions about the balance between began after Hans Eysenck’s (1952) scientific rigor and personalized care. controversial claim that psychotherapy had no proven benefits. Research later refuted Advantages of Evidence-Based Eysenck, showing that psychotherapy is Practice/Manualized Therapy generally effective. However, the focus shifted toward more specific questions: Scientific Legitimacy: Before the "Which therapies work best for which advent of annualized therapies, disorders?" clinical psychology often resembled a “cottage industry,” In the 1980s, researchers began testing with each therapist offering a specific therapies for specific disorders, unique, standardized approach to leading to the development of therapy treatment. This inconsistency manuals to ensure uniformity across challenged the field's claim to therapists. This approach helped scientific rigor. Evidence-based demonstrate the efficacy of particular practices (EBP) and annualized treatments like exposure and response therapies address this by providing prevention for obsessive-compulsive standardized, empirically supported disorder, dialectical behavior therapy treatments. This scientific approach (DBT) for borderline personality disorder, aligns clinical psychology with the and cognitive therapy for depression. medical model, where uniformity These studies led to the establishment of and evidence-based standards are empirically validated or evidence-based expected. treatments, which later expanded into Establishing Minimal Levels of "evidence-based practice." Competence: Annualized therapies ensure that therapists use Evidence-based practice integrates three treatment methods proven to be essential components: the best available effective, thus minimizing the risk research, clinical expertise, and patient of delivering ineffective or harmful characteristics/preferences. This approach therapy. These standardized is often described as a three-legged stool, treatments set a benchmark for where each leg supports effective competence, helping to ensure that  all psychologists adhere to emphasize mechanical application established, effective practices, of techniques over the human thus enhancing overall treatment connection, potentially quality and accountability. undermining the therapeutic Training Improvements: The alliance and the nuanced, inclusion of manualized, evidence- empathetic engagement that clients based therapies in graduate training often need. programs helps ensure that new Diagnostic Complications: psychologists are educated in Evidence-based treatments are techniques with proven efficacy. typically tested on clients with Accreditation bodies like the “textbook” cases of a disorder, American Psychological without comorbid conditions. In Association consider evidence- real-world settings, clients often based training in their evaluations, present with multiple, complex leading to improved educational issues (e.g., panic disorder with standards and more competent comorbid mood or personality future practitioners. disorders). Manualized therapies Decreased Reliance on Clinical might not be as effective for these Judgment: Clinical judgment can more complex, "messy" cases be biased and flawed, potentially (Angold, Costello, & Erkanli, compromising therapy outcomes. 1999; Kessler, 1994). By emphasizing evidence-based Restrictions on Practice: The techniques over personal judgment, focus on evidence-based practices manualized therapies reduce the can lead to the view that only reliance on subjective decision- therapies with empirical support making, leading to more consistent are valid. This perspective might and effective treatment outcomes. marginalize therapies not included This shift helps minimize biases in the evidence-based lists and and enhances therapeutic efficacy. limit therapists' autonomy and creativity. Rigid adherence to Disadvantages of Evidence-Based manuals can lead to a Practice/Manualized Therapy “one-size-fits-all” approach, potentially stifling clinical Threats to the Psychotherapy judgment and innovation Relationship: Manualized (Wampold, 2009). Furthermore, therapies focus on specific insurance and managed-care techniques rather than the companies might use evidence- therapeutic relationship. The based criteria to restrict the range quality of the therapist-client of acceptable treatments, relationship is crucial for therapy’s emphasizing brief, cost-effective success, often more so than the approaches (Seligman & Levant, techniques used (Norcross & 1998). Wampold, 2011a; Wampold & Debatable Criteria for Empirical Imel, 2015). Manuals might Evidence: The criteria for what  qualifies as an evidence-based antidepressant medication (Paris, practice can be contentious. Some 2013a). argue that the criteria are biased Reason for the climb of mental towards certain therapies (e.g., disorder rates: over diagnosis, behavioral and cognitive) and do diagnostic expansion, diagnostic not adequately represent therapies inflation, diagnostic creep, with less quantifiable outcomes medicalization of everyday (e.g., psychodynamic or humanistic problems, false positives, and in approaches) (Lebow, 2006; Tolin et severe cases, false epidemics al., 2015). The criteria might also (Frances, 2013a; Pierre, 2013). overlook failed trials or less Concerns about the expanding traditional therapies that could still definition of mental illness were be effective in practice. around long before DSM-5 was Flexibility vs. Rigidity: While published (Dobbs, 2013; Frances, evidence-based practices offer 2013b; Horwitz & Wakefield, structured approaches, they may 2007). For example, excessive not always allow for the flexibility shyness that interferes with a needed to tailor treatments to person’s life was once considered individual client needs. The debate an unfortunate personality around the balance between characteristic, but since 1980, it has adhering to manuals and allowing been included in the DSM as social for therapeutic flexibility suggests anxiety disorder (C. Barber, 2008; that a rigid approach might not Horwitz & Wakefield, 2012). always yield the best outcomes. In a 2014 survey of more than 500 Flexibility within the framework of therapists from eight countries evidence-based practices may around the world, over 60% of enhance client engagement and participants identified at least one treatment efficacy (B. C. Chu & disorder that should be completely Kendall, 2009; Forehand et al., removed from DSM, and the most 2010) common reasons for their choice were unclear boundaries between Overexpansion Of Mental Disorders the disorder and either another disorder or normalcy (Robles et al., The size and scope of the 2014). Diagnostic and Statistical Manual (DSM) has vastly increased since New Disorders and New Definitions of its inception in the 1950s. Old Disorders Correspondingly, the number of people with mental disorders has This expansion of the scope of mental climbed: Half of the U.S. disorders happens in at least two ways: population is diagnosable at some introduction of new disorders to capture point in their lifetime, and 11% of experiences once considered normal and the population is currently taking “lowering the bar” for existing disorders such that more people meet the criteria. - Examples of new disorders that definition of a mental disorder, and critics point out of which appear in some cases, they offer treatments for the first time in DSM-5 and whether or not a diagnosis has been which have the potential to made at all (G. Greenberg, 2013; describe large numbers of people. Paris, 2013b). - Premenstrual dysphoric disorder (a In these cases, over diagnosis is as more disabling version of the likely to stem from decisions made symptoms of premenstrual by the mental health professional syndrome). who sees the client as from the - Binge eating disorder (out of mental health professionals who control overeating at least once per wrote the diagnostic manual. week). - As examples of “lowering the bar,” The Influence of the Pharmaceutical critics might point to changing the Industry age by which symptoms of ADHD must appear from 7 to 12, or The overexpansion of mental changing the required frequency of health diagnoses has been binges in bulimia nervosa from connected, at least by some experts twice per week to once per week, in the field, to the possible both of which are also DSM-5 influence of the pharmaceutical innovations industry. Whether the risk of over diagnosis The more disorders there are, and comes from a new disorder or a the more they overlap with the new definition of an old disorder, unfortunate experiences of normal the consequences can be very real. life, the more potential customers A mental illness diagnosis can have these companies have to target many other effects as well: It can their advertising toward (C. Barber, affect a person’s self-image via the 2008; Frances, 2013a; Paris, stigma that some people attach to 2013b; Pierre, 2013; Sadler, 2013; mental illness (“I’m mentally ill”) Whitaker & Cosgrove, 2015). and subsequently the person’s Specifically, Cosgrove, Krimsky, self-efficacy and overall wellness; Vijayaraghavan, and Schneider it can influence how health (2006) found that of the 170 panel insurance companies consider the members of DSM-IV, 95 of them, person as a potential enrollee; and or 57%, had financial ties to the it can affect how a court of law major pharmaceutical companies. views the person in terms of guilt In the Work Groups, or teams of regarding a crime or suitability for DSM authors with expertise in child custody (Caplan, 2012; particular areas, for mood disorders Frances, 2013a, 2013c). (e.g., major depressive disorder, There is at least some truth to the bipolar disorder) and psychotic notion that practicing clinicians disorders (e.g., schizophrenia), make diagnoses without detailed disorders for which medication is consideration of the precise extremely common, the percentage  was 100%. The percentages were individuals who might not also high for other Work Groups in otherwise be able to pay for it. which medication is common, such However, the companies who as anxiety disorders (81%), eating control these benefits are disorders (83%), and childhood concerned about their financial disorders (62%), but lower for bottom line as well as the health of Work Groups in which medication their members, and at times, their is uncommon, such as priorities can strongly affect the substance-related disorders (17%). work of clinical psychologists. The most frequent types of financial ties were research Effect on Therapy funding, consultant fees, and speaking fees. According to a survey by M. J. Cosgrove and Wheeler (2013) have Murphy et al. (1998), psychologists since argued that the in private practice describe pharmaceutical industry is trying to managed care as having a negative “colonize” psychiatry—that is, impact on their practices and, more attempting to control the mental specifically, on the quality of health field, beginning with a deep therapy they provide. connection between its core The managed-care companies are diagnostic manual and their exercising too much control over financial interests. clinical decisions. One study suggests that the power The managed-care companies’ of such a financial arrangement can emphasis on financial concerns be remarkable. Carey and Harris often made it difficult for the (2008) studied the prescribing psychologists to provide habits of psychiatrists in Minnesota appropriate, ethical psychological and found that those who had services. received at least $5,000 from Confidentiality was specifically pharmaceutical companies had noted as an ethical concern. written three times as many From the psychologists’ point of prescriptions for antipsychotic view, the downside of working medication as doctors who had with managed-care companies can received none. have many facets: lower pay than from clients who pay directly; Payment Methods: Third-Party taking time away from direct Payment Versus Self-Payment clinical work to spend on paperwork, phone calls, and other The presence of this third-party interaction with the managed-care payer in the therapy relationship company; denial of care that the has numerous consequences (Reich psychologist believes is necessary; & Kolbasovsky, 2006). and numerous other frustrations Managed-care and insurance (Reich & Kolbasovsky, 2006). benefits bring therapy to many  Of course, paying for method as well (Kielbasa, psychotherapy without using Pomerantz, Krohn, & Sullivan, insurance or managed-care benefits 2004). has its own drawbacks. Additional studies have suggested First, many individuals would that for a wider range of problems, struggle to pay for therapy out of including symptoms of pocket, at least without reduced inattention/hyperactivity and social fees or services from low-cost phobia (Lowe, Pomerantz, & community clinics. Pettibone, 2007) or for symptoms For a large segment of the that are clearly below diagnosable population, self-pay is simply an levels (Pomerantz & Segrist, unaffordable option (and the health 2006), psychologists’ diagnostic insurance/managed-care option is decisions depend on whether the what makes therapy attainable). client or the client’s insurance For those who can afford it, company pays for therapy. self-pay therapy does allow the therapist and client to make The Influence Of Technology: important decisions—such as Telepsychology And More establishing the goals of therapy, agreeing on a treatment method, Contemporary clinical and determining when therapy psychologists can perform should end—without the assessments and treatments via intervention of a third party with a computer or smartphone as a financial interest. supplement to, or instead of, traditional in-person meetings with Effect on Diagnosis clients (Eonta et al., 2011). This use of technology, and It is worth noting first that most particularly the Internet, by clinical health insurance and managed-care psychologists often goes by the companies require a Diagnostic name telepsychology but is als