Foundations of Clinical Psychology PDF | Laguna State Polytechnic University

Republic of the Philippines Laguna State Polytechnic University Province of Laguna LSPU Self-Paced Learning Module (SLM) Course Clinical Psychology Sem/AY Second Semester...

Republic of the Philippines Laguna State Polytechnic University Province of Laguna LSPU Self-Paced Learning Module (SLM) Course Clinical Psychology Sem/AY Second Semester/2024-2025 Module No. 1 Lesson Title Foundations of Clinical Psychology Week 1-4 Duration Date Jan. 27 – Feb. 21, 2025 Chapter 1: Clinical Psychology: An Introduction Description Chapter 2: Historical Overview of Clinical Psychology of the Chapter 3: Diagnosis and Classification of Psychological Problems Lesson Learning Outcomes Intended Students should be able to meet the following intended learning outcomes: Learning 1. Distinguishes a clinical psychologist from other mental health professionals Outcomes 2. Identify the current trends that will likely affect the future roles of clinical psychologists 3. Knowledge in the history and systems of psychology, including philosophical foundations, key movements and figures that influenced the field, the formal founding of the discipline of psychology, and current theoretical orientations and specialty areas, applying this understanding to the profession of clinical psychology. 4. Know the importance of mental disorder diagnoses. Targets/ At the end of the lesson, students should be able to: Objectives 1. Learn how a clinical psychologist integrate research and practice (clinical work) 2. Determine how clinical psychologists come to be so involved in the treatment of adult emotional problems 3. Obtain knowledge in psychopathology, including DSM-5 diagnoses and treatment approaches that correspond with the various diagnostic categories. 4. Describe the five diagnostic axes used for a DSM-IV diagnostic formulation. Student Learning Strategies LSPU SELF-PACED LEARNING MODULE: CLINICAL PSYCHOLOGY  Republic of the Philippines Laguna State Polytechnic University Province of Laguna Class Activities A.​ Lecture-Discussion (Synchronous/ You will be directed to attend in a Three-Hour class discussion per week on the Foundations of Clinical Psychology. Asynchronous) The lecture-discussion on this module will happen on January 27 – February 21, 2025 according to class schedule. (For further instructions, refer to your Google Classroom and see the schedule of activities for this module) B.​ Learning Guide Questions: 1.​ What is Clinical Psychology? 2.​ Who are the different mental health professionals? 3.​ Who was the founder of Clinical Psychology? 4.​ What are the 3 major definition of abnormal behavior? 5.​ What is Diathesis-Stress Model? Note: The insight that you will post on online discussion forum using Learning Management System (LMS) will receive additional scores in class participation. Lecture Guide Chapter 1: CLINICAL PSYCHOLOGY: AN INTRODUCTION What Is Clinical Psychology What is clinical psychologist? Although it seems as though we are inundated with real and fictional portrayals of clinical psychologists in the media, the general public remains rather confused about what psychologists do as well as their educational backgrounds (J. Peterson, 1995). Perhaps this should not be too surprising given that clinical psychologists are a heterogeneous group with Offline Activities respect to age, gender, theoretical allegiance, and roles (Norcross, Karpiak, & (e-Learning/Self-P Santoro, 2004). After all these years, people still confuse clinical psychology is aced) synonymous with psychoanalysis. Others see a bit of the witch doctor in clinical psychologists, and still others view them as somewhat peculiar. Fortunately, there are many who regard them as researchers, therapists, or members of prestigious professional societies. ​ In an attempt to define and describe clinical psychology, J. H. Resnick (1991) proposed the following definition and description of clinical psychology: ​ The field of clinical psychology involves research, teaching, and services relevant ​ to the applications of principles, methods, and procedures for understanding, ​ predicting, and alleviating intellectual, emotional, LSPU SELF-PACED LEARNING MODULE: CLINICAL PSYCHOLOGY  Republic of the Philippines Laguna State Polytechnic University Province of Laguna biological, psychological, and social ​ and behavior maladjustment, disability and discomfort, applied to a wide range of ​ client populations (p. 7). ​ According to Resnick, the skill areas central to the field of clinical psychology include assessment and diagnosis, intervention or treatment, consultation, research, and the application of ethical and professional principles. Clinical psychologists are distinguished by their expertise in the areas of personality and psychopathology and their integration of science, theory, and practice. ​ A more recent definition of clinical psychology appears on the Web page of the American Psychological Association’s Division 12 (Society of Clinical Psychology; www.apa.org/divisions/div12): ​ The field of Clinical Psychology integrates science, theory, and practice to ​ understand and alleviate maladjustment, disability, and discomfort as well as to promote human adaption, adjustment, and personal development. Clinical Psychology focuses on the intellectual, emotional, biological, psychological, social, and behavioral aspects of human functioning across the life span, in varying cultures, and at all socioeconomic levels. ​ Although these definitions describe what clinical psychologists aim to do and, by implication, the skills they possess, we must also take note of how others see the profession and try to correct any false images. The main purpose of this chapter is to clarify the nature of clinical psychology by describing what clinical psychologists do and where they do it, how they became clinicians, and how they differ from other professionals who also tend to people’s mental health needs. In the process, we should gain a better understanding of the field of clinical psychology. Closely Related Mental Health Professions Before we examine the nature of clinical psychology, let us briefly review some of the other major professions in the mental health field. Because most confusion lies in contrasting clinical psychology with psychiatry and with counseling psychology, we focus most of our discussion on these fields. Following this review, we can better present the characteristics that give clinical psychology its unique identity. Psychiatrists The psychiatrist is a physician. Psychiatry is rooted in the medical tradition and exists within the framework of organized medicine. Thus, LSPU SELF-PACED LEARNING MODULE: CLINICAL PSYCHOLOGY  Republic of the Philippines Laguna State Polytechnic University Province of Laguna psychiatrists are often accorded the power and status of the medical profession, even though their intellectual heritage comes from the nonmedical contributions of Freud, Jung, Adler, and others. Although the latter were physicians, they stepped out of the medical tradition to develop a psychoanalytic system of thought that had very little to do with medicine. The psychiatric profession has vocally and effectively pushed for a superior role in the mental health professional hierarchy, and much of the profession’s argument has been based on its medical background. ​ Because of their medical training, psychiatrists may function as physicians. They may prescribe medication, treat physical ailments, and give physical examinations. In addition to their concentration on psychotherapy and psychiatric diagnosis, psychiatrists make extensive use of a variety of medications in treating their patients’ psychological difficulties. Furthermore, their medical training makes them potentially better able to recognize medical problems that may be contributing to the patient’s psychological distress.​ ​ Following completion of the medical degree and the general medical internship required of all physicians, the typical psychiatrists-to-be receives psychiatric training during 4-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. ​ The following description of psychiatrist appears on the Web page of the American Psychiatric Association (www.psych.org): ​ A psychiatrist in a physician who specializes in the diagnosis, treatment, and prevention of mental illnesses and substance use disorders…[The] extensive medical training [required for psychiatry] enables the psychiatrists to understand the body’s function and the complex relationship between emotional illness and other medical illnesses. The psychiatrist is thus the mental health professional and physician best qualified to distinguish between physical and psychological causes both mental and physical distress. ​ In contrast to psychiatrists, clinical psychologists typically receive little training in medicine and more extensive training in the psychological principles governing human behavior, in formal assessment of psychological functioning, and in scientific research methods. ​ Psychiatry is no longer enjoys the prestige and popularity it once did. The proportion of medical school graduates who choose psychiatric residencies LSPU SELF-PACED LEARNING MODULE: CLINICAL PSYCHOLOGY  Republic of the Philippines Laguna State Polytechnic University Province of Laguna has generally declined since 1970 (Sierles & Taylor, 1995). In 1994, only 3.4% of U.S medical school graduates chose psychiatry, the lowest percentage since 1929 (Sierles & Taylor, 1995). Reasons offered for this decline include psychiatry’s recent emphasis on biological approaches (thus making the field more conventional and similar to other medical specialties), the economic impact of managed care and psychiatric practice, and the increased competition from other mental health specialties, such as clinical psychology (Sierles & Taylor, 1995). ​ As for practicing psychiatrists, one survey highlighted several demographic trends (Zarin et al., 1998). First, a higher percentage of psychiatrists are now women (25% in 1996 vs. 14.5% in 1982). In addition, recent years have seen a higher proportion of psychiatrists representing minority ethnic groups. Finally, the mean number of hours worked per week by practicing psychiatrists has been on the decrease. Counseling Psychologists The activities of counseling psychologists overlap with those of clinical psychologists. Traditionally, counseling psychologists work with normal or moderately maladjusted individuals. Their work may involve in group counseling or counseling with individuals. Their principal method of assessment is usually the interview, but counseling psychologists also do testing (e.g., assessment of abilities, personality, interests and vocational aptitude). Historically, they have done a great deal of education and occupational counseling. More recently, many counseling psychologists have begun to employ cognitive – behavioral techniques and even biofeedback. ​ Traditionally, the most frequent employment areas for counseling psychologists have been educational settings, especially colleges and universities. However, counseling psychologists (like clinical psychologists) also work in hospitals, rehabilitation centers, mental health clinics and industry. A good example of the kind of work conducted by counseling psychologists within educational settings is suggested in the heading that appeared above an article in a campus newspaper several years ago: “Counseling Center Responds to Married Students’ Needs.” The article went on to describe group counseling sessions designed to help students who are parents deal with a special problems that marriage and children create for them in pursuing their academic goals. ​ In general, counseling psychologists see themselves in the following activities: (a) preventive treatment (b) consultation (c) development of outreach programs (d) vocational counseling and (e) short-term LSPU SELF-PACED LEARNING MODULE: CLINICAL PSYCHOLOGY  Republic of the Philippines Laguna State Polytechnic University Province of Laguna counseling/therapy of from 1 to 15 sessions. However, younger counselors seem more and more to view themselves as engaged in activities, such as psychotherapy, that are traditionally in the clinical province. Today, they are frequently less interested in vocational or career counseling and more interested in private practice. ​ Although there are a number of similarities between counseling and clinical psychologists, there are several distinguishing features as well (Norcross, Sayette, & Mayne, 2002). The field of clinical psychology is much larger in terms of the number of doctoral-level professional as well as the number of accredited doctoral training programs. There are approximately three times as many accredited programs, producing four times as many graduates, in clinical psychology as in counseling psychology. In contrast to majority of clinical psychology programs, counseling programs are less frequently housed in psychology departments. Finally, counseling psychologists are more likely to specialize in career or vocational assessment. Results from a recent survey (Norcross, Sayette, Mayne, Karg, & Turkson, 1998) indicate several further distinctions between doctoral programs in clinical and counseling psychology. ​ About twice as many people apply to clinical programs, although acceptance rates are similar. ​ Average GRE scores of accepted students are slightly higher in clinical than in counseling programs. ​ Counseling programs accept a higher percentage of ethnic minority students and students with a master’s degree. ​ Research focusing on minority/cross-cultural issues and vocational testing is more common among counseling faculty at doctoral programs. ​ Research focusing on psychological disorders and clinical health psychology is more common among clinical faculty and doctoral programs. ​ There are more than 70 doctoral training programs in counseling psychology accredited by the American Psychological Association (APA). It is estimated that more than 500 doctoral degrees in counseling psychology are granted annually (Norcross et al., 2002). Other Mental Health Professionals Psychiatric Social Workers. The professional activities of psychiatric social workers often seem similar to those of psychiatrists and clinical psychologists. LSPU SELF-PACED LEARNING MODULE: CLINICAL PSYCHOLOGY  Republic of the Philippines Laguna State Polytechnic University Province of Laguna ​ Many psychiatric social workers conduct psychotherapy on an individual or group basis and contribute to the diagnostic process as well. ​ In years past, social workers tended to deal with the social forces and external agents that were contributing to the patient’s difficulties. The social worker would take the case history, interview employers and relatives make arrangements for vocational placement, or counsel parents; the psychiatrist conducted psychotherapy with patients; and the clinical psychologist tested them. However, these professional roles have blurred over the years. ​ Perhaps it was the close association with psychiatrist and psychologists that led many social workers to focus less on social or environmental factors and to become, like their colleagues, pre-occupied with internal, psychological factors. Now, though, it appears that many social workers are moving away from psychoanalytic influences and returning to their earlier focus on the familiar and social determinant of psychopathology. ​ The social work profession has been a leader in the use of supervised fieldwork as a learning device for students. Fieldwork placement is part of the program for the master’s degree (usually the terminal degree for social workers), which typically requires 2 years. Compared to the training of clinical psychologists and psychiatrists, social work training is rather belief. As a result, the responsibilities of social worker are generally not as great as those of the psychiatrist or clinical psychologist. Characteristic of social workers is their intense involvement with the everyday lives and stresses of their patients. They are more likely to visit the home, the factory, or the street – places where their patients spend the bulk of their lives. Their role tends to be active, and they are less concerned with the abstract, theoretical generalizations that can be drawn from a particular case than they are with the practical matters of living. ​ Many psychiatric social workers are employed by public agencies of one sort or another. Some find their way into private practice, where their work in individual or family therapy is often indistinguishable from that of psychiatrists or clinical psychologists. Other social workers function as part of the mental health team (psychiatrist, clinical psychologist and psychiatric social worker) in hospitals, social service agencies, or mental health clinics. ​ Currently, the field of social worker appears to be growing tremendously. It is estimated that social workers now provide more than half of all nation’s mental health services, and social works likely to gain an even greater foothold in the mental health market in the future because they are a low-cost alternative to psychiatrists and psychologists (Clay, 1998). Enrollment LSPU SELF-PACED LEARNING MODULE: CLINICAL PSYCHOLOGY  Republic of the Philippines Laguna State Polytechnic University Province of Laguna in social work programs continues to increase, and the number of social workers is predicted to rise by 34% by the year 2005 (Clay, 1998). School Psychologists ​ School psychologists work with educators and other to promote the intellectual, social and emotional growth of school-age children. Toward this end, they may help to plan the learning environment. For example, they may generate programs to assist the development of children with special intellectual, emotional, or social needs. Often, they evaluate such children and recommend special programs, treatment, or placement if necessary. They also consult with teachers and school officials on issues of school policy or classroom management. Their work settings range from schools, nurseries and day-care centers to hospitals, clinics and even penal institutions. A few are in private practice. There are more than 50 APA accredited programs in school psychology, and it is estimated that fewer than 100 doctoral degrees in school psychology are awarded each year (Norcross, Sayette, & Mayne, 1998). Rehabilitation Psychologists ​ In both research and practice, the focus of rehabilitation psychologists is on people who are physically or cognitively disabled. The disability may result from a birth defect or later illness or injury. Rehabilitation psychologists help individuals adjust to their disabilities and the physical, psychological, social and environmental barriers that often accompany them. Their most frequent places of employment are in rehabilitation institutes and hospitals. Health Psychologists ​ The field of health psychology has emerged in recent years and is growing rapidly (Brannon & Feist, 2004). Health psychologists are those who, through their research or practice, contribute to the promotion and maintenance of good health. They are also involved in the prevention and treatment of illness. They may design, execute and study programs to help people stop smoking, manage stress, lose weight, or stay fit. Because this is an emerging field, those in it come from a variety of backgrounds, including clinical psychology, counseling psychology, social psychology, and others. Many health psychologists are employed in medical centers, but increasingly, they are serving as consultants to business and industry- in any organization that recognizes the importance of keeping its employees or members well. Psychiatric Nurses ​ In recent years, the roles of other mental personnel have been expanding. We have long been aware of the role of psychiatric nurses. Because LSPU SELF-PACED LEARNING MODULE: CLINICAL PSYCHOLOGY  Republic of the Philippines Laguna State Polytechnic University Province of Laguna they spend many hours in close contact with patients, they can also play a crucial and sensitive role in fostering an appropriate therapeutic environment. Working in close collaboration with the psychiatrist or the clinical psychologist, they (along with those they supervise—attendants, nurse’s aide, volunteers, etc.) implement therapeutic recommendations. Others ​ Most well-satisfied hospitals employ a variety of other therapeutic personnel, including occupational therapist, and so on. By virtue of their training and experience, these people can play a vital adjunctive role in enhancing the adjustment patterns of patients. They can teach skills that will help patients in a variety of nonhospital settings. They can help make hospitalization a more tolerable experience, and they can provide outlets that increase the therapeutic value of institutions. Whether their role is to help put patients in touch with their feelings via art, music, gardening, or dancing or to enhance patients’ personal and social skills, the contributions of such therapeutic personnel are significant. ​ People who are trained to assist professional mental health workers are called paraprofessionals, and their role has expanded greatly in recent years. Volunteers are often provided short training sessions and then become the most visible personnel in crisis enters (both walk-in and telephone). Certain paraprofessional activities have become accepted practice. Research indicates strongly that the efforts of paraprofessionals can effectively supplement the work of professionals (Christensen & Jacobson, 1994). We will discuss the issue extensively in Chapter 16. ​ Now that we have briefly examined some of the other helping professions, let us turn to the work of the clinical psychologist. The clinical Psychologist Trying to define clinical psychology in terms of the problems with which clinicians deal is hopeless. The number and kinds of problems are so extensive as to boggle the mind: depression, anxiety, psychosis, personality disorders, mental retardation, addictions, learning disabilities, juvenile delinquency, vocational problems, and sexual difficulties, to name but few. Further, this list does not cover those individuals who seek out psychotherapy not because of current dysfunctional symptoms but as way to better understand themselves. ​ Instead of defining clinical psychology in terms of problems or issues clinical psychologists are asked to address, we will try to give a picture of the field by reviewing the activities engaged in clinical psychologists. LSPU SELF-PACED LEARNING MODULE: CLINICAL PSYCHOLOGY  Republic of the Philippines Laguna State Polytechnic University Province of Laguna Activities of Clinical Psychologists Much of our information about clinical activities comes from a series of studies conducted between 1973 and 1995. Each study involved random sample members of Division 12 (Division of Clinical Psychology) of the American Psychological Association (APA). Garfield and Kurtz (1976) examined more than 800 questionnaires collected in 1973; Nacross, Proschasca (1982) studied nearly 500 returns gathered in 1981; Nacross, Proschasca, and Gallagher (1989b) were to analyze 579 questionnaires from 1986; Nacross, Karg, and Proschasca (1997a, 1997b) surveyed 546 clinical psychologists in 1994-1995; and finally, Norcross et al. (2004) surveyed 694 clinical psychologists in 2003. The results of these five surveys are presented in Table 1-1 and Table 1-2. T A B L E 1-1 Clinicians’ Activities Percentage involved in Mean percentage of time Activity 1995 2003 1973 1981 1986 1995 2003 Psychotherapy 84 80 31 35 35 37 34 Diagnosis/Assessment 74 64 10 13 16 15 15 Teaching 50 49 14 12 14 09 10 Clinical Supervision 62 50 08 08 11 07 06 Research/Writing 47 51 07 08 15 10 14 Consultation 54 47 05 07 11 07 07 Administration 52 53 13 13 16 11 13 ​ From Table 1-1, it is apparent that psychotherapy of one sort or another is the most frequently engaged in the activity and occupies the most time, as it has in all the cited surveys from 1973-2003. Diagnosis and assessment also continue as major activities. Research activity has grown over the years (to around 14% of the 2003 respondents’ time), which is a bit surprising light of the fact that 39% of the 2003 sample was employed full time in a private practice. Still, it is important to note that some clinical psychologists never publish a research paper and that only 10-15% of all clinicians produce 40-50% of all the work published by clinical psychologists (Norcross et al., 1989b). Teaching is another relatively common activity among clinical LSPU SELF-PACED LEARNING MODULE: CLINICAL PSYCHOLOGY  Republic of the Philippines Laguna State Polytechnic University Province of Laguna psychologists. Unfortunately, the time denoted to administration remains significant, perhaps reflecting the bureaucracy that is so prevalent in modern society. Let us now take a closer look at the six activities represented in Table 1-1. Therapy/Intervention. It is clear from Table 1-1 that therapy is the activity that most frequently engages the typical clinician’s efforts and to which the most time is devoted. The layperson often has an image of the therapy situation as one in which the client lies on a couch while the therapist, bearded and furrowed brow. Actually, therapy comes in many different sizes and shapes. A few therapists sit face-to-face across from the therapist. In most cases, therapy involves a one-to-one relationship, but today, couple’s therapy, family therapy and group therapy are also very common. For example, a group of six or eight clients, all having trouble with alcohol use, may meet together with a therapist to work on their problems. Finally, sizable proportions of therapists were women, not men. ​ ​ In some instances, therapy involves mainly a search for insight into the origins of one’s problem or purposes served by one’s undesirable behavior. In other cases, therapy consists primarily of a relationship between client and therapist to produce an atmosphere of trust that will help dissolve the client’s debilitating defenses. Other forms of therapy are cognitive-behavioral in the sense that the client learns new and more satisfying ways of thinking and behaving. Sometimes the goals of therapy are sweeping and involve major changes in behavior. Other times patients desire help only with a troublesome fear that prevents them from achieving certain goals. Therapy varies, then, along many different dimensions. ‘ Diagnosis/Assessment. All practicing clinicians engage in assessment of one form or another. Take, for example, the following cases: ▪​ A child who is failing the fourth grade is administered an intelligence test. Is there an intellectual deficit? ▪​ Personality tests are given to a client who is depressed and has lost all zest for life. Can the test results shed light on personality factors contributing to the depression? LSPU SELF-PACED LEARNING MODULE: CLINICAL PSYCHOLOGY  Republic of the Philippines Laguna State Polytechnic University Province of Laguna ▪​ It has been decided that a client will profit from therapy. But what form or therapy will be most suitable? ▪​ A father has been charged with child abuse. He is interviewed and tested to determine whether he suffers from a mental disorder that influences his judgment and impulse control. Common to all these examples is the effort to better understand the individual so that a more informed decision can be made or the most desirable course of action selected. Assessment, whether through observation, testing, or interviewing, is a way of gathering information so that an important question can be answered or so that a problem can be solved. These questions or problems are virtually infinite in variety, as the foregoing examples suggest. Assessment has long been a critical part of the clinical psychologist’s role. Indeed, for many years, assessment, especially testing, was the chief element in the clinician’s professional identity. Teaching. Clinical psychologists who have full- or part-time academic appointments obviously devote a considerable amount of time to teaching. Those whose responsibilities are primarily in the area of graduate education teach courses in advanced psychopathology, psychological testing, interviewing, intervention, personality theory, experimental psychopathology, and so on. Some of them may also teach undergraduate courses such as introductory psychology, personality, abnormal psychology, and introduction to clinical psychology, psychological testing, and others. Even clinicians whose primary appointments are in clinics or hospitals or whose primary appointments are in clinics or hospitals or who operate a private practice sometimes teach evening courses at a nearby college or university or may even have part-time appointments in graduate programs. ​ Much of this teaching is of the familiar classroom-lecture type. But a considerable amount of teaching is also done on a one-to-one, supervisory basis. Clinical psychologists in clinical settings may also teach informal classes or do orientations work with other mental health personnel, such as nurses, aides, social workers, occupational therapists, and so on. In some cases, the clinician may go out into the community and lead workshops on various topics for police officers, volunteers, ministers, probation officers, and others. LSPU SELF-PACED LEARNING MODULE: CLINICAL PSYCHOLOGY  Republic of the Philippines Laguna State Polytechnic University Province of Laguna Clinical Supervision. This activity is really another form of teaching. However, it typically involves more one-to-one teaching, small group approaches, and other less formal, nonclassroom varieties of instruction. Whether in university, internship, of general clinical settings, clinical psychologists often spend significant portions of their time supervising students, interns, and others. Becoming skilled in the intricacies of therapy and assessment techniques requires more than just reading textbook. It also involves seeing more experienced supervisor. In short, one learns by doing but under the controlled and secure conditions of a trainee-supervisor relationship. This kind of “practicum” teaching and supervision can occur both in university and internship settings in postdoctoral programs as well. Research. Clinical psychology has grown out of an academic research tradition. As a result, when clinical training programs were first established after World War II, the scientist-practitioner model was adopted. This meant that, in contrast to other mental health workers such as psychiatrists or social workers, all clinicians were to be trained as scientists and as practitioner. Although this research emphasis may not be as prominent in some training programs as it once was, the fact remains that clinical psychologists are in a unique position both to evaluate research conducted by others and to conduct their own research. By virtue of their training in research, their extensive experience with people in distress, and their knowledge of both therapy and assessment, clinical psychologists have the ability to consume and to produce new knowledge. ​ 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. To provide something of the flavor of these efforts. 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. For example, one might consult with colleague who is having difficulty with a therapy case. Such consultation might be a one-shot affair with someone who simply needs help with one specific case. In other instances, however, a clinician might be trained on a relatively permanent basis to provide the staff of an agency with help. Perhaps, for example, our consulting clinician is an expert on the problems of individuals addicted to drugs. By working with LSPU SELF-PACED LEARNING MODULE: CLINICAL PSYCHOLOGY  Republic of the Philippines Laguna State Polytechnic University Province of Laguna the staff, the consultant can increase the effectiveness of the entire agency. Consultation could come in the form of case by case advice, or the consultant might be asked to discuss general problem associated with drug addiction. Further, more police departments have begun using clinical psychologists as consultant in hostage negotiations. Finally, a growing number of clinical psychologists serve as consultants to physicians who deliver primary care services (Haley et al., 1998; Pace, Chaney, Mullins, & Olson, 1995). ​ ​ 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. Consulting, regardless of the setting in which it occurs on the particular purpose it has, is a significant activity of many clinical psychologists today. Administration. It has been said half jokingly that no one in clinical psychology enjoys administrative work except masochists or those with obsessive- compulsive personalities. Nevertheless, nearly ever clinical psychologist spends time on administrative tasks. For example, client record must be filled out each month, and research projects must be cleared by committees set up to safeguard the rights of human subjects. Clinical psychologists who work for agencies or institutions will likely serve on several committees: personnel, research, patient rights, or even the committee to select films for the patients’ Friday night movies. ​ ​ Some really hardly souls become full-time administrators. They do so for many reasons. Sometimes they are drafted by colleagues who regard them as skillful in human relations. Others may grow a bit weary of therapy or assessment and want a change. Or maybe they have the fantasy that administration is the route to power and wealth. In any event, good administrators are the ones who keep their organization running smoothly and efficiently. Being sensitive to the needs and problems of people in the organization and having the patience sometimes suffer in silence are useful attributes of the good administrator. The ability to communicate well with those under supervision is also important, as is a knack for selecting the right people for the right jobs. LSPU SELF-PACED LEARNING MODULE: CLINICAL PSYCHOLOGY  Republic of the Philippines Laguna State Polytechnic University Province of Laguna This category includes professional schools, correctional facilities, managed care organizations, nursing homes, child and family services, rehabilitation centers, school systems, psychoanalytic institutes, and health maintenance organizations and so on. ​ It would be difficult to list all the sorts of administrative posts held by clinical psychologists. However, here are few examples: head of a university psychology department, director of a Veterans Administration clinic, vice president of a consulting firm, director of the psychological clinic in a university psychology department, chief psychologist in a state hospital, and director of a regional crisis center. Employment Sites Where are clinical psychologists employed? Data from the previously noted surveys will again help answer this question. The results pertaining to work settings from the 1973 survey (Garfield &Kurtz, 1976) and the 1981, 1986, 1995, and 2003 surveys (Norcross & Prochaska, 1982; Norcross, Prochaska, & Gallagher, 1989a; Norcross et al., 1997a, Norcross et al., 2004, respectively) are shown in table 1.2. it is evident that practice have grown steadily over the years and is now clearly the most frequent employment setting for clinical psychologists. University setting ate the second most common employment sites, with medical schools a distant third. Although not shown in Table 1-2, the data from Norcross et al. (1997b) indicate that of those clinical psychologists whose primary job is that of full-time university professor, 59% are engaged in some part-time form of private practice or supervision. From Tables 1-1 and 1-2, the diversity of both activities and work settings is very obvious. This is also evident in the “Other” category in Table 1-2. This diversity is illustrated in the background and activities of the hypothetical clinician described in the next section. Training: Toward a Clinical Identity The preceding pages have provided a sketch of some of the activities, affiliations, and orientations of clinicians, touched upon the scientific tradition, and raised the issue of art versus science in clinical psychology. Now let us turn to a discussion of the unique background and skills that set clinical psychologists apart from other mental health professionals. None of this is set in stone, of course. The field is changing, and as always, there are LSPU SELF-PACED LEARNING MODULE: CLINICAL PSYCHOLOGY  Republic of the Philippines Laguna State Polytechnic University Province of Laguna disagreements among clinicians as to how to train students and in what direction the field should move. However, it is useful to remember that clinical psychology is but a specialized application of the more basic core of psychology. An Overview The typical clinical psychologist completes a bachelor’s degree and then 5 years of graduate work. The latter typically includes training in assessment, research, diagnosis, and therapeutic skills, along with an internship. Most often, this effort culminates in Ph. D. (Doctor of Philosophy) degree from a university psychology or from a training institution not affiliated with a university. There are also 2-year programs that award the master’s degree. Because of contemporary licensing laws that dictate who may practice independently as a psychologist, fewer individuals graduating from master’s programs can achieve much in the way of professional independence. Many of them hope to transfer to Ph. D. or Psy. D. programs later, and indeed, some are quite successful in doing so. Past evidence suggests that master’s-level clinicians, are paid less competent. Few states allow master’s-level clinicians to be fully licensed to practice independently in psychology. However, the number of master’s degrees and the number of master’s degrees conferred appear to be growing. For example, in 2000, over three times as many master’s degrees as doctoral degrees as doctoral degrees were awarded in psychology (APA Office of Research;http://research.apa.org/WPA2003.pdf). ​ ​ Master’s-level training in clinical psychology has always been somewhat controversial. Master’s-level psychologists claim that research indicates that master’s level clinicians are as effective as doctoral-level clinicians. The American Psychological Association, however, accepts the doctoral degree is a prerequisite for the title “psychologist” and that a doctoral degree should be required for those who wish to practice psychology independently (Lowe Hayes-Thomas, 2000). Nevertheless, master’s level clinicians continue to work in a variety of service-delivery settings. The increasing influence of managed care in the mental health care market-place may lead to a resurgence of the popularity of master’s program in clinical psychology (Lowe Hayes-Thomas, 2000; Sleek,1995a). in general, master’s-level practitioners charge lower fees, making them an attractive alternative (in managed cure insurers’ eyes) to doctoral-level clinicians. It will be interesting to see how this controversial LSPU SELF-PACED LEARNING MODULE: CLINICAL PSYCHOLOGY  Republic of the Philippines Laguna State Polytechnic University Province of Laguna issue unfolds as lobbying efforts to give master’s-level clinicians “psychologist” status increase and as increasing economic pressures come into play. ​ With this thumbnail sketch of training in clinical psychology, we can now examine the content of doctoral training more closely. Clinical Training Programs The predominant training philosophy in clinical psychology today is still the scientist-practitioner model (Raimy, 1950). We shall have a good deal more to say about this model in the next chapter, and in Chapter 3, we will discuss alternative training models for clinical psychologists as well. For the moment, however, a brief overview of the scientist-practitioner training model will be useful. ​ Training programs that emerged after World War II were based on the principle that the scientist and practitioner roles could be integrated. The goal was the creation of a unique profession. More recently, the training model has come under attack as unrealistic and unresponsive to the needs of students who aspire only to clinical practice. Nevertheless, a majority of clinical psychologists from the rest of the mental health pack. A Sample Program. How does this model translate into a program that trains clinical psychologists? Table 1-5 presents a fairly typical program of study. ​ Several points should be made about the program outlined in Table 1-5. First, it is just one example. Some programs place less emphasis on research and more on clinical techniques. Some are structured so that one can complete all the work in 4 years, especially if summers can be devoted to coursework. In some programs, the internship comes in the fourth year, often before the dissertation has been completed. A few schools still require competence in a foreign language, although many now allow the student to substitute courses in statistics or computer technology. It is also true that each school tends to have its own “personality.” Some programs have a distinct cognitive-behavioral orientation, emphasizing such techniques as cognitive therapy for depression. Others have a psychodynamic flavor and emphasize projective testing. Faculty interests in some programs center in children, whereas others focus on adults. Although there is diversity among clinical programs, there is a great deal of commonality as well. A student applying for graduate work should investigate such emphases so as to make informed choices. LSPU SELF-PACED LEARNING MODULE: CLINICAL PSYCHOLOGY  Republic of the Philippines Laguna State Polytechnic University Province of Laguna Coursework. Clinical students normally must take a series of basic courses such as statistics and research design, biological foundations of behavior, social psychology, developmental psychology, and cognitive psychology. The exact number and content of these courses vary somewhat from program to program. The intent is to give the student an understanding of the basics that underlie human behavior or that permit us to investigate that behavior. These courses provide a strong scientific foundation for the student’s clinical training and give life to the scientist-practitioner model in clinical psychology. Depending on the student’s interests, several electives, advanced courses, and seminars in these same topics are often taken as well. ​ Clinical students also enroll in several courses that teach the fundamentals of clinical practice or deal with clinical topics at an advanced level. For example, there are often courses in psychopathology, theory and research in therapy, or principles of cognitive-behavioral interventions. There are seminars in such topics as schizophrenia, methods of family and group therapy, community psychology, or neuropsychological assessment. Practicum Work. Books and coursework are fine, but ultimately, one must learn by doing. As a result, all programs seek to build the student’s clinical skills through exposure to clinical practica. The dictionary defines a practicum as “work done by an advanced student that involves the practical application of previously studied theory.” In many instances, the practicum will combine academic content with practical experience. Typically, there are practica or clinics in assessment (intelligence, neuropsychology, personality, etc.), therapy (psychodynamic treatment, cognitive-behavioral interventions), interviewing, and even methods of consulting with school officials, community agencies, or industry. Whatever the specific of form or content of the practicum experience, it is a major vehicle for the acquisition of specific clinical skills. The student’s practicum work is supervised by clinical faculty members or by clinicians in the community who have special skills. Most psychology departments that have clinical training programs also operate a psychological clinic. This clinic often provides assessment, therapy, and consulting services to university students, staff, and faculty, as well as to families of university personnel and to people in the surrounding community. Cases are accepted selectively in terms of their teaching value. Such a clinic may be staffed by a full-time secretary, a social worker, and clinical faculty. LSPU SELF-PACED LEARNING MODULE: CLINICAL PSYCHOLOGY  Republic of the Philippines Laguna State Polytechnic University Province of Laguna Research. The implementation of the scientist-practitioner model requires that the student developed research competence. This is accomplished through courses in statistics, computer methods, and research methodology and also by active participation in research methodology and also by active participation in research projects. Therefore, differences also exist among departments in the emphasis they place on research training and in the rewards they dispense to students for devotion to research. Most departments do, however, require the completion of a master’s thesis (usually by the end of the second year). A dissertation reporting the results of an original research project is also required (by the end of either the fourth or fifth year depending on the specific program). The dissertation is a more extensive project than the master’s thesis, and it is designed to contribute significant new information to the field. Most programs continue to stress traditional experimental or correlational research for the dissertation. ​ Programs that emphasize the research commitment usually to see to it that research experience is not confined to the thesis and dissertation. In one department, for example, each clinical student joins the research “team” of a faculty member. The team consists of from four to eight graduate students who are at varying year levels in the program. The team meets one evening per week for 2 to 3 hours. Research topics are discussed, and research projects are designed. Thesis and dissertation proposals may be discussed and defended. The more advanced students can provide guidance and also serve as role models for the younger students. In any case, the vigorous give-and-take of such meetings can go a long way toward building the research commitment. The Qualifying Examination. Most clinical programs require students to pass a qualifying examination, sometimes called the preliminary examination. Whatever its title, some students regards it as the most anxiety-provoking experience in their training. It is a written examination that takes different universities. In some cases, three written examination, each lasting 4 hours, are spread over a week; others have a 5-day examination as well. In certain programs, the tests cover all areas of psychology, whereas in others, they are confined to the field of clinical psychology. Most often, these examinations are taken during the third year. Qualifying examinations serve a very useful function in ensuring the student’s overall academic competence. A few programs, however, employ “innovative” alternatives. For example, students might prepare a research grant application or perhaps complete several LSPU SELF-PACED LEARNING MODULE: CLINICAL PSYCHOLOGY  Republic of the Philippines Laguna State Polytechnic University Province of Laguna integrative literature reviews of important topics in clinical psychology (e.g., the etiology of schizophrenia). The Internship. The internship is a vital part of any training program. It is the capstone of the student’s previous experiences in clinical courses and practica and provides the experience that begins to consolidate the scientist-practitioner role. An internship of one sort to another is required of all students in clinical programs accredited by the APA. In the years, immediately following World War II, the internship was most commonly taken during the third year of training. Now, however, so many programs are essentially 5 years in length that the internship most often seems to come at the end of graduate training. In seems to come at the end of graduate training. In a few instances, students may take halftime internships over a 2 year. Usually, an intern works at the independent facility off campus. However, some intern in such university facilities as counseling centers and medical schools. Over 450 pre-doctoral internship sites are fully approved by the American Psychological Association; this “approved” internship programs are listed each year in the December issue of the American Psychologist. ​ The values of internship training are many. For example, it allows the student to work full time in a professional setting. New skills can be acquired; older ones can be sharpened. Experience in a professional setting gives the student a real taste of the demands of professional life. Students are also exposed to clinical psychologists who may have ideas and orientations different from those of their university faculty. Thus, the experience can help breakdown any provincialism that may have crept into the student’s university training. Exposure to different kinds of clients can likewise enhance the student’s competence. Students encounter the clinical condition that they have studied, in this experience can help stimulate research ideas. Ideally, the internship provides the opportunity to expand one’s professional horizons and to integrate what one has learned at the university with the demands of the professional world. It become the final element in the three dimensional world of academics, research and experience. Chapter 2: HISTORICAL OVERVIEW IN CLINICAL PSYCHOLOGY HISTORICAL ROOTS ​ Establishing a certain time period or designating a particular person as the beginning of clinical psychology can be arbitrary if not downright misleading. One can certainly go back to Greek philosophers such as Thales, LSPU SELF-PACED LEARNING MODULE: CLINICAL PSYCHOLOGY  Republic of the Philippines Laguna State Polytechnic University Province of Laguna Hippocrates, or Aristotle who, long before the birth of Christ, were speculating about human beings and the nature of thought, sensation, and pathology. ​ For the years prior to 1890, there is really very little in the history of clinical psychology to separate it from the history of abnormal psychology or, as Zilborg and Henry(1941) finds it more useful to search for the roots of modern clinical psychology in reform movements of the 19th century. One of the major figures in this movement was philippe pinel, a French physician. Shocked by the senseless brutality that aws the custom in 19th century “mental hospitals,” he managed to get himself appointed head of the asylum at bicetre and, later, Salpetriere. Through kindness and humanity, he accomplished much in a very difficult field. ​ At about the same time, an Englishman, William tuke, was devoting himself to the establishment of what might bee called a model hospital for humane treatment of the sick and troubled. In America, Eli Todd was laboring long and successfully to develop a retreat in Hartford for the mentally ill. Like his European Counterparts, Todd emphasized the role of civilized care, respect, and morality. Through his efforts, it became less fashionable to regard mental patients as incurable. The search for psychological antecedents to mental illness and an emphasis on treatment had begun to replace the routine harshness of custody. ​ Another American who had a profound effect on the mental health movement was Dorothea Dix. She campaigned for better facilities for the mentality ill. With determination and single-mindedness, Dix pushed, prodded, and cajoled until government officials responded. Using the force of logic, facts, public sentiments, and good old-fashioned lobbying, she wrought her will. And in 1848, New Jersey responded by building a hospital for the “insane” the first in a procession of more than 30 states to do so. ​ These short sketches represent some of the roots of clinical psychology. In the following pages, we trace its development in the specific areas of diagnosis and assessment, intervention, research, and professional matters. SIGNIFICANT EVENTS IN ASSESSMENT 1882 – Galton established anthropometric laboratory. 1890 – Cattle coins the term mental test 1904 – Binet begins work on his intelligence scale. 1905 – Jung begins using the world-association method 1913 – Kraepelin publishes work on diagnosis. 1914 – Terman’s American version of binet scale. 1921 – Rorchach’s Psychodiagnostic is published LSPU SELF-PACED LEARNING MODULE: CLINICAL PSYCHOLOGY  Republic of the Philippines Laguna State Polytechnic University Province of Laguna 1935 – TAT is published. 1937 – Term Projective techniques is coined 1939 – Wechsler-Bellevue Intelligence Scale is published. 1943 – MMPI is published. 1949 – Halstead introduces neuropsychological test battery. 1952 – DSN-I is published. 1986 – DSM-II is published. 1970’s – Rise of behavioral assessment. 1980 – DSM-III is published. 1980’s – Interest rises in personality assessment and computer-based test interpretations. 1987 – DSM-III R is published. 1990’s – Managed health care impacts psychological assessment. 1994 – DSM-IV is published. SIGNIFICANT EVENTS IN INTERVENTION 1793 – Pinel introduce humane care in French asylums 1848 – Dorothea Dix successfully lobbies for the better facilities for the mentally ill in New Jersey. 1895 – Breuer and Freud publish Studies on Hysteria. 1909 – Healy founds a child guidance clinic in Chicago. 1920 – Watson and Rayner describe the conditioning of fears. 1932 – Moreno introduces group therapy. 1950 – Dollard and Miller publish Personality and Psychotherapy. 1951 – Rogers publish Client-Centered Therapy. 1952 – Eyesenk publishes his critique of psychotherapy. 1953 – Skinner outlines application of operant principles. 1958 – Wolpe describes method of systematic desensitization. 1965 – Conference in Swampscott, MA, gives birth to community psychology. 1980’s – Rise of health psychology, increasing focus on brief psychotherapy, increase in psychotherapy research. 1990’s – Managed health care has tremendous impact on psychological services. 1995 – List of empirically the first supported treatment appear. SIGNIFICANT EVENTS IN REASEACH 1879 – Wundt established the first psychological lab in Leipzig. 1890 – William James published Principles of psychology. 1905 – Binet and Simon offer validity data for their test. 1916 – Terman’s research on the Binet scale appears. 1939 – Wechsler publishes his research on the Wechsler-Bellevue. 1943 – Hathaway and McKinley publish MMPI data. LSPU SELF-PACED LEARNING MODULE: CLINICAL PSYCHOLOGY  Republic of the Philippines Laguna State Polytechnic University Province of Laguna 1954 – Rogers and Dymond report their research on the counseling process. ​ Rotter publishes his social theory. 1977 – Smit and Glass report mera-analysis of psychotherapy. 1980 – Psychopathology research grows following publication of DSM-II. 1990’s – Interest in behavioral genetics increases. Lightner Witmer: The Founder of Clinical Psychology ​ ​ Lightner Witmer (1867 -1958) is credited with founding the field of clinical Psychology. His contributions to the field include the following. In 1896, he established the first “psychological” clinic. In 1907, he proposed a new profession, clinical psychology. He served as founder and editor of the first journal in the field, The Psychology Clinic. He developed the first training program in clinical psychology (McReynolds, 1996). ​ In addition, Witmer’s work influenced and anticipated future developments in clinical psychology, including an Emphasis on children’s academic problems, the use of active clinical interventions to improve individuals’ lives, and collaboration with other professionals (e.g., physicians) in providing treatment (Routh, 1996). SIGNIFICANT EVENTS IN THE PROFFESSIONAL OF CLINICAL PSYCHOLOGY 1892 – American Psychological Association (APA) is founded. 1896 – Witmer established the first “psychological” Clinic. 1909 – Section of Clinical Psychology established within APA. 1930 – Psi Chi founded. 1935 – APA committee on Standards of training defines within APA. 1936 – Louttit publishes first clinical psychology text. 1937 – Journal of Consulting Psychology founded. 1845 – Connecticut passes first certification law. 1946 – VA and NIMH begins support of psychology. 1947 – ABEPP/ABPP is established to certify the competence of clinicians. 1949 – Boulder Conference promulgates the scientific-practitioner model. 1953 – APA publishes Ethical Standards. 1968 – First Psy.D. program established. 1981 – Revised Ethical Standards published. 1988 – Schism within APA leads to the foundation of the American Psychological Society (APS). 1992 – Most recent revisions of Ethical Principles published. 1995 – APA endorses pursuit of prescription privilege for psychologists. LSPU SELF-PACED LEARNING MODULE: CLINICAL PSYCHOLOGY  Republic of the Philippines Laguna State Polytechnic University Province of Laguna Chapter 3: Diagnosis and Classification of Psychological Problems What is Abnormal Behavior? No single descriptive feature is shared by al forms of abnormal behavior and no one criterion for “abnormality” is sufficient. No discrete boundary exists between normal and abnormal behavior. Three Proposed Definitions of Abnormal Behavior: ⦿​ Conformity to norms – One of the three major definitions of abnormal behavior, this definitions labels behavior as abnormal if it violates cultural norms. ⦿​ The experience of subjective distress ⦿​ Disability or dysfunction – This definition labels behavior as abnormal if it creates social or occupational problems for the individuals. 1. Conformity to Norms: Statistical Infrequency or violation of social norms: When a person’s behavior tends to conform to prevailing social norms or when this particular behavior is frequently observed in other people, the individual is not likely to come to the attention of mental health professionals. However, when a person’s behavior becomes patently deviant; outrageous or otherwise non-comforming, then he or she is more likely to be categorized as “abnormal”. The Case of Dmitri Dmitri is now second grade. He is of average height and weight and manifests no physical problems. He is somewhat aggressive and tends to bully children smaller than himself. His birth was a normal one, and although he was a bit slow in learning to walk and talk, the deficit was not marked. The first grade was difficult for Dmitri, and his progress was slow. By the end of the school year, he was considerably behind the rest of the class. However, the school officials decided to promote him anyway. They reasoned that he was merely a bit slow in maturing and would “come around” shortly. They noted that his status as an only child. A pair of doting parents, a short attention span, and aggressiveness were all factors that combined to produce his poor school performance. At the beginning of the second grade, Dmitri was administered a routine achievement test on which he did very poorly. As matter of school policy, he was referred to the school psychologist for individual testing and evaluation. Based on the results of an intelligence test, a draw a person test, school records LSPU SELF-PACED LEARNING MODULE: CLINICAL PSYCHOLOGY  Republic of the Philippines Laguna State Polytechnic University Province of Laguna and a social history taken from the parents, the psychologist concluded that dmitri suffered from mental retardation. His IQ was 64 on the stanford-binet and was estimated to be 61 based on the draw a person test. Further, a social maturity index derived from parental reports of his social behavior was quite low. The Case of Martha L. Martha seemed to have a normal childhood. She made adequate progress in school and caused few problems for her teachers or parents. Although she never made friends easily, she could not be described as withdrawn. Her medical history was unremarkable. When martha entered highschool, changes began. She combed her hair in a very severe, plain style. She chose clothing that was quite ill fitting and almost like that worn 50 years ago. She wore neither makeup nor jewelry of any kind. Although she would have been hard to distinguish from the other girls in her class earlier, she now stood out. Martha’s schoolwork began to slip. She spent hours alone in her room reading the bible. She also began slipping notes to other girls that commented on their immorality when she observed them holding hands with boys, giggling, dancing and so on. She attented religious services constantly; sometimes on sundays she went to services at 5 or 6 separate churches. She fasted frequently and decorated her walls at home with countless pictures of christ, religious, quotations, and crucifixes. When martha finally told her parents that she was going to join an obscure religious sect and travel about the country to bring people christ’s message. They became concerned and took her to a psychiatrist. Shortly afterward, she was hospitalized. Her diagnosis varied, but it included such terms as schizophrenia, paranoid type; schizoid personality and schizoprenia, undifferentiated type. Advantages of this definition The definition of abnormality in terms of statistical infrequency or violation of social norms is attractive for at least two reasons. a. Cutoff Points – The statistical infrequency approach is appealing because it establishes cutoff points that are quantitative in nature. b. Intuitive Appeal – It may seem obvious that those behaviors we ourselves consider abnormal would be evaluated similarly by others. Problems with this Definition Conformity criteria seems to play a subtle yet important role in our judgements of others. However, although we must systematically seek the determinants of the individuals nonconfirmity or deviance, we should resist the reflexive tendency to categorized every nonconformist behavior as evidence of mental health problems. ⦿​ Choice of Cutoff Points LSPU SELF-PACED LEARNING MODULE: CLINICAL PSYCHOLOGY  Republic of the Philippines Laguna State Polytechnic University Province of Laguna ⦿​ The number of Deviations ⦿​ Cultural Relativity In the context of conformity – oriented definitions of abnormal behavior, the fact that judgments about the abnormality of a particular behavior may vary from culture to culture or subculture to subculture. Subjective Distress One of the three major definitions of abnormal behavior, this definition labels as psychologically abnormal those people with a poor sense of well-being or a high level of subjective distress. The case of Cynthia S. ​ Cynthia has been married for 23years. Her husband is a highly successful civil engineer. They have 2 children, one in high school and the other in college. There is nothing in cynthia’s history to suggest psychological problems. She is above average in intelligence and she completed 2 years of college before marrying. Her friends all characterize her as devoted to her family. Of all her features, those that seem to describe her best include her strong sense of responsibility and a capacity to get things done. She has always been a “coper” she can continue to function effectively despite a great deal of personal stress and anxiety. She is a warm person, yet not one to wear her feelings or her troubles on her sleeve. She recently enrolled in a night course at the local community college. In that course the students were asked to write an “existential” account of their innermost selves. The psychologist who taught the course was surprised to find the following excerpts in cynthia’s account. ​ “In the morning, I often feel as if I cannot make it through the day. I frequently experience headaches and feel that I am getting sick. I am terribly frightened when I have to meet new people or serve as a hostess at a party. At times I feel a tremendous sense of sadness; whether this is because of my lack of personal identity, I don’t know”. ​ What surprised the instructor was that none of these expressed feelings were apparent from cythia’s overt behavior. She appeared confident, reasonably assertive, competent in good spirits and outgoing. The Case of Robert G. Robert was interviewed by the personnel analyst in the accounting company for which he worked. A number of robert’s peers in the office were also questioned about him. In the course of these interviews, several things were established. Robert was a very self-confident person. He seemed very sure of his goals and what he needed to do to achieve them. Although hardly a happy-go-lucky person, he was certainly content with his progress so far. He LSPU SELF-PACED LEARNING MODULE: CLINICAL PSYCHOLOGY  Republic of the Philippines Laguna State Polytechnic University Province of Laguna never expressed the anxieties and uncertainty that seemed typical of so many of his peers. There was nothing to suggest any internal distress. Even his enemies conceded that robert really “had it together”. These enemies started to become quite visible as the screening process moved along. Not many people in the office liked robert. He tended to use people and was not above stepping on them now and then to keep his career moving. He was usually inconsiderate and frequently downright cruel. He was particularly insensitive to those below him. He loved ethnic humor and seemed to revel in his prejudices toward minority groups and those women who intruded into a “man’s world”. Even at home, his wife and son could have reported that they were kept in constant turmoil because of his insensitive demands for their attention and services. Disability or Dysfunction One of the three major definitions of abnormal behavior, this definition labels behavior as abnormal if it creates social or occupational problems for the individual. The case of Richard Z. Richard was convinced by his wife to consult with a clinical psychologist. Previous contacts with psychiatrists had on one occasion resulted in a diagnosis of “hypochondriacal neurosis” and, on another, a diagnosis of “passive aggressive personality”. Richard has not worked in several years, even though he has a bachelor’s degree in library science. He claims that he is unable to find employment because of his health. He reports a variety of physical symptoms, including dizziness, breathlessness, weakness and funny sensations in the abdominal area. Making the rounds from physician to physician has enabled him to build an impressive stock of pills that he takes incessantly. None of his physicians, however, has been able to find anything physically wrong with him. As a child, Richard was the apple of his mother’s eye. She doted on him, praised him constantly and generally reinforced the notion that he was someone special, his father disappeared about 18 months after Richard was born. His mother died 6 years ago, and he married shortly after that. Since then, his wife has supported both of them, thus enabling him to finish college. Only recently has she begun to accept the fact that something may be wrong with Richard. What Does This Leave Us? Mental Illness The term mental illness or mental disorder is difficult to define. For any definition, exceptions come to mind. Nevertheless, it seems important to LSPU SELF-PACED LEARNING MODULE: CLINICAL PSYCHOLOGY  Republic of the Philippines Laguna State Polytechnic University Province of Laguna actually define mental illness rather than to assume that we all share the same implicit idea if what mental illness is. ⦿​ A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. Diagnostic and Statistical Manual of Mental Disorders (DSM–5) ​ Is the official diagnostic system for mental disorders in the united states. It states that a mental disorder is conceptualized as a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g; a painful symptom) or disability (i.e; impairment in one or more important areas of functioning) or with a significantly increased risk of suffering, death, pain, disability, or an important loss of freedom. Several Aspects of this Definition are important to note: ⦿​ The Syndrome – must be associated with distress, disability or increased risk of problems. ⦿​ Mental Disorder - is considered to represent a dysfunction within an individual. ⦿​ Not all deviant behavior or conflicts with society are signs of mental disorder. The Importance of Diagnosis ⦿​ Categorization is essential to our survival because it allows us to make important distinctions (e.g a mild cold vs viral pneumonia, a malignant vs a benign tumor). The diagnosis of mental disorders is an expert level of categorization used by mental health professionals that enables us to make important distinctions (e.g schizophrenia vs bipolar disorder with psychotic features). a) Most important, a primary function of diagnosis is communication. A wealth of information can be conveyed in a single diagnostic term. Diagnostic system for mental disorders are especially useful for communication because these classificatory systems are largely descriptive. b) The use of diagnoses enables and promotes empirical research in psychopathology. Clinical psychologists define experimental groups in terms of LSPU SELF-PACED LEARNING MODULE: CLINICAL PSYCHOLOGY  Republic of the Philippines Laguna State Polytechnic University Province of Laguna individuals diagnostic features, thus allowing comparisons between groups with regard to personality features, psychological test performance or performance on an experimental task. c) In a related vein, research into the ethology or causes of abnormal behavior would be almost impossible to conduct without a standarlized diagnostic system. d) Diagnoses are important because at least in theory, they may suggest which mode of treatment is most likely to be effective. ⦿​ This is general goal of a classification system for mental disorders (Blashfield & Draguns, 1976). ⦿​ As Blashfield and Draguns (1976) stated “ The final decision on the value of psychiatric classification for prediction rests on an empirical evaluation of the utility of classification for treatment decisions. Early Classification Systems Classification system for mental disorders have proliferated for many years. For example, the earliest reference to a depressive syndrome appeared as far back as 2600 B.C. Since that time, both the number and breadth classification systems have increased. To bring some measure of order out of this chaos, the congress of Mental science adopted a single classification system in 1889 in Paris. The American Psychiatric Association published its own classification system in the Diagnostic and Statistical Manual, and this manual contained a glossary describing each of the diagnostic categories that were included. This first edition, known as DSM-L, was followed by revisions in 1968 (DSM-II), 1980 (DSM-III), 1987 (DSM-III-R),1994 (DSM-IV), 2000 (DSM-IV-TR). Presently, the most widely used classification system is the DSM-5; American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) ​ It is the 2013 update to the Diagnostic and Statistical Manual of Mental Disorders, the taxonomic and diagnostic tool published by the American Psychiatric Association (APA). In the United States, the DSM serves as the principal authority for psychiatric diagnoses. Treatment recommendations, as well as payment by health care providers, are often determined by DSM classifications, so the appearance of a new version has practical importance. The DSM-5 is the only DSM to use an Arabic numeral instead of a Roman numeral in its title, as well as the only living document version of a DSM. LSPU SELF-PACED LEARNING MODULE: CLINICAL PSYCHOLOGY  Republic of the Philippines Laguna State Polytechnic University Province of Laguna The DSM-5 is not a major revision of the DSM-IV-TR but there are significant differences. Changes in the DSM-5 include the reconceptualization of Asperger syndrome from a distinct disorder to an autism spectrum disorder; the elimination of subtypes of schizophrenia; the deletion of the "bereavement exclusion" for depressive disorders; the renaming of gender identity disorder to gender dysphoria; the inclusion of binge eating disorder as a discrete eating disorder; the renaming and reconceptualization of Paraphilias, now called paraphilic disorders; the removal of the five-axis system; and the splitting of disorders not otherwise specified into other specified disorders and unspecified disorders. Changes from DSM-IV ⦿​ DSM-5 replaces the Not Otherwise Specified (NOS) categories with two options: other specified disorder and unspecified disorder to increase the utility to the clinician. The first allows the clinician to specify the reason that the criteria for a specific disorder are not met; the second allows the clinician the option to forgo specification. ⦿​ DSM-5 has discarded the multiaxial system of diagnosis (formerly Axis I, Axis II, Axis III), listing all disorders in Section II. It has replaced Axis IV with significant psychosocial and contextual features and dropped Axis V (Global Assessment of Functioning, known as GAF). The World Health Organization's Disability Assessment Schedule is added to Section III (Emerging measures and models) under Assessment Measures, as a suggested, but not required, method to assess functioning. General Issu