PSYCLPS Book PDF

PSYCLPS BOOK CHAPTER 1: INTRODUCTION TO CLINICAL PSYCHOLOGY CLINICAL PSYCHOLOGY - Involves: ○ Research ○ Teaching ○ Services - Relevant to the: ○ Applications of principles, methods, and procedures ○ For understanding, predicting, an...

PSYCLPS BOOK CHAPTER 1: INTRODUCTION TO CLINICAL PSYCHOLOGY CLINICAL PSYCHOLOGY - Involves: ○ Research ○ Teaching ○ Services - Relevant to the: ○ Applications of principles, methods, and procedures ○ For understanding, predicting, and alleviating intellectual, emotional, biological, psychological, social and behavioral maladjustment, disability and discomfort - Applied to a wide range of client populations SKILL AREAS ○ Assessment & Diagnosis ○ Intervention/Treatment ○ Consultation ○ Research ○ Application of Ethical & Professional Principles AREAS OF EXPERTISE ○ Psychopathology ○ Personality ○ Integration of science, theory, & practice CLINICAL PSYCHOLOGIST - Works with a range of individuals ○ From infants to the elderly - Involves individuals themselves, families/ partners, school personnel, other health care workers, and communities - Work in a large range of settings including universities, hospitals, private practice offices, or group medical practices PhD - Doctoral degree in clinical psychology - Considered to be the most versatile ○ Can lead to a very wide range of possible job opportunities MENTAL HEALTH PROFESSIONALS - Must have fulfilled specific educational requirements and licensing requirements regulated by the government  - These mental health workers must: ○ Document that they have obtained appropriate professional training ○ Pass a licensing exam indicating familiarity with current practice parameters, ethical regulations, and state laws ○ Maintain their current knowledge of the field through ongoing educational requirement RELATED MENTAL HEALTH PROFESSIONALS PSYCHIATRIST - Rooted in the medical tradition and exists within the work of organized medicine A physician ○ PSYCHIATRY - Regards psychopathology as a mental “illness” with discrete causes that can best be remedied with a medical treatment - Often accorded the power & status of the medical profession Even though their intellectual heritage comes from the non-medical contributions of Freud, Jung, Adler, and others - Try to develop a psychoanalytic system Resulted to stepping out from medical profession - Complete a general medical school curriculum early in their training ○ Psychiatrists have the skills to function as physicians ○ May prescribe medication, treat physical ailments, and give physical examinations - Make extensive use of a variety of medications in treating their patients’ psychological difficulties ○ Their medical training makes them potentially better able to recognize medical problems that may be contributing to the patient’s psychological distress - Many psychiatrists do not conduct extensive psychotherapy with their patients ○ But rather often schedule brief medication management appointments with each patient COUNSELING PSYCHOLOGISTS - Work with normal or moderately maladjusted individuals - May involve group counseling or counseling with individuals - Principal method of assessment is usually the interview ○ Also do testings such as abilities assessment,personality/interests/vocational aptitude - Focused on conducting a person-centered/humanistic educational & occupational counseling  ○ Much more common to encounter counseling psychologists representing a wide range of theoretical orientations and treating clients across the life span - Commonly practice in education settings ○ They also work in hospitals, rehabilitation centers, mental health clinics, & industry ○ SERVICES OFFERED BY COUNSELING PSYCHOLOGIST Preventive treatment Consultation Development of outreach programs Vocational counseling Short-term counseling/therapy ○ COUNSELING PROGRAMS - Less frequently housed in psychology departments - Many counseling psychology programs may be based in a department or school of education OTHER MENTAL HEALTH PROFESSIONALS CLINICAL SOCIAL WORKERS - Many conduct psychotherapy on an individual or group basis and contribute to the diagnostic process as well ○ There are more clinically trained social workers than psychiatrists & psychologists - Assist individuals, groups, or communities to restore or enhance their capacity for social functioning ○ Practice of social work requires knowledge of human development & behavior, of social, economic and cultural institutions, and of the interaction of all these factors -Social worker would take the case history, interview employers and relatives, make arrangements for vocational placement, or counsel parents ○ Tended to deal with the social forces and external agents that were contributing to the patient’s difficulties - Often perform many of the same psychotherapeutic activities as their psychological and psychiatric counterparts ○ They still place a greater focus on the familial and social determinants of psychopathology - Leaders in the use of supervised fieldwork - Intense involvement with the everyday lives and stresses of their patients ○ More likely to visit the home, the workplace, or the street  ○ Less concerned with the abstract, theoretical generalizations that can be drawn from a particular case than they are with the practical matters of living ○ EMPLOYMENT OF SOCIAL WORKERS Public Agencies Private Practice Part of Mental Health Team In hospitals, social service agencies, or mental health clinics SCHOOL PSYCHOLOGISTS - Work with students, educators, parents, and school administrators to promote the intellectual, social, and emotional growth of school-age children and adolescents ○ Conduct psychological and educational assessments ○ Develop learning programs and evaluate their effectiveness ○ Consult with teachers, parents, and school officials - There is a great need for school psychologists to evaluate the intellectual ability and academic achievement of youth ○ EMPLOYMENT SETTINGS FOR SCHOOL PSYCHOLOGISTS Schools Nurseries Day-care centers Hospitals Penal Institutions HEALTH PSYCHOLOGIST - Contribute to the promotion and maintenance of good health through research or practice - Involved in the prevention and treatment of illness ○ May design, execute, & study health programs to help people stop smoking, manage stress, lose weight, or stay fit - Come from various psychological background ○ Such as clinical psychology, counseling psychology, social psychology, etc. ○ EMPLOYMENT SETTINGS FOR HEALTH PSYCHOLOGISTS Medical centers Business/Industry Consultants Organizations that recognizes the importance of keeping its employees /members well REHABILITATION PSYCHOLOGIST - Focuses on people who are physically or cognitively disabled  - Help individuals adjust to their disabilities & the physical, psychological, social, and environmental barriers that often accompany them ○ Advocate for the improvement of life conditions for those with disabilities and help develop and promote legislation to promote this cause - May also provide expert testimony in insurance cases, conduct testing, and serve on interdisciplinary teams ○ EMPLOYMENT SETTINGS FOR HEALTH PSYCHOLOGISTS Acute care facilities Medical centers Rehabilitation institutes Hospitals Community agencies VA hospitals Universities PSYCHIATRIC NURSES - Play a crucial and sensitive role in fostering an appropriate therapeutic environment - Provide information about patient’s hospital adjustment - Implement therapeutic recommendations ○ Working in close collaboration with the psychiatrist or the clinical psychologist THERAPEUTIC PERSONNEL - Including: ○ Occupational therapists ○ Recreational therapists ○ Art therapists - Play a vital adjunctive role in enhancing the adjustment patterns of patients ○ Help make hospitalization a more tolerable experience they can provide outlets that increase the therapeutic value of institutions - Teach skills that will help patients in a variety of non-hospital setting PARAPROFESSIONALS - People who are trained to assist professional mental health workers VOLUNTEERS - Often provided short training sessions and then become the most visible personnel in crisis centers ○ Both walk-in & telephone CLINICAL PSYCHOLOGIST ACTIVITIES ○ PSYCHOTHERAPY - Most frequently engaged in activity and occupies the most time  ○ RESEARCH - Has grown over the years - Some clinical psychologist never publish a research paper ○ TEACHING ○ ADMINISTRATION - Remains significant, reflecting the bureaucracy that is so prevalent in modern society THERAPY/INTERVENTION - A search for insight into the origins of one’s problems or the purposes served by one’s undesirable behavior - Consisted primarily of a relationship between client and therapist designed to produce an atmosphere of trust that would help dissolve the client’s debilitating defenses - Comes in many different sizes & shapes ○ One-to-one relationship/session ○ Couples therapy ○ Family therapy ○ Parent training ○ Group therapy - Specific skills may be useful for reducing client’s problems ○ Sometimes the goals of therapy are sweeping and involve major changes in behavior -Patients desire help only with a single type of symptom that prevents them from achieving certain goals - Most therapists are women DIAGNOSIS/ASSESSMENT - All practicing clinicians engage in assessment of one form or another - Effort to better understand the individual so that a more informed decision can be made or the most desirable course of action selected - A way of gathering information so that an important question can be answered or so that a problem can be solved ○ Through observation, testing, or interviewing - Chief element in the clinician’s professional identity TEACHING -May teach undergraduate and/or graduate courses ○ Through evening courses or part-time appointments - May also teach informal classes or do orientation work with other mental health personnel - May go out into the community and lead workshops on various topics ○ FORMS OF TEACHING One-to-one Supervisory Classroom type  CLINICAL SUPERVISION - Involves more one-to-one teaching, small group approaches, and other less formal, non-classroom varieties of instruction ○ Compared to teaching - Clinical psychologists often spend significant portions of their time supervising students, interns, and others ○ 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 and in postdoctoral programs as well RESEARCH - All clinicians were to be trained as scientists and as practitioners ○ It was believed that to be an effective clinical psychologist, one must have expertise in “thinking like a scientist” - Clinical psychologists are in a unique position both to evaluate research conducted by others and to conduct their own research - Range of research projects carried out by clinicians is enormous ○ Searching for the causes of mental disorders ○ Development & validation of assessment devices ○ Evaluation of therapy techniques ○ Etc. CONSULTATION - Clinical psychologists also can serve as consultants ○ FORMS OF CONSULTATION Case-by-case advice Discussing general problems ○ CONSULTATION “SERVICES” Advertising agencies/corporations Legal System Physicians under primary care services Business, personnel, & profit - May be remedial or prevention ADMINISTRATION - Nearly every clinical psychologist spends time on administrative tasks - Common among clinical psychologists working in agencies/institutions EMPLOYMENT SITES OF CLINICAL PSYCHOLOGISTS Private Practice University Medical school RESEARCH & SCIENTIFIC TRADITION - Emphasizes the quest for knowledge  - Training in clinical psychology that incorporates courses and experience in research and statistical methods gives clinicians unique skills that help establish their professional identity ○ Such methodological training helps develop a capacity for evaluation and an attitude of caution and skepticism that permits clinical psychologists to become better, more perceptive diagnosticians and therapists as well as researchers TRAINING AMONG CLINICAL PSYCHOLOGISTS - A typical clinical psychologist completes a bachelor’s degree and then 5 years of graduate work ○ Includes training in assessment, research, diagnosis, and therapeutic skills, along with an internship - Results to: DOCTORAL DEGREE - Key to work as an independent professional ○ PhD (Doctor of Philosophy) - From a university psychology department ○ Psy.D (Doctor of Psychology) - Either from a university department of psychology or from a training institution not affiliated with a university MASTER’S DEGREE - Awarded through two-year programs - Rare that individuals graduating from master’s programs can engage in professional clinical work independently ○ Less in demand than doctoral-level clinicians ○ Paid less ○ Perceived as less competent CLINICAL PSYCHOLOGY TRAINING PROGRAMS ○ SCIENTIST-PRACTITIONER MODEL - The predominant training philosophy in clinical psychology 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 - Exact number and content of these courses vary somewhat from program to program - Give the student an understanding of the basics that underlie human behavior or that permit us to investigate that behavior - Clinical students also enroll in several courses that teach the fundamentals of clinical practice or deal with clinical topics at an advanced level PRACTICUM WORK - All programs seek to build the student’s clinical skills through exposure to clinical practica  - Practicum will combine academic content with practical experience ○ Supervised by clinical faculty members or by clinicians in the community who have relevant 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 RESEARCH - Requires that the student develop research competence Accomplished through courses in statistics, computer software and technology, and research methodology and also by active participation in research project ○ THESIS ○ DISSERTATION QUALIFYING EXAMINATION - Should be passed by the students - Tests cover all areas of psychology ○ Whereas in others, they are confined to the field of clinical psychology INTERNSHIP - Capstone of the student’s previous experiences in clinical courses and practica - Provides the experience that begins to consolidate the scientist-practitioner role ○ VALUES IN INTERNSHIP New skills acquired 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 - 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 TRAINING MODELS - New degree programs have been established within the structure of universities ○ Example: Doctor of Psychology (Psy.D.) degree has become a more common alternative to traditional research-oriented Ph.D COMBINED TRAINING PROGRAM - Combined programs were developed under the assumption that a core of both knowledge and skills cuts across applied areas of psychology ○ This base of knowledge and skills can be utilized in a wide variety of practice settings  CLINICAL SCIENCE MODEL - A training model that has gained some prominence over the past decade ○ Arose from concerns that clinical psychology, as currently practiced, is not sufficiently grounded in science - Focus training on evidence-based approaches to assessment, prevention, and clinical intervention WOMEN IN PSYCHOLOGY - More women than men are receiving their doctorates in psychology ○ Especially true for clinical psychology, where the ratio is 3:1 - An increased representation of women in clinical psychology will serve to greatly advance the field because it will bring a broader range of perspectives to problems encountered in both clinical practice and clinical research CHAPTER 2A: HISTORICAL OVERVIEW OF CLINICAL PSYCHOLOGY - DIAGNOSIS & ASSESSMENT HISTORICAL ROOTS OF CLINICAL PSYCHOLOGY MEDICAL PSYCHOLOGY - Rise of abnormal psychology ○ May include clinical psychology MODERN CLINICAL PSYCHOLOGY [19th Century] - Reform movements resulting to improved care for the mentally ill ○ RISE MENTAL HEALTH PROFESSIONS [Philippine Pinel] - Managed to get himself appointed head of the asylum at Bicêtre and, later, Salpêtrière Through kindness and humanity, he accomplished much in a very difficult field - His work was a milestone in the development of psychiatry, the mental health approach, and ultimately, of clinical psychology CONTINUITY OF HUMANE TREATMENT [William Tuke] - Same situation applied in UK RETREAT FOR THE MENTALLY ILL [Eli Todd] - Emphasized the role of civilized care, respect, and morality - Search for psychological antecedents to mental illness and an emphasis on treatment had begun ○ Became less fashionable to regard mental patients as incurable BETTER FACILITIES FOR THE MENTALLY ILL [Dorothea Dix] - Lobbied through force of logic, facts, public sentiments - New Jersey responded by building a hospital for the “insane”  - An atmosphere of “knowledge through experimentation” began to prevail ○ A feeling that people can predict, understand, and perhaps even control the human condition began to replace older wisdom ○ Ferment in science, literature, politics, government, and reform combined to produce the first clear and unmistakable signs of new professions in what would come to be referred to as “mental health” DIAGNOSIS & ASSESSMENT: THE BEGINNINGS [1850-1899] - Essence of clinical psychology has always been its emphasis on assessing differences among people ANTHROPOMETRIC LABORATORY [Francis Galton] - Galton devoted a great deal of effort to the application of quantitative methods to understanding differences among people - Interests in sensory acuity, motor skills, & reaction time MENTAL TESTS [James McKeen Cattell] - Study of reaction time differences was a way of approaching the study of intelligence ○ Despite the disapproval of their mentor, Wilhem Wundt - Cattell hoped to discover the constancy of mental processes through the use of a battery of 10 tests ○ Even predicting that such tests could be used in the selection and training of people as well as in the detection of disease “THE PSYCHOLOGICAL CLINIC” [Lightner Witmer] - First psychological journal ○ Published after opening the first psychological clinic in 1986 - Interested in the variation in psychology skills among children ○ Continued despite the disapproval of their mentor, Wilhem Wundt - Witmer’s groundbreaking work identified and treated children who experienced educational difficulties - The field of clinical psychology arose as a profession dedicated towards scientific examination and treatment of individuals who were unable to function adaptively in their society ○ An initial major emphasis in clinical psychology assessment and treatment involved a focus on youth ○ Continued until the end of the Second World War DIVISION & CLASSIFICATIONS OF MENTAL ILLNESSES [Emil Kraeplin, 1913] - His descriptions and classifications of patients were heuristic & have served to stimulate an enormous amount of discussion about psychopathology ○ EXOGENOUS FACTORS - Curable ○ ENDOGENOUS FACTORS - Incurable DIAGNOSIS & ASSESSMENT: THE ADVENT OF MODERN ERA [1900-1919] - One of the major developments in this era was the rise of mental measurement or diagnostic psychological testing - Rise of intelligence tests and personality tests BINET-SIMON SCALE [Alfred Binet & Theodore Simon, 1908] - Developed a measurement for ensuring that children with cognitive limitations were properly educated ○ Pioneered measurements of intelligence - Binet was convinced that the key to the study of individual differences was the notion of norms and deviations from those norm PERSONALITY TESTS ○ WORD-ASSOCIATION METHOD [Carl Jung, 1905] - A personality test to uncover unconscious material in patients ○ KENT-ROSANOFF FREE ASSOCIATION TEST ○ WOODWORTH’S PERSONAL DATA SHEET [Robert S. Woodworth, 1918] INTELLIGENCE TESTS ○ GENERAL INTELLIGENCE (g) [Charles Spearman, 1904] ○ SEPARATE ABILITIES [Edward Thorndike] - Emphasized by Thorndike ARMY ALPHA & ARMY BETA [APA/Robert Yerkes, WWI/1917] - Made to address the need to screen and classify the hordes of military recruits being pressed into service ○ Application of psychological theories to the practices of the U.S. military started a gradual emphasis in clinical psychology ○ ARMY ALPHA - A system for classifying men according to their ability levels ○ ARMY BETA - Nonverbal version PSYCHONEUROTIC INVENTORY [Robert Woodworth, 1917] - First questionnaire designed to assess abnormal behavior DIAGNOSIS & ASSESSMENT: BETWEEN THE WARS [1920-1939] - Psychologists now had individual and group tests as well as verbal and nonverbal tests, and clinicians were using terms like “intelligence quotients.” - Rise of nonverbal intelligence scales (Pintner & Paterson) NONVERBAL INTELLIGENCE SCALES ○ ARTHUR POINT SCALE ○ CORNELL-COXE TEST ○ GOODENOUGH DRAW-A-MAN - Technique for measuring intelligence  APTITUDE TESTS ○ STRONG VOCATIONAL INTEREST BLANK ○ KUDER PREFERENCE RECORD INTELLIGENCE TESTS - Spearman, Thorndike, and Thurstone had all now entered the intelligence arena ○ FACTOR ANALYSIS [Louis Thurstone, 1927] - Sparked more debates on theoretical issues in intelligence ○ WECHSLER-BELLEVUE TEST [David Wechsler, 1939] - Served as the premier individual tests for adult intelligence BEHAVIORAL TESTS ○ DEVELOPMENTAL SCALES [Arnold Gesell, 1928] ○ VINELAND SOCIAL MATURITY SCALE [Edgar Doll, 1936] - Approached behavior based on an individual’s social maturity or competence PERSONALITY TESTS ○ PRESSEY X-O TEST [Sidney Pressey, 1921] - For emotions ○ DOWNEY WILL-TEMPERAMENT TEST [June Downey, 1923] ○ ALLPORT-VERNON STUDY OF VALUES [Gordon Allport, 1931] PROJECTIVE TESTING ○ RORSCHACH INKBLOT TEST [Hermann Rorschach, 1921] - Use of inkblots to diagnose psychiatric patients Based from his book, Psychodiagnostik - Proposed that when people respond to an ambiguous test stimulus, they will reveal something of their responses to real-life experiences ○ PROJECTIVE TECHNIQUE [L.K. Frank, 1939] - Coined term for projective testing ○ THEMATIC APPERCEPTION TEST (TAT) [Christiana Morgan & Henry Murray, 1935] - Requires the person to look at ambiguous pictures and then make up a story to describe the activities, thoughts, and feelings of the people in those pictures ○ BENDER-GESTALT TEST [Laura Bender, 1938] - A projective measure of personality DIAGNOSIS & ASSESSMENT: WORLD WAR II & BEYOND [1940 - PRESENT] - Referring physicians and psychiatrists gradually began to ask more complex questions - Dealt with differential diagnosis - Psychologists began to look at patterns of performance rather than just an overall score  MINNESOTA MULTIPHASIC PERSONALITY INVENTORY (MMPI) [Starke Hathaway, 1943] - An objective self-report test whose major function, initially, seemed to be attaching psychiatric labels to patients - No theoretical interpretation of scores or responses was necessary TESTING TECHNOLOGY [1940s & 1950s] INTELLIGENCE TESTS - Marked the beginning of a whole series of subsequent revisions of child and adult forms of the Wechsler scales ○ WECHSLER INTELLIGENCE SCALE FOR CHILDREN [David Wechsler, 1949] - A serious alternative to Stanford-Binet ○ WECHSLER ADULT INTELLIGENCE SCALE [David Wechsler, 1955] - A revision of the Wechsler-Bellevue Scale PERSONALITY/PROJECTIVE TESTS ○ PSYCHODIAGNOSIS - Use and interpretation of psychological test scores as a basis for diagnostic formulation as well as treatment planning Division of sides on whether objective or projective assessment measures were better suited to accurately describe personality and psychopathology ○ PROJECTIVE TESTS -Focus may be more on the individual, and interpretations are often guided as much by psychodynamic theory as they are by empirically supported rules BEHAVIORAL ASSESSMENT [1970s] - Behaviors were understood within the context of the stimuli or situations that either preceded or followed them ○ RADICAL BEHAVIORISM [Late 1950s] - Held that only overt behavior can be measured Personality traits cannot be measured directly PERSONALITY DISORDERS [1980s-1990s] - Introduction of a number of more contemporary and psychometrically sound personality inventories - Several empirical demonstrations that personality traits do appear to be fairly stable across time and across situations ○ DIAGNOSTIC & STATISTICAL MANUAL OF MENTAL DISORDERS (DSM-I) - Focuses on psychopathology in adulthood - There are subsequent editions & revisions SELF-REPORT INVENTORIES - Designed to measure DSM mental disorders STRUCTURE DIAGNOSTIC INTERVIEWS - Consist of a standard list of questions that are keyed to the diagnostic criteria for various disorders from the DSM NEUROPSYCHOLOGICAL ASSESSMENT - Used to evaluate relative strengths and deficits of patients based on empirically established brain–behavior (test responses) relationships  ○ TEST BATTERY FOR NEUROPSYCHOLOGICAL PROBLEMS [Will Halstead, 1947] ○ MODERN NEUROPSYCHOLOGICAL ASSESSMENT - Involves one of two approaches Some use a uniform group, or battery, of tests for all patients Others use a small subset of tests initially ○ Based on the results of these initial tests, use additional tests to resolve & answer the referral questions HALSTEAD-REITAN [Ralph Reitan, 1969] LURIA-NEBRASKA NEUROPSYCHOLOGICAL BATTERY [Golden, Purisch, & Hammeke, 1985] ○ BRAIN IMAGING - Validate and supplement information garnered from neuropsychological tests Test results are integral components of rehabilitation planning MANAGED HEALTH CARE [1990s] - Developed in response to the rapidly increasing cost of health care Including mental/behavioral health - Requires those who provide services to be more accountable and more efficient in service delivery - Clinical psychologists who are providers for various managed health care plans have become increasingly interested in using reliable and valid psychological measures or tests that: ○ Aid in treatment planning by identifying and accurately assessing problematic symptoms ○ Sensitive to any changes or improvements in client functioning as a result of treatment ○ Relatively brief CHAPTER 2B: HISTORICAL OVERVIEW OF CLINICAL PSYCHOLOGY - INTERVENTIONS INTERVENTIONS: THE BEGINNINGS [1850-1899] PSYCHOSES [Emil Kraeplin] HYSTERIA [Jean Charcot] - Patients with “physical symptoms” that did not seem to have an identifiable physical cause ○ JEAN CHARCOT - Master of clinical demonstration with hypnotized patients  Believed that only patients with hysteria could be hypnotized - Investigating hypnosis rather than hysteria HIPPOLYTE BERNEHIM & PIERRE JANET - Critical of Charcot’s work HIPPOLYTE BERNHEIM - Felt that symptoms of hysteria reflected nothing more than suggestibility PIERRE JANET - Hysteria as a manifestation of a “split personality” and also as a kind of hereditary degeneration ○ ANNA O [Josef Breuer & Sigmund Freud, Early 1880s] - A patient diagnosed with hysteria Sigmund Freud went to Paris to learn all that Charcot could teach him about hysteria “STUDIES ON HYSTERIA” - Published by Breur & Freud - Their collaboration served as the launching pad for psychoanalysis Most influential theoretical & treatment development in the history of psychiatry and clinical psychology THE ADVENT OF THE MODERN ERA [1900-1919] CLINICAL INSTITUTION ○ CHILD GUIDANCE CLINIC [William Healy, 1909] - Established in Chicago - Used a team approach involving psychiatrists, social workers, and psychologists They directed their efforts toward juvenile offenders rather than toward the learning problems of children - Healy’s approach was greatly influenced by Freudian concepts and methods Had the effect of shifting clinical psychology’s work with children in the dynamic direction of Freud rather than into an educational framework BOOKS ○ “THE INTERPRETATION OF DREAMS” [Sigmund Freud, 1900] - Included psychoanalytic concepts Such as the unconscious, the Oedipus complex, and the ego became part of the mainstream of psychological language, and sexuality became a focus within the psychological realm - Began the psychoanalytic movement  ○ “A MIND THAT FOUND ITSELF”[Clifford Beers, 1908s] - Published to expose the abuses in the hospital care of the mentally ill Based on when Beers was hospitalized in the wake of several severe depressions - Began the mental hygiene movement in America PSYCHOLOGICAL INTERVENTIONS SUPPORTIVE DISCUSSION AMONG HOSPITALIZED MENTAL PATIENTS [Joseph Pratt & Elwood Worcester, 1905] - Began to use a method of supportive discussion among hospitalized mental patients GROUP THERAPY METHOD [1920s & 1930s] - Based on supportive discussion by Pratt & Worcester BETWEEN THE WARS [1920-1939] PSYCHOANALYSIS - Devoted to the treatment of adults and was practiced almost exclusively by analysts whose basic training was in medicine The medical profession claimed exclusive rights to psychoanalytic therapy and in so doing made the subsequent entry of psychologists into the therapy enterprise quite difficult Defied Freud’s arguments that psychoanalysts did not need medical training PSYCHOLOGICAL PRINCIPLES - Based on Sigmund Freud & Alfred Adler ○ FREUD - Emphasis seemed to lie with adults & with the sexual antecedents of their problems ○ ADLER [1930s] - Emphasis on the structure of family relationships GUIDANCE CLINICS - Entry of psychologists into therapeutic activities was a natural outgrowth of their early work with children ○ CHILDREN’S INTELLECTUAL ABILITIES - Main focus of guidance clinics - Involved consultations with parents & teachers - Psychologists offer advice & make recommendations to parents and teachers about managing children’s behavior THERAPIES ○ PLAY THERAPY [Anna Freud, 1928] - More directly derived from traditional Freudian principles - Relies on the curative powers of the release of anxiety or hostility through expressive play ○ GROUP THERAPY [J.L. Moreno & S.R. Slavson, Early 1930s] ○ PASSIVE THERAPY [Frederick Allen, 1934] - Beginning of a client-centered therapy  ○ RELATIONSHIP THERAPY [J. Levy, 1938] - Marked the beginning of behavior therapy along with other conditioning experiment/therapies BEHAVIORAL CONDITIONING ○ LITTLE ALBERT [John Watson, 1920] - A young boy was conditioned to develop a neurotic-like fear of white, furry object ○ FEAR CONDITIONING [Mary Cover Jones, 1924] - Showed how fear could be removed through conditioning WORLD WAR II & BEYOND [1940 - PRESENT] - Psychologists began to fill the mental health breach The role of psychologists was ancillary and often mainly involved group psychotherapy Later on, they began to provide individual psychotherapy for the short-term goal of returning men to combat and in the longer- term goal of rehabilitation TURMOIL IN EUROPE [1930s] - Forced many European psychiatrists and psychologists to leave their homelands Many of them ultimately settled in the United States - Ideas of the Freudian movement generated excitement and also gained increasing credence in psychology Clinical psychologists are more interested in personality development rather than assessment of intelligence & ability, and measurement of cognitive dysfunction PSYCHOANALYTIC MOVEMENTS ○ “PSYCHOANALYTIC THERAPY: PRINCIPLES & APPLICATION” [Franz Alexander & Thomas French, 1946] - Published an influential book on briefer psychoanalytic interventions ○ “PERSONALITY & PSYCHOTHERAPY” [John Dollard & Neal Miller] - An attempt to translate the psychoanalysis of Freud into the language of learning theory THERAPIES ○ “CLIENT-CENTERED THERAPY” [Carl Rogers, 1951] - First major alternative to psychoanalytic therapy ○ GESTALT THERAPY [Perls, Hefferline, & Goodman, 1951] - Form of psychotherapy in which self-awareness and self-acceptance are considered keys to personal growth ○ LOGOTHERAPY [Viktor Frankl, 1953] - Talked about its relationship to existential theory ○ FAMILY THERAPY [Nathan Ackerman, 1958]  ○ RATIONAL-EMOTIVE THERAPY (RET) [Albert Ellis, 1962] - Forerunner of cognitive-behavioral therapy ○ TRANSACTIONAL ANALYSIS (TA) [Eric Berne, 1961] ○ CRITIQUE OF THERAPY [Hans Eysenck, 1952] - Report on the ineffectiveness of psychotherapy alarmed many - Inspired others to conduct research designed to prove him wrong BEHAVIORISM ○ “CONDITIONED REFLEX THERAPY [Andrew Saltzer, 1949] - A pioneering work in what later evolved into desensitization methods ○ OPERANT CONDITIONING [B.F. Skinner, 1953] - Operant principles were outlined for therapeutic & social interventions ○ SYSTEMATIC DESENSITIZATION [Joseph Wolpe, 1958] - Technique based on conditioning principles - An effective treatment for fears, phobias, anxiety disorders, & PTSD COGNITIVE PSYCHOLOGY ○ RET [Aaron Beck, 1962] - One of the most effective psychological treatments for psychological problems “DEPRESSION: CAUSES & TREATMENT” - Cognitive therapy is now used effectively to treat a range of condition Although the initial focus for cognitive therapy was depression TRENDS IN INTERVENTION ○ GROWING NUMBER IN TREATMENT UTILIZED [J.D. Frank, 1971] - Range from cognitive-behavioral approaches that have empirical support to “trendier” approaches like “inner-child therapy” that have no empirical support -Clinicians employ the techniques of more than one theoretical orientation Basing their selection on the particular problems presented by the individual client or patient - Many clinical psychologists are interested in integrating various approaches into one therapeutic modality Also identifying common factors that underlie different approaches to treatment ○ BRIEF/TIME-EFFECTIVE THERAPY [Budman & Gurman, 1988]- Preferred mode of psychotherapeutic intervention As many individuals cannot afford years of psychotherapy - Have been shown to be equally as effective and more effective than traditional psychotherapy  MANUALIZED FORMS OF TREATMENT - Introduced in clinical work for managed care companies - Useful for clinicians because they outline treatment goals for each session as well as techniques to be used ○ Typically, the treatment “package” can be implemented and completed in 10 to 15 sessions or less - Assist research aimed at determining the efficacy or effectiveness of psychological intervention PREVENTIVE APPROACH IN THERAPY [1950s] - Resulted to: ○ COMMUNITY PSYCHOLOGY [1960s] ○ HEALTH PSYCHOLOGY [1980s] - Growing number of clinical psychologists provide services related to the prevention of health problems, mental health problems, and injury EMPIRICALLY SUPPORTED TREATMENTS - Lists for adults and youth have been widely disseminated among clinical psychologists - A call to authorize psychologists with specialized training the authority to write prescriptions for psychotropic medication CHAPTER 2C: HISTORICAL OVERVIEW OF CLINICAL PSYCHOLOGY - RESEARCH THE BEGINNINGS [1850-1899] FIRST PSYCHOLOGICAL LABORATORY [Wilhem Wundt, 1879] - Located in Leipzig, Germany “PRINCIPLES OF PSYCHOLOGY” [William James, 1890] THE ADVENT OF THE MODERN ERA [1900-1919] BEHAVIORAL CONDITIONING ○ CONDITIONED REFLEX [Ivan Pavlov] - A part of his work on conditioning left an important legacy for clinical psychology - Notion of classical conditioning has become a central part of theory & research Also played a significant role in a variety of therapeutic method INTELLIGENCE TESTING ○ VALIDITY OF BINET & SIMON TEST RESEARH ON BINET-SIMON [Lewis terman, 1916] ○ DEVELOPMENT OF ARMY ALPHA & BETA TESTS BETWEEN THE WARS [1920-1939]  TEST DEVELOPMENT ○ PUBLICATION WECHSLER-BELLEVUE TEST ○ PERSONALITY TESTS [1930s] PSYCHOLOGICAL ACADEMIC RESEARCH ○ BEHAVIORISM - Taught clinicians the power of conditioning in the development and treatment of behavior disorders ○ GESTALT PSYCHOLOGY - Emphasized the importance of understanding that patients’ unique perceptions contribute to their problems WORLD WAR II & BEYOND [1940s - PRESENT] DIAGNOSIS & ASSESSMENT ○ INTELLIGENCE TESTING & PERSONALITY ASSESSMENTS [1950s] - Studies dealt with various aspects of the Stanford-Binet & the Wechsler scales Research on their validity and reliability, their use with various diagnostic groups, short forms, and implications for personality appeared in waves ○ PROJECTIVE TESTS [1950s] -Studies dealing with the Rorschach and TAT were published Many of these studies also focused on issues of reliability and validity Some observers attribute part of the subsequent decline in projective testing to the many negative validity studies that appeared during this time ○ DECLINE OF DIAGNOSIS & ASSESSMENT [Mid-1960s] PSYCHOTHERAPY - Emergence of studies the process & effectiveness of psychotherapy ○ PSYCHOTHERAPY RESEARCH [Carl Rogers, 1951] - Considered use of recordings to study the process of therapy opened windows to an activity that had long been shrouded in mystery CONTROLLED RESEARCH FINDING ON COUNSELING PROCESS [Rogers & Dymond, 1954] - Effectiveness of psychotherapy was questioned ○ SURVEY ON EFFICACY OF PSYCHOTHERAPY [Mary Smith & Gene Glass, 1977] - Laid the basis for a series of studies that has helped us better understand the way therapeutic methods affect patients SOCIAL LEARNING THEORY ○ “SOCIAL LEARNING & CLINICAL PSYCHOLOGY” [Julian Rotter, 1954] - A series of controlled studies that provided an empirical foundation for the theory  - Provided a solid foundation upon which subsequent social learning theorists could build BEHAVIORISM ○ BEHAVIOR THERAPY RESEARCH PROJECT [B.F. Skinner, Ogden Lindsley, & Harry Solomon, 1953] ○ SYSTEMATIC DESENSITIZATION [Joseph Wolpe, 1958] - Based on a research in South Africa on animal and human learning convinced him that his work was relevant to human emotional problems ○ CLIENT-CENTERED THERAPY [Arnold Lazarus & Stanley Rachman] ○ HANS EYSENCK - Introduced many clinicians to behavior therapy through his important book DIAGNOSIS & CLASSIFICATION - Published research on psychological inventories, interviews, and rating scales has also increased ○ DSM-III - Prompted research aimed at evaluating the reliability, validity, and utility of specific criteria listed for the mental disorders included in this manual ETIOLOGICAL FACTORS - Became a focus in identifying diagnosis - Factors investigated ranged from genetic predispositions to traumatic childhood events ○ JOURNAL OF CONSULTING & CLINICAL PSYCHOLOGY (JCCP) - Was split into two PSYCHOLOGICAL ASSESMENT - New journal aside from JCCP BEHAVIORAL GENETICS - Focused on both genetic & environment influences on the development of behavior are evaluated Individual differences such as intelligence, personality, & psychopathology are investigated - Contributed to theories & treatments of psychological disorders BRAIN IMAGING - View of both the structure and function of the brain and is becoming an important component in research on psychopathology - Contributed to theories & treatments of psychological disorders CHAPTER 2C: HISTORICAL OVERVIEW OF CLINICAL PSYCHOLOGY - THE PROFESSION THE BEGINNINGS [1850-1899] FOUNDATION OF AMERICAN PSYCHOLOGICAL ASSOCIATION (APA) - Membership of the association was still fewer than 100 As of the end of 19th century ○ G. STANLEY HALL - First APA president BIRTH OF CLINICAL PSYCHOLOGY [Lightner Witmer]  ○ FIRST PSYCHOLOGICAL CLINIC [Lightner Witmer, 1896] - Located at the University of Pennsylvania - Devoted to the treatment of children who were experiencing learning problems or who were disruptive in the classroom - Witmer’s contribution only added little in terms of new theories or methods ○ COINING OF “CLINICAL PSYCHOLOGY” ○ “THE PSYCHOLOGICAL CLINIC” - First journal in clinical psychology - Ceased publication in 1935 THE ADVENT OF THE MODERN ERA [1900-1919] - Only a very small number of psychologists could be found employed outside the universities JOURNALS - Led to applied clinicians to form their identity ○ JOURNAL OF ABNORMAL PSYCHOLOGY [Morton Prince, 1906] ○ THE PSYCHOLOGICAL CLINIC [Lightner Witmer, 1907] PSYCHOLOGICAL INSTITUTIONS ○ IOWA PSYCHOLOGICAL CLINIC ○ JUVENILE PSYCHOPATHIC INSTITUTE [William Healy, 1909] - Located in Chicago AMERICAN PSYCHOLOGICAL ASSOCIATION (APA) - Focus was on psychology as a science, not as a profession - A total of 222 members ○ CREATION OF FIRST SECTION OF CLINICAL PSYCHOLOGY PSYCHOLOGICAL TESTING - Public schools clamor for testing services - Universities were beginning to respond with testing courses and studies of those with cognitive limitations BETWEEN THE WARS (1920-1939) AMERICAN PSYCHOLOGICAL ASSOCIATION (APA) - Mission was to further psychology as a science Many clinically-oriented psychologists were becoming uneasy and increasingly sought to gain recognition of their unique roles and interests from the APA ○ COMMITTEE WITHIN CLINICAL SECTION - Focused on training standards for clinical psychology ○ APA COMMITTEE ON STANDARDS OF TRAINING - Defined clinical psychology as “that art and technology which deals with the adjustment problems of human beings”  JOURNALS ○ FIRST CLINICAL PSYCHOLOGY TEXT [Chauncey Lottit, 1936] ○ JOURNAL OF CONSULTING PSYCHOLOGY - Serves as a major publication outlet for the research of many clinicians PSYCHOLOGICAL TESTS ○ PSYCHOLOGICAL CORPORATION [James McKeen Cattell, 1921] - Utilized to develop and market psychological tests WORLD WAR II & BEYOND [1940-1969] PSYCHOLOGICAL TESTS ○ LARGE-SCALE SCREENING PROGRAM [Early 1940s] - Utilized to classify individuals who are unfit for military service Due to large numbers of soldiers in the US military PSYCHOLOGISTS DURING THE WWII - More than 1,700 psychologists served They returned to civilian life with increased confidence in their abilities and a determination to build a profession VETERANS ADMINISTRATION (VA) - Providing care and rehabilitation who had suffered some form of emotional trauma from their military service - Clinical psychologists to conduct individual and group psychotherapy along with their accustomed psychodiagnostic activities ○ TRAINING OF CLINICAL PSYCHOLOGISTS - Played a chief role in upgrading and building the profession of clinical psychology - Increased the availability of mental health professionals by providing financial support for their training RISE OF CLINICAL PSYCHOLOGY ○ DOCTORATE IN CLINICAL PSYCHOLOGY - Offered by 42 schools ○ US PUBLIC HEALTH SERVICE & NATIONAL INSTITUTE OF MENTAL HEALTH - Initiated support of clinical psychology graduate students working toward the Ph.D. Sponsored research Sponsored training programs ○ FIRST CERTIFICATION LAW FOR PSYCHOLOGISTS - Happened in Connecticut ○ AMERICAN BOARD OF EXAMINERS IN PROFESSIONAL PSYCHOLOGY (ABEPP) - Established to certify the professional competence of clinicians holding the Ph.D ○ EDUCATIONAL TESTING SERVICE ○ APA - Now asserting that psychotherapy was an integral function of clinical psychologists  - Beginning to make recommendations for the training of clinical psychologists and also to certify clinical training program “ETHICAL STANDARDS” - Codification of ethical behavior for psychologists MEMBERSHIP [1950s] 1,000 members in Clinical Division 7, 250 members in Clinical Division 16, 644 members in Clinical Division JOURNAL ○ “AMERICAN PSYCHOLOGIST” PSYCHOLOGICAL CONFERENCE ○ CONFERENCE ON GRADUATE EDUCATION IN CLINICAL PSYCHOLOGY - Held in Boulder, Colorado SCIENTIST-PRACTITIONER MODEL - Utilized for training clinical psychologists Clinical psychologists shall pursue their training in university departments They shall be trained as psychologists first and clinicians second They shall be required to serve a clinical internship They shall achieve competence in diagnosis, psychotherapy, and research The culmination of their training shall be the Ph.D. degree GROWTH OF A PROFESSION [1970 - PRESENT] BEHAVIORISM [Mid-1960s] - The trend in assessment, intervention, & research - Focus on the effects of the following on behavior ○ SITUATIONAL FACTORS ○ CONDITIONING & ALTERED REINFORCEMENT CONTINGENCIES COGNITIVE THEORY [Mid-1970s] ○ COGNITIVE-BEHAVIOR METHOD - Common orientation of treatment COMMUNITY PSYCHOLOGY [1960s] - Began to fall - Used to revolutionize clinical psychology ○ HEALTH PSYCHOLOGY [1980s] - Rekindled the interest CLINICAL PSYCHOLOGISTS - Many clinical psychologists now have hospital privileges Most can be reimbursed for their services by insurance and managed care companies - Increase in the number of clinical psychology graduate programs  ○ GRADUATE TRAINING PROGRAMS [1970s] - 81 approved 12,000 clinicians 67, 000 clinicians Approximately 80, 000 clinicians THE 1988 SCHISM - Conflicts within APA - Academic-scientific wing of the APA seems to have concluded that the APA was under the control of the practitioners who were using their power to promote their own interests Many had come to feel that the APA was no longer responsive to the academic-scientific needs of a significant number of its members - A plan to reorganize the APA so as to help heal the growing schism between the clinical wing Academic-scientific wing failed by a 2-to-1 vote of the membership AMERICAN PSYCHOLOGICAL SOCIETY (APS) - Led by 22 former APA presidents who became founding members Those disenchanted with the APA was to form a new, separate organization ○ “THE OBSERVER” - Monthly newsletter of APS ○ FOUR JOURNALS - Psychological Science, Psychoogical Science in the Public Interest, Current Directions in Psychological Science, and Perspectives on Psychological Science - 20,000 members currently CHAPTER 3A: CURRENT ISSUES IN CLINICAL PSYCHOLOGY - MODELS OF TRAINING IN CLINICAL PSYCHOLOGY DOCTOR OF PSYCHOLOGY DEGREE [Psy.D.] - Special characteristics of these degrees are an emphasis on the development of clinical skills and a relative deemphasis on research competence Master’s thesis is not required Dissertation is usually a report on a professional subject rather than an original research contribution - Psy.D. programs have moved toward compressing formal coursework into the first year and expanding clinical experience by requirements  [1st Year & 2nd Year] Not substantially different from Ph.D. programs [3rd Year] Increasing experience in therapeutic practice and assessment [4th Year] Continued clinical emphasis with a series of internship assignments - Graduates with a Psy.D. degree are not less qualified than those with Ph.D.s for professional practice PROFESSIONAL SCHOOLS - Emphasize clinical functions and generally have little or no research training in the traditional sense Most offer Psy.D. - Have no affiliation with universities DIFFCULTIES/PROBLEMS WITHIN PROFESSIONAL SCHOOLS ○ STABILITY OF FUNDING - Many such institutions must depend on tuition as their chief source of funds Which may not generate enough money to make them financially secure - Majority of university-based Ph.D. programs waive tuition completely for graduate students ○ PART-TIME FACULTY - Depended heavily on by professional schools - Difficult for students to have the frequent and sustained contacts with their professors ○ PROFESSIONAL ACCEPTANCE OF GRADUATES - Major handicap that such schools will have to overcome Although some professional schools are fully accredited by the APA, they are the exception rather than the rule THE SCIENTIST-PRACTITIONER MODEL (Boulder Model) - Some will be primarily researchers and others primarily clinicians No one ever intended to have all clinicians devote exactly 50% of their time to their clinical practice and 50% to formal research - Applicable to clinical researchers as it is to practicing clinicians ○ CLINICAL RESEARCHERS - Produce solid, meaningful research if they keep their clinical sensitivity and skills honed by continuing to see patients ○ CLINICAL PRACTITIONERS - Must not forsake their research training and interests, neither must researchers ignore their clinical foundation  SCIENTIST-PRACTITIONER MODEL IN PROFESSION - Skilled practitioners who could produce their own research as well as consume the research of others - A systematic union between clinical skill and the logical empiricism of science The psychological clinician would contribute to the body of clinical knowledge by understanding how to translate experience into testable hypotheses and how to test those hypotheses SCIENTIST-PRACTITIONER MODEL IN EDUCATION - Clinical psychology began in universities as a branch of scientific psychology ○ TRAINING IN CLINICAL PSYCHOLOGY - The practice did not receive the priority - Clinical psychology professors carried out research and they published their work Their own research detracted from their training of clinical students in the skills of the profession - Some students complained that they were learning little about psychotherapy and diagnostic testing Too much focus on statistics, theories of conditioning, or principles of physiological psychology DEBATE ON INTERPRETATION OF SCIENTIST-PRACTITIONER MODEL [Conference in Salt Lake City, Utah; 1987] - Accepted approaches that deemphasize research experience in favor of more direct and extensive training in clinical skills - Mood of professionalism seems to grow every year ○ GROUPS AMONG CLINICAL PSYCHOLOGISTS CLINICAL PRACTICE CLINICAL RESEARCH - Others conclude that scientist-practitioner model is a poor educational model The prospect of totally abandoning the Boulder model is worrisome to many CLINICAL SCIENTIST MODEL - Clinical psychologists were urged to help build a science of clinical psychology by: ○ Integrating scientific principles into their own clinical work ○ Differentiating between scientifically valid techniques & pseudoscientific ones ○ Focusing graduate training on methods that produce clinical scientists CONCERNS THAT LED TO ESTABLISHMENT OF CLINICAL SCIENTIST MODEL  ○ Empirically oriented clinical psychologists have become increasingly concerned that clinical psychology is not well grounded in science ○ Many of the methods that practitioners employ in their treatment have not been demonstrated to be effective in controlled clinical studies ○ Research that has been completed does not support continued use of the technique Use of assessment techniques that have not been shown to be reliable and valid and to lead to positive treatment outcome has been called into question MANIFESTO FOR A SCIENCE OF CLINICAL PSYCHOLOGY [Richard McFall, 1991] ○ Scientific clinical psychology is the only legitimate and acceptable form of clinical psychology ○ Psychological services should not be administered to the public (except under strict experimental control) until they have satisfied these four minimal criteria: The exact nature of the service must be described clearly The claimed benefits of the service must be stated explicitly These claimed benefits must be validated scientifically Possible negative side effects that outweigh any benefits must be ruled out empirically ○ Primary and overriding objectives of doctoral training programs in clinical psychology must be to produce the most competent clinical scientists possible - A network of graduate programs and internships that adhere to the clinical science model has developed ○ Programs share ideas, resources, and training innovations ○ Collaborate on projects aimed at increasing grant funding from governmental agencies ○ Addressing state licensing requirements for the practice of psychology ○ Increasing the visibility of clinical science programs in undergraduate education ACADEMY OF PSYCHOLOGICAL SCIENCE - Consists of graduate programs and internships - Committed to training in empirical methods of research and to the integration of this training with clinical training ○ TRAINING - Foster the training of students for careers in clinical science research Who skillfully will produce and apply scientific knowledge ○ RESEARCH & THEORY - Advance the full range of clinical science research & theory and their integration with other relevant sciences  ○ RESOURCES & OPPORTUNITIES - Foster the development of & access to resources and opportunities for training, research, funding, & careers in clinical science ○ APPLICATION - Foster the broad application of clinical science to human problems in responsible and innovative ways ○ DISSEMINATION - Foster the timely dissemination of clinical science to policy-making groups, psychologists, and other scientists, practitioners, and consumers COMBINED PROFESSIONAL-SCIENTIFIC TRAINING PROGRAM - Training model combined specialty in counseling, clinical, and school psychology - Assumes that: ○ These specialties share a number of core areas of knowledge ○ The actual practices of psychologists who graduate from each of these specialties are quite similar CURRICULUM - Focuses on core areas within psychology and exposes students to each subspecialty of counseling, clinical, and school psychology - Emphasizes breadth rather than depth of psychological knowledge Graduates from this type of training program may not develop a specific subspecialty or area of expertise by the end of their doctoral training - Appears to be better suited for the future practitioner than for the future academician or clinical scientist GRADUATE PROGRAMS CHANGES IN GRADUATE TRAINING - Have mirrored the marketplace for clinical psychologists for over 60 years ○ RISE OF PRIVATE PRACTICE [Mid-1960s] - Shift occurred from university-based academic jobs to jobs in private practice COMPLAINTS ON THE LIMITATIONS OF THE SCIENTIST-PRACTITIONER MODEL - Focused primarily on the perceived inadequacy of the Boulder model of training for future practitioners Training in clinical skills was deficient as faculty members were oblivious to the training needs of future practitioners ○ VAIL TRAINING CONFERENCE - Came an explicit endorsement of alternative training models to meet the needs of the future practitioner These alternative training programs became increasingly influential  - Alternative Psy.D. degree and professional school model of training can be traced to the positions adopted by those attending this conference Some have argued in support of designating any clinical psychologist who practices clinical work with a Psy.D. degree TRENDS AFFECTING THE SUCCESS OF THE TRAINING MODEL [Vail Training Conference] ○ Many have argued that there is an oversupply of practice- oriented psychologists given market demands This may ultimately affect the number of students entering and finishing graduate programs in clinical psychology As the internship and practice-oriented job markets tighten, the programs that primarily train practitioners will likely feel the brunt of this effect Students from practice-oriented doctoral programs have had more difficulty securing internships than those from scientist-practitioner and clinical scientist programs ○ Managed health care revolution in this country will likely affect the demand for clinical psychologists in the future As well as the curriculum in training programs More emphasis will be placed on coursework involving empirically supported brief psychological interventions and focal assessment Training programs that do not employ faculty with expertise in these areas may produce graduates without the requisite skills to compete in the marketplace ○ There may be an undersupply of academic and research-oriented clinical psychologists Scientist-practitioner and clinical scientist programs may be in a better position to meet this need Research-oriented clinical psychologists will be better able to develop & evaluate effective treatments for psychological problems, evaluate programs in health care settings, and provide supervision for both research and for administering empirically supported treatments CHAPTER 3B: CURRENT ISSUES IN CLINICAL PSYCHOLOGY - PROFESSIONAL REGULATION - Has attempted to protect the public interest by developing explicit standards of competence for clinical psychologists As issues of professional competence began to arise CERTIFICATION - Guarantees that people cannot call themselves “psychologists” while offering services to the public for a fee unless they have been certified by a state board of examiners An attempt to protect the public by restricting the use of the title “psychologist” - Developed by state psychological associations - Often involves an examination Sometimes it consists only of a review of the applicant’s training and professional experience WEAKNESS OF CERTIFICATION - Does not prevent anyone from the poorly trained to outright quacks ○ QUACKS - Non-certified persons who offer psychological services to the public CERTIFICATION LAWS - Often the result of effective psychiatric lobbying of state legislatures - Many psychiatrists resisted any law that would recognize the practice of psychotherapy by any non-medical specialty LICENSING - Specifies the nature of the title (“psychologist”) and training required for licensure Usually defines what specific professional activities may be offered to the public for a fee - Stronger regulation that certification STATE LICENSING LAWS - Designed to prevent such evasions by defining psychotherapy Specifically making it the province of psychiatry, clinical psychology, or other designated professions SUMMARY OF REQUIREMENTS FOR LICENSURE ○ EDUCATION - A doctoral degree from an APA-accredited program in professional psychology is required ○ EXPERIENCE - 1-2 years of supervised postdoctoral clinical experience is required ○ EXAMINATIONS - A candidate for licensure must pass the Examination for Professional Practice in Psychology (EPPP) - Some states and provinces require an oral or essay examination  ○ ADMINISTRATIVE REQUIREMENTS - Additional requirements include citizenship or residency, age, evidence of good moral character, and so on ○ SPECIALTIES - Licensure to practice psychology is generic Psychologists must practice within the scope of their demonstrated competence, as indicated by their educational background and training. CHALLENGES WITHIN LICENSING ○ Licensing standards should not be enforced until research demonstrates their utility and positive client outcomes can be shown to relate to the licensee’s competence ○ Licensing should be designed to ensure that the public will not be harmed rather than to regulate levels of competence ○ Licensing requirements violate academic freedom because these requirements essentially dictate the coursework offered by clinical psychology programs Requirements for licensure may make it difficult for academic clinical psychologists themselves to attain licensure AMERICAN BOARD OF PROFESSIONAL PSYCHOLOGY (ABPP) - Established due to the failure of individual states to take the lead on professional regulation - Offers certification of professional competence in various psychological fields REQUIREMENTS & PROCESS IN OBTAINING ABPP CERTIFICATION - More rigorous than those involved in state certification or licensing ○ Verification of credentials in the specific psychological field ○ Submission of practice samples (videotaped) and a written statement regarding professional expertise and handling of clinical cases ○ Completion of an oral examination conducted by three expert peers BENEFITS OF OBTAINING ABPP CERTIFICATION ○ Reduced liability insurance ○ Increased status as a clinician or expert witness ○ Increased ease of mobility if one chooses to move to another state NATIONAL REGISTER - Clinical psychologists have gained recognition as competent providers of those services involving prevention, assessment, and therapy - In recent years, insurance companies have increasingly extended their coverage to include mental health services  “NATIONAL REGISTER OF HEALTH SERVICE PROVIDERS IN PSYCHOLOGY” “THE REGISTER” - Listing only those practitioners who are licensed or certified in their own states and who submit their names for inclusion and pay to be listed A self-certification CHAPTER 3C: CURRENT ISSUES IN CLINICAL PSYCHOLOGY - PRIVATE PRACTICE & HEALTH CARE PRIVATE HEALTH CARE - Substantial numbers of clinical psychologists work in private practice settings The physician is now serving as a role model for these aspiring clinicians HAZARDS IN PRIVATE PRACTICE ○ Emphasis on restrictive legislation, diplomas, and political activism and the deemphasis on research strike many as misguided They fear that what began as an honest and dedicated attempt to improve training, provide continuing professional growth, protect the public, and improve the common good will end in a selfish posture of vested interest ○ ECONOMIC SQUEEZE - Some predict that private practitioners will need to expand their roles to areas such as alternative medicine, telehealth, psychopharmacy, and life coaching Due to the rise of managed health care COSTS OF HEALTH CARE MANAGED CARE - Initial attempt to address high costs for health care in general and mental health care ○ FEE-FOR-SERVICE - Traditional mental health care system was “unmanaged” Doctoral-level practitioners could be used, the amount paid for services, the quality of services, and the frequency of service utilization - Shifted economic control from practitioners to those that ultimately pay the bills Focus became cost containment With corporations expanding into a kind of medical-industrial complex and emphasizing a marketplace mentality  ○ INSURANCE PLANS - Become “more managed” Provider networks become more selective, as utilization of services is evaluated with regard to appropriateness and effectiveness MODELS OF MANAGED CARE - Attempts to control costs and reduce use of services while at the same time ensuring their quality ○ HEALTH MAINTENANCE ORGANIZATION (HMO) - Employs a restricted number of providers to serve those who enroll in the plan Costs for all services are fixed ○ PREFERRED PROVIDER ORGANIZATION (PPO) - Contracts with outside providers to meet the needs of its membership In exchange for the discounted rate, the providers theoretically receive an increased number of referrals ○ POINT OF SERVICE PLAN (POS) - Members have more options regarding how “managed” their health care choices are Pay more for these non-managed features - Combines features of HMOs and PPOs CONSUMER-DRIVEN HEALTH PLANS - Way to reduce overall costs to institutions - Companies & institutions are offering high-deductible plans that allow more choices but effectively shift the majority of the costs to consumers IMPROVEMENT IN BEHAVIORAL HEALTH CARE MODELS IN BEHAVIORAL HEALTH CARE ○ CONSUMER-DIRECTED HEALTH CARE PLANS - Shift the cost & responsibility of behavioral health care services to the consumer - Individuals will be spending more out-of-pocket - Likely to shop around to find the highest quality services for the best prices ○ DISEASE MANAGEMENT MODEL - Provides pay-for-performance incentives to clinicians to provide high-quality, effective services Clinicians will be able to share in the health care savings if they are able to achieve the same results with less intensive treatment EFFECTS OF IMPROVEMENT IN BEHAVIORAL HEALTH CARE ○ Clients are likely to be seen for fewer sessions & psychological treatments administered are likely to be from a list of evidence-based treatments ○ Self-care or self-help methods will be used more  Self-help methods are attractive as a first line of treatment because they are inexpensive, widely available, and can be disseminated in a wide variety of settings ○ Computer/Internet-assisted therapy is more likely to be used Many of the most effective treatments for psychological problems are structured & based on manualized therapies ○ More behavioral health services will occur in primary care and other less traditional settings like schools & the workplace Shift is driven by a number of factors Availability of self-help modalities Increased use of medications to manage psychological problems Stigma still associated with presenting to a psychologist’s or psychiatrist’s office CONSEQUENCES OF TRENDS IN MANAGED CARE & DELIVERY OF BEHAVIORAL HEALTH SERVICES ○ Directly affect the employment outlook for doctoral-level clinical psychologists Master’s-level practitioners and paraprofessionals are much “cheaper” to use for the same services Will be seen as more economically attractive to managed care companies BENEFITS TRAINING OF THE SCIENTIST-PRACTITIONER/CLINICAL SCIENTIST - An increased focus on accountability and patient outcomes will open the doors for clinical psychologists who have expertise in clinical and psychometric research ○ Clinical psychologists as consultants and overseers of psychological treatment in an environment that emphasizes quality and cost-effectiveness - Trainings should focus more on cost-effectiveness CHAPTER 3D: CURRENT ISSUES IN CLINICAL PSYCHOLOGY - PRESCRIPTION PRIVILEGES - The decision to pursue these privileges will have far-reaching implications for the role definition of clinical psychologists, the training they require, and their actual practice BACKGROUND SHIFT TO GENERAL HEALTH ISSUES - Clinical psychologists have expanded their area of interest from mental health issues to health issues  -Raises a number of interesting issues Such as how best to ensure that clinical psychologists can function autonomously and not be controlled or regulated by medical or other professions PRESCRIPTION PRIVILEGES FOR PSYCHOLOGISTS - Will ensure the autonomy of clinical psychologists as health service providers Will enable a continuity of care ○ PSYCHIATRISTS - Prescribes the patient’s medications ○ PSYCHOLOGIST - Provides the same patient’s psychotherapy - Clinical psychologists with prescription privileges would be available to meet the needs of underserved populations As it is the professional and ethical duty to improve and broaden the services we offer so that society’s needs can be met - Pursuit of prescription privileges has been questioned Some have argued that we should not incorporate medical interventions into the treatment repertoire Based on the professional boundaries between clinical psychology & psychiatry PROS & CONS OF PRESCRIPTION PRIVILEGES - Discussed in a 1995 interview with the Executive Director of the Practice Directorate of the American Psychological Association PROS OF PRESCRIPTION PRIVILEGES ○ PROVIDE A WIDER VARIETY OF TREATMENTS - Will lead to treating a wider range of clients or patients - More involvement by clinical psychologists in the treatment of conditions in which medications are the primary form of intervention ○ INCREASE IN EFFECIENCY & COST-EFFECTIVENESS OF CARE - Directed for patients who need both psychological treatment & medication Individuals often enlist more than one mental health professional ○ PSYCHIATRIST - For medications ○ CLINICAL PSYCHOLOGIST - For cognitive-behavioral treatment ○ COMPETITIVE ADVANTAGE FOR CLINICAL PSYCHOLOGISTS - Provide an advantage to clinical psychologists over other health care professionals - A natural progression for clinical psychology to become a “full-fledged” health care profession rather than just a mental health care profession  ○ QUALIFICATION OF CLINICAL PSYCHOLOGISTS - Psychologists are most qualified to consider psychopharmacological treatment as an adjunctive option to psychosocial treatment Due to their unique training Psychologists have longer sessions with clients Compared to psychiatrists ○ 50 minutes with clients vs 15 minutes with clients Psychologists developed a more thorough understanding of their client’s psychological symptoms Using an empirical approach to monitor their client’s symptoms Using repeated evidence based assessments to track symptoms over different types of treatment or varying doses of medication Psychologists with prescription privileges also are most likely to be able to offer “combined” treatment since they would be thoroughly trained in both approaches Combined treatment is more efficacious ○ Compared to either psychosocial or psychopharmacological alone for a variety of disorders in adults and youth CONS OF PRESCRIPTION PRIVILEGES DE-EMPHASIS OF “PSYCHOLOGICAL” FORMS OF TREATMENT - Medications are often faster acting and potentially more profitable than psychotherapy - A conceptual shift may occur, with biological explanations of emotional conditions taking precedence over psychologi- cal ones DAMAGE CLINICAL PSYCHOLOGY’S RELATIONSHIP WITH PSYCHIATRY & GENERAL MEDICINE - May lead to lawsuits May turn into a financial burden - Granting of prescription privileges would likely lead to increases malpractice liability costs MORE DRUG COMPANY-SPONSORED RESEARCH - Many fear that the introduction of a vested party into the scientific research process may contaminate current scientific practices in psychology IMPLICATIONS FOR TRAINING RECOMMENDED COMPETENCE CRITERIA FOR TRAINING PSYCHOLOGIS TO PROVIDE PSYCHOTROPIC MEDICATION SERVICES [Ad Hoc Task Force, 1993] ○ [Level 1] BASIC PHARMACOLOGY TRAINING - Competence in:  NEUROPSYCHOPHARMACOLOGY - Biological basis MEDICATION USED FOR TREATMENT - Including knowledge of abused substances PSYCHOPHARMACOLOGY - At least a one-semester survey course ○ [Level 2] COLLABORATIVE PRACTICE - Competence in: PSYCHOPHARMACOLOGY CONSULTANCY - Involve a more in-depth knowledge of psychopharmacology and drugs of abuse Diagnostic assessment Physical assessment Drug interactions Drug side effect PRACTICAL TRAINING IN PSYCHOPHARMACOLOGY RECOMMENDED COURSEWORK IN RELATED AREAS PRACTICAL TRAINING IN RELATED AREAS ○ [Level 3] PRESCRIPTION PRIVILEGES - Competence to practice independently as a prescribing psychologist UNDERGRADUATE BACKGROUND IN BIOLOGICAL SCIENCES 2 YEARS OF GRADUATE TRAINING IN PSYCHOPHARMACOLOGY POST-DOCTORAL PSYCHOPHARMACOLOGY RESIDENCY EFFECTS OF GRADUATE TRAINING BASED ON THE RECOMMENDED COMPETENCE CRITERIA ○ LONGER TIME TO COMPLETE GRADUATE SCHOOL - Due to additional course requirements - Additional faculty would need to be hired to teach the new required courses Most of these courses are not currently offered in clinical psychology graduate programs ○ MORE COURSEWORK - The average graduate student of clinical psychology has completed significantly less coursework in the physical sciences than psychiatric residents Programs that seek to prepare psychologists for prescribing at a later point in their career may screen out applicants who do not have a good foundation in undergraduate courses in the physical sciences ○ MAJOR CHANGE IN THE NATURE OF CLINICAL PSYCHOLOGY CHAPTER 3E: CURRENT ISSUES IN CLINICAL PSYCHOLOGY - TECHNOLOGICAL INNOVATIONS & CULTURALLY SENSITIVE MENTAL HEALTH SERVICES TELEHEALTH - Delivery and oversight of health services using telecommunication technologies Assessing, evaluating, treating psychological & behavioral problems through websites, emails, telephones, online videoconferencing, & transmitting medical images ○ ADVANTAGES OF TELEHEALTH Increased accessibility to services More efficiency in service delivery Reducing stigma Ability to obtain expert consultations in a more expeditious manner ○ APPLICATIONS OF TELEHEALTH RURAL POPULATION - Where services are harder to obtain due to distance and number of local providers INSTITUTIONALIZED POPULATIONS - Such as prisoners INDIVIDUALS WHO ARE NOT YET READY FOR SERVICES AMBULATORY ASSESSMENT - Involves assessing the emotions, behaviors, and cognitions of individuals as they are interacting with the environment in real time Motivation is due to the deficiency of individuals with their memory and report of past personal experiences Including moods, events, and behavior - Clinical psychologists typically rely on questionnaires and interviews that require retrospective assessment of clinical symptoms and conditions ○ ADVANTAGES OF AMBULATORY ASSESSMENT ONLY LITTLE RETROSPECTION FROM CLIENT MORE ECOLOGICALLY VALID - Ratings & assessments are collected on the client’s experiencing their natural environment ○ More likely to generalize to the client’s typical experience than are retrospective assessments gathered in the clinician’s office MULTIPLE ASSESSMENTS ON THE SAME CLIENT - Enabling the clinician to explore the variability of moods states within each individual MULTIPLE FORMS OF AMBULATORY ASSESSMENT - Focusing on different response domains ○ Can be conducted & combined for the single client - May include data in three realms such as psychological, psychophysiological, & behavioral data  EASILY INCORPORATED WITH TREATMENT - Begins to blur the boundaries between ambulatory assessment and treatment ESTABLISHING BASELINE FUNCTIONING - To monitor progress throughout the course of treatment ALERTS TO THERAPIST - From certain responses to an electronic diary or smart phone survey ○ Like triggers - Leads to some coaching or instruction provided to the client COMPUTER-ASSISTED THERAPY - Less stigmatizing, more efficient, more accessible, and more convenient for clients ○ REASONS FOR COMPUTER-ASSISTED THERAPY UNCOMFORTABLE CLIENTS - More willing to initiate a treatment contact if this can occur in the privacy of the clients’ own choosing LACK OF ACCESSIBILITY & INCOVENIENCE - To the extent clients are able to access mental health services from any location that has telephone or Internet service - Effective in cognitive therapy [Wright et al., 2005] and behavior therapy [Bickel et al., 2008] CULTURALLY SENSITIVE MENTAL HEALTH SERVICES - Urgency in developing mental health services that effectively serve the needs of cultural, racial, and ethnic minorities Essential to develop training programs that produce therapists who have learned to consider appropriate cultural factors in their clinical work with culturally diverse client ETHNICITY ○ GUIDELINES ON MULTICULTURAL EDUCATION, TRAINING, RESEARCH, PRACTICE, & ORGANIZATIONAL CHANGE FOR PSYCHOLOGISTS [APA, 2003] Make a commitment to cultural awareness As well as knowledge of self and others as cultural beings Recognize the importance of multicultural sensitivity Integrate multiculturalism & diversity into education and training Recognize the importance of culture in psychological research and clinical work ○ CULTURAL COMPETENCE - Knowledge and appreciation of other cultural groups and the skills to be effective with members of these group  MAJOR CHARACTERISTICS OF CULTURAL COMPETENCE SCIENTIFIC-MINDEDNESS - Formulate and test hypotheses regarding the status of their culturally different clients DYNAMIC SIZING - Skilled in knowing “when to generalize and be inclusive and when to individualize and be exclusive” - Allows the clinician to avoid stereotypes but still appreciate the importance and influence of the culture CULTURE-SPECIFIC EXPERTISE - Understand one’s own culture and perspectives, have knowledge of the cultural groups with whom they work, & be able to use culturally informed interventions GENDER ○ GENDER ISSUES IN PSYCHOLOGY Some diagnostic criteria may be applied in a biased way, depending on the biological sex of the client Women & girls are more likely to: Experience a traumatic event & oppression More vulnerable to sexually transmitted diseases More likely to be victims of violence Need for sensitivity to the experience of girls and women when providing psychological services ○ RECOMMENDATIONS TO ADDRESS GENDER ISSUES [APA, 2007] Use treatment interventions that have been shown to be effective with girls and women When providing treatment, promote empowerment and a range of choices Be sensitive to the issue of sex bias when conducting assessment and formulating a diagnosis Become familiar with and utilize community resources for girls and women during treatment CHAPTER 3F: CURRENT ISSUES IN CLINICAL PSYCHOLOGY - ETHICAL STANDARDS ETHICAL STANDARDS [APA, 2002] BENEFICIENCE & NON-MALEFICENCE FIDELITY & RESPONSIBILITY INTEGRITY  JUSTICE RESPECT FOR PEOPLE’S RIGHTS & DIGNITY OTHER ETHICAL STANDARDS COMPETENCE - Practice only based on acquired training & competency PRIVACY & CONFIDENTIALITY - Always establish consent and confidentiality HUMAN RELATIONS - Avoid having a relationship outside clinician-client relationship ○ CLIENT WELFARE CHAPTER 4A: RESEARCH METHODS IN CLINICAL PSYCHOLOGY - METHODS PURPOSES OF RESEARCH ESCAPE FROM SPECULATION/APPEAL TO AUTHORITY - Research procedures enable us to: ○ Accumulate facts ○ Establish the existence of relationships ○ Identify causes & effects ○ Generate the principles behind those facts & relationships EXTEND & MODIFY THEORIES - Establish the parsimony & utility of theories ○ THEORY - Stimulates & guides the research - Also modified by the outcomes of research ENHANCE OF ABILITY TO PREDICT & UNDERSTAND BEHAVIOR, FEELINGS, & THOUGHTS OF PEOPLE OBSERVATION - Most basic and pervasive of all research methods Experimental, case study, & naturalistic approaches all involve making observations of what someone is doing or has done UNSYSTEMATIC OBSERVATION (Casual Observation) - Utilized to develop hypotheses that can eventually be tested more systematically NATURALISTIC OBSERVATION - Limited to a relatively few individuals or situations Carried out in real-life settings - No real control exerted by the observer freely flowing events Relies on freely flowing events - May be uncertain how far one can generalize to other people or other situations Observer may unwittingly interfere with or influence the events under study - More systematic & rigorous than unsystematic observation - A source of hypotheses that can be subjected to careful scrutiny later  Bring investigators closer to the real phenomena that interest them Observations avoid the artificiality and contrived nature of many experimental settings CONTROLLED OBSERVATION - Investigator exerts some degree of control over the events - Utilized to deal with the criticisms of unsystematic & naturalistic observation CASE STUDIES - Involves the intensive study of a client or patient who is in treatment Intensive study and description of one person - Include material from interviews, test responses, and treatment accounts Might also include biographical and autobiographical data, letters, diaries, life-course information, medical histories, and so on - Have long been prominent in the study of psychological problems and in the description of treatment methods Richness as potential sources of understanding and as hypothesis generators ○ ADVANTAGES OF CASE STUDIES Providing descriptions of rare or unusual phenomena or novel, distinctive methods of interviewing, assessing, or treating patients Disconfirming “universally” known or accepted information Generating testable hypotheses ○ DISADVANTAGE OF CASE STUDIES Difficult to use individual cases to develop universal laws or behavioral principles EPIDEMIOLOGICAL METHODS - Study of the incidence, prevalence, and distribution of illness or disease in a given population ○ INCIDENCE - Rate of new cases of illness that develop within a given period of time Some sense of whether the rate of new cases of the illness or disorder is on the increase ○ PREVALENCE - Overall rate of old or new cases within a given period Estimate what percentage of the target population is affected by the illness or disorder EPIDEMIOLOGY IN MEDICAL RESEARCH - Help understand and control the major epidemic diseases  - Identify the causes of a particular disease and the methods by which it spreads through: Analyzing the distribution of cases in a community or region Uncovering the distinguishing characteristics of the affected individuals or groups - Important in identifying groups of individuals who are at risk MULTIPLE CAUSATION IN EMPIDEMIOLOGY - Several factors must be present before the disease occurs Greater the number of associated factors that are present, the greater the risk of the disease - Obtained correlations suggest causes rather than definitively prove causation METHODS IN CONDUCTING EPIDEMIOLOGICAL STUDY - Based on survey & interviews However, objective methods of defining and measuring a problem - Some respondents may be asked to remember things from several years ago Such retrospective data can be subject to all sorts of distortions, omissions, or embellishments