Reuben Psych 3445 - Class 4 - 1.23.25 PDF

History + Current Issues in Clinical Psychology PSYCH 3445 - SPRING 2025 Class 4 – January 23, 2025 Questions, comments, concerns? Quiz time! A. 12% B. 19% C. 24% 1. What percent of clinical D. 47% psychologists are employed in private practice? 2. What are 3 differe...

History + Current Issues in Clinical Psychology PSYCH 3445 - SPRING 2025 Class 4 – January 23, 2025 Questions, comments, concerns? Quiz time! A. 12% B. 19% C. 24% 1. What percent of clinical D. 47% psychologists are employed in private practice? 2. What are 3 differences between a psychologist and a psychiatrist? Psychologist Psychiatrist ? ? 3. Which of these is not a type of clinical psychology training model? Clinical Scientist Scientist practitioner Practitioner scholar 4. Which of these is “Vail” and which is “boulder?” Clinical Scientist Scientist practitioner Practitioner scholar  3. Which of these is not a type of clinical psychology training model? Clinical Scientist Scientist practitioner Practitioner scholar Producing clinical science Implementing clinical science Psychology in the 20th century First clinic = 1904 but limited expansion of clinical work  Psychology in the 20th century That changed with World War I  Psychology in the 20th century That changed with World War I Before the war America had a smaller army than Romania! It would grow 32x before the end of the war (to 4 million soldiers)  Psychology in the 20th century That changed with World War I Acute need to screen, classify, and assign soldiers led to:  Psychology in the 20th century That changed with World War I Acute need to screen, classify, and assign soldiers led to: Army Alpha test (verbal IQ) Army Beta test (nonverbal IQ) Woodsworth Personal Data Sheet (first formal personality test)  Sample Army Alpha items 1. A company advanced 6 miles and retreated 2 miles. How far was it then from its first position? 2. A dealer bought some mules for $1,200. He sold them for $1,500, making $50 on each mule. How many mules were there? 3. Thermometers are useful because a) They regulate temperature b) They tell us how warm it is c) They contain mercury 4. A machine gun is more deadly than a rifle, because it a) Was invented more recently b) Fires more rapidly c) Can be used with less training  Sample Army Beta items Identify what is missing from each picture  Psychology in the 20th century After the war New interest in testing adult function Clinicians gradually added some treatment to supplement their assessments  Psychology in the 20th century After the war New interest in testing adult function Word Association Test (1919) Rorschach (1921) Miller Analogies Test (1926) Thematic Appreciation Test (1935) Bender-Gestalt Test (1938) Wechsler-Bellevue Test of Intelligence (1939) Thematic Appreciation Test (1935) Thematic Appreciation Test (1935) A “projective test” Designed for individuals to reveal attitudes, feelings, conflicts, and personality by the stories they make up The Rorschach Inkblot Test (1921) is a projective assessment in which subjects look at 10 ambiguous images and describe what they see https://www.youtube.com/watch?v=LYi19-Vx6go&t=117s Wechsler-Bellevue Test of Intelligence (1939) Aimed to measure adult intelligence Has evolved to become the gold standard cognitive / IQ test: The Wechsler Adult Intelligence Scale (WAIS) Psychology in the 20th century By the late 1930s ○ Some practitioners providing psychotherapy (mostly to kids) ○ Clinical psych still not recognized as profession No official training programs Few PhDs or master’s degree holders Little support from universities ○ Most treatments applied by psychiatrists 24 December 8, 1941 Acute need to screen, classify, and assign soldiers! Acute need to screen, classify, and assign soldiers! Over 60 million aptitude tests would be given before the war ended 28 29 Acute need for psychological treatment after the war 30 Acute need for psychological treatment after the war ~50,000 soldiers returned with neuropsychiatric, trauma, and stressor- related conditions  Va supports the profession After the war the Veterans Administration injects new life into the profession First VA clinical internships offered VA grants to psychology departments for training clinicians  Things happen quickly 1945: First state passes licensing law for clinical psychology (Connecticut) 1946: VA asks universities for formal training programs 1949: Boulder Conference establishes clinical psych (PhD) guidelines 1953: APA establishes ethics code for clin psych  Things happen quickly 1945: First state passes licensing law for clinical psychology (Connecticut) 1946: VA asks universities for formal training programs 1949: Boulder Conference establishes clinical psych (PhD) guidelines 1953: APA establishes ethics code for clin psych  Things happen quickly 1945: First state passes licensing law for clinical psychology (Connecticut) 1946: VA asks universities for formal training programs 1949: Boulder Conference establishes clinical psych (PhD) guidelines 1953: APA establishes ethics code for clin psych 1950’s = growth of new therapies Freud’s psychanalysis grows into Psychodynamic Therapy ○ Jung, Erikson, Kohut Framework: Illness arises from conflict between internal urges and external constraints Goal: Use free-association to let the patient uncover deep emotional conflicts 1950’s = growth of new therapies Freud’s psychanalysis grows into Psychodynamic Therapy ○ Jung, Erikson, Kohut Illness arises from conflict between internal urges and external constraints Goal: Use free-association to let the patient uncover deep emotional conflicts  1950’s = growth of new therapies Behaviorism as a subfield of psychology leads to effective Behavioral Therapies (The “First Wave”) ○ Classical Conditioning (Pavlov) (1897) ○ Operant Conditioning (Skinner) (1938) ○ Systematic Desensitization (Wolpe) (1958) 1950’s = growth of new therapies Behaviorism as a subfield of psychology leads to effective Behavioral Therapies (The “First Wave”) ○ Classical Conditioning (Pavlov) ○ Operant Conditioning (Skinner) ○ Systematic Desensitization (Wolpe) Problems are learned behaviors – so are solutions 39 Classic behavioral examples Fear conditioning: ○ “Little Albert” trained to fear a laboratory rat (Watson and Rayner) Fear extinction: ○ 3-year-old “Peter” trained to not fear a laboratory rabbit 40 Pioneered by Mary Cover Jones 1950’s = growth of new therapies Humanistic / Client-centered Therapy 1950’s = growth of new therapies Humanistic / Client-centered Therapy ○ Carl Rogers Problems are based on how we view the world 1950’s = growth of new therapies Humanistic / Client-centered Therapy ○ Carl Rogers https://www.youtube.com/watch?v=mmgOxMsBaJI 1950’s-60’s = growth of new empirical studies First efficacy studies – Do these therapies work under controlled, laboratory conditions? First effectiveness studies – Do these therapies work in the real world? First meta-analyses – Do these therapies work across multiple studies? 45 1950’s: Start of deinstitutionalization 46 1950’s: Start of deinstitutionalization 1955: Invention of first antipsychotic drug Chlorpromazine kick starts the process of moving psychiatric patients out of asylums Chlorpromazine 47 1950’s: Start of deinstitutionalization 1955: Invention of first antipsychotic drug Chlorpromazine kick starts the process of moving psychiatric patients out of asylums Chlorpromazine 48 1950’s: Start of deinstitutionalization Psychiatric hospitals closed and patients moved to: ○ Home, halfway homes, and group homes, ○ Regular hospitals and short-stay clinics ○ The streets (unhoused) 49 1950’s: Start of deinstitutionalization In 1955: There were 340 psychiatric hospital beds for every 100,000 Americans. In 2005: There were 17 per 100,000. 50 The results were mixed The good: ○ Growth of more diverse, community- oriented, and humane treatment settings ○ Realization that many patients could have richer more independent lives outside the asylum 51 The results were mixed The bad: ○ Uncoordinated, underfunded efforts to accommodate former patients left shocking numbers of mentally unwell on the streets – or worse 52 https://www.youtube.com/watch?v=St3431QCfUA 53 The results were mixed The bad: ○ Uncoordinated, underfunded mixed efforts left shocking numbers of mentally unwell on the streets – or worse 54 The results were mixed The bad: ○ Uncoordinated, underfunded mixed efforts left shocking numbers of mentally unwell on the streets – or worse 55 To learn more, skim the 2022 report of the American Psychiatric Association 1960s-’70s = growth of new therapies Cognitive Therapy (The “Second Wave”) Framework: “Our thoughts, interpretations, and perceptions of things (cognitions) influence our feelings and actions.” Goal: “search and destroy” distorted, exaggerated, or unhelpful cognitions that drag down our mood or stimulate fear and anxiety 1960’s = growth of new therapies Cognitive Therapy (The “Second Wave”) ○ George Kelly ○ Albert Ellis ○ Aaron Beck https://www.youtube.com/watch?v=xrX43cCW6uE 58 Common cognitive distortions 59 Common cognitive distortions 60 1990’s Growth of Therapies An appreciation of the role of social systems ○ Culture, identify, social roles, discrimination An appreciation of the role of biology ○ Hormones, genes, environmental exposures Now thought of as bio-psycho-social frameworks 61 62 Vulnerability + 63 Late 1990’s Growth of Therapies Cognitive Behavioral Therapies branch out and expand (The ”Third Wave”) Goal: Holistic promotion of health and well- being over the mere reduction or elimination of symptoms Inspired by positive psychology movement (the science of “happiness”) 64 Late 1990’s Growth of Therapies Newer, 3rd wave CBTs incorporate: ○ A focus on the function and context of behaviors ○ Bio-psycho-social frameworks ○ Mindfulness techniques ○ Acceptance 65 66 https://www.youtube.com/watch?v=c1Ndym-IsQg  Current Issues in Clinical Psychology Current issues 01 02 03 Managed care Rx Privileges Changing landscape of practice 04 05 06 Social media Loneliness Climate change 01 Changing landscape of practice 70 Changing landscape of practice Hard truth: 71 Changing landscape of practice Hard truth: you don’t need a PhD to be an effective psychotherapist 72 Changing landscape of practice Good therapy is being increasingly provided by: ○ Guidance, school, rehab counselors ○ Social workers ○ Psychiatric nurses and PAs ○ Etc. 73 Changing landscape of practice Hard truth: face-to-face treatments are not getting the job done 74 Changing landscape of practice Hard truth: face-to-face treatments are not getting the job done ○ Untreated patients ○ Difficult to prevent illness this way  Brainstorm Turn to the person next to you and discuss: 1. Can you think of some alternatives to face-to-face therapy that could either treat more patients or help prevent illness in the first place? 76 Changing landscape of practice Alternative approaches listed by our book: ○ More psychotherapy aides (bachelor’s level) ○ Phone apps ○ Online self-instruction materials ○ More group therapy 77 78 79 80 Changing landscape of practice Other alternative approaches to improve mental health? ○ Universal basic income ○ Universal healthcare ○ Public daycare ○ Paid family and parental leave 81 Changing landscape of practice Other alternative approaches to improve mental health? ○ Universal basic income ○ Universal healthcare ○ Public daycare ○ Paid family and parental leave 02 Managed care 83 Managed care Since 1980s healthcare in US shifted: ○ From non-profit hospital model Patient pays doctor or hospital ○ To for-profit health insurance. Patient pays insurer. Insurer pays doctor (sometimes). 84 Managed care The good: Widely credited with subduing medical cost inflation in the 1980s by ○ Reducing unnecessary hospitalizations, ○ Forcing provider discounts ○ Creating a more efficient and competitive industry 85 Managed care The bad: ○ Cost-control efforts are driven by the need to generate profits ○ Perverse incentive to deny care ○ Providers have less time with patients ○ Patients find it harder to see providers ○ Costs haven’t really come down 86 Managed care The bad: ○ Cost-control efforts are driven by the need to generate profits ○ Perverse incentive to deny care ○ Providers have less time with patients ○ Patients find it harder to see providers ○ Costs haven’t really come down 87 88 89 One good advancement 2008’s Mental Health Parity and Addiction Equity Act (MHPAEA) Requires health insurance plans to provide similar coverage for mental health and substance use disorders as they do for medical and surgical benefits 90 One good advancement 2008’s Mental Health Parity and Addiction Equity Act (MHPAEA) Requires health insurance plans to provide similar coverage for mental health and substance use disorders as they do for medical and surgical benefits 03 Prescription privileges for clinical psychologists 92 Rx Privilege (RxP) Argument in favor ○ This would dramatically expand treatment ○ Psychologists are in a good position to monitor Rx effectiveness ○ It’s not difficult to train PhDs to understand benefits / risks / side effects 93 Rx Privilege (RxP) Argument against ○ This would shift psychologists from skills to pills Less psychotherapists More medication managers ○ Insufficient training to protect patient health 94 As of 2023 6 states grant RxP 7 states had RxP bills pending 6 states had “significant activity” towards RxP 95 As of 2023 6 states grant RxP 7 states had RxP bills pending 6 states had “significant activity” towards RxP 04 Youth mental health and social media 97 2023 US Surgeon General’s Advisory report 98 2023 US Surgeon General’s Advisory report 95% of teens (age 13-17) use social media. 1/3 say they use it "almost constantly". 99 Is this a problem? Teenage is a time of: ○ Intense development in the brain’s reward and threat processing networks ○ Social comparison and identity formation 100 It is a hotly debated topic 101 It is a hotly debated topic 102 05 Climate change The world is changing Specifically, it is aging, urbanizing, and warming 104 Risks from environmental hazards are growing Climate driven storms, droughts, fires, heat waves Infrastructure failures Loss of biodiversity Accumulation of pollutants in urban areas 105 What have been your climate experiences? What have been your climate experiences? 108  Take a moment Consider your own experiences with climate change 1. How has it influenced your mental health? 2. What are your biggest concerns for the future? “normal” responses Eco-depression Solastalgia Climate anxiety “normal” responses Eco-depression ○ A feeling of being overwhelmed by the potential ecological and environmental disaster that climate change is creating, resulting in periods of hopelessness and helplessness. Solastalgia Climate anxiety “normal” responses Eco-depression Solastalgia ○ A form of emotional or existential distress caused by environmental change. Climate anxiety “normal” responses Eco-depression Solastalgia Climate anxiety ○ A chronic fear of the environmental consequences of climate change ”normal” responses Eco-depression Solastalgia Climate anxiety 10,000 youth from 10 country survey 116 117 Cosh’s conclusions: We need to equip mental health care workers with skills and knowledge to address the impacts of climate change. Mental health professionals need to integrate environmental factors into their clinical practice. 06 Loneliness 119 120 121 Brief Reflection There are 2 clinical psychology degrees (PsyD and PhD) and 2 training models Which one appeals to you more? Why? If you were seeking services, would it matter to you which training your psychologist received? That’s it for today!