Introduction To Clinical Psychology PDF

**INTRODUCTION TO CLINICAL PSYCHOLOGY** Clinical Psychology - as a field is rather difficult to define in a precise way since the activities of clinical psychologists vary greatly. - (APA) psychological specialty that provides continuing and comprehensive mental and behavioral health care fo...

**INTRODUCTION TO CLINICAL PSYCHOLOGY** Clinical Psychology - as a field is rather difficult to define in a precise way since the activities of clinical psychologists vary greatly. - (APA) psychological specialty that provides continuing and comprehensive mental and behavioral health care for individuals, couples, families, and groups; consultation to agencies and communities; training, education, and supervision; and research-based practice. - specialty in breadth --- one that addresses a wide range of mental and behavioral health problems--- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities, and varied systems. ***Professions in psychology:*** 1. PSYCHIATRISTS - attend medical school and earn an MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine) degree. They can go on for additional, specialized training in psychiatry during a residency (an additional three to four years). - Training for psychiatrists focuses primarily on the biological aspects of mental illness. Because of their medical training, psychiatrists can prescribe medications, and their work with clients may include talk therapy combined with medications. 2. COUNSELING PSYCHOLOGISTS - Counseling Psychology uses a broad range of culturally informed and culturally sensitive practices to help people improve their well-being, prevent and alleviate distress and maladjustment, resolve crises, and increase their ability to function better in their lives. - It focuses specifically but not exclusively on normative life-span development, with a particular emphasis on prevention and education as well as amelioration, addressing individuals as well as the systems or contexts in which they function. It has particular expertise in work and career issues. 3. SOCIAL WORKERS - specialize in dealing with issues that come from the environment. They are trained to perform psychotherapy, with a particular emphasis on connecting people with the community and support services available there. 4. SCHOOL PSYCHOLOGISTS - uniquely qualified members of school teams that support students\' ability to learn and teachers\' ability to teach. They apply expertise in mental health, learning, and behavior, to help children and youth succeed academically, socially, behaviorally, and emotionally. 5. PSYCHIATRIC NURSES - specially trained nurses who care for the psychological and physical well-being of people with mental health conditions or behavioral problems. **Historical Roots** The reform movements in the 19th century ultimately resulted in improved care for the mentally ill and such improvements fostered the emergence of the mental health professions as we know them today. The following are some of the major figures that contributed to this development. 1. PHILIPPE PINEL - often said to be the father of modern clinical psychiatry. - most famous for being a committed pioneer and advocate of humanitarian methods in the treatment of the mentally ill, and for the development of a mode of psychological therapy known as moral treatment. 2. DOROTHEA LYNDE DIX - American advocate on behalf of the indigent mentally ill who, through a vigorous and sustained program of lobbying state legislatures and the United States Congress, created the first generation of American mental asylums. 3. LIGHTNER WITMER - began the current model of clinical psychology by opening the first psychological clinic in 1896. - The term clinical psychology was first used by Witmer in print in 1907 in their first psychological journal, called The Psychological Clinic. 4. EMIL KRAEPELIN - German psychiatrist who theorized that biological abnormalities and genetic mutations were the primary causes of psychiatric conditions. - He is widely considered the father of modern psychiatry. Kraepelin was directly responsible for today's classification system of mental disorders. - One of his most significant achievements was in the identification and distinction of two specific disorders: manic depression and dementia praecox, later termed schizophrenia, as distinct forms of psychosis. 5. JOSEF BREUER & SIGMUND FREUD - Breuer and Freud\'s collaboration on the case of Anna O (Bertha Pappenheim) led to the theoretical breakthroughs that greatly influence psychotherapy practice for years to come. - Their Studies on Hysteria book served as a launching pad for psychoanalysis - one of the most influential theoretical and treatment development in the field\'s history. Freud also made use of dream interpretation and hypnosis. 6. CARL ROGERS - widely regarded as one of the most eminent thinkers in psychology. - best known for developing the psychotherapy method called client-centered therapy and for being one of the founders of humanistic psychology. **Roadmap to Become a Licensed Clinical Psychologist** DEGREE LEVEL: Masters Degree in Clinical Psychology / PhD in Clinical Psychology DEGREE FIELD: Clinical Psychology LICENSURE: Psychologist Board Examination (PRC) EXPERIENCE: Varies by employer, can range from 1-2 years KEY SKILLS: Communication, observation, and analytical skills; work well with others; maintain patient confidentiality; knowledge of statistical, testing, and medical software SUCCESS TIPS: Look for opportunities to gain research experience. Undergraduates who work as research assistants have the opportunity to learn about scientific methods, explore their research interests and develop relationships with professors who can write letters of recommendation for their graduate school applications. ***Activities of a Clinical Psychologist:*** Clinical psychologists - work in out-patient and in-patient mental healthcare facilities, private practices, and academic settings. 1. DIAGNOSIS/ ASSESSMENT - Generally, psychologists are the only mental health professionals who administers psychological tests. Clinical Psychologists not only conduct psychological evaluations with individuals to assess intellectual, educational, personality and neuropsychological functioning but also assess groups of people (e.g.families) and even organizations. Many clinical psychologists use psychological tests and procedures to assess or diagnose various psychiatric as well as nonpsychiatric issues. 2. THERAPY/ INTERVENTION - Psychotherapy may involve individuals, couples, families and groups and address an endless array of target problems. Anxiety, phobias, depression, shyness, physical illness, loss, trauma, drug addiction, eating difficulties, sexuality concerns, hallucinations, relationship problems and work difficulties may all prompt individuals to seek psychological treatment. 3. TEACHING - Some clinical psychologists also work as full-time or part-time teachers. They may also teach informal classes or do orientation work with other mental health personnel. Some of them who are in the clinical setting may also go out into the community and lead workshops on various topics for different members of the community. 4. RESEARCH - foundation of all psychology activities just as how it provides the basis and direction for all professional activities. Research findings help determine which assessment or treatment approach might be most effective for a particular clinical problem such as depression, anxiety, eating disorders or substance abuse problems. 5. CLINICAL SUPERVISION - form of teaching which typically involves more one-on-one teaching, small group approaches, and other less formal, non-classroom varieties of instruction. It also involves seeing clients and then discussing their cases with a more experienced supervisor. In short, one learns by doing, but under the controlled and secure conditions of a trainee--supervisor relationship. 6. CONSULTATION - Many clinical psychologists provide consultation to churches, health care professionals, businesspersons, schools, lawmakers, organizations and even to other mental professionals. Consultation might involve an informal discussion, brief report or a more ongoing and formal consultation arrangement. **Subspecialties in Clinical Psychology** 1. CHILD PSYCHOLOGY - Child clinical-specialize working with both children and families in hospital settings where the child has a significant medical disorder. These medical problems might include cancer, epilepsy, diabetes, neurological disorder, and disabilities. - May offer pain management strategies to a child while helping the family cope more effectively with and locate community resources. - He may act as a consultant to various medical illnesses in children. 2. CLINICAL HEALTH PSYCHOLOGY - Works to help healthy people to stay healthy and assist people with various illnesses or risk factors to cope more effectively with their symptoms. - Works with individuals and groups in order to maximize health-enhancing behaviors (exercise, low-fat consumption) and minimize health-damaging behaviors. 3. CLINICAL NEUROPSYCHOLOGY - focuses on brain-behavior relationships. - Neuropsychologists assess brain and behavioral functioning and offer strategies for patients suffering from brain impairment due to a large range of problems such as dementia, head injuries, tumors, autism, stroke, AIDS, Alzheimer's disease, epilepsy and other problems that result in cognitive and neurological dysfunction. 4. FORENSIC PSYCHOLOGY - application of psychology to legal issues. May conduct psychological evaluations with defendants and present their findings as an expert witness in court. It is often focused on the criminals themselves. Professionals in this field are often given the ominous responsibilities of trying to figure out why certain types of people commit crimes; what type of person committed a crime; and how to prevent people from committing crimes. 5. GERIATRIC PSYCHOLOGY - subspecialty within clinical psychology that deals with the specific needs and concerns of older adults. - Geropsychologists focus primarily on the continued physical, mental, social, and emotional development of older adults. - These professionals work with older adults and their families or other caregivers to provide assessment and treatment of those issues that affect older adults, such as cognitive function and depression, and to improve the quality of life of older adults and their caregivers. **DIAGNOSIS AND CLASSIFICATION OF PSYCHOLOGICAL PROBLEM** Abnormal Behavior - 'behavior that is atypical or statistically uncommon within a particular culture or that is maladaptive or detrimental to an individual or those around that individual. ***DSM V-TR Criteria for Abnormal Behavior:*** 1. MALADAPTIVE BEHAVIOR - actions intended to help relieve or avoid stress, but they are often disruptive and interfere with a person\'s ability to adapt to and function within society. 2. PERSONAL DISTRESS - occurs when an individual engages in abnormal behavior due to some type of difficulty that they are experiencing 3. STATISTICAL RARITY - refers to someone who is atypical in some way, and because of that, they are engaging in behavior that is considered abnormal 4. VIOLATION OF SOCIAL NORMS - when a person\'s behavior becomes patently deviant, outrageous, or nonconforming, it is classified as abnormal. ***4 Ds:*** 1. Deviance 2. Distress 3. Dysfunction 4. Danger ***DSM-5 TR UPDATES:*** a. Published by the American Psychiatric Association (2022) b. Official classification system in the USA c. Provides standard language for clinicians, researchers, and public health officials to communicate about mental disorders *DSM-5 TR SECTION I: BASICS* - The creation of the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was a massive undertaking that involved hundreds of people working toward a common goal over a 12-year period. - DSM-5 strives to fulfill the need of clinicians, patients, families, and researchers for a clear and concise description of each mental disorder, which has been operationalized using diagnostic criteria that are supplemented by dimensional measures of severity and is accompanied by a digest of information about the diagnosis, including risk factors and culture and sex- and gender-related issues. - To accurately assess potential signs and symptoms of psychopathology, clinicians should routinely consider the impact of cultural meanings, identities, and practices on the causes and course of illness. - During the DSM-5-TR review process, steps have been taken to address the impact of culture, racism, and discrimination on psychiatric diagnosis in the text of the disorder chapters. - DSM-5-TR contains a new text section for each diagnosis, "Association With Suicidal Thoughts or Behavior," - A mental disorder is a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. - Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. - Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above. *SECTION II: DIAGNOSTIC AND CRITERIA CODE* +-----------------------+-----------------------+-----------------------+ | - Neurodevelopmenta | - Somatic Symptom | - Neurocognitive | | l | and Related | Disorders | | Disorders | Disorders | | | | | - Personality | | - Schizophrenia | - Feeding and | Disorders | | Spectrum and | Eating Disorders | | | Other Psychotic | | - Paraphilic | | Disorders | - Elimination | Disorders | | | Disorders | | | - Bipolar and | | - Other Mental | | Related Disorders | - Sleep-Wake | Disorders and | | | Disorders | Additional Codes | | - Depressive | | | | Disorders | - Sexual | - Medication-Induce | | | Dysfunctions | d | | - Anxiety Disorders | | Movement | | | - Gender Dysphoria | Disorders and | | - Obsessive-Compuls | | Other Adverse | | ive | - Disruptive, | | | and Related | Impulse-Control, | - Effects of | | Disorders | and Conduct | Medication | | | Disorders | | | - Trauma- and | | - Other Conditions | | Stressor-Related | - Substance-Related | That May Be a | | Disorders | and Addictive | Focus of Clinical | | | Disorders | Attention | | - Dissociative | | | | Disorders | | | +-----------------------+-----------------------+-----------------------+ ***ICD-11 (INTERNATIONAL CLASSIFICATION OF DISEASES)*** - Currently on its 11th edition (2019) - Published by the World Health Organization - Comprehensive classification system of medical conditions and mental disorders - Mental disorders (chapter 5) - Official medical & psychiatric nosology used throughout most of the world ***The Major Approaches in Clinical Psychology and Psychopathology*** **THE PSYCHODYNAMIC APPROACH** - Human behavior is derived from the constant struggle between the individual's desire to satisfy inborn sexual and aggressive instincts and the need to respect social rules and realities. - When the conflict between these internal and external forces leads to anxiety, the person uses psychological defenses against it. - If the anxiety becomes too intense, or the defense mechanisms fail, symptoms of psychological disorder can appear. - Freud compared his treatment method to archeology. - Effective therapy helps to make the unconscious conscious, allowing us to understand and gain control over previously inaccessible psychological forces. - Freud's psychoanalysis placed a great deal of emphasis on how early relationships with parents and other childhood experiences shape our sexuality and hence our personality. **HUMANISTIC APPROACH -** It described people not as arenas in which intrapsychic conflicts play themselves out, but as individuals with an innate drive toward personal growth, a tendency for self-actualization. - suggests that psychological disorders occur when a person's natural growth potential is blocked by distorted perceptions of reality or lack of awareness of true feelings. - Therapies are rooted in a philosophy known as phenomenology. **BEHAVIORAL APPROACH -** based on the idea that our personalities and the psychological problems that we may have are a reflection of environmental influences that have shaped how we have learned to behave. - The cases of Albert and Peter encouraged the application of learning principles in the treatment of many other disorders. - Treatments are designed to help people learn new and more adaptive alternative patterns of behavior. **COGNITIVE APPROACH -** behavior is guided mainly by how people think, and especially by how they think about themselves at a conscious level. - These thought patterns, they said, are an important aspect of personality, and because thoughts are so closely linked to emotions, they serve as key factors in the development of psychological disorders. - focus on what and how clients are thinking, and their treatment methods focus on modifying maladaptive behavior by influencing what clients believe, assume, and expect about the world, what they say to themselves, and the cognitions that guide (or misguide) their efforts at problem-solving. **COGNITIVE BEHAVIORAL APPROACH -** both of them focus on assessing and treating clearly defined and specific aspects of human behavior and both emphasize the importance of conducting well-controlled research to evaluate their underlying theories, their assessment techniques, and their treatment methods. **SOCIAL SYSTEMS APPROACHES -** characterized by the clinician's sensitivity to the role of environmental factors, such as experiences of poverty or discrimination, in shaping the client's behavior, mental processes, willingness to seek treatment, and likelihood of responding well to it **BIOLOGICAL APPROACH -** behavioral and psychological effects of hormones, genes, brain activity, and other biological variables. - identify genetic and other biological factors that might increase clients' risk for developing disorders, predict the severity of those disorders, and forecast the likelihood of improvement following psychological and/or drug treatments. - biological factors combine with psychological, social, and cultural ones in causing problems **CLINICAL ASSESSMENT** Clinical Assessment - involves an evaluation of an individual\'s or family\'s strengths and weaknesses, a conceptualization of the problem at hand (as well as possible etiological factors), and some prescription for alleviating the problem; all of these lead us to a better understanding of the client. - Abnormal behavior does not necessarily indicate mental illness. - Mental illness is a large class of frequently observed syndromes that are comprised of certain maladaptive behavior features. Proper and accurate diagnosis is crucial in providing the best help for our clients. REFERRAL - act of directing a patient to a therapist, physician, agency, or institution for evaluation, consultation, or treatment. - Referrals can be done by a parent, friend, teacher, counselor, psychiatrist, judge, or even oneself. ***How does assessment begin:*** 1. Does my child have ADHD, autism, depression, or anxiety? 2. Why can\'t Alicia learn to read like the other children? 3. Is this patient capable of murder? 4. Why is Juan disobedient? 5. "Is \_\_\_\_ normal or does my child need some kind of special support? ***What influences how a clinician addresses the referral question:*** 1. CLINICIAN\'S THEORETICAL ORIENTATION - Theoretical orientation in counseling and psychotherapy essentially refers to what concepts or perspectives a clinician uses to assess, understand, and treat their clients. - Any theory that a clinician uses to guide their practice is their theoretical orientation. 2. CHOICE OF ASSESSMENT INSTRUMENTS - The purpose of assessment is not to discover the \"true psychic essence\" of the client, but to describe that client in a way that is useful to the referral source \-- a way that will lead to the solution of a problem. ***THE CLINICAL ASSESSMENT PROCESS:*** In all cases, clinical assessment activities should be organized in a sequence of systematic, logically related steps driven by a goal. 1. Receiving and Clarifying the Referral Question 2. Planning data collection procedures 3. Collecting Assessment Data 4. Processing Data and Forming Conclusions 5. Communicating Assessment Results ***THE GOALS OF CLINICAL ASSESSMENT:*** 1. Classification and Diagnosis 2. Description 3. Planning and Evaluating Treatment 4. Prediction An 11-year-old boy was brought by his mother for psychological evaluation. The mother reported that the boy is currently observed to be socially withdrawn and would just spend his time playing computer games. There were also reports of unusual behavior such as having no eye contact, remaining quiet while the family is happily chatting, and no interaction with others. Although he was reported as shy during his early childhood years, he was able to interact with some children in the neighborhood. His mother also reported of his marked withdrawal from others happened when he was in his 6 th grade. This occurred after he was bullied and trapped in a room by one of the older children in his school. The client was reported to have had difficulties in school, particularly in Filipino subjects ever since he entered school. The client was adopted and learned about it when he was 6 years old. For developmental milestones, the mother can only remember that he walked and talked at around age 2. During the intake interview, the psychologist clarified with the mother the purpose of the evaluation. It was agreed that they wanted to rule out the presence of possible developmental disorders, or depression and anxiety that might probably be brought about by adoption and phobia. ***What is the important information to address the purpose of evaluation:*** The purpose of the evaluation is to classify if the client has presence of developmental or psychological disorder. 1. Cognitive Skills - it was reported that the client have difficulties in school particularly in Filipino subject. This is important to note to identify whether the child has delay in his ability to think, learn and solve problems. 2. Social and Emotional Skills - the client was reported to be socially withdrawn even with his family. - It was also reported that he experienced bullying when he was in 6th grade which might have affected him negatively. - It was also noted that the client was adopted, and he found out about it at a young age (although it was not mentioned how it was explained to him). 3. Fine and Gross Motor Skills \| Speech & Language Skills - according to the mother, the client walked and talked at around age 2. His possible speech and language delay may also explain his difficulty in Filipino. 4. Activities of Daily Living - the day-to-day experience of the client 5. Personality of the client **Assessment Interview** **Almost all professions count interviewing as a chief technique for gathering data and making decisions. The assessment interview is at once the most basic and the most serviceable technique used by the clinical psychologist. In the hands of a skilled clinician, its wide range of applications and adaptability make it a major instrument for clinical decision-making, understanding, and prediction.** ***General Characteristics of Interviews:*** a. AN INTERACTION - An interview is an interaction between at least two persons. - A clinical interview is initiated with a goal or set of goals in mind. - The interviewer approaches the interaction purposefully, bearing the responsibility for keeping the interview on track and moving toward the goal. b. THE ART OF INTERVIEWING - There is a degree of freedom to exercise one\'s skill and resourcefulness that is generally absent from other assessment procedures. - With experience, one learns to respond to interviewee cues in a progressively more sensitive fashion that ultimately serves the purpose of the interview. c. INTERVIEW vs TESTS - An interview falls between a conversation and an actual psychological test. It is more purposeful and organized than a conversation, but not formal or standardized like a test ***ESSENTIALS AND TECHNIQUES:*** 1. Physical Arrangements - Certain physical arrangements are especially desirable for an interview. a. Two of the most important considerations are privacy and protection from interruptions. 2. Note-taking and Recording - A few key phrases jotted down will help the clinician\'s recall. b. Most patients will not be troubled by it, and if one should be, the topic can be discussed. However, avoid taking verbatim notes as this practice may prevent the clinician from attending fully to the essence of the patient\'s verbalization. **Building Rapport** Rapport -- used to characterize the relationship between patient and clinician. d. It involves a comfortable atmosphere and a mutual understanding of the purpose of the interview. e. Attitudes of understanding, sincerity, acceptance, and empathy are helpful in building a good rapport with patients. ***Skills Or Techniques That Will Ensure Maximum Communication:*** 1. BEGINNING A SESSION - It is often useful to begin a session with a casual conversation. 2. LANGUAGE - Use of language that the patient can understand; abandon psychological jargon to be understood by patients. 3. THE USE OF QUESTIONS - The clinician\'s questions may become progressively more structured as the interview proceeds. 4. SILENCE - Silence can mean many things: perhaps the client is organizing thoughts or deciding which topic to discuss next or perhaps it is indicative of some resistance 5. LISTENING - It is by listening that we come to appreciate the information and emotions that the patient is conveying. **VARIETIES OF INTERVIEWS** 1. Intake Admission Interview - to determine why the patient has come to the clinic or hospital - to judge whether the agency's facilities, policies, and services will meet the needs and expectations of the patient - to inform the patient of such matters as the clinic's functions, fees, policies, procedures, and personnel. 2. The Case-History Interview - Provides a broad background and context in which both the patient and the problem can be placed based on his/her personal and social history. - Covers both childhood and adulthood, and it includes educational, sexual, medical, parental environmental, religious, and psychopathological matters. - Informants: knowledgeable adults in the patient's life that can provide additional information about the patient 3. The Mental Status Examination Interview - A mental status examination is typically conducted to assess the presence of cognitive, emotional, or behavioral problems. - It is important to be familiar with the mental status examination because these interviews are one of the primary modes of clinical assessment for a variety of mental health professionals. 4. The Crisis Interview - Purpose of the crisis interview is to meet problems as they occur and to provide an immediate resource. - It deflects the potential for disaster and encourage the person to enter into a relationship with the clinic or make a referral so that a longer-term solution can be worked out. - Such interviewing requires training, sensitivity, and judgment. 5. The Diagnostic Interview: a. UNSTRUCTURED INTERVIEW: free-form, content varies greatly depending on clinicians. b. STRUCTURED INTERVIEW: standard set of questions and follow-up probes in a specific sequence. All patients are asked the same questions. **Behavioral Assessment** BEHAVIORAL OBSERVATION - During behavioral interviews, the clinician attempts to gain a general impression of the presenting problem and of the variables that seem to be maintaining the problem behavior ***Different Behavioral Observations:*** 1. Naturalistic Observation- has not been used in clinical practice as much as it might be. - It is still more prominent in research than in clinical practice. - However, one need not be a diehard proponent of the behavioral approach to concede the importance of observational data (Ex. Home, school and/or hospital observation). 2. Controlled Observation - sometimes referred to as analogue behavioral observation (Haynes, 2001). - Such observation can occur in a clinic setting or in the natural environment. - The important feature is that the environment is "designed" such that it is likely that the assessor will observe the targeted behavior or interactions. 3. Self-monitoring - When dealing with individual clients, it is often impractical or too expensive to observe them\ as they move freely about in their daily activities. - clinicians have been relying increasingly on self-monitoring, in which individuals observe and record their own behaviors, thoughts, and emotions. ***WHAT TO OBSERVE:*** 1. General physical appearance - Physical appearance may tell us about the person's capacity to take care of himself/herself, socioeconomic status, psychological condition, possible medical condition, and his/her identity or possible affiliation. c. Description (height, build, complexion, posture, notable facial\ features or expression, hair) a. Deformities (if any) - mention use of eyeglasses, hearing aid,\ cane, wheelchair, etc. b. Grooming (make-up, clothes, nails, hair, other things that indicate\ bad/good grooming) c. Body Art 2. Behaviors during assessment - Behaviors during testing may reflect the client's level of comfort with the situation, sincerity, willingness to cooperate, level of respect to the session and therapist, maturity, and psychological or medical condition. a. Hand & body movement b. Posture c. Eye contact (e.g. no eye contact, blank stares) d. Developmentally inappropriate behaviors e. Behavior -- speech inconsistency 3. Language and speech - Language & speech may tell us about the client's maturity, confidence, willingness to cooperate, socioeconomic status & educational attainment, principles and beliefs, medical or psychological condition. a. Pitch, tone, and volume b. Articulation, fluency, phrase length c. Content (e.g., coherence, meaningfulness) d. Verbalizations or expressions 4. Client's attitude and mood - These may tell us about the client's present or general disposition, or possible psychological condition