J5H2y5_Clinical Psychology_ Science, Practice, and Diversity2020.pdf

 The Hallmark Features 4 DIVERSI TY AND...

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SAGE remains majority owned by our founder and after her lifetime will become owned by a charitable trust that secures the company’s continued independence. Los Angeles | London | New Delhi | Singapore | Washington DC | Melbourne Clinical Psychology Science, Practice, and Diversity Fifth Edition Andrew M. Pomerantz Southern Illinois University Edwardsville FOR INFORMATION: Copyright © 2020 by SAGE Publications, Inc. All rights reserved. Except as permitted by U.S. copyright SAGE Publications, Inc. law, no part of this work may be reproduced or distributed in 2455 Teller Road any form or by any means, or stored in a database or retrieval Thousand Oaks, California 91320 system, without permission in writing from the publisher. E-mail: [email protected] All third party trademarks referenced or depicted herein are included solely for the purpose of illustration and are SAGE Publications Ltd. the property of their respective owners. Reference to these 1 Oliver’s Yard trademarks in no way indicates any relationship with, or 55 City Road endorsement by, the trademark owner. London EC1Y 1SP Printed in the United States of America United Kingdom Library of Congress Cataloging-in-Publication Data SAGE Publications India Pvt. Ltd. B 1/I 1 Mohan Cooperative Industrial Area Names: Pomerantz, Andrew M., author. Mathura Road, New Delhi 110 044 Title: Clinical psychology : science, practice, and diversity / India Andrew M. Pomerantz, Southern Illinois University Edwardsville. SAGE Publications Asia-Pacific Pte. Ltd. Description: Fifth edition. | Los Angeles : SAGE, | 18 Cross Street #10-10/11/12 Includes bibliographical references and index. China Square Central Identifiers: LCCN 2019011933 | ISBN 9781544333618 Singapore 048423 (hardcover : alk. paper) Subjects: LCSH: Clinical psychology. | Diagnostic and statistical manual of mental disorders. Classification: LCC RC467.P64 2020 | DDC 616.89—dc23 LC record available at https://lccn.loc.gov/2019011933 Acquisitions Editor: Abbie Rickard This book is printed on acid-free paper. Editorial Assistant: Elizabeth Cruz Content Development Editor: Jennifer Thomas Production Editor: Andrew Olson Copy Editor: Colleen Brennan Typesetter: C&M Digitals (P) Ltd. Proofreader: Jeff Bryant Indexer: Beth Nauman-Montana Cover Designer: Candice Harman Marketing Manager: Katherine Hepburn 19 20 21 22 23 10 9 8 7 6 5 4 3 2 1 BRIEF CONTENTS Preface xxiii About the Author xxxvii PART I INTRODUCING CLINICAL PSYCHOLOGY CHAPTER 1 Clinical Psychology: Definition and Training 3 CHAPTER 2 Evolution of Clinical Psychology 27 CHAPTER 3 Current Controversies and Directions in Clinical Psychology 47 CHAPTER 4 Diversity and Cultural Issues in Clinical Psychology 73 CHAPTER 5 Ethical and Professional Issues in Clinical Psychology 101 CHAPTER 6 Conducting Research in Clinical Psychology 127 PART II ASSESSMENT CHAPTER 7 Diagnosis and Classification Issues: DSM-5 and More 151 CHAPTER 8 The Clinical Interview 179 CHAPTER 9 Intellectual and Neuropsychological Assessment 205 CHAPTER 10 Personality Assessment and Behavioral Assessment 225 PART III PSYCHOTHERAPY CHAPTER 11 General Issues in Psychotherapy 253 CHAPTER 12 Psychodynamic Psychotherapy 283 CHAPTER 13 Humanistic Psychotherapy 311 CHAPTER 14 Behavior Therapy 335 CHAPTER 15 Cognitive Psychotherapy and Mindfulness-Based Therapies 363 CHAPTER 16 Group and Family Therapy 391 PART IV SPECIAL TOPICS CHAPTER 17 Clinical Child and Adolescent Psychology 419 CHAPTER 18 Health Psychology 449 Laura A. Pawlow and Andrew M. Pomerantz CHAPTER 19 Forensic Psychology 473 Bryce F. Sullivan and Andrew M. Pomerantz Glossary 497 References 515 Author Index 577 Subject Index 599 DETAILED CONTENTS Preface xxiii About the Author xxxvii PART I INTRODUCING CLINICAL PSYCHOLOGY CHAPTER 1 Clinical Psychology: Definition and Training 3 What Is Clinical Psychology? 3 Original Definition 3 More Recent Definitions 4 Education and Training in Clinical Psychology 5 Balancing Practice and Science: The Scientist-Practitioner (Boulder) Model 6 Leaning Toward Practice: The Practitioner-Scholar (Vail) Model 6 ´´ Box 1.1: Comparing PhD Programs With PsyD Programs 7 Leaning Toward Science: The Clinical Scientist Model 8 Getting In: What Do Graduate Programs Prefer? 13 ´´ Box 1.2: Interview Questions to Anticipate 15 Internships: Predoc and Postdoc 16 Getting Licensed 17 Professional Activities and Employment Settings 18 Where Do Clinical Psychologists Work? 18 What Do Clinical Psychologists Do? 19 How Are Clinical Psychologists Different From... 19 Counseling Psychologists 19 Psychiatrists 21 ´´ Box 1.3: In My Practice... 21 Social Workers 22 School Psychologists 23 Professional Counselors 23 Marriage and Family Therapists 23 Chapter Summary 24 Key Terms and Names 24 Critical Thinking Questions 24 Looking Toward Graduate Programs 25 Key Journals 26 Student Study Site Resources 26 CHAPTER 2 Evolution of Clinical Psychology 27 Origins of the Field 27 Early Pioneers 27 William Tuke (1732–1822) 28 Philippe Pinel (1745–1826) 28 Eli Todd (1769–1833) 29 Dorothea Dix (1802–1887) 29 Lightner Witmer and the Creation of Clinical Psychology 30 Assessment 31 Diagnostic Issues 31 ´´ Box 2.1: Is It a DSM Disorder? Decisions to Include or Exclude Potential Disorders 33 Assessment of Intelligence 35 Assessment of Personality 36 Psychotherapy 37 ´´ Box 2.2: The Influence of War on Clinical Psychology 38 Development of the Profession 40 ´´ Box 2.3: Timeline of Key Historical Events in Clinical Psychology 41 Chapter Summary 44 Key Terms and Names 44 Critical Thinking Questions 45 Key Journals 45 Student Study Site Resources 45 CHAPTER 3 Current Controversies and Directions in Clinical Psychology 47 Prescription Privileges 47 Why Clinical Psychologists Should Prescribe 48 Why Clinical Psychologists Should Not Prescribe 50 Evidence-Based Practice/Manualized Therapy 52 ´´ Box 3.1: Metaphorically Speaking: Evidence-Based Treatment Manuals and Teaching Manuals 54 Advantages of Evidence-Based Practice/Manualized Therapy 55 Disadvantages of Evidence-Based Practice/Manualized Therapy 57 Overexpansion of Mental Disorders 59 New Disorders and New Definitions of Old Disorders 60 ´´ Box 3.2: In My Practice... 61 The Influence of the Pharmaceutical Industry 62 Payment Methods: Third-Party Payment Versus Self-Payment 63 Effect on Therapy 63 Effect on Diagnosis 64  The Influence of Technology: Telepsychology and More 65 Applications of Technology in Clinical Psychology 65 How Well Do Telepsychology and Other Applications of Technology Work? 66 Emerging Professional Issues 67 Chapter Summary 69 Key Terms and Names 70 Critical Thinking Questions 70 Looking Toward Graduate Programs 71 Key Journals 71 Student Study Site Resources 72 CHAPTER 4 Diversity and Cultural Issues in Clinical Psychology 73 The Rise of Multiculturalism in Clinical Psychology 73 The Diversification of the U.S. Population 73 Multiculturalism as the “Fourth Force” 74 Recent Professional Efforts to Emphasize Issues of Diversity and Culture 75 Cultural Competence 79 What Is Cultural Competence? 79 Cultural Self-Awareness 80 ´´ Box 4.1: In My Practice... 81 Knowledge of Diverse Cultures 81 ´´ Box 4.2: Considering Culture: Interviews With Multicultural Experts: Cultural Competence With Clients From Specific Cultures 82 ´´ Box 4.3: Metaphorically Speaking: If You’ve Seen Yao Ming, You Understand Heterogeneity Within a Culture 87 Culturally Appropriate Clinical Skills 88 Are We All Alike? Or All Different? 90 Etic Versus Emic Perspective 90 Tripartite Model of Personal Identity 91 What Constitutes a Culture? 91 Narrow Versus Broad Definitions 92 Interacting Cultural Variables 93 Training Psychologists in Issues of Diversity and Culture 94 Educational Alternatives 94 Measuring the Outcome of Culture-Based Training Efforts 95 An Example of Culture Influencing the Clinical Context: The Parent–Child Relationship 96 Chapter Summary 97 Key Terms and Names 98  Critical Thinking Questions 98 Looking Toward Graduate Programs 98 Key Journals 100 Student Study Site Resources 100 CHAPTER 5 Ethical and Professional Issues in Clinical Psychology 101 American Psychological Association’s Code of Ethics 101 Aspirational and Enforceable 102 Ethical Decision Making 104 Psychologists’ Ethical Beliefs 105 Confidentiality 105 Tarasoff and the Duty to Warn 106 When the Client Is a Child or Adolescent 107 ´´ Box 5.1: In My Practice... 108 ´´ Box 5.2: Considering Culture: Confidentiality, Ethnicity, and Family 110 Informed Consent 111 Boundaries and Multiple Relationships 113 Defining Multiple Relationships 113 What Makes Multiple Relationships Unethical? 114 Competence 116 Ethics in Clinical Assessment 118 Ethics in Clinical Research 119 Contemporary Ethical Issues 120 Managed Care and Ethics 120 Technology and Ethics 121 Ethics in Small Communities 121 ´´ Box 5.3: Metaphorically Speaking: If You’ve Played the “Six Degrees of Kevin Bacon” Game, You Understand Multiple Relationships in Small Communities 122 Chapter Summary 123 Key Terms and Names 124 Critical Thinking Questions 124 Key Journals 124 Student Study Site Resources 125 CHAPTER 6 Conducting Research in Clinical Psychology 127 Why Do Clinical Psychologists Do Research? 127 Psychological Disorders 127 Treatment Outcome 128 ´´ Box 6.1: Measuring Therapy Outcome: Essential Questions 129 ´´ Box 6.2: Considering Culture: Treatments That Work, but for Whom? 132  Assessment Methods 133 Diagnostic Issues 134 Professional Issues 135 Teaching and Training Issues 136 How Do Clinical Psychologists Do Research? 137 The Experimental Method 137 Quasi-Experiments 138 Between-Group Versus Within-Group Designs 138 Analogue Designs 139 Correlational Methods 140 Case Studies 140 Meta-Analysis 141 ´´ Box 6.3: Metaphorically Speaking: If You Read Movie Reviews, You Understand Meta-Analysis 142 Cross-Sectional Versus Longitudinal Designs 143 Use of Technology in Clinical Psychology Research 144 Ethical Issues in Research in Clinical Psychology 145 ´´ Box 6.4: Key American Psychological Association Ethical Standards Related to Research in Clinical Psychology 145 Chapter Summary 146 Key Terms and Names 147 Critical Thinking Questions 147 Looking Toward Graduate Programs 147 Key Journals 148 Student Study Site Resources 148 PART II ASSESSMENT CHAPTER 7 Diagnosis and Classification Issues: DSM-5 and More 151 Defining Normality and Abnormality 151 What Defines Abnormality? 151 Who Defines Abnormality? 152 ´´ Box 7.1: Considering Culture: Typical but Abnormal? 153 Why Is the Definition of Abnormality Important? 154 ´´ Box 7.2: In My Practice... 155 Diagnosis and Classification of Mental Disorders: A Brief History 156 Before the DSM 156 DSM—Earlier Editions (I and II) 157 DSM—More Recent Editions (III, III-R, IV, and IV-TR) 158 DSM-5: The Current Edition 160 Criticisms of the DSM 168 ´´ Box 7.3: Considering Culture: Are Eating Disorders Culturally Specific? 169  ´´ Box 7.4: Premenstrual Dysphoric Disorder 172 Alternative Directions in Diagnosis and Classification 174 ´´ Box 7.5: Metaphorically Speaking: If You’ve Eaten Chocolate Chip Cookies, You Understand the Dimensional Model of Psychopathology 176 Chapter Summary 177 Key Terms and Names 177 Critical Thinking Questions 178 Key Journals 178 Student Study Site Resources 178 CHAPTER 8 The Clinical Interview 179 The Interviewer 180 General Skills 180 Specific Behaviors 183 Components of the Interview 185 Rapport 185 Technique 186 ´´ Box 8.1: Considering Culture: Communication Across Cultures 186 ´´ Box 8.2: Metaphorically Speaking: If You’ve Taken Multiple-Choice, True/False, and Essay Exams, You Understand Open- and Closed-Ended Interview Questions 189 Conclusions 191 Pragmatics of the Interview 191 Note Taking 192 Audio and Video Recordings 192 ´´ Box 8.3 In My Practice... 193 The Interview Room 193 Confidentiality 194 Types of Interviews 195 Intake Interviews 195 Diagnostic Interviews 196 Mental Status Exam 198 Crisis Interviews 199 Cultural Components 200 Appreciating the Cultural Context 200 Acknowledging Cultural Differences 201 ´´ Box 8.4: Interview Questions to Consider When Inquiring About the Cultural Backgrounds of Clients 202 Chapter Summary 202 Key Terms and Names 203 Critical Thinking Questions 203 Looking Toward Graduate Programs 203  Key Journals 204 Student Study Site Resources 204 CHAPTER 9 Intellectual and Neuropsychological Assessment 205 Intelligence Testing 206 Classic Theories of Intelligence 206 More Contemporary Theories of Intelligence 207 ´´ Box 9.1: Metaphorically Speaking: If You’ve Watched Multi-Sport Athletes, You Understand the Challenges of Defining and Assessing Intelligence 208 Wechsler Intelligence Tests 209 Stanford-Binet Intelligence Scales—Fifth Edition 213 Additional Tests of Intelligence: Addressing Cultural Fairness 214 Achievement Testing 216 Achievement Versus Intelligence 216 ´´ Box 9.2: Considering Culture: Defining Intelligence Around the World 217 Wechsler Individual Achievement Test—Third Edition 218 Neuropsychological Testing 218 Full Neuropsychological Batteries 219 Brief Neuropsychological Measures 220 Chapter Summary 222 Key Terms and Names 223 Critical Thinking Questions 223 Looking Toward Graduate Programs 223 Key Journals 224 Student Study Site Resources 224 CHAPTER 10 Personality Assessment and Behavioral Assessment 225 Multimethod Assessment 225 Evidence-Based Assessment 226 Culturally Competent Assessment 228 ´´ Box 10.1: Considering Culture: Culture-Specific Norms for Personality Tests 229 Objective Personality Tests 230 Minnesota Multiphasic Personality Inventory-2 230 ´´ Box 10.2: Simulated MMPI-2 Items 231 ´´ Box 10.3: Metaphorically Speaking: If You’ve Shopped on Amazon.com, You Understand Empirical Criterion Keying 232 Personality Assessment Inventory 237 Millon Clinical Multiaxial Inventory-IV 237  NEO Personality Inventory-3 238 Beck Depression Inventory-II 239 Projective Personality Tests 240 Rorschach Inkblot Method 241 ´´ Box 10.4: Simulated TAT Card With Simulated Responses 243 Thematic Apperception Test 244 Sentence Completion Tests 245 Behavioral Assessment 246 Methods of Behavioral Assessment 247 Technology in Behavioral Assessment 248 Chapter Summary 249 Key Terms and Names 249 Critical Thinking Questions 250 Key Journals 250 Student Study Site Resources 250 PART III PSYCHOTHERAPY CHAPTER 11 General Issues in Psychotherapy 253 Does Psychotherapy Work? 253 Whom, When, and How Should Researchers Ask? 254 Efficacy Versus Effectiveness of Psychotherapy 255 ´´ Box 11.1: Considering Culture: Culture-Specific Expectations About Psychotherapy 256 Results of Efficacy Studies 258 Bridging the Gap Between Research and Practice 259 Results of Effectiveness Studies 261 Alternate Ways to Measure Psychotherapy Outcome 261 Which Type of Psychotherapy Is Best? 262 The “Dodo Bird Verdict” and Common Factors 263 Therapeutic Relationship/Alliance 263 Other Common Factors 265 ´´ Box 11.2: Metaphorically Speaking: If You Use Toothpaste, You Understand Common Factors in Psychotherapy 267 Reconsidering the Dodo Bird Verdict: Specific Treatments for Specific Disorders 268 ´´ Box 11.3: In My Practice... 269 What Types of Psychotherapy Do Clinical Psychologists Practice? 270 The Past and Present 270 ´´ Box 11.4: Considering Culture: Are Evidence-Based Treatments Appropriate for Diverse Clients? 271 The Future 274 Eclectic and Integrative Approaches 275  ´´ Box 11.5: Metaphorically Speaking: If You Know the Difference Between a Fruit Salad and a Smoothie, You Understand the Difference Between Eclectic and Integrative Psychotherapists 276 Denise: A Fictional Client to Consider From Multiple Perspectives 277 ´´ Box 11.6: Denise: A Fictional Client to Consider From Multiple Perspectives 278 Chapter Summary 278 Key Terms and Names 279 Critical Thinking Questions 279 Looking Toward Graduate Programs 280 Key Journals 280 Student Study Site Resources 281 CHAPTER 12 Psychodynamic Psychotherapy 283 Defining Psychodynamic Psychotherapy 284 Goal of Psychodynamic Psychotherapy 284 Accessing the Unconscious 285 ´´ Box 12.1: Metaphorically Speaking: If You’ve Been to a Movie Theater, You Understand Projection 290 ´´ Box 12.2: In My Practice... 294 ´´ Box 12.3: Considering Culture: Culture-Specific Responses to the “Blank Screen” Therapist 296 Psychosexual Stages: Clinical Implications 297 Oral Stage 297 Anal Stage 298 Phallic Stage 298 More Contemporary Forms of Psychodynamic Psychotherapy 299 Interpersonal Therapy 300 Time-Limited Dynamic Psychotherapy 301 How Well Does It Work? 302 ´´ Box 12.4: Metaphorically Speaking: If You’ve Watched the Olympics, You Understand Allegiance Effects 303 ´´ Box 12.5: Denise in Psychodynamic Psychotherapy 305 Chapter Summary 307 Key Terms and Names 308 Critical Thinking Questions 308 Looking Toward Graduate Programs 308 Key Journals 309 Student Study Site Resources 309 CHAPTER 13 Humanistic Psychotherapy 311 Humanistic Concepts: Clinical Implications 312 Goal of Humanistic Psychotherapy 313  Elements of Humanistic Psychotherapy 315 Empathy 315 Unconditional Positive Regard 315 ´´ Box 13.1: Considering Culture: Empathy Across Cultures 316 Genuineness 317 Necessary and Sufficient? 318 ´´ Box 13.2: In My Practice... 319 Therapist Attitudes, Not Behaviors 320 Reflection: An Important Therapist Response 320 ´´ Box 13.3: Metaphorically Speaking: If You’ve Looked in a Magnifying Mirror, You Understand Reflection 321 Alternatives to Humanism 322 Historical Alternatives 322 Motivational Interviewing 323 Positive Interventions and Strength-Based Counseling 325 Emotionally Focused Therapy 327 Other Contemporary Alternatives 327 How Well Does It Work? 328 ´´ Box 13.4: Denise in Humanistic Psychotherapy 329 Chapter Summary 331 Key Terms and Names 331 Critical Thinking Questions 331 Looking Toward Graduate Programs 332 Key Journals 333 Student Study Site Resources 333 CHAPTER 14 Behavior Therapy 335 Origins of Behavior Therapy 336 Goal of Behavior Therapy 337 Emphasis on Empiricism 337 Defining Problems Behaviorally 339 Measuring Change Observably 340 Two Types of Conditioning 341 Classical Conditioning 341 Operant Conditioning 342 Techniques Based on Classical Conditioning 342 Exposure Therapy 342 Systematic Desensitization 344 Assertiveness Training 345 ´´ Box 14.1: Considering Culture: Assertiveness Training and Collectivist Values 346 Techniques Based on Operant Conditioning 347 Contingency Management 347 ´´ Box 14.2: In My Practice... 348  Extinction 349 ´´ Box 14.3: Metaphorically Speaking: If You’ve Lost Money in a Soda Machine, You Understand Extinction and the Extinction Burst 350 Token Economies 351 Shaping 352 Behavioral Activation 353 Observational Learning (Modeling) 354 Alternatives to Behavior Therapy 355 Behavioral Consultation 355 Parent Training 356 Teacher Training 357 ´´ Box 14.4: Denise in Behavior Therapy 358 How Well Does It Work? 359 Chapter Summary 359 Key Terms and Names 360 Critical Thinking Questions 360 Looking Toward Graduate Programs 361 Key Journals 361 Student Study Site Resources 361 CHAPTER 15 Cognitive Psychotherapy and Mindfulness-Based Therapies 363 Goal of Cognitive Therapy 364 The Importance of Cognition 365 Revising Cognitions 366 Teaching as a Therapy Tool 367 Homework 367 ´´ Box 15.1: Considering Culture: Cognitive Therapy With LGBTQ 368 A Brief, Structured, Focused Approach 369 Two Approaches to Cognitive Therapy 369 Albert Ellis 370 ´´ Box 15.2: Considering Culture: Are Some Beliefs Too Sacred to Dispute? 373 Aaron Beck 374 ´´ Box 15.3: In My Practice... 376 Recent Applications of Cognitive Therapy 377 ´´ Box 15.4: Metaphorically Speaking: If You’ve Seen Attorneys Argue in Court, You Understand How Cognitive Therapists Dispute Thought Distortions 378 The Third Wave: Mindfulness- and Acceptance-Based Therapies 379 Cognitive Therapy for Medical Problems 384 Schema Therapy 385  How Well Does It Work? 385 ´´ Box 15.5: Denise in Cognitive Psychotherapy 387 Chapter Summary 388 Key Terms and Names 389 Critical Thinking Questions 389 Looking Toward Graduate Programs 389 Key Journals 390 Student Study Site Resources 390 CHAPTER 16 Group and Family Therapy 391 Group Therapy 391 An Interpersonal Emphasis 391 Practical Issues in Group Therapy 396 Ethical Issues in Group Therapy 398 How Well Does It Work? 399 ´´ Box 16.1: Denise in Group Therapy 399 Family Therapy 400 The System as the Problem 400 Assessment of Families 402 ´´ Box 16.2: In My Practice... 406 Family Therapy: Essential Concepts 406 ´´ Box 16.3: Considering Culture: Gender, Abuse, and Family Therapy 407 ´´ Box 16.4: Metaphorically Speaking: If You’ve Been to a Car Repair Shop, You Understand Systems Theory 408 Ethical Issues in Family Therapy 412 How Well Does It Work? 413 Chapter Summary 414 Key Terms and Names 415 Critical Thinking Questions 415 Looking Toward Graduate Programs 415 Key Journals 416 Student Study Site Resources 416 PART IV SPECIAL TOPICS CHAPTER 17 Clinical Child and Adolescent Psychology 419 Psychological Issues of Childhood 420 Disorders of Childhood 420 Resilience and Vulnerability 421 ´´ Box 17.1: Factors Fostering Resilience in Children 422 Assessment of Children and Adolescents 423 The Developmental Perspective 423  ´´ Box 17.2: Considering Culture: Parent–Child Relationships Across Cultures 424 A Comprehensive Assessment 426 ´´ Box 17.3: In My Practice... 427 Assessment Methods 428 The Frequency of Use of Specific Assessment Techniques 433 Psychotherapy With Children and Adolescents 434 Cognitive-Behavioral Therapies for Children 435 Self-Instructional Training 437 ´´ Box 17.4: Metaphorically Speaking: If You’ve Had Dancing Lessons, You Understand Self-Instructional Training 439 Parent Training 440 Play Therapy 441 How Well Does Psychotherapy for Children and Adolescents Work? 444 Chapter Summary 445 Key Terms and Names 446 Critical Thinking Questions 446 Looking Toward Graduate Programs 446 Key Journals 447 Student Study Site Resources 448 CHAPTER 18 Health Psychology 449 Laura A. Pawlow and Andrew M. Pomerantz Definitions: Health Psychology Versus Behavioral Medicine 450 Stress 450 Stress and Physical Illness 451 Stress and Coping 452 ´´ Box 18.1: Considering Culture: Physical and Psychological Expressions of Depression Across Cultures 454 Social Support 455 Clinical Applications 456 Weight Management 457 Smoking 459 Alcohol Use 460 Pain Management and Biofeedback 461 ´´ Box 18.2: Metaphorically Speaking: If You’ve Used Exercise Equipment With a Heart Rate Monitor, You Understand Biofeedback 463 ´´ Box 18.3: Sample of an Abbreviated Progressive Relaxation Training Script 463 Compliance With Medical Regimens 464 Coping With Medical Procedures 465 A Trend in Health Psychology: Patient-Centered Medical Homes 467  Cultural Factors in Health Psychology 467 Chapter Summary 469 Key Terms and Names 469 Critical Thinking Questions 470 Looking Toward Graduate Programs 470 Key Journals 471 Student Study Site Resources 472 CHAPTER 19 Forensic Psychology 473 Bryce F. Sullivan and Andrew M. Pomerantz Definition and History 473 Forensic Activities of Clinical Psychologists 475 Assessment Activities 475 ´´ Box 19.1: Metaphorically Speaking: If You’ve Bought Car Insurance, You Understand Clinical and Statistical Methods of Predicting Dangerousness 480 Treatment and Other Forensic Activities 488 ´´ Box 19.2: Considering Culture: Cultural Competence in Forensic Clinical Psychology 491 Chapter Summary 494 Key Terms and Names 495 Critical Thinking Questions 495 Looking Toward Graduate Programs 495 Key Journals 496 Student Study Site Resources 496 Glossary 497 References 515 Author Index 577 Subject Index 599 PREFACE C linical psychology is an increasingly expansive field. This textbook is my attempt to introduce its students to the vast range of issues it encompasses. My rationale for creating this textbook was multifaceted: To provide a balanced approach to clinical psychology. There is no shortage of diverse points of view and ongoing debates within clinical psychology, and I believe that the ideal way to introduce students to the spectrum of opinions represented by clinical psychologists is to maximize the even-handedness of the text. To promote cultural competence. Clinical psychologists must appreciate cultural and diversity-related factors in all their professional activities, and as students familiarize themselves with the field, cultural sensitivity should be woven into their lessons. To offer many illustrative examples, including clinical applications for clinically relevant topics. To write in a scholarly yet clear and accessible style and include up-to-date information. Along the same lines, the text covers a distinctly broad range of topics while maintaining an adequate degree of depth. Previous editions of this text were enthusiastically received by both instructors and students. We were pleased to learn that they found numerous components of the book—its emphasis on issues of culture, its unique pedagogical features, its scholarly yet readable style, its many clinical examples, its balanced approach, and its ancillary package, among others—beneficial to student learning. WHAT’S THE SAME IN THE FIFTH EDITION This edition retains all the strengths of the previous edition of the book: Considering Culture boxes appear in almost every chapter. These boxes highlight multicultural aspects of the various topics covered throughout the book. Along with the discussions of culture integrated throughout the text, these boxes encourage the student to appreciate culturally relevant issues surrounding research, psychotherapy, assessment, and other topics. Chapter 4 (Diversity and Cultural Issues in Clinical Psychology) is devoted entirely to topics related to multiculturalism. Interviews with nine renowned experts in multicultural clinical work appear in Chapter 4 and on the companion website. Each of these experts—Melba xxiii  Vasquez, Frederick Leong, Joseph E. Trimble, Robert L. Williams, Monica McGoldrick, Nadya A. Faoud, Karen Haboush, Kathleen J. Bieschke, and Lewis Z. Schlosser—discusses cultural competence with a specific cultural group based on ethnicity, religion, gender, or sexual orientation. In My Practice text boxes appear in most chapters (including all chapters focusing on individual psychotherapy, as well as the chapters focusing on interviewing, diagnosis, ethics, group and family therapy, clinical child psychology, and cultural issues), in which textbook author Andrew Pomerantz shares cases and stories directly from his own clinical psychology practice to illustrate key concepts. These text boxes are accompanied by whiteboard videos, which bring the cases and stories to life for students. In all of the In My Practice text boxes and accompanying whiteboard videos, information that might identify the client has been disguised, altered, or omitted to protect client confidentiality. Key Journals sections, in the end-of-chapter material for every chapter, list important journals to which students can turn for more information on chapter- related topics. Metaphorically Speaking boxes appear in almost every chapter. These boxes use metaphors to teach students about novel concepts by drawing parallels to concepts with which they are already familiar. Denise in _____ Psychotherapy boxes appear in all the chapters relevant to psychotherapy. “Denise” is a fictional therapy client created exclusively for this textbook. She is introduced at the end of Chapter 11, and the Denise boxes that appear at the end of each of the subsequent chapters illustrate how she would be treated according to psychodynamic, humanistic, behavioral, cognitive, and group therapy approaches. Chapter 3 (Current Controversies and Directions in Clinical Psychology) is devoted entirely to contemporary issues such as prescription privileges, evidence-based practice, payment methods, and technological advances. Chapter 5 (Ethical and Professional Issues in Clinical Psychology) is devoted entirely to ethical and professional issues in clinical psychology, including confidentiality, multiple relationships, and more. Chapters 12 through 16 are each devoted entirely to a particular approach or modality of psychotherapy (i.e., psychodynamic, humanistic, behavioral, cognitive/mindfulness-based, and group/family), and each contains coverage of contemporary versions and variants of these therapies. Icons (three to five per chapter) in the margin refer students to web-based resources (e.g., videos, websites, articles), accessible through the student study site, that have been carefully selected to enhance learning of key concepts. Chapter 7 (Diagnosis and Classification Issues: DSM-5 and More) and other chapters contain detailed descriptions of what changed in DSM-5, including {{ new features (e.g., Arabic rather than Roman numeral system to facilitate the transition to a “living document”), xxiv   Clinical Psychology  {{ new disorders (e.g., disruptive mood dysregulation disorder, mild neurocognitive disorder, binge eating disorder), and {{ adjusted criteria for existing disorders (e.g., autism spectrum disorder encompassing autism and Asperger’s disorder, revision of the bereavement exclusion criteria for major depressive episodes, more inclusive criteria for bulimia nervosa and attention-deficit/hyperactivity disorder). Coverage of what didn’t change in DSM-5 (changes that were considered but rejected). Coverage of how DSM-5 was made, including {{ steps in the revision process, {{ controversies that arose during the process, {{ criticisms by prominent authors about the process, and {{ forces that may have influenced the process. Possible consequences of DSM-5, including {{ continued broadening of the scope of mental illness, {{ treatment issues (e.g., insurance coverage, psychotherapy, drug treatment), and {{ other implications (e.g., legal issues, disability claims). WHAT’S NEW IN THE FIFTH EDITION This edition includes numerous important enhancements and updates: More than 320 new references, including more than 110 published in 2018/2019 and more than 160 published in 2016/2017 ensuring extremely current coverage across all chapters. A new end-of-chapter feature, Looking Toward Graduate School, which serves as a bridge between the topics in a particular chapter and graduate programs that offer further training or experience in those topics. Specifically, this feature provides students interested in applying to graduate school with relevant index terms they can find in the Insider’s Guide to Graduate Programs in Clinical and Counseling Psychology (Sayette & Norcross, 2018). Students can use these terms to find specific graduate programs that offer clinical opportunities, research experiences, and concentrations/tracks in topics within the chapter. This process should help students appreciate the vast range of experiences in various graduate programs and give them a practical head start toward finding programs that best match their interests. New videos, created by and featuring the author, on ethics topics including confidentiality and multiple relationships. These videos, professionally produced by Sage Knowledge, feature the author playing the role of the clinician (and narrator) in simulated clinical cases in which actors play the roles of clients. P reface    xxv  Chapter 1 (Clinical Psychology: Definition and Training) {{ New coverage of research on what PhD and PsyD graduate programs value among application materials {{ New coverage of marriage and family therapists (as an additional mental health profession similar to clinical psychology) {{ New coverage of states’ decisions since 2008 to drop the postdoc requirement for licensure {{ New coverage of research on trends across doctoral training in clinical psychology {{ Update of Table 1.2 to include new examples of doctoral programs following various training models {{ Minor update on the origins of the PsyD degree {{ Minor update on the internship shortage/crisis {{ Minor update on master’s level training {{ Minor update on counseling psychologists {{ Minor update on school psychologists {{ Minor update on professional counselors Chapter 2 (Evolution of Clinical Psychology) {{ Minor update on the number of clinical and counseling psychologists working in the Department of Veterans Affairs Chapter 3 (Current Controversies and Directions in Clinical Psychology) {{ Revised language from cybertherapy to telepsychology to match APA usage {{ New coverage regarding prescription privileges, including states that have approved it, number of psychologists who have obtained it, attitudes of medical professionals toward prescribing psychologists, and timing of prescription training {{ New coverage regarding evidence-based treatment, including the three- legged stool model, research on the importance of accommodating clients’ preferences, APA Practice Guidelines as an additional source for therapists to learn “what works” for particular disorders, and flexibility-within-fidelity regarding therapy manuals {{ New coverage regarding telepsychology suggestions, specifically regarding the disposal of technologies and data, practicing across state lines, and choosing apps and other technologies carefully Chapter 4 (Diversity and Cultural Issues in Clinical Psychology) {{ Added the word Diversity to the chapter title to broaden the focus {{ Added “diversity” terminology throughout the chapter {{ Updated data about the population of immigrants in the United States {{ Added brief mention of connection between cultural competence and lower therapy drop-out rates xxvi   Clinical Psychology  {{ New coverage of the effects of microaggressions on clients {{ New coverage of research showing potentially harmful effects when cultural adaptations of therapies are not considered {{ New coverage of language-based differences in symptom reports in interviews {{ Added brief mention of increased research on cultural humility Chapter 5 (Ethical and Professional Issues in Clinical Psychology) {{ Added “Professional Issues” to title to more accurately reflect the scope of the chapter {{ Added links to four videos featuring narration by the author and clinical vignettes in which clients (played by actors) and a therapist (played by the author) enact a variety of ethically challenging situations involving multiple relationship and confidentiality issues {{ Supplemented the history of the Tarasoff case, including a better explanation of “duty to warn” and “duty to protect” {{ New coverage of difference in duty to warn and duty to protect laws in various states {{ Supplemented the list of APA Professional Guidelines regarding the treatment of diverse groups {{ New coverage of research on burnout rates among psychologists and the consequences of psychologist burnout for therapy clients {{ New coverage of self-care, including research on the rates at which psychologists seek their own therapy {{ New coverage, in the section on Ethics in Small Communities, of the issue of clients becoming aware of the psychologist’s own personal information {{ Minor updates to the Metaphorically Speaking box about the “Six Degrees of Kevin Bacon” game and multiple relationships for clinical psychologists in small communities Chapter 6 (Conducting Research in Clinical Psychology) {{ Added a new subsection, Psychological Disorders, under the heading Why Do Clinical Psychologists Do Research?, including several recent specific examples {{ Added coverage of dissemination strategies as a research topic {{ Added two new examples of research on assessment methods {{ Added a new example of research on professional issues {{ Added a new example of research on teaching and training issues {{ Clarified the coverage of randomized clinical trials {{ Added an example of correlational research {{ Added brief coverage of the alternative treatments design (variation of ABAB design) {{ Added examples of ethical issues in clinical psychology research P reface    xxvii  Chapter 7 (Diagnosis and Classification Issues: DSM-5 and More) {{ Added update regarding the use of Arabic, rather than Roman, numerals in the title of DSM-5 {{ Added full name of International Classification of Diseases (rather than only ICD abbreviation) for clarity {{ Added coverage of upcoding and related research in the subsection on controversial cutoffs in DSM Chapter 8 (The Clinical Interview) {{ Added a subsection, Observing Client Behaviors, under the heading Specific Behaviors {{ Slightly edited the primary example of an open-ended interview question to better distinguish it from closed-ended interview questions {{ Added example and a clinical example about judicious decisions to use clarification during interviewing {{ Added coverage of no-suicide contracts, including research on their effects Chapter 9 (Intellectual and Neuropsychological Assessment) {{ Added coverage, including research, of Q-interactive system of administering and scoring Wechsler tests {{ Added coverage of the NEPSY-II neuropsychological battery {{ Added mention of additional intelligence tests, including Woodcock-Johnson and Kaufman tests {{ Added brief explanation that intelligence tests and achievement tests by same company are typically paired and co-normed {{ Added mention of the Wechsler Nonverbal Scale of Ability in the section on addressing cultural fairness in intelligence testing {{ Slightly edited title and content of Metaphorically Speaking box to broaden and update it {{ Added coverage of evolution of neuropsychological testing from fixed- battery phase to flexible-battery phase {{ Added coverage of neuropsychological assessment anxiety Chapter 10 (Personality Assessment and Behavioral Assessment) {{ Added coverage of Personality Assessment Inventory {{ Removed coverage of California Psychological Inventory {{ Updated coverage of the NEO-PI-R to NEO-PI-3 {{ Added brief coverage of the research on relative popularity of the MMPI-2 and MMPI-2-RF {{ Added brief mentions of the Beck Anxiety Inventory and Beck Hopelessness Scale in the section on the Beck Depression Inventory xxviii   Clinical Psychology  {{ Added brief mention of the use of the term performance-based test in place of projective test Chapter 11 (General Issues in Psychotherapy) {{ Added coverage of recent research on the components of the therapeutic relationship that are demonstrably effective regarding therapy outcome {{ Added coverage of research on graduate training related to the therapeutic relationship/working alliance {{ Added coverage of APA Clinical Practice Guidelines and APA Guidelines for Practitioners to Box 11.4: Considering Culture {{ Added coverage of research on stages of change and therapy outcome {{ Added coverage of the assimilative approach to psychotherapy (as an alternative to the eclectic and integrative approaches) {{ Briefly clarified Eysenck’s early findings on the outcome of psychotherapy {{ Minor edit to the definitions and explanations of efficacy and effectiveness {{ Briefly added explanation of opposition to the dodo bird verdict Chapter 12 (Psychodynamic Psychotherapy) {{ Added coverage of research on clients doing online searches of their therapists and its impact on the “blank screen” role preferred for transference {{ Added brief coverage of a research treatment outcome study involving insight via transference {{ Added a note that free association is rare, even in psychotherapy Chapter 13 (Humanistic Psychotherapy) {{ Added a seven-point summary of techniques commonly used in positive psychology interventions {{ Added a couple of health-related items to the list of psychological problems that motivational interviewing has evidence for improving {{ Added brief coverage, in the section on positive psychology, of research indicating that happiness is a protective factor against mental disorders {{ Added brief coverage of research on the relative acceptability of positive psychology interventions compared with cognitive-behavioral therapy {{ Added coverage of research on the benefits of humanistic therapy both overall and with specific disorders and problems Chapter 14 (Behavior Therapy) {{ Added coverage of research on the applicability of behavioral activation with disorders beyond depression, and on the idea that behavioral activation may be a common mechanism of change across disorders and therapy approaches {{ Added brief clarification regarding the disorders for which exposure therapies are effective, and the fact that exposure and response prevention is the treatment of choice for obsessive-compulsive disorder P reface    xxix  Chapter 15 (Cognitive Psychotherapy and Mindfulness-Based Therapies) {{ Added a brief note about the connection between mindfulness and Zen Buddhism {{ Added brief coverage of research suggesting that mindfulness can have therapeutic benefits as a supplement to more traditional treatments {{ Added explanation of the dialectics on which therapists often focus in dialectical behavior therapy (DBT) {{ Added coverage of research on the efficacy of Albert Ellis’s Rational Emotive Behavior Therapy (REBT) specifically, and on the negative correlation between rational beliefs and psychological distress. {{ Added brief coverage of the results of meta-analyses of mindfulness-based therapies for specific disorders, including eating disorders and psychosis Chapter 16 (Group and Family Therapy) {{ Added, in the section on confidentiality issues in group therapy, brief mention of social media as a potential method of clients sharing confidential information about other clients, and of confidentiality contracts as a possible method of minimizing such confidentiality violations {{ Added brief coverage of the efforts to create relational diagnostic alternatives to DSM since the 1980s {{ Added coverage of the research on financial benefits, in terms of spending of taxpayer dollars, for multisystemic family therapy Chapter 17 (Clinical Child and Adolescent Psychology) {{ Added coverage of “youth culture” as a cultural variable to which psychologists should be sensitive, and related research on the correlation between adolescent clients’ ratings of their therapists’ social media competency and the therapeutic alliance {{ Added coverage of problem-solving strategies and affective education strategies within the discussion of cognitive-behavioral therapy (CBT) approaches and self-instructional training {{ Added research on play therapy outcome studies, including their methodological limitations {{ Added research on a five-decade meta-analysis on overall efficacy of psychotherapy with children and adults {{ Added updated coverage of the most frequently used assessment techniques for children and adolescents {{ Added a brief note about how the inferential, rather than empirically- based, method of interpreting drawing techniques brings their reliability and validity into question Chapter 18 (Health Psychology) {{ Added coverage of the tend-and-befriend response to stress as an alternative to fight-or-flight xxx   Clinical Psychology  {{ Added coverage of emotion-focused coping as an alternative to problem- focused coping {{ Added a bullet-point list of components of successful weight loss strategies {{ Added coverage of the STAR approach to smoking cessation Chapter 19 (Forensic Psychology) {{ Added coverage of the use of Internet searches and social media information as part of forensic assessments {{ Added coverage of the fact that the approach to criminal responsibility in not guilty by reason of insanity (NGRI) cases differs across diverse countries {{ Added coverage of research on rehospitalization outcomes of NGRI release evaluations with agreement or disagreement among evaluators {{ Added brief coverage of research on linguistic issues, including the use of translators and interpreters, in forensic assessment in the Considering Culture box {{ Added brief mention of the fact that a small number of forensic psychologists are conducting evaluations to determine the need for emotional support animals {{ Removed coverage of Psychology and the Nuremberg Ethic A CHAPTER-BY-CHAPTER OVERVIEW The textbook begins with a definition of clinical psychology, a consideration of how clinical psychologists are trained, and a survey of the professional activities and settings of clinical psychologists (Chapter 1). Chapter 2 considers the rich history of clinical psychology, and Chapter 3 highlights the current controversies and directions that char- acteri