Clinical Psych Exam 1

Original definition

Person whose work w/ others involved aspects of treatment, education, and interpersonal issues

Limitations of simple definitions

As a group, contemporary clinical psychologists do many different different things, w/ many different goals, for many different people

Division of Clinical Psycholgy

• division 12 of the APA

Working definition for this textbook

“Clinical psychology involves rigorous study and applied practice directed toward understanding and improving the psychological facets of the human experiences, including but not limited to issues or problems of behavior, emotions, or intellect”

Scientist-Practitioner (Boulder) Model

• Balancing practice and science

• Balanced, two-pronged approach to clinical psych training

• Most widely used model

• Put year?

Practitioner-Scholar (Vail) Model

• Leaning toward practice

• Emphasis on clinical practice

• PsyD

• Half of doctoral degrees are PsyD

• PsyD programs accept more students

Clinical Scientist Model

• leaning toward science

• Approach that emphasizes research and science

• Academy of psychological science

• Insider’s Guide to Graduate Programs in Clinical and Counseling Psychology ?

• Trends in Clinical Psychology?

• Increased stress for students ?

What do Grad Programs Prefer?

• know your professional options

• Take appropriate undergrad courses

• Get to know your professors

• Get research experience

• Get clinically relevant experience

• Maximize your GRE score

• Select grad programs wisely

• Write effective personal statements

• Prepare well for admissions interviews

• Consider your long-term goals

• Search the literature

• Evaluate each program

Predoctoral Internship

1 year full time internship

Take on greater clinical responsibilities and obtain supervised experience

Postdoctoral internship

• some states have dropped requirement of a postdoc

• Occurs after degree is obtained

Getting Licensed

• licensure

• Examination for Professional Practice in Psych; Examination for Professional Practice in Psychology (EPPP)

• Continuing education units

Where do clinical psychologists work?

• private practice

• University psych department

• Hospitals/health centers

• Global distribution of psychologists

What do clinical psychologists do?

• psychotherapy

• Spend 31-37% of time conducting psychotherapy

• +50% of psychologists somewhat involved in other activities

What characteristics do clinical psychologists have ?

• ethnicity, gender, age?

• Less religious

• More liberal

• Cognitive/cognitive-behavioral approach; especially the ones who learned science/research approach

Vs. Counseling Psychologists

• Work w/ clients w/ less severe disorders

• Work in university counseling centers

• Endorse client-centered approaches (humanistic) rather than behaviorism

• Interest in vocational teaching/career counseling

Vs. Psychiatrists

• can prescribe medications

• Emphasize biology

• Favor medication

Vs. Social Workers

• focus on the interaction between a client and society

• Get into the “nitty-gritty” of their client worlds by visiting their homes or work places, or by making contacts on their behalf w/ organizations that might prove beneficial

• Focus on clients’ successful transition by ensuring that needs such as those for housing, employment, and outpatient mental health services are being met

• Field has expanded and the similarity of some to clinical psychologists has increased (esp. those conducting therapy)

• Master’s degree instead of doctorates and training includes strong emphasis on field work, rather than research methods, psychological testing, or physiological psychology

Vs. School Psychologists

• Professionals who enhance lives of students

• Usually work in schools, but some may work in other settings such as daycare centers or correctional facilities

• Frequently conduct psychological testing to determine diagnoses such as specific learning disorders or ADHD

• Use or develop programs designed to meet the educational and emotional needs of students

• Consult w/ adults involved in students’ lives

• Requires master’s degree in many states

Vs. Professional Counselors

• Licensed Professional Counselors (LPC)

• Earn a master’s degree

• Serve wide varieties of clients

• Often specialize in areas and every state has some version of professional counselor licensure

Vs. Marriage and Family Therapists

• MFTs

• Work w/ couples, families, or individuals

• Master’s degree

• Half work in private practices

Western Hemisphere (1700s-1800s)

• people w/ mental illness understood to be possessed by evil spirits

• People seen as deserving their symptoms as a consequence of some reprehensible action or characteristic

William Tuke (1732-1822)

• early pioneer who devoted life to improving conditions in asylums

• York retreat

Philippe Pinel (1745-1826)

• brought people w/ mental illness out of dungeons

• Worked to dispel myths that people w/ mental illness were not possessed by devils and that they deserved compassion and hope rather than maltreatment and scorn

• Treatise on Insanity (1806)

Eli Todd (1762-1832)

• learned about Pinel’s efforts in France, and he spread the word among his own medical colleagues in the US

• The Retreat

Dorothea Dix (1802-1887)

• early pioneer of clinical psychology who traveled to collect data

• +30 state institutions created thanks to her

Lightener Witmer and the Creation of Clinical Psych

• late 1800s: psychologists did not practice

• Founder of first psychological clinic (1896)

• 1914: 20 psychological clinics in US

• 1935: 150 clinics

• The Psychological Clinic (1907)

The Psychological Clinic

• Witmer founded first scholarly journal in the field entitled The Psychological Clinic

• 1907

• Authored first article titled “Clinical Psychology” in first issue

• Article included first known publication of term clinical psychology, as well as a definition of the term and an explanation of the need of its existence and growth

Winter’s definition of clinical psychology

Defined as related to medicine, education, and social work but stated that physicians, teachers, and social workers would not be qualified to practice clinical psych

Treatments that he mentions in definition aren’t accompanied by any mention of a plan for empirically measuring their effectiveness

Samuel A. Cartwright

• 1851

• Proposed drapetomania as a mental disorder/disease that prompted slaves to run away rather than remain submissive to their white owners

Eugenics Movement

• 1800s - early 1900s

• Prominent figures in psych aligned themselves w/ this movement

• Promoted the idea that society should control reproduction opportunities to increase racially desirable qualities in the next generations

• Psychologists created or used intelligence tests used to measure fitness to reproduce, and thousands who scored too low were sterilized

• (Early 1900s) most states had laws governing sterilization; “feeble-mindedness”; “mental deficiency”

G. Stanley Hall

• (1892) first APA president

• Described people of African, indigenous, and Chinese heritage as immature races who development was inferior to that of white people

• Promoted “civilizing programs” for Native Americans’ supposed need for further development, and those programs included efforts to strip Native Americans of their culture, language, and spiritual beliefs

Lewis Terman

• psychologist

• Early APA president

• Creator of still-influential IQ test (Stanford-Binet)

• Described Black people as dull due to racial inheritance

• Recommended that Black children be educated differently than white children because their intellectual skills were limited to concrete and practical tasks, not the ability to think abstractly

Carl Jung

• Once-prominent figure in the psychotherapy field who theories still retain some followers today

• (1930s) Described African people as primitive and inferior, and by contrast described white people as civilized

1930s survey of psychologists

• 25% agreed that the inherent mental ability of Black people was inferior to that of white people

• Another 64% said the data was inconclusive

• Only 11% said the inherent mental abilities of the two groups was equal

APA: culturally based intelligence tests

• US army asked APA (and some specific psychologists) to create intelligence tests to help determine whether prospective soldiers were fit to serve

• Tests were quite culturally biased w/ references to things, words, and ideas that were much more common knowledge in the lives of white people than in the lives of people of color

• Results showed that even when education level was controlled for, Black people consistently scored lower than white people on these tests

Arthur Jensen’s view on IQ

• 1960s

• Influential professor of psych at the University of California

• Made the claim that Black people had lower IQs than white people, and that the difference was due to genetic factors

• Also argued that Black people were better at rote learning than abstract thinking

• Claims were promoted by neo-Nazi organizations

Richard J. Hernstein’s The Bell Curve

• 1990s

• Harvard Psychologist

• Coauthored a book about IQ called The Bell Curve, which argued that Black people were genetically inferior to white people and Asian people in terms of intelligence

2000s Microaggressions survey

• Black clients often experience microaggressions from white therapists

APA formal apology

• 2021

• APA issued formal apology for toke in promoting racism

Neurosis

• patients suffer from some psychiatric symptoms (including anxiety and depression) but still maintain reality

• Neurotic

Psychosis

• Patients demonstrate break from reality in the format of hallucinations, delusions, or grossly disorganized thinking

• Ex; Schizophrenia

• Psychotic

Emil Kraepelin (1833-1926)

• Considered father of “descriptive psychology”

• Offered a different two-category system of mental illness

• Differentiated exogenous disorders from endogenous disorders and suggested that exogenous were far more treatable

• Also assigned names to specific examples of disorders in the broad exogenous or endogenous categories

• Ex; he put forth the term dementia precox to describe one endogenous disorder similar to what is now known as Schizophrenia

• Also proposed terms such as paranoia, manic depressive psychosis, involuntional melancholia, cyclothymic personality, and autistic personality

• Most of his specific terms have long been replaced, but by offering such specific terminology, he set a precedent for the creation of diagnostic forms that eventually led to the DSM

Exogenous

Caused by EXTERNAL factors

Endogenous

Caused by INTERNAL factors

Diagnostic and Statistical Manual of Mental Health Disorders (DSM)

• (1952) ORIGINAL published by American Psychiatric Association

• (1968) DSM-II not significantly different

• (1980) DSM-III signified fundamentally different way of thinking about mental disorders

• Several more revisions: DSM-III-R, DSM-IV, DSM-IV-TR, and DSM-5

• (MARCH 2022) CURRENT edition is the DSM-5-TR

Edward Lee Thorndike

• among those who promoted the idea that each person possesses separate, independent intelligences

Charles Spearman

• led a group of theorists who argued for the existence of “g”, a general intelligence thought to overlap w/ many particular abilities

Alfred Binet

• French govt. sought help in determining which public school students should qualify for special services

• Along w/ Theodore Simon, created the first Binet-Simon Scale (1906)

• Yielded a single overalls score endorsing the concept of “g”

• The first to incorporate a comparison of mental age to chronological age as a measure of intelligence; this comparison when expressed a division problem, yielded the “intelligence quotient” or IQ

• Binet’s test grew in popularity and was eventually revised by Lewis Terman in 1937 into the Standford-Binet Intelligence Scales, the name by which its now known

David Wechsler

• 1939

• Filled the need for a test of intelligence designed specifically for adults w/ the publication of his Wechsler-Bellevue Test

• Has been revised a numerous times: the Wechsler Preschool and Primary Scale of Intelligence (WPPSI), 1989 (WPPSI-R), 2002 (WPPSI-III), and 2012 (WPPSI-IV)

Hermann Rorschach

• (1921) released famous set of 10 inkblots

• Projective personality test so inkblot method was based on assumption that people will “project” their personalities onto ambiguous or vague stimuli

• The way individuals perceive and make sense of the blots correspond to the way they perceive and make sense of the blots corresponds to the way they perceive and make sense of the world around them

• Rorschach Inkblot Method

Christina Morgan and Henry Murray

• published the Thematic Apperception Test (TAT) in 1935

• Similar to Rorschach in that the test taker responded to cards featuring ambiguous stimuli

• Instead of inkblots, the TAT cards depicted people in scenes or situations that could be interpreted in a wide variety of ways; instead of identifying objects in the card, clients were asked to tell stories to go along w/ the interpersonal situations in the TAT cards; their responses were thought to reflect personality characteristics

Other projective personality tests

• Drwa-A-Person test; psychologists infer personality characteristics from clients’ drawings of human figures

• Julian Butter’s Incomplete Sentence Bank (Butter and Rafferty 1950); psychologists assess personality by examining the ways in which clients finish sentence stems

Objective Personality Test

• appeared soon after projectives, offering a very different method of assessing personality

• Typically, tests were pencil-and-paper instruments for which clients answered multiple-choice or true-false questions about themselves, their experiences, or their preferences

• Scoring and interpretation were typically more straight-forward

• Some focused on specific aspects of personality, whereas others aimed to provide a more comprehensive overview of personality

Minnesota Multiphasic Personality Inventory (MMPI)

• (1943) written by Starke Hathaway and J.C. McKinley

• Originally, consisted of 550 true false statements; test takers’ patterns of responses were compared w/ those of groups in the standardization sample who represented many diagnostic categories

• Could help a psychologist categorize a client through use of its clinical scales and also used validity scales to access the test-takers approach to the test

• MMPI had a built-in system to detect random responding or intentionally misleading responses

MMPI-2

• released in 1989

• It’s norms were more appropriate than those of the original MMPI, especially in terms of including minorities and individuals from various regions of the country in the standardization sample

• Eliminated outdated or confusing language from original

MMPI-A

• 1992

• Adolescent version of MMPI

NEO Personality Inventory

• successors: NEO-PI-R and NEO-PI-3

• Less geared toward psychopathology than MMPI

• Rather than diagnostic categories, its scales are based on universal personality characteristics common to all individuals (Big Five personality factors)

Beck Inventories

• Instruments measuring more specific states or traits have also appeared, including the Beck Depression Inventory and Beck Anxiety Inventory

Psychotherapy

• clinical psychologists initially worked in academic after Witmer

• (1940s/1950s) psychotherapy played a significant role in the history of clinical psych

• Middle of the 20th century, psychodynamic approach to therapy dominated

• (1950s/1960s) Behaviorism surfaced as a fundamentally different approach to human beings and their behavioral or emotional problems

• Behavioral approach was in part a reaction to lack of empiricism evident in psychodynamic psychology

• (1960s) Humanistic (client-centered) therapy flourished

• (1950s) Family therapy revolution

• Cognitive Therapy became most popular among clinical psychologists

• Wide array of approaches now

Psychodynamic Approach

Emphasizes the influence of unconscious thoughts, motives, and early childhood experiences on behavior and personality

Humanistic Approach

• Carl Rodger’s relationship and growth-oriented approach to therapy offered an alternative to both psychodynamic and behavioral approaches that many therapists and clients found attractive

Family therapy revolution

• as 1960s and 1970s arrived, understanding mentally ill individuals as symptomatic of a flawed symptom had become a legitimate and therapeutic perspective

Development of the Profession

• (1940s) education more widespread

• (1950s) therapy approaches proliferated w/ new behavioral and humanistic/existential approaches rivaling established psychodynamic techniques

• (1960s and 1970s) diversifying field and clinical approaches

• (1980s) clinical psychologists gained hospital admitting and payment privileges

• (1990s-2010s) growth of profession

• Continued growth, diversification, and specialization

Prescription Privileges

• (1980s) Movement started

• Victory in (New Mexico, Louisiana, Illinois), Iowa, Idaho (5 or 3 states)

• Creation of APA division 55; society for prescribing psychology

Why Clinical Psychologists Should Prescribe?

• shortage of psychiatrists

• More expert at mental health than primary care physicians

• Other non physician professionals already have prescription privileges (dentists, podiatrists, optometrists, and nurse practitioners

• Convenience for clients

• Professional autonomy

• Professional identification

• Evolution of the profession

• Revenue for the profession

Why Clinical Psychologists Should Not Prescribe

• Training Issues

• Threats to psychotherapy

• identity confusion

• Potential influence of pharmaceutical industry

Evidence-Based Practice/Manualized Therapy

• movement had intensified in recent decades

• Development and proliferation of therapy manuals

• Change in terminology in listed therapies; “empirically VALIDATED” treatments to “empirically SUPPORTED” treatments to “EVIDENCE-BASED PRACTICE”

• First list of empirically validated treatments published in 1995; updates in 1996 and 1998

• Books and websites for updated lists of treatments; A Guide to Treatments that Work; Division 12 (Clinical psych) and Division 53 (Clinical child + Adolscents) websites

• Defined as three-legged stool; 1. Research, 2. Clinician’s knowledge and capability, 3. Qualities of client

Advantages of Evidence-Based Practice/Manualized Therapy

• Scientific legitimacy

• Establishing minimal levels of competence

• Training improvements

• Decreased reliance on clinical judgement

Disadvantages of Evidence-Based Practice/Manualized Therapy

• Threats to psychotherapy relationship

• Diagnostic complications using textbook cases

• Restrictions on practice w/ those using empirically tested methods more trusted

• Debatable criteria for empirical evidence

Overexpansion of Mental Disorders

• increase in size and scope of DSM

  • significant time and energy spent on considering every proposed disorder

  • Controversies on some decisions regarding symptoms believed to be common

• Criticism of DSM

  • no real epidemic of mental illness

  • Extends scope of mental disorders

  • No validity to the concept of mental disorders could be argued if most of population could relate to symptoms

• New Disorders and New definitions of Old Disorders

  • introduction of new disorders that once were normal

  • Lowering the bar for existing disorders

• Influence of Pharmaceutical Industry

  • drug companies have stake in the way mental disorders are defined; prefer broader definitions to get more buyers

  • DSM authors on payrolls of pharma companies

Payments Methods: Third-Party Payment Versus Self-Payment

• Earlier, direct payment

• Now, health insurance/managed care

• Development of third-party payers

Effect of Payment Methods on Therapy

• On psychologists

  • negative impact on practice and quality

  • Too much control over clinical decisions

  • No confidentially

  • Lower pay by managed care compared to self-pay by clients

  • Extra time spent on paperwork, phone calls, and other interactions

  • Denial of care to patients

• On clients

  • self-pay allows therapist and client to make import decisions

  • Self-pay an unaffordable option for many

  • Managed care makes therapy attainable

Effects of Payment Methods on Diagnosis

• Not paid if disorder does not qualify for a diagnosis

• Psychologists diagnose mild symptoms only when insurance companies pay

The Influence of Telepsychology: Telepsychology and More

• applications of technology in clinical psych

  • benefits are “accessibility, affordability, anonymity, acceptability, and adaptability”

  • Provide services to people living in poverty, in rural areas, or in war-torn/violent regions

• Methods

  • videoconferencing, e-mail or text, interactive internet sites, online psychotherapy programs, virtual reality techniques, self-instructional programs, apps and biofeedback sensors on handheld devices

How well do Telepsychology and other applications of technology work?

• works as well as traditional forms

• Weaker client/therapist relationship, but reduction of symptoms somewhat equal

Suggestions for Online Practitioners

• obtain informed consent from clients

• Know and follow laws on telehealth

• Know and follow recent version of APA ethical code

• Ensure client confidentiality

• Appreciate issued of diversity and culture

• No practice outside scope of expertise

• Be knowledgeable about emergency resources

• Choose technologies carefully; use legit apps

• Dispose of data carefully

• Stay a read of changes to laws and ethical standards

Effectiveness of Teletherapy depends on

• Telepsychology being used

• Device of delivery

• Setting of delivery

• Specific referral knowledge source

• Live human support