Intro to Clinical Psychology Exam 1

How is clinical psychology defined?

Research, teaching and services relevant to the
applications of principles, methods, and procedures
for understanding, predicting, and alleviating
intellectual, emotional, biological, psychological, social
and behavioral maladjustment, disability and
discomfort, applied to a wide range of client
populations

What degree/training is required to become a clinical psychologist?

Clinical psychologists must obtain a doctoral
degree

What does graduate training typically involve?

advanced coursework, research, teaching experience, training in assessment, practicum training, 1 year long predoctoral internship (accredited by APA)

What requirements exist post-graduation for clinical psychs?

Most states require one to two years of postdoctoral clincial
training for licensure

Getting licensed
 Requirements vary from state to state
 Requires passing the national licensure exam (the
Examination for Professional Practice in Psychology)
 Also, there is typically a state-specific exam

Scientist-Practitioner Model

-equal emphasis on application and research

-coursework reflects dual emphasis

-historically dominated the field, most common model

Scholar-Practitioner (Vail) Model

-emphasis on delivering psychological services (not research)

-reflected in coursework

-created due to CPs questioning the utility of research training

-led to the development of PsyD

Clinical-Scientist Model

 Emphasis on empirically supported treatments and on
scientific training (even more so than the Scientist-
Practitioner model)
 Richard McFall (1991) published the “Manifesto
for a Science of Clinical Psychology”
 Stated “scientific clinical psychology is the only
legitimate and acceptable form of clinical
psychology...after all, what is the alternative? ...Does
anyone seriously believe that a reliance on intuition
and other unscientific methods is going to hasten
advances in knowledge?”

differences between a Psy.D. and a Ph.D. degree

Characteristics of Ph.D. Programs:

 Stronger emphasis on research

 Smaller class sizes and faculty to student ratios

 More full-time faculty

 Higher admissions standards

Characteristics of Psy.D. Programs:

 Stronger emphasis on psychological practice

 More likely to be housed in free-standing, independent

schools

 Lower admissions standards

 Offer significantly less funding to enrolled students

 Much larger class sizes

 Have lower rates of success placing students in APA-

accredited predoctoral internships

 This internship is required to complete the doctoral degre

What do graduate schools prefer in applicants? (I.e., what would make a student a strong/competitive applicant?)

 Strong undergraduate education in psychology

 Relevant coursework

 High GPA

 Get to know your professors

 Leads to stronger letters of recommendation

 Research experience

 High GRE (Graduate Record Examination)

scores

 Clinically relevant experience

 E.g., internship, volunteer experience

Select programs to apply to wisely

 Research interests that fit with a faculty member’s area of study

 Write effective personal statements

 This is a goal statement discussing your experiences

and career aspirations

 Prepare well for interviews

 What are your long-term goals?

 E.g., conducting therapy, assessments, conducting research?

 Finally...know your options!

 There are many careers that overlap with clinical psychology in

terms of professional activities

What does the professional activity of supervision involve?

a specialized type of teaching graduate

students

 Takes many forms (e.g., direct observation, reviewing

audio or video-taped sessions)

 Potential ethical issues

 It can also be difficult to evaluate the performance of a

supervisee

What professional activity do clinical psychologists tend to engage in most?

psychotherapy (but also do research, teaching, supervision, assessment, consultation, and administration work)

Psychiatry

 Psychiatrists attend medical school and are licensed

physicians

 Spend little time engaging in psychotherapy

 Primarily prescribe psychotropic medication

Counseling Psychology

 Historically, tended to treat problems of adjustment or

minor forms of maladjustment

 Differences are shrinking (compared to clinical psychology)

School Psychology

 Primarily conduct psychological testing to diagnose

learning disabilities, ADHD, and developmental

disabilities

Professional Counselor

 Master’s degree; focus on psychotherapy (not

assessment, research)

 Often called LPCs (licensed professional counselors)

Social Work

 Focus on the interaction between an individual and the

components of society that may contribute to or

alleviate the individual’s problems

 Traditionally have connected individuals with social

resources (e.g., disability benefits, food stamps) and

arranged vocational and residential placements

Moral Treatment Movement

significant efforts were made to reform mental health treatment

 William Tuke (1732-1822)—founded the York Retreat in England

 Philippe Pinel (1745-1826)—worked to reform mental health carein France

 Also encouraged record keeping

Eli Todd

advocated for the humane treatment of the mentally ill in the US.

 Opened The Retreat in Hartford, Connecticut in 1824

Dorothea Dix

her efforts resulted in the
establishment of more than 30 state institutions for the
mentally ill in the US

Lightner Witmer (1867-1956)

 Prior to Witmer, psychology was an academic discipline only—

focused on research, not on application

 Opened the world’s first psychological clinic in 1896

 Primarily treated children who had difficulty learning in schools

 Proposed that psychologists should continue to function as

scientists, but also apply what they learn to address practical

problems

 First to formally propose the profession of clinical psychology

Emil Kraeplin

published first textbook on

psychiatry (considered the “father of descriptive psychiatry”)

 Dementia praecox as a predecessor of schizophrenia

 Came up with a two-category system of mental illness:

 Exogenous Disorders: Caused by external factors

 Endogenous Disorders: Caused by internal factors

 Set a precedent for the creation of diagnostic terms

first to recognize bipolar disorder

Alfred Binet

 Also interested in helping children with learning difficulties

 Established a test to help the Parisian public school system identify students who would not benefit from instruction in a regular classroom

 Binet-Simon Scale

 Why was it so important???

 First norm-referenced test of intelligence

 Adapted by researchers and clinicians interested in intelligence

and classifying children with learning difficulties

 Predecessor of modern intelligence testing

 Now referred to as the Stanford-Binet Intelligence Scales

What historical event created more of a demand for practicing clinical psychologists and formalized graduate training?

World War II

Projective Personality Tests

A personality test in which individuals are assumed to

project their personality characteristics via responses to ambiguous or vague stimuli

 Heavily influenced by psychodynamic theory

 Projective assessments of personality

 Herman Rorschach (1884-1922)

 Inkblot Test (Rorschach Inkblot Method)

 Thematic Apperception Test (TAT)

 Developed at the Harvard Psychological Clinic by Henry Murray and was published in 1938

Objective Personality Tests

Objective personality tests

 More scientifically sound

 Scoring and interpretation more straightforward

 Typically self-directed paper and pencil instruments

 Minnesota Multiphasic Personality Inventory (MMPI; Hathaway

& McKinley)

 Published in 1943

 Validity scales—assessed random responding, intentionally misleading

responses

 Several revisions (MMPI-2; MMPI-2-RF; MMPI-3) and MMPI-A for adolescents

psychodynamic approach

initially dominated the field

 Psychodynamic approach was challenged as time passed, different approaches were developed

behavioral approach

popular in 1950s, 1960s

 Emphasized empirical method

 Measure problems and progress in observable, quantifiable terms

humanistic approach

(“client-centered”) popular in 1960s
 Emphasized relationships, personal growth

cognitive therapy

currently very popular
 Emphasis on logical thinking

What major change occurred in the structure of the DSM when the third edition was published (i.e., DSM-III)?

 Original Diagnostic and Statistical Manual of Mental

Disorders (DSM) was published in 1952

 DSM-II published in 1968—no major changes

 Broad, vague descriptions of disorders

 DSM-III (published in 1980) marked the first significant

change

 Provided specific diagnostic criteria

 The DSM has been revised several more times (currently on

DSM-5), but no changes have been as significant as DSM-III

 Rapid expansion of disorders in DSM

 Number of disorders represented in the DSM increased by 300%

from the first DSM to DSM-IV (1994)

 Scientific discovery or social invention?

What field (within psychology—e.g., clinical, cognitive, social, developmental, etc.) do most members of the

American Psychological Association belong to?

Majority of psychologists in APA are clinical psychologists
 More dominated by clinical interests

What are the arguments in favor of granting prescription privileges to clinical psychologists?

 Shortage of psychiatrists
 Underserved populations may benefit
 Clinical psychologists are more expert than primary care
physicians
 ~50-80% of prescriptions written for psychotropic medications come from primary care physicians and other non-psychiatrist physicians
 Other non-physician professionals already have prescription privileges
 E.g., dentists, podiatrists, optometrists, and advanced practice
nurses
 Convenience for clients
 Many clients are treated with both psychotherapy and psychotropic medication
 Streamlines the process

 Professional autonomy
 Able to treat clients without having to rely on other professionals
 Professional identification
 Would further differentiate clinical psychology from other mental
health professionals
 Evolution of the profession
 Some argue that impeding prescription privileges is standing in the way of the field progressing
 Revenue for the profession
 Could help offset salary decreases seen by many Clinical
Psychologists over the past few decades
 In 2018 alone, 600 million prescriptions were written for psychiatric medications in the US
 Strong opposition from psychiatric organizations

What are the arguments against granting prescription privileges to clinical psychologists?

 Training issues
 What kind of education should clinical psychologists receive
before prescribing? How in depth should it be? When should
it occur?
 Should psychologists be trained regardless to promote
understanding/communication?
 Threats to psychotherapy
 The way psychologists understand and intervene with their
clients may shift from behavioral, cognitive, and emotional
processes to symptom reduction via psychotropic medications

Are there states that currently allow clinical psychologists to prescribe?

Yes, such as Louisiana, Illinois, New Mexico, Iowa, and Idaho

What are the advantages of using manualized treatments?

 Scientific legitimacy
 Prior to evidence-based treatments, clinical psychology could
be considered a “cottage industry”—every psychologist puts
their own spin on treatment
 Establishing minimal levels of competence
 Reducing client harm/use of ineffective approaches
 Training improvements
 Training can be very different between different graduate
programs
 Decreased reliance on clinical judgment
 Clinical judgment is often flawed (and subjective to bias)

What are the disadvantages of using manualized treatments?

 Threats to the psychotherapy relationship
 Much of whether or not therapy is successful depends on the
quality of the therapeutic alliance
 Diagnostic complications
 Each evidence-based treatment manual targets a specific
disorder
 Restrictions on practice
 Some professionals are very dismissive of any treatments that
are not empirically supported
 Debatable criteria for empirical evidence
 More difficult to measure outcomes with certain techniques
(e.g., psychodynamic therapy)

What diagnostic complications might exist when utilizing manualized treatments?

some people have more than one diagnosis, how do you apply manualized treatments?

What might lead to the overexpansion of psychological disorders?

 Introducing new disorders that capture experiences once
considered “normal”
 E.g., premenstrual dysphoric disorder, binge-eating disorder,
prolonged grief disorder
 “Lowering the bar” for diagnosing existing disorders (so that
the criteria for a disorder might apply to more people)
 E.g., changing the age that symptoms of ADHD must be present by from 7 to 12 years
Potential consequences:
 People may receive treatment they don’t actually need

telepsychology

the use of technology including the internet,
videoconferencing, smartphones, and text-based services, in the
application of clinical psychology

-empirically supported

What are the potential advantages and disadvantages of telepsychology?

Benefits:

-more accessible, no driving time, ease anxiety, natural environment, stay with same therapist if moved

Disadvantages:

-privacy concerns, issues with state residency and licensure, some people are bad with tech, lack of body language issue, lack of outside world exposure

What changes related to telepsychology occurred due to the COVID-19 pandemic?

The COVID-19 pandemic greatly accelerated the use of technology in delivering therapy and assessments
 E.g., one study found that the use of technology in delivering services increased from 7% pre-pandemic to 85% during COVID (Pierce et al., 2021)
 Additionally, the pandemic increased the number of people seeking psychological services

narrow definition of culture

limiting culture to just race and ethnicity

broader definition of culture

culture can be composed of any group that shares a theme or issues

-socioeconomic status, gender, geography/region, age, sexual orientation, religion/spirituality, disability/ability status

subcultures

Relatively small groups within a society that may not fully
constitute cultural groups but whose members may
nonetheless possess typical and culturally meaningful
characteristics
 E.g., a psychologist working in a prison setting, working
with military personnel
 Adolescents have even been identified as a subculture

Recent efforts to emphasize culture in Psychology

 Increase of specialized journals and books

 Emergence of APA Divisions

 E.g., Society for the Psychology of Sexual Orientation and

Gender Diversity(Division 44); Society for the Study of Culture,

Ethnicity and Race(Division 45)

 APA’s ethical code compels psychologists to work with

cultural sensitivity and competence

 Principle E: Respect for People’s Rights and Dignity

 This states that psychologists need to be aware of and respect

cultural, individual, and role differences

 Standard 2.01 Boundaries of Competence

 Standard 3.01 Unfair Discrimination

 APA accreditation standards for graduate programs

 “Cultural and Individual Differences and Diversity” is one of 8

domains that a program must address

 DSM changes in light of multiculturalism

 General guidance to help with cultural competence (e.g.,

suggests aspects of culture to assess in clients)

 Glossary listing of cultural concepts of distress

 Includes 9 terms that represent psychological problems

observed in groups in various parts of the world (e.g., taijin

kyofusho—found in Japanese culture as well as some other

cultures)

 taijin kyofusho—a condition in which a person anxiously avoids

interpersonal situations because they believe that their appearance,

actions, or odor will offend other people

 Revisions of prominent assessment methods

 E.g., When the Minnesota Multiphasic Personality Inventory

(MMPI) was revised and became the MMPI-2

cultural competence

Therapist’s acquisition of awareness, knowledge,

and skills related to cultural diversity

 When clients perceive a therapist as culturally

competent—more likely to form better working

relationships

 Cultural self-awareness

 Knowledge of diverse cultures

 Culturally appropriate clinical skills

Cultural Self Awareness

 First step in being culturally competent is learning about

one’s own culture

 Everyone’s viewpoint is unique, everyone has had

unique experiences

 Cultural self-awareness may help us

 Realize that differences between people are not

deficiencies

 Explore our own personal reactions to differences and

address any discomfort

 Becoming self-aware can be difficult, unpleasant

cultural humility

an attitude about diversity
centered on the recognition of the limits of your own
knowledge and an openness to learning about the
identities and experiences of other people

Knowledge of Diverse Cultures

Need to be familiar with a client’s culture
 An ongoing process
 Psychologists can’t know everything about every culture
 What steps can you take then?
 What should cultural knowledge include?
 Current lifestyle of members of the culture, the group’s
history (especially regarding social and political issues)
 We also can’t assume that a member of a cultural group
will exhibit all of the characteristics common to that
group
 Heterogeneity
 Some of the heterogeneity within a culture stems from
differences in acculturation

Culturally Appropriate Clinical Skills

 Approaches and techniques used by a psychologist

should be consistent with the values and life

experiences of that client

 Awareness of microaggressions

 Cultural adaption of treatments with empirical

evidence

 We can’t assume that just because a

treatment works with one group, it will work

with clients from all backgrounds

 E.g., Guided imagery scripts

microaggressions

comments or actions made in a cross-cultural context that convey prejudicial, negative, or stereotypical beliefs and may suggest dominance or superiority of one group over another

 Can involve a variety of differences between people (e.g.,

gender, SES, age, religion/spirituality, sexual orientation)

 Microaggressions cause distress and can contribute to

serious psychological problems (Lui & Quezada, 2019)

etic perspective

a perspective that emphasizes the similarities between all people and deemphasizes the differences between cultural groups

emic perspective

a perspective that recognizes and emphasizes culture specific norms and the appreciation of clients within the context of their own culture

Tripartite Model of Personality

individual level: every person, in some ways, is like no other person

group level: every person is, in some ways, like some other people

universal level: every person is, in some ways, like all other people

When was the first APA code of ethics published?

1953

general principles

aspirational

broader descriptions of ethical behavior

ethical standards

enforceable

rules of conduct that psychologists can be found guilty of breaking, ethical violations

APA General Ethical Principles A-E

A. Beneficence and Nonmaleficence

B. Fidelity and Responsibility

C. Integrity

D. Justice

E. Respect for People’s Rights and Dignity

Beneficence and Nonmaleficence

Psychologists strive to benefit those with whom they work and take care to do no harm

Fidelity and Responsibility

Psychologists establish relationships of trust with those with whom they work

Integrity

Psychologists seek to promote accuracy, honesty, and truthfulness in the processes, procedures, and services being conducted by psychologists.

Justice

fairness and justice entitle all persons to access and benefit from the contributions of psychology and to equal quality in the processes, procedures, and services being conducted by psychologists

Respect for People’s Rights and Dignity

Psychologists respect the dignity and worth of all people, and the rights of individuals to privacy, confidentiality, and self-determination

When is it appropriate to break client confidentiality?

-imminent harm to self or others

-child or elder abuse

-court order

-consent

Tarasoff case

August1969—a student at the University of California at Berkley

(Prosenjit Poddar)

• Became romantically interested in another student (Tatiana Tarasoff)

• Sought therapy—disclosed he intended to kill Tatiana

• Psychologist broke confidentiality

• Police involvement—did not hold the student

• Student never returned to therapy

• October 1969—Poddar killed Tarasoff by stabbing and shooting her

• Tarasoff’s parents sued the psychologist and others involved in the

case for wrongful death

• Court found the psychologist liable

• Tarasoff v. Regents of the University of California (1976)

Duty to Warn

resulted from the Tarasoff case

• Set a legal precedent for psychologists

• Duty to warn people toward whom their clients make credible,

serious threats

• “The protective privilege ends where the public peril begins”

• Makes sense in theory—therapists could potentially save lives

• Some potential difficulties with practical applications

Why is confidentiality more of a challenge with child and adolescent clients?

• Concerns about privacy from caregivers

• Clinical psychologists will sometimes openly discuss this

dilemma with clients and their parents

• Reach an informal agreement regarding confidentiality

• Disclosing vs. not disclosing can be complicated

• What if your adolescent client is consuming alcohol?

• What if they are being bullied?

• Does the age of the client matter?

informed consent

the ethically mandated process of informing an individual about proposed activities (e.g., as a therapy client or research participant) and obtaining the individual’s voluntary consent before proceeding with the activities.

• Gives the individual the right to gather information, refuse

Research: Purpose of study, procedures, length of time required, risks or adverse effects, incentives to participate, right to decline

Assessment: Nature and purpose of the assessment, any relevant fees, the involvement of other parties, and limits of confidentiality

Therapy: Nature and anticipated course of therapy, fees, involvement of third parties, and limits of confidentiality

• Variations in timing

• Should also provide the opportunity for clients to ask questions

Multiple Relationships

when a psychologist is in a professional role with a person and:
• (1) at the same time is in another role with the same person,
• (2) at the same time is in a relationship with a person closely
associated with or related to the person with whom the
psychologist has the professional relationship, or
• (3) promises to enter into another relationship in the future with the person or a person closely associated with or related to the person

Unethical multiple relationships:

1. impairment in the psychologist

2. exploitation or harm to client

most damaging multiple relationship

sexual multiple relationships

technology and ethics

ensuring technology used is secure, planning

ahead to handle emergencies in other locations, etc.)

• Social media

• Should you interact with clients on social media platforms?

• Should you search for information on your clients online?

-these issues have not been addressed by APA code of ethics