Clinical Psychology Exam 1

What is Clinical Psychology?

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 with a wide range of client populations

Clinical psychologists must obtain

a doctoral degree

Scientist-Practitioner Model (Boulder Model)

balances science and practice; includes lot of statistics and quantitative methods courses. This dominates the field.

Scholar-Practitioner Model (Vail Model)

delivering psychological services, not on research training

Clinical-Scientist Model

emphasis on empirically supported treatments and on scientific training 

Ph.D. programs

• Stronger emphasis on research

• Smaller class sizes and faculty to student ratios

• More full-time faculty

• Higher admissions standards

• More funding to enrolled students

Psy.D. programs

• Stronger emphasis on psychological practice

• More likely to be housed in free-standing,  independent schools

• Lower admission standards

• Offer less funding to enrolled students

• Larger class sizes

• Have lower rates of success placing students in APA-accredited predoctoral internships

  • Required to complete the doctoral degree

PhD programs admit

7-16% of applicants

PsyD programs admit

40-50% of applicants

Clinical Training

• Practicum training

• One year long per-doctoral internship

  • To graduate from an APA accredited program, a one year long pre-doctoral internship is required

Research Training

• Graduate students work closely with faculty meteors to develop an area of research

• Many PhD programs require their students to complete a master’s thesis

• All PhD program require their students to complete a doctoral dissertation 

  • Student must defend their dissertation to a committee of faculty members to demonstrate their knowledge

Predoctoral Internship

• All clinical psychology programs end in a one-year internship

  • Full year of supervised clinical experience in applied setting 

  • Must be completed before the doctoral degree is awarded

  • Application process has many similarities to apply to graduate programs

    • “Match” process

50% of clinical psychologists

spend at least part of their time teaching supervision 

psychotherapy is

predominant

Assessment is

second most common

Formal

evaluate students with behavioral problems to work with teachers to find effective interventions

Informal

between colleagues

Psychiatry

• Psychiatrists attend medical school and are licensed physicians

• Engages in psychotherapy

• Prescribe psychotropic medication

Counseling Psychology

• Historically tended to treat problem of adjustment or minor forms of maladjustment

  • Differences are shrinking

School Psychology

Primarily conduct psychological testing to diagnose learning disabilities, ADHD, and developmental disabilities

Professional Counselor

• Masters degree; focus on psychotherapy

• LPC

Social Work

• Traditionally have connected individuals with social resources and arranged vocational and residential placements

• MSW

Moral Treatment Movement

• William Tuke

  • Founded the York Retreat in England

• Philippe Pinel

  • Worked to reform mental health care in france

  • Record keeping

Eli Todd

• Advocated for the human treatment of the mentally ill

  • Opened the Retreat in Hartford, Connecticut

Dorothea Dix

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

Lightner Witmer

• Psychology was an academic discipline only focused on research so he

• Opened the world’s first psychological clinic

  • Treated children who had a difficulty learning in schools

• Proposed that psychologists should continue to function as scientists, but also apply what they learn to address practical problems

• To formally propose the profession of clinical psychology

Emil Kraepelin

• Wrote textbook on psychiatry

• The father of descriptive psychiatry

• Dementia praecox as a predecessor of schizophrenia

  • Set a precedent for the creation of diagnostic terms

Neurosis

Mental health symptoms, in touch with reality

Psychosis

Broken from reality in their thinking

Exogenous disorders

Caused by external factors 

Endogenous disorders

Cause by internal factors

when was the DSM first published?

1952

When was the DSM II published?

1968

broad and vague

When was the DSM III published?

1980

First significant change

Changed diagnostic criteria

The number of disorders represented in the DSM increased by ___% from the first DSM to DSM IV

300

Binet-simon scale

• Established a test to help the Parisian public school system

• This was the first norm-referenced test of intelligence

• Adapted by researchers and clinicians interested in intelligence and classifying children with learning difficulties

David Wechsler

• Created intelligence test for adults

• Wechsler-Bellevue test

• Currently the Wechsler Adult Intelligence Scale

• Wechsler intelligence scale for children (WISC)

• Wechsler Preschool and Primary Scale of Intelligence (WPPSI)

Projective personality test

Individuals are assumed to project their personality characteristics via responses to ambiguous or vague stimuli

Objective personality tests

• Scoring and interpretation more straightforward

• Self-directed paper and pencil instruments

Validity scales

• Assessed random responding, intentionally misleading responses

• Several revisions and MMPI-A for adolescents

Influence of war on psychotherapy

WWI

• Helped move intelligence testing forward

• Created demand for more practicing clinical psychologists

  • Shell shock (PTSD)

  • The government and VA requested formalized training to help meet demands

Psychodynamic approach

• Initially dominated the field

• It was challenged as time passed

Behavioral approach

• Popular in the 40-50s

• Measure problems and progress in observe, quantifiable terms

Humanistic approach (client-centered)

• Popular in the 1960s

• Emphasized relationships and personal growth

• Carl Rogers

  • Bigger pictures, what are their experiences like, how can we help them grow as a person

Cognitive therapy

• 1980s-Present

• Emphasis on logical thinking

Psychiatrists have the ability to prescribe medications (T/F)

true

Some states have granted prescription privileges to trained psychologists since the early 2000s, why?

• Shortage of Psychiatrists

• Clinical psychologists are more expert than primary care physicians

• Other non-physician professionals already have prescription privileges

  • Dentists, podiatrists, optometrists

• Convenience for clients

  • Many clients treated with both psychotherapy and psychotropic medication

  • Streamlines the process

Why is a clinical psychologist prescribing medication good?

• Professional autonomy

  • Able to treat clients without having to rely on other professionals

• Professional identification

  • 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

Why is a clinical psychologist prescribing medication bad?

• Training issues

  • What education should psychologists receive before prescribing

  • Should psychologists be trained to promote understanding

• Threats to psychotherapy

  • The way psychologists understand and intervene with their clients may shift from behavioral, cognitive, and emotional process to symptom reduction via psychotropic medications

• Identity confusion

  • Clients do not understand

Evidence-based practice is defined as

"integration of the best available research with clinical expertise in the context of patient characteristics, culture and preferences.”

Authors of the DSM do not review research and solicit feedback from professionals before including any new disorders and changing existing disorders (T/F)

false

Over expansion of disorders

• Introducing new disorders that capture experiences once considered normal

  • Prolonged grief disorder and binge-eating disorder

• Lowering the bar

  • For diagnosing existing disorders

Attribute over expansion to

the pharmaceutical industry

Tele-psychology

• The use of technology including the internet, video conferencing, smartphones, and text based services

• Helps underserved populations

Code of Ethics

Clinical psychologists are obligated to behave ethically in all of their professional activities

two distinct sections of code of ethics

• General principles

  • Aspirational- broader descriptions of ethical behavior

• Ethical standards

  • Enforceable- rules of conduct

APA General Ethical Principles

• Beneficence and nonmaleficence

  • Benefit those with whom they work and do no harm

• Fidelity and responsibility

  • Relationships of trust

• Integrity

  • Promote accuracy, honesty, and truthfulness

• Justice

  • All persons to access and benefit from the contributions of psychology

• Respect for people’s rights and dignity

  • Privacy, confidentiality, and self-determination

Psychologists Ethical Beliefs

• Behaviors sometimes considered blatantly unethical

• Some are considered unquestionably ethical

• Some fall into a gray area

Confidentiality is the most important area of ethics for clinical psychologists (T/F)

true

what set the precedent for duty to warn?

Tarasoff v. Regents of the University of California

Informed consent

Informing an individual about proposed activities and obtaining the individuals voluntary consent before proceeding with the activities

Three areas of informed consent

• Research

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

• Assessment

  • Nature and purpose of assessment, any relevant fees, involvement of other parties, and limits of confidentiality

• Therapy

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

  • Clients should ask questions

Multiple relationships

• Occurs when a psychologist is in a professional role with a person AND

  • At the same time is another role with the same person; or

  • 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

  • Promises to enter into another relationship in the future with the person or a person closely associated with or related to the person

Sexual multiple relationships

• Most damaging

• “Psychologists do not engage in sexual intimacies with current therapy clients.

Nonsexual multiple relationships

Friendship, business relationships, affiliations through religious activities

Competence

Sufficient capability, skill, experience, and expertise to complete particular tasks adequately

burnout

• A state of exhaustion that relates to engaging continually in emotionally demanding work

• ⅔ clinical psychologists report experiencing mental health difficulties themselves

Two main components of multiple relationships

1. impairment in the psychologist

2. exploitation or harm to the client

Standard 4.01

the obligation and take reasonable precautions to protect confidential information

Clinical Psychologists must obtain a doctoral degree (T/F)

true

Arroyo is interested in becoming a Clinical Psychologist. However, he is primarily interested in conducting therapy and assessments (i.e., providing clinical services). He is not interested in research training. Which training model would best fit his goals?

Scholar-Practitioner Model

Eliza is interested in becoming a Clinical Psychologist. She is most interested in ultimately pursuing an academic career conducting and disseminating research. Which training model would best fit her goals?

Clinical Scientist Model

During the Moral Treatment Movement, William Tuke opened up the York Retreat in England. What was the York Retreat?

A large farmhouse where patients were given freedom and asked to participate in chores

Ethical Standard 3.05a states that

multiple relationships occur when a psychologist is in a professional role with a person and at the same time

1. is in another role with the same person

2. in a relationship with a person

3. promises to enter into another relationship in the future with the person

Who is widely viewed as the individual responsible for the creation of the field of Clinical Psychology?

Lightner Witmer

Emil Kraepelin proposed that most mental illnesses could be divided into two categories. What two categories did he propose?

Exogenous and Endogenous

A(n) ____________________ personality test assumes that individuals project their personality characteristics via responses to ambiguous or vague stimuli.

Projective

What historical event led to formalized training for Clinical Psychologists in the U.S. and also led to the establishment of an accreditation process for graduate programs in Clinical Psychology?

WWII

Advocates for prescription privileges for clinical psychologists cite _____ as support for their argument.

convenience for clients

Disadvantages of the emergence of manualized therapies with empirical support include

restriction of clinicians to use only empirically supported treatments.

Some clinical psychologists criticize the DSM, stating some disorders and symptoms are difficult to distinguish from normal behavior. This criticism best illustrates the debate surrounding

the over-expansion of mental disorders.

When psychotherapy outcome researchers seek clients on whom to conduct psychotherapy in a study, they typically seek clients who

are "textbook cases" of the diagnosis the therapy intends to treat.

The use of technology including the internet, videoconferencing, smartphones, and text-based services, in the application of clinical psychology is referred to as:

Telepsychology

Which of the following Ethical Principles best captures the idea that clinical psychologists strive to benefit the patients with whom they work, while at the same time ensuring they do not harm their patients?

Beneficence and Nonmaleficence

The _________ section of the current APA code of ethics includes enforceable rules of conduct, as opposed to aspirational ideals regarding the behavior of clinical psychologists.

Ethical Standards

For contemporary psychotherapists, the most relevant implication of the finding in the Tarasoff case is the

duty to warn

According to the most recent edition of the APA code of ethics, it is necessary to obtain _____________ before proceeding with research, psychotherapy, or assessment.

informed consent

According to the most recent edition of the APA code of ethics, which of the following statements is TRUE regarding multiple relationships?

Multiple relationships are unethical only when they can be reasonably expected to cause impairment in the psychologist or risk exploitation or harm of the client.