PS381; Intro to Clinical Psychology

What is Clinical Psych

• Application of psychological knowledge to alleviate distress and promote well-being

• Range of Activities:

  • Assessment

  • Diagnosis

  • Consultation

  • Treatment

  • Program evaluation

  • Administration

  • Research

Ethical Principles

• Respect for dignity of persons

• Responsible caring

• Integrity in relationships

• Responsibility to society

*Some can come into conflict*

Evidence-Based Practice

• Clinical psych has increasingly moved toward requiring that psycholohsts base their work on evidence

• Emphasis on:

  • Utilizing data from research, the patient, and the professional’s experience

  • Importance of informing patients about options for assessment, prevention, or intervention services

What Do Clinical Psychologists Do

• Diagnose

• Treat

• Testify in court

• Self-supervising and governing

Counselling

• Target populations

• Entry to graduate programs

• Can obtain registration as a clincial psychologist

Social Worker

• Flexible scope of practice

• Therapy with groups, individuals, families

• Support groups

• Social skills training groups

• Helps with practical arrangements -- Housing, home care, applications of ODSP, ontario works

Nurse

• May work in psychiatry

• May work in continuing care programs

• Run support groups

• Addiction

• Range of administrative/management positions in health care

• May diagnose physical illness and mental disorders -- allowed to prescribe medications

Hippocrates

• Origins of biopsychosocial view

• Though psychiatric problems were treated poorly and abusive

• Mental illness is due to physical causes

• Did not fully understand it was the brain

• People should be living in peaceful environment, getting good food, getting rest

Bethlehem Hospital

• Earliest hospital in the UK

• Windows for people to come watch mentally ill -- like zoo animals

• Chaotic and unorganized

Benjamin Rush

• American Physician

• Expoused humanitarian values

• Believed that mental illness was due to brain disorder -- not demon possession

• Used inhumane methods

  • Bloodletting, purging, tranquilizing chair, etc

Phillipe Pinel

• Unchained psychiatric patients

• Relaxed the way patients were treated

  • Gave a “day pass” to some

  • Released some patients

Dorothea Dix

• Improved conditions for the poor in asylums in the US

• Had major issues with depression

Lobotomy

• About 10,000 performed worldwide

• Women were given hysterectomies as late as the 1960’s in a failed attempt to teat depression and anxiety

Rosemary Kennedy

• Had below average intelligence

• Father was embarrassed

  • Gave her a lobotomy without permission

• Lobotomy went very wrong

• Ended up in wheelchair

• Instituted for the rest of her life

Insulin Coma Therapy

• Used on people with schizophrenia

• Many died -- Very dangerous

• Controlled randomized study in 1957 showed no improvements form ICT

Electroconvulsive Therapy

• Initially used without anesthesia or muscle relaxants

• Still used, with general anesthetic as well as muscle relaxants

Assessment

• Prior to the mid 1940s, assessment was the focus of clinical psychology

  • Intelligence testing

  • Mental disorders and diagnostic systems

  • Personality

• Shortage of medical doctors and psychologists to provide therapy after WWII

Emil Kraeplin

• Thought that biological factors cause mental disorders, and medicine was incapable of treater these disorders

• Focused on studying disorders and developing a classification system

• Identified schizophrenia and bipolar disorder and used the term “syndromes” to indicate that certain symptoms occur together

• His work was an early precursor to the DSM

Alfred Binet

• Developed tests for assessing intelligence in children

• Gathered data on childhood performance on these tests and established norms

• His work provided a foundation for intelligence testing

Projective Testing

• Rorschach test -- Herman Rorschach

• Became popular in 1937

• Thematic Apperception test (TAT) published in 1935

World War II

• Prior to WWII, psychologists did testing but not therapy

• Many soldiers returning from war had PTSD

• Shortage of psychiatrists and medical doctors to provide therapy to returning soldiers, and many psychologists extended their practices to include psychotherapy

Revival of Personality Testing

• After period of unpopularity, there was a resurgence of personality testing in 80’s that has continued to this day

• 90s and 90s, Five Factor theory findings provided support for importance of personality traits

• FFT personality traits are relatively stable over time and occur in different cultures

• Acronym OCEAN

Cognitive Behavioural Therapy

• If you change your behavioour and change your thinking, your feelings will change

Dialect Behavioural Therapy

• Psychologist who worked with suicidal patients developed DBT to stop these suicidal thoughts

• Helps with BPD as well

Therapy Efficacy

• Efficacy research -- therapy research that takes place under ideal conditions

  • Involves a control group, the use of a treatment manual to ensure fidelity to the treatment model, randomized assignments to treatment groups 

Therapy Effectiveness

• Treatment effectiveness research -- Involve assessing how well a therapeutic approach works when therapy is developed under real-world conditions, as opposed to rigorous scientific conditions

• In the effectiveness approach -- The patient is typically asked to indicate how effective the therapy has been