Clinical Psychology Final Exam

What is Clinical Psychology?

a branch of psychology that studies, assesses, and treats people with psychological problems or disorders

Definition of clinical psychology

rigorous study and applied practice directed toward understanding and improving the psychological facets of human experience

What can Clinical Psychologists do?

psychotherapy, diagnosis/assessment, teaching, research, consultation, administration, supervision

Scientist-Practitioner (Boulder)

Training model that balances practice and science

Practitioner-Scholar (Vail)

Training model that leans toward practices --> less research, more clinical training (PsyD)

Clinical Scientist

training model that leans towards science --> opposite of Vail model

When did the field of clinical psychology begin?

20th century

William Tuke (1732-1822)

• concerned about deplorable conditions in England's asylums

• argued for the humane treatment of people with mental illness

• York retreat: a residential treatment center where the mentally ill could go

Phillippe Pinel (1745-1826)

• worked to move individuals with mental illness out of dungeons in Paris

• work Treatise on Insanity --> goal was empathy for those living with mental illness

Eli Todd (1762-1832)

• a physician who spread Pinel's words/work around the U.S.

• raised funds to open The Retreat in Connecticut in 1824 (led to more institutions)

Dorothea Dix (1802-1887)

• noticed that many inmates were mentally ill rather than criminals

• collected city-wide data to present to community leaders, which resulted in the establishment of 30 state institutions throughout the U.S.

Lightner Witmer (1867-1956)

• founded 1st psychological clinic at UPENN in 1856, --> 150 opened by 1935

• founded 1st scholarly journal in the field: The Psychological Clinic in 1907, in which he coined the term 'clinical psychology'.

Describe the moral treatment movement

An emphasis on humane care and respect for individuals with mental illness

History of intelligence testing and the inherent racism

Intelligence tests, biased in favor of white people, were used to justify sterilizations, segregation,and economic inequality (as recently as the 1990s)

Drapetomania

a mental disorder of the desire to escape slavery

Scientific Racism

argument that race is biological rather than a social construct

Eugenics

controlling reproduction to improve the genetic quality of the population

What is the DSM? What is the most recent edition?

Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR)

How many more diagnoses have come about in the most recent edition (%)?

Has greatly expanded over time to the point of criticism of overexpansion

Projective Tests

People will "project" their personalities if presented with unstructured, ambiguous stimuli and unrestricted opportunity to respond (ex: Rorschach Inkblot Method)

Objective Tests

Unambiguous test items offer clients a limited range of responses, and are objectively scored (ex: Minnesota Multiphasic Personality Inventory - MMPI)

What are the main approaches to psychotherapy?

• Psychodynamic (20th century)

• Behavioral (1950-60s)

• Humanistic (60s)

• Family (50s)

• Cognitive (2000s)

What is Telepsychology?

The use of technology (e.g., the internet, videoconferencing, smartphones, text-based services) in the application of clinical psychology

Pros of telepsychology

• Can be equally effective as in-person therapy

• Increases access to psychotherapy

Cons of telepsychology

• Comes with its own barriers regarding accessibility (individuals with no technology or internet)

• Concerns about confidentiality

For: Prescription Privileges (1980s - early 2000s)

• Shortage of psychiatrists

• Clinical psychologists are more expert than primary care physicians

• Other non-physician professionals already have prescription privileges

• Convenience for clients

• Professional autonomy/identification

• Evolution of the profession

• Revenue for the profession

Against: Prescription Privileges (1980s - early 2000s)

• Training issues

• Threats to psychotherapy

• Identity confusion

• The potential influence of the pharmaceutical industry

Evidence-based practice (EBP)

Effective techniques can be shared in exact terms, which keeps variability among therapists to a minimum

Pros of EBP

• Scientific legitimacy

• Establishing minimal levels of competence

• Training improvements

• Decreased reliance on clinical judgement

Cons of EBP

• Threats to psychotherapy relationship

• Diagnostic complications

• Restrictions on practice (client care would be less personalized and individual-tailored)

• Debatable criteria for empirical evidence

• Concerns about diversity and equity

Manualized therapies (pros and cons)

Same as EBP?

Overexpansion of disorders in DSM

• no real epidemic of mental illness

• extends the scope of mental disorders

• No validity to the concept of mental disorders

• Drug companies have a stake in the way mental disorders are defined

3rd-Party Pay vs. Self-Pay

Use of health insurance/managed care versus direct payment from the client

Pros of 3rd-Party Pay

Therapy becomes more accessible and affordable

Cons of 3rd-Party Pay

• Time taken away from direct clinical work

• Too much control over clinical decisions

  • Denial of care (requires diagnosis)

  • time limit to treatment

• Confidentiality concerns

• Lower pay

Cultural Competence

the awareness, knowledge, and skills needed to function effectively; the ability to understand, respect, and interact with people from different cultures

Structural Competence

The ability of psychologists to recognize and act on the profound impact of social, economic, and political structures on mental health, moving beyond individual factors to address systemic inequalities like poverty and discrimination

Cultural Self-Awareness

understanding that his/her viewpoint is unique, --> viewpoint towards clients that is less egocentric and more appreciative of the varying experiences of life

Cultural humility

recognizing the limits of one's knowledge about other cultures

Microaggressions

Comments or actions made in a cross-cultural context that convey prejudicial, negative, or stereotypical beliefs

Training Issues

• No single "best method" or consensus for training

• Identification of critical elements in the curriculum

• Training in cultural humility is considered an important element for therapy outcomes

• Huge gap between learning and implementation

• How to measure multicultural training outcomes

APA Code of Ethics: 5 general principles

Aspirational; describe an ideal level of ethical functioning or how psychologists should strive to conduct themselves

APA Code of Ethics: 10 ethical standards

enforceable rules of conduct; standards that can be violated

Limits to Confidentiality (3)

1. Risk of harm to self or others; Tarasoff Case; duty to warn (or protect)

2. Child/elder abuse

3. Court order or subpoena

Informed Consent

Essential process that should include the purpose, procedures, length of time, risks, adverse effects, incentive for participation, right to decline/withdraw from participation, responses, answers, and other notes made by the CP + confidentiality discussion

Multiple Relationships

when a CP has both a professional and informal relationship with a client, someone close to the client, or future plans to do either

Consequences of Multiple Relationship?

• Can cause impairment in the psychologist; difficulty remaining objective, competent, or effective

• Exploitation or harm to the client; unequal-power relationship

• 'Boundary violations'

Is every multiple relationship unethical?

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

Boundaries of competence

should only practice within the limits of their education and training

Efficacy

success of a particular therapy in a controlled study criteria (how well it works in the lab) - high internal validity, low external validity

Effectiveness

success of a therapy in actual clinical settings in which client problems span a wider range and clients aren't chosen as a result of diagnostics (how well it works in the real world) - low internal validity, high external validity

Internal Validity

extent to which the change in the dependent variable is due solely to the change in the independent variable

External Validity

generalizability of the result; valid for different settings and populations

Experiential Method

1. observation of events

2. The CP develops a hypothesis to explain the observed events

3. empirical testing of the hypothesis

4. Altering the hypothesis to match the results and interpretations obtained during empirical testing

Randomized Clinical Trials (RCTs)

Researchers test the outcome of a particular, manualized therapy on a particular diagnosis (common in CP)

Quasi Experiments

• not a true experimental design

• used when constraints limit the testing of certain hypotheses

• can determine a relationship between 2 variables, not a causal relationship (frequently used in CP)

Between-group Design

participants in different conditions receive entirely different treatments

Within-group Design

comparisons of participants in a single condition to themselves at various points in time

Mixed Group Design

combined aspects of Between Group and Within Group (can compare two groups as well as participants of each group)

Cross-sectional study

assess or compare a participant or group of participants at one particular point in time (Pros/Cons: easier and more efficient )

Longitudinal study

emphasize changes across time, often making within-group comparisons from one point in time to another

(Pros/Cons: provide valid approximations for changes that take place or evolve over time; require longer periods of time)

Case Study

thorough and detailed observation/ examination of one person or situation

Meta-analysis

Statistical method of combining the results of separate studies to create a summation of the findings

Skills of a clinical interviewer

1. Being self-aware (the interviewer's ability to know how he or she tends to affect others interpersonally and how others tend to relate to him or her)

2. Quieting yourself (not necessarily talking but internal, self-directed thinking pattern → preoccupied with own thoughts)

3. Developing positive working relationships (good to start during the interview, as they are a possible client)

Open-Ended Questions

allows for individualized and spontaneous responses

Closed-Ended Questions

allows for far less elaboration and self-expression but yields quick, precise answers

Clarification

make sure the interviewer has an accurate understanding of the client's comments --> also communicates they're listening and processing

Confrontation

asking a client about a previous comment; used when there are discrepancies or inconsistencies in a client's comments

Paraphrasing

repeating back what the client has said in a different form to assure clients know that they are being accurately heard

Reflection of feeling

Telling the client what they may be feeling to make clients feel their emotions are recognized

Summarizing

tying together various topics that may have been discussed, connecting statements that may have been made at different point, and identifying themes that have recurred during the interview

Importance of rapport building

positive, comfortable relationship between interviewer and client; put the client at ease so comfortable sharing

Directive approach

get exactly the info they need by asking clients specifically for it; can provide crucial data that may not otherwise be revealed (sometimes necessary to sacrifice rapport)

Non-directive approach

allows the client to determine the course of the interview; can reveal information that the interviewer did not ask

Intakes

determine whether the client needs treatment, what kind, and where?

Diagnostic Interview

Assign DSM diagnoses to the client's problems

Mental status exams

quickly assess how the client is functioning at the time

Crisis interviews

Assess a problem demanding urgent attention and provide immediate and effective intervention for that problem

Structured Interview

predetermined, planned sequence of questions

Unstructured Interview

no predetermined or planned questions

Semi-Unstructured Interview

start with unstructured segment, then asks specific diagnostic question.

"Dodo bird effect"

Common factors across all forms of psychotherapy; research shows that therapies work equally well.

Transdiagnostic approach

One core underlying factor can be a cause of many different disorders. Therefore, the focus of treatment should be the factor rather than the symptoms.

What is the therapeutic alliance? What is its importance?

A strong, reciprocal relationship between therapist and client that contributes to psychotherapy outcome

Common factors of psychotherapy

Therapeutic alliance
Feedback*
Goal consensus
Cohesion*
Empathy*
Positive regard and affirmation
Hope/Positive Expectations

Prescriptive

Specific therapy techniques for specific disorders

Integrative

blending techniques to create a new, hybrid form of therapy

Assimilative

firm grounding in one psychotherapy model, but willingness to selectively incorporate practices and views from other models

Eclectic

selecting the best treatment based on empirical data

Stages of change model

Precontemplation (belief that nothing's wrong, not a problem)
Contemplation (have a problem, but dragging feet)
Preparation (getting ready to change)
Action (making changes)
Maintenance (maintain the changes)
Relapse (reverting and having to go through the cycle again)

Tripartite model

Identifies three parties (client, therapist, society/outsider) who have a stake in how well therapy works and who may have different opinions about what constitutes successful therapy outcomes

What is the primary goal of psychodynamic psychotherapy?

To make the unconscious conscious

Insight

become aware of thoughts, feelings, etc that the client wasn't aware of before therapy

Free Association

a technique in which PP therapists ask clients to say whatever comes to mind without censoring themselves at all

Freudian Slips

client's verbal or behavioral slips that represent underlying intentions

Dream Work

our minds convert latent content to manifest content when we sleep; use symbols to express wishes, which can result in unconscious wishes appearing in a very distorted or disguised form

Latent content

the raw thoughts and feelings of the unconscious

Manifest Content

actual plot of the dream as we remember it

Resistance

When clients express reluctance to discuss certain topics, it could become a productive topic of conversation later

Id

pleasure-seeking, selfish, indulgent, animalistic impulses