clinical exam

what is clinical psych

-limitations of simple defintions

• AmThe field of Clinical Psychology involves 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” otional, biological, psychological, social and
  behavioral maladjustment, disability and discomfort, applied to
  a wide range of client populations”

American Psychological Association (APA

Provides parameters for the definition

Clinical psych involves…… study and
applied practice directed toward understanding
and …… the psychological facts of the
human experience, including but not limited to
issues or problems of behavior, emotions, or
intellect

rigorus, improving

Docctoral degree in clinical psychology required (PsyD or PhD)

• 4 years

• masters thesis amd doctoral disseration

• practicum training

• 1 year predoctoral internship

The Scientist-Practitioner (Boulder) Model

1949 conference in Boulder, Colorado
• Balanced, two-pronged approach to
clinical psychology training.
– Coursework and independent work reflect
dual emphasis

The Practitioner-
Scholar (Vail) Model

• Emphasis on clinical practice.
• 1973 conference in Vail, Colorado
• PsyD (coursework/practice > research)
• Half of doctoral degrees are PsyD.
• PsyD programs accept more students.
Pomerantz, Clinical Psychology, 6e. © 2023 SAGE Publishing. 7

psyD tend to

Compared to PhD programs, PsyD tend to:
• Place more emphasis on clinical training
• Accept students with lower GRE scores and GPAs
• Offer less funding
• Accept a higher % of those with master’s degrees
• Have less success in APA internship placements
• Produce graduates who produce lower EPPP
scores
• Graduate students in a briefer time period
• Graduate students who pursue practice-related
(vs. research/academic) careers

Clinical scientist Model

Sc

• Conceptualized in 1990’s
• Approach that emphasizes science and research
• Academy of Psychological Science
• Minority of all clinical psychology graduate
programs

TRENDS in clinical psych

• shift toward cbt

• tech

• marginalized people are represented

• emphasis on competencies

• increased stress FOR STUDENST

The Boulder model of training is also known
as the ______ model of training

scientist practitioner

The ______ typically consists of a full year of
supervised clinical experience in an applied setting
and takes place before the doctoral degree is
awarded

• predoctoral internship

The scientist-practitioner model of training
is characterized by a(n) ______.

emphasis on practice and research

WHat do grad programs like

• Know your professional options.
• Take appropriate undergraduate courses.
• Get to know your professors.
• Get research experience.

Get clinically relevant experience.
• Maximize your GRE score.
• Select graduate programs wisely.
– Training model, geography, $$, and family
• Write effective personal statements.
– Writing skills are crucial
– Do not be overly personal
– Highlight why you are a good fit
lishing. 19
. 18

what do grads also prefer

Prepare well for admissions interviews.
• Consider your long-term goals.
– Clinician vs. researcher
– Theoretical orientation
– Financial debt
• Search the literature.
– PhD vs. PsyD
• Evaluate each program.
– Competitive vs. collaborative
– Are current students happy
– Interpersonal functioning of faculty

• gettinf licensed

• state laws

What Do Clinical Psychologists Do?

• Psychotherapy.
• Assessment
• +50% of psychologists somewhat involved
in other activities.
Pomerantz, Clinical Psychology, 6e. © 2023 SAGE Publishing. 24

What Characteristics Do Clinical
Psychologists Have?

• Ethnicity, gender, age.
• Less religious.
• More liberal.
• Cognitive/cognitive-behavioral approach.
Pomerantz, Clinical Psychology, 6e. © 2023 SAGE Publishing. 25

Counseling Psychologists

• Work with clients with less severe
disorders.
• Work in university counseling centers.
• Endorse client-centered approaches.
• Interest in vocational teaching

Psychiatrists

• Can prescribe medications.
• Emphasize biology.
• Favor medication.

Social Workers

• Focus on the interaction between a client
and society.
• Get into the “nitty-gritty.”
• Focus on clients’ successful transition.
• Master’s degree

School Psychologists

Professionals who enhance lives of students.
• Areas of work.
• Psychological testing for learning disorders.

• Use of programs designed to meet
students’ needs.
• Consultation with others.
• Master’s degree.

Professional Counselors

• Professionals that counsel people.
• Master’s degree.
• Counselors serve wide varieties of clients.
• Specialization and specific state licensing.
ng. 32

Marriage and Family Therapists

• Professionals who work with couples,
families, or individuals.
• Master’s degree.
• ~50% in private practice.

Western hemisphere 1700-1800

People with mental illness understood to
be possessed by evil spirits.
• People seen as deserving their symptoms.
SAGE Publishing. 2

William turk

• Early pioneer who
devoted life to
improving conditions
in asylums.
• England
• York Retreat.
3

Phillippe Pinel

• Early pioneer who
brought people with
mental illness out of
dungeons.
• France
• Pinel worked to dispel
myths.
• Treatise on Insanity
(1806).

ELi todd

Early pioneer of
clinical psychology
who carried out
Pinel’s message.
• United States
• The Retreat.
5

Dorothea Dix

Early pioneer of clinical
psychology who
traveled to collect data.
• +30 state institutions
created thanks to Dix’s
efforts

Who founded first psychological clinic

Lightner Witmer

was an early pioneer in the field of
mental health who advocated for better
treatment of those with mental illness in
France, regarding them as patients rather than
inmates.

philipee pinel

Lightner Witmer originally defined clinical
psychology as related to the disciplines of

medicine education and social work

Diagnostic Issues

Neurosis vs. Psychosis.
• Emil Kraepelin.
– Exogenous and endogenous

Assessment of Intelligence**

edward lee thorndike

charles spearman

alfred binet

david wechsler

Edward Lee Thorndike (separate intelligences)
• Charles Spearman (“g”)
• Alfred Binet (IQ quotient)
• David Wechsler
Publishing. 16

Assessment of Personality:
Hermann Rorschach

• Projective personality test.
• Rorschach Inkblot Method.

Assessment of Personality
• Christina Morgan & Henry
Murray

-thematic apperception test (TAT)

• other test

  • draw a person test

  • incomplete sentence blank

Assessment of Personality: Other Objective
Personality Tests

• The Beck Depressive Inventory
• The Beck Anxiety Inventory
• The NEO Personality Inventory
. 20

• Humanistic –
• Family therapy –
• **Cognitive –
• Wide array of approaches.
SAGE Publishing. 22

• Humanistic – client centered approach
• Family therapy – flawed system
• **Cognitive – logical thinking
• Wide array of approaches.

types of psychotherapies

humanistic, family therpay, cognitive

Currently, the most popular singular
psychotherapy orientation among clinical
psychologists is the ______ orientation

cognitive

a term coined by Emil Kraepelin,
described a cluster of symptoms similar to
what is now known as schizophrenia

dementia praecox

Telepsychology

use of tech by clinical psychologists to deliver care

APPS fot clinical psych

• videoconference

• apps email text

• interactive internet sites

• online psychotherapy programs

• Virtual reality

• computer self instructional programs

• wearable biofeedback sensors

• increase access and affordability

How well does telepsychology and APPS work?

• reviews meta-analyses of efficiancy

  • works as ell as traditional therapy

• Advantages and limitations of videoconference therapy

• Virtual reality is effective

Emerging Tech iSSUES

• apa ethical code updates w telepsych

• specific ethical guidelines

  • florida law for physical presence

  • PSYPACT license

• Fundamental suggestions

  • confidentitality

  • emergency resources

  • choosing tech

Prescription privleges

prescibe meds to patients

-movement started un 1980 and still happening

• states that allow it- NM, Louisiana, IL, Idaho

• Patrick DElon

• Sammons

• Mcgrath

Why should Clinical psychologist prescribe?

- Shortage of psychiatrists.
• Clinical psychologists more expert.
– 50 – 80% of prescriptions come from ? gyno and doctors
• Other nonphysician professionals have
privileges.
• Convenience for clients.

• professional autonomy

  • provide wider range of services

• professional identification

• evolution of profession

• revenue for profession

WhY clinical should not prescribe

Training issues and identity confusion.
• Threats to psychotherapy.
• Influence of pharmaceutical industry.
• Medication may not work effectively

Evidence-Based Practice/Manualized Therapy

Evidence-based practice and manualized
therapy.
– Integration of best available research with
clinical expertise
• Therapy manual.
– Tool used to keep variability to a minimum
• Exposure and response prevention.
– Manualized therapy for OCD

Dialectical behavior therapy DBT

borderline personality disorder

Note- specific cog therapy technique are manualized for depression

Change from empirically supported treatments to evidence based practice

• incorporation of treatment and factors

• defintion- “the integration of the best
  available research with clinical expertise
  in the context of patient characteristics,
  culture, and preferences”
  – 2018 meta-analysis with 53 studies

Empirically resource list

Division 12 is….

division 53 is….

clincal, child clinical amd adolescent

Advantages of Evidence Based Practice/manulized therapy

• scientific legitimacy

• minimal levels of competence

• training improvements

• decreased reliance on clinical judgements

Disadvantages of Evidence-Based
Practice/Manualized Therapy

• Threats to psychotherapy relationship.
• Diagnostic complications
• Restrictions on practice.
• Debatable criteria for empirical evidence.
• Concerns about diversity and equity

Statistics on diagnosing mental disorders

50% of US pop can be diagnosed a mental disorder at some point on life

Newest edition of DSM

DSM-5-TR

therapists views on disorders and DSM

unclear boundaries between disorder and another disorder or normalcy

New Disorders and New Definitions of Old
Disorders

expansion

expansion- introducing new disorders (prolonged grief DSM 5 TR grieving messed up for a year)

-risk of overdiagnosis

-diagnoses without detailed consideration (72% of those prescribed antidepresants do not receive a diagnosis).

Influence of pharmaceutical industry

• More disorders, more potential customers.
• Many DMS panel members have financial
ties to major companies
– Especially groups on mood disorders

Health insurance/managed care

– Clients use health insurance to pay for therapy
– Managed care: prepaid healthcare plan that limit
network of providers

Third-party payer/Insurance company

– Affects payment in the therapeutic relationship
– Priorities and policies strongly impact out work

Payment effects on therapy

• Psychologists’ views on managed-care.
• Companies exercise too much control over clinical decisions
• Confidentiality is an ethical concern
• Lower pay than from clients who pay directly
• Takes time away from direct clinical work
• Denial of care the psychologist believes is necessary
• Clients’ responses.
– When clients learn of psychologists’ negative reactions to
managed care, many thought more negatively about therapy

effect of payment on diagnosis

Effect on Diagnosis
• Most companies require a diagnosis.
• Psychologists more likely to assign
diagnosis for clients with managed-care.

Multiculturalsim as the “………”

fourth force

Multiculturism is the

new era of psych

enhances existing models by infusing them with sensitivity and awareness of go to apply to diverse groups

American Psychological Association accreditation
standards. says this about diversity

– “Commitment to Cultural and Individual Differences and Diversity

DSM toawrds multiculturalsim

cultural concepts of distress in DSM-5

example susto

-culturalformulation interview

Cultural competemce

• awarenessknowledge and skills clinicans can display to best treat client

• when patients percieve their therapists as culturally competent, strong working relationships are more likely to form between them

cultural humility

recognition of the limits of
one’s own knowledge and an openness to
learning about the identities and experiences
of other people

Knowledge of Diverse Groups

• Efforts to educate.
• Acknowledging cultural differences.
• Cultural knowledge.
• Heterogeneity.
• Dynamic sizing (norm doesn’t always
apply)
• Acculturation- assimilation-

An Example of Culture Influencing the
Clinical Context: The Parent–Child
Relationship

britian- kid moves out

italy- be geographically close and emotionally

jewish- open discussion like arguing

etic-

emic-

Etic: emphasizes similarities between all people. (university, high ses)
• Emic: emphasizes culture-specific norms

Narrow Versus Broad Definitions of culture

• Subcultures.
• Age/generation
• Disabilities present since birth
• Disabilities acquired later in life
• Religion/spiritual orientation
• Ethnicity/race
• Socioeconomic status
• Sexual orientation
• Indigenous heritage
• National origin
• Gender

Intersecting Cultural Variables

intersectionality-

cultural variables interact in unique ways

i-
unique interaction of a person’s
combination of diversity and cultural factors,
especially as related to discrimination or inequitable
treatment
– Applied to understanding the COVID-19 pandemic

education for diversity

1+ course on diversity

requirements of training program

• Explicitly state a commitment to diversity
• Actively recruit graduate students from diverse populations
• Actively recruit and retain a diverse faculty
• Ensure students gain awareness of their own cultural values and
biases, knowledge of other groups, and skills to work with diverse
populations
• Evaluate students on their cultural competence on a regular basis,

What are the three levels of the tripartite
model of personality identity?

individual group universal

Maria recently immigrated from her
hometown of Bowling Green, New York, to
Mexico City, Mexico. Once in Mexico, Maria
adopts much of her new nation’s culture and
abandons much of her original U.S. culture.
Which acculturation strategy is Maria using?

assimilation

When Dr. Howie works with a patient, she
recognizes and emphasizes culturally specific
norms. She considers the client’s behaviors,
thoughts, and feelings within the context of
that client’s culture. Dr. Howie is
demonstrating the ______ perspective.

-emic

code of ethics

guidelines that govern ethical
standards across professional activities.
• Originally published in 1953, with 9
subsequent revisions

ethics in small communities

• rural small

• small communities

• multiple relationships diffifcult for small towns

APA ETHICS- Aspirational and enforceable

— general principles

— ethical standards

5

10

ethical code not just a list of rules

positive ethics- every behavior is ethical as possible opposite if a punitive approach

ethical decision making

celia fishers decoding the ethics code models how maintain professional ethics

Prior to any ethical dilemma arising, make a commitment to doing what is
ethical, so your ethical “alarm” will ring in the appropriate situations
• Know the American Psychological Association ethical code and any other
relevant standards or guidelines
• Identify any laws that might apply
• Understand the perspectives of various people who could be affected by
the decision you may make. Consult with colleagues (always protecting
confidentiality) for additional input and discussion
• Generate and evaluate your options, and wisely choose one
• Monitor and evaluate the effectiveness of the option you chose, and if
possible and justified, modify your decision and continue to monitor and
evaluate

SURVEYRS OF ETHICAL BELIEFS

blantantly unethical-

sex with clients/former clients;
socializing with current clients; disclosing confidential info
without cause

SURVEYRS OF ETHICAL BELIEFS

ethical-

shaking hands with a client; addressing clients by
their first name; breaking confidentiality if clients are
suicidal/homicidal

ethical beliefs may vary (gender age)

Confidentiality

• The ethical process of taking reasonable
precautions to protect confidential
information
• Specifically mentioned in general
principles and ethical standards.
• Not absolute

Confidentiality

Tarasoff CAse 1969 and the durty to warn

• tarasoff case - protect from murder

• • Difficult in application.
  – Credibility and intent to follow through
  – Threats that merit warnings
  – Protect potential victims vs. treatment of clients

when a client is a child or adolescent

Factors influencing a trusting relationship.
• Discussing confidentiality dilemma.
– Specific conditions- self harm, harm, gen psych condition,

-child abuse

legal vs ethical standards

Informed consent

• Information about psychological
intervention given before intervention
begins
• Ensures opportunity to become
knowledgeable.
• Facilitates educated decision.
• Affords opportunity to refuse to consent

Informed consent is required for

research assments psychotherapy

BOUNDARIES

multiple relationships

• Clinical psychologist knows someone
professionally and in another way.
• Significant portion of complaints to the
Ethics Committee involves:

defining mutliple relationships

Psychologist in a professional role with a
client and:

-sexual and nonsexual multiple relationships

another relationship w someone close to client

promises a relationship in the future

What makes multiple relationships unethical

2 factors- impairment of the psychologist, exploytation/harm to client

slippery slope- boundary crossings-) boundary violations

Competence

• Skills, experience, and expertise that
qualifies a clinical psychologist.
• Boundaries of competence. (having a degree does not make therapist competent in all areas)
• Continuing education

… of 500 psychologists experienced high levels of emotional exhaustion

1/3 – Overcommitment to clients
– Low sense of control over therapy
– Relatively low salary

…. of psychologists had mental health problems

2/3

TEST SELECTION for ethics in clinical science

• Psychologists’ competence.
• Client’s culture, language, and age.
• Test’s reliability, validity, obsolescence,
most recent edition

ethical obligations of psychologist

minimize harm to participamt. avoid date fabrication

efficacy- controlled study

Fundamental reason clinical psychologists do
research

psychological disorders

• gain knoweldge about psychological disorders

internal validity

examines whether the study design conduct ND ANLYIS ANSWER THE RESEARCH QUESTIONS WITHOUT BIASED

external validity

examines whether the study findings can be generalized to other contexts

Dissemination Strategies- why clinical psych do research

• Efforts to promote therapies that have
demonstrated effectiveness.
• Strategies target experienced therapists,
graduate students, or novice therapists\

• Examples of dissemination strategies.
• Therapists less eager to accept evidence-based therapies.
• Some suggest different strategies:
• Directly advertising to consumers/clients
• Requiring therapists to use evidence-based therapies for licensure or
payment
• Testing clinicians on competence with evidence-based therapies
• Changing accreditation standards of graduate programs to more
strongly emphasize evidence-based therapies
• Even threatening lawsuits against therapists who choose other
approaches

Assessment Methods

• Studies designed to evaluate and improve
assessment methods.
• Examples of studies:
• MMPI-3’s validity scales’ ability to catch overreporting
• Gendered influence on rating boys’ ADHD scores
• Mode of assessment’s effect on psychologists’
assessment of depressive symptoms
• DSM-5’s validity and reliability when translated into
another language