Summary Clinical Psychology - Chapters 1-3,5-9,11-13,18 PDF

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Chapter 1: Clinical Psychology Pages What is Clinical Psychology? Clinical psychologists are individual trained in assessment and diagnosis, intervention or treatment, consultation, research, and the application of ethical and professional principles Clinical psychologists work with a range of indiv...

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Chapter 1: Clinical Psychology Pages 3-30 What is Clinical Psychology?      

Clinical psychologists are individual trained in assessment and diagnosis, intervention or treatment, consultation, research, and the application of ethical and professional principles Clinical psychologists work with a range of individuals, from infants to the elderly. They work in a large range of settings, including universities, hospitals, private practice offices… Little medical training, extensive training in psychotherapy or talk therapy. Focus on client autonomy and collaboration with patient Only New Mexico and Louisiana allow trained clinical psychologists to prescribe medication

Closely Related Mental Health Professions Psychiatrists   

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A physician rooted in medicine Regards psychopathology as an “illness” that is biologically based and its causes can be treated with medicine. Complete four years of medical school (M.D.), general medical internship, 4-year residency training in psychiatry. o Supervised work in clinical setting or outpatient facility (supervised by experienced psychiatrist) o May thus be better able to identify medical problems for psychological distress. Blurred lines between clinical psych and psychiatrists. Specialization is slowly declining—economic impact, competition from other specialties like clinical psych. Brief quarter-hour sessions of medication management not long psychotherapy sessions. Prescription privileges are being allocated to other specialties as well and people no longer rely on psychiatrists for advice on medication treatment. More authoritarian and focus on medication prescription.

Counseling Psychologists   

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Work with moderately maladjusted individuals and use assessment methods, most commonly interviews. Employed in educational settings, but also employed in hospitals, mental health centers. Focused on: o Preventative treatment, consultation, development of outreach programs, vocational counseling, short-term therapy. Counseling psychology is a small field (the file of clinical is bigger with 4x as many graduates from doctoral programs). Most counseling psychology programs are in the School of Education. Counseling doctoral program acceptance rates are higher, greater focus on minority/crosscultural issues. Only 70 Ph.D. programs are there for counseling psych but there are 360 for clinical psych.

Clinical Social Workers  

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Work to improve social functioning of individuals, groups, or communities. In the past social workers focused on external or social factors contributing to patient’s difficulties, while the psychiatrist prescribed medication and the clinical psychologist tested them. Today social workers are more likely to deal with psychological factors that play a role in individual and family difficulties (more focus on familial factors). Requires only master’s degree to practice (2 years). More likely to engage in home visits, workplace visits—active role The social work field is rapidly growing as a result of them being low-cost alternatives to psychiatrists and psychologists.

School Psychologists    

Work with students, educators and administrators to promote social and emotional growth of school age children and adolescents. School psychologists are in high-demand, as they conduct assessment for special educational needs. Workplace include schools, nurseries, daycare, hospital, clinics… 60 APA programs for doctoral degrees.

Health and Rehabilitation Psychologists  

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May have a doctorate in clinical, but this is not required. This field is new and is rapidly growing. Through research and practice contribute to the promotion of good health, involved with prevention and treatment of illness. o Ex: design prevention programs to help quit smoking, reduce weight. Most likely to engage in consultation with different organizations. Rehabilitation psychologists focus on physical or cognitive disability. o Help with adjustment to physical, social, psychological barriers. Work at care facilities, medical centers, rehabilitation facilities, hospitals…

Psychiatric Nurses   

Others

Working alongside psychiatrists and clinical psychologists They implement the therapeutic recommendations. Have prescriptive privileges in all but a few states.

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Include occupational therapists and recreational therapists, can help teach patients skills that will help outside hospital settings. Can help patients deal with feelings via art, music, dance. Can help supplement work by professionals. Those who are trained to help mental health professionals—Paraprofessionals

Professionals and Titles Not Regulated by the Government   

Clinical psychologists, counseling psychologists, school psychologists and so on all require specific educational requirements to practice. Titles like psychotherapist and therapist can be used by anyone wishing to offer any service. The public is not aware of such distinctions and may seek to use services offered by someone unregulated rather than a professional individual just because unregulated services use such titles.

Activities of Clinical Psychologists Activities include psychotherapy, research, diagnosis, teaching and administration.

Therapy or Intervention   

Client sit face-to-face across from the therapist and therapy involves either a one-to-one relationship or couples, family, child therapy. Majority of therapists are women and not men Therapy involving specific skills is more useful to reduce problems (ex: CBT therapy).

Diagnosis/Assessment  

Used to better understand the individual so that a more informed decision can be made Gathering information through testing so that a problem can be solved.

Teaching   

May teach graduate courses in specific areas—advanced psychopathology, development psychopathology, testing, personality theory…or even do undergraduate testing. Some clinicians may supervise doctoral students completing their degree (supervision). Clinicians may also conduct workshops and seminars to teach skills to nurses, aides, probation officers and so on.

Clinical Supervision  

A form of teaching, more one-to-one teaching that is less formal. Involves supervising students and interns; people learn by doing under the guidance of a supervisor-trainee relationship.

Research

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Scientist-Practitioner model was adapted—thinking like a scientist. Clinical work is enhanced by knowledge of scientific methods and exposure to clinical practice. Clinical psychologists have the ability to both consume and produce knowledge.

Consultation   

Consultation can occur on a case by case basis with another individual in the field or for an organization looking for help in a particular domain (ex: drug addiction). Clinical psychologists also serve as consultants for advertising agencies. A large number of consultants work for primary care services.

Administration   

All clinical psychologists have to engage in administrative duties like maintaining client record and filling out reports. Some are drafted by colleagues as a result of their skills to perform greater admin duties Ex: head of the psychology department, vice president of a consulting firm, program director of a clinic.

Employment Sites    

Employment sites that are the biggest are: (1) private practice, (2) universities and (3) medical schools. Other settings include: Psychiatric hospitals, outpatient facilities… Clinical psychologists tend to engage in a diversity of both private practice and research. Demographics—in 2005 only 34% of clinical psych doctoral majors were women and only 7% were racial minorities—this is slowly increasing.

Research and the Scientific Tradition An Overview     

Clinical Psychology is based on research tradition and the quest to acquire new knowledge Typically, a clinical doctorate student engages in assessment, research, diagnosis and therapeutic skill development with an internship. Psychology programs offer a two-year Master’s program that some students pursue before doing the Ph.D. Master level students are viewed as less competent and can’t practice independently. Growing Master’s field with 3x as many Masters than Ph.D.’s being awarded.

Coursework and Practicum Work   

Students have to take a series of basic courses that help found their basic knowledge of human behavior. Use scientist-practitioner model During the advance years of graduate school students are exposed to practica work, that involves application of theories studied.

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o Acquisition of specific clinical skills Practicums can be in assessment, therapy, interviewing methods or even in consulting within specific areas/agencies.

Research    

Competence needs to be developed in computer software, technology and research methods by engaging in research projects. Different universities place different emphasis on research o Completion of Master’s thesis by the end of second year A research project/dissertation is required by the end of 4th/5th year that adds new information to the field. When entering grad school, a student joints a “team of faculty members”—team meets 2/3 hours per week.

Qualifying Exam  

Preliminary or comprehensive examination, it is three written exams each lasting 4-hours over the span of one-week or 5-day examinations. Often taken during the 3rd year or students write an in-depth literature review or research grant.

The Internship    

Provides experience to complete the scientist-practitioner role, required of all clinical programs. Occurs at the end of graduate training, usually at an independent facility off campus or at university counseling centers or medical schools. Allows the student to work full-time in a professional setting provides the students with skills that will mirror that of a professional career. Women are increasingly growing in the field of clinical psych.

Training Models    

Professional clinical psych programs use the Ph.D. scientist-practitioner model focused on research but the Psy.D. program is an alternative degree more focused on application. Professional schools award 60% of doctoral degrees for clinical psych. Combined Program—focuses on core of both knowledge and skills across applied psychology areas—broad skills. Clinical-Science Model is focused on evidence-based approaches.

Clinical Practice  

Clinical psychologists are slowly going into private practice and para-professionals & master’s level individuals are being employed more in mental-health settings. Clinical psychologists need to have a capacity to tolerate ambiguity

Chapter 2: Historical Overview of Clinical Psychology pages 32-58 Historical Roots  

Individuals that altered the field of clinical psychology and began viewing mental illness as treatable—Pinel, Tuke, Todd, Dix The development of clinical psychology slowly expanded in the fields of diagnosis, assessment, intervention, research and professional matters.

Diagnosis and Assessment The Beginnings (1850-1899)   

James Keen Cattell, a student of William Wundt believed that studying reaction time differences would help to understand intelligence —mental tests. Witmer founded the current model of treatment by forming the first psychological clinic & a journal called the Psychological Clinic. Initial emphasis focused on the youth population of children and adolescents who were unable to functionally adapt to society.

The Advancement of the Modern Era (1900-1919)   

Binet and Simon developed the Binet-Simon Scale—measures intelligence. Carl Jung developed testing methods around word-associations and 1910 brought the arrival of the Kent-Rosanoff Free Association Test. WWI brought the screening of individuals entering the military, marking the movement away from children and youth towards adults.

Between the Wars (1920-1939)    

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By the late 1920’s psychologists had individual and group testing tools at their disposal. The field of intelligence was being expanded with work by Spearman, Thorndike, Thurstone Wechsler-Bellevue test—first adult intelligence test; created in 1939 and since then modified & adapted. Rorschach—inkblot tests that attempted to bring people to reveal their real-life experiences by looking at ambiguous stimuli. He published this in his book Psychodiagnostik. Projective Techniques—Designed to allow a person to respond to ambiguous stimuli, and reveal hidden emotions and internal conflicts projected by the person into the test. Thematic Appreciation Test (TAT)—Requires an individual to make up stories reflecting activities, thoughts and feelings of the people in the picture.

World War II and Beyond (1940-Present) 

More complex tests began to develop. Minnesota Multiple Personality Inventory (MMPI)-self-report test, and unique because no interpretation of scores was needed.

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Wechsler Intelligence Scale for Children—Alternative to Stanford-Binet scale. Clinical psychologists were viewed as experts of psychodiagnosis—use of interpretation of test scores as a basis of diagnosis and treatment. Different approaches—objective nomothetic approach (empirically tested rules) vs. projective idiographic approach (focused more on the individual and interpretations). Radical Behaviorism: Only overt behavior can be measured and psychological trait measurement is not useful. It brought the era of behavioral assessment—behaviors were understood in the context of the stimuli or situation in which they occurred. First DSM appeared in 1952, focused mostly on adult psychopathology and post-war symptoms. Structured Diagnostic Interviews: Standard list of questions that are used as criteria to assess different disorders. Health care insurers became more interested in managed health because it controlled and reduced costs and required mental health professionals to be more efficient.

Interventions The Beginnings (1850-1899)  

Jean Charcot focused on interventions for hysteria using hypnosis Freud and Breuer collaborated on a patient Anna O’s whose treatment was challenging o Psychoanalysis (most influential theoretical and treatment development for clinical psychology)

The Advent of the Modern Era (1900-1919) 

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1900’s—psychoanalytic movement began with Freud’s publication of The Interpretation of Dreams. o Terms like Oedipus complex, ego, id began part of psychological terminology. Healey’s establishment of the child guidance center in Chicago in 1909 reflected a movement towards looking at juvenile offenders and not simply learning problems of children.

Between the Wars (1920-1939)    

Psychoanalytic therapy was viewed as being the sole right of a medical practitioner but psychologists soon began to use it in their work with children (child guidance clinics). Adler’s emphasis on family relationships instead of sexuality grew prominent with practitioners. Play Therapy: Release of anxiety or hostility through expressive play (Freudian Principle based). Behavior Therapy: Encompassing the works of Watson, Jones, Levy and others it focused on conditioning.

World War II and Beyond (1940-Present) 

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As psychiatrists and physicians were too few to help WWII men, psychologists began to fill the role and aid with psychotherapy, assisting men to return to combat and help with rehabilitation. Shifting away from intelligence and focusing on personality, psychoanalytic intervention grew. Carl Rogers publication, Client-Centered Therapy was the first alternative to psychoanalytic therapy. Therapy was a growing field with the introduction of rational-emotive therapy (RET), cognitive-behavioral therapy (CBT), and behavioral therapy work by B.F. Skinner and Joseph Walope o Looked at desensitization, operant principles and conditioning.

Research The Beginnings (1850-1899) and the Advent of the Modern Era (1900-1918)   

William Wundt and William James, both of whom formed research laboratories and influenced the scientist-practitioner model. Ivan Pavlov’s classical conditioning theories became important 1905-Binet-Simon improved their intelligence tests and in 1916 development of the Army Alpha and Beta tests appeared.

Between the Wars (1920-1939) + World War II and Beyond (1940-Present)        

Behaviorism (power of conditioning) and Gestalt psychology (emphasized patient’s unique perceptions) were prominent. By the 1960’s diagnosis and assessment were less important, but in the 1950’s it was largely hyped up. Focus on effectiveness of psychotherapy (Carl Rogers and Dymond) Wolpe (1958)—developed systematic desensitization DSM-III published focused on reliability, validity of criteria used for mental disorders in the DSM manual. Focus on etiological factors or causes for many mental disorders. Behavioral Genetics: Both environmental and genetic factors influence development of behavior. Brain imaging: Allows us to view both the structure and function of the brain.

The Profession The Beginnings (1850-1899)  

1892—Founding of the American Psychological Association (APA) o President: G. Stanley Hall 1896—Lightner Witmer—first Psychological Clinic establishment at U of Pennsylvania. He named the field clinical psychology

The Advent of the Modern Era (1900-1919)    

1909—Establishment of the Psychopathic Institute in Chicago (Healy) 1910—222 APA members, $1 membership. Focus on APA was psychology as a science not a profession. 1919—First Clinical Psychology Section was created within APA

Between the Wars (1920-1939)  

APA 1935 Clinical Psychology---art and technology that deals with adjustment & problems of human beings. 1937—Journal of Consulting Psychology was founded

World War II and Beyond (1940-1969)      

Psychologists experience in research and tools for testing differentiated them from psychiatrists. With the end of WWII soldiers that were returning experienced extensive emotional trauma/ The Veterans Administration (VA) increased availability of mental health professionals by providing financial support for training. VA’s needs to deal with the psychological problems of adults resulted in a shift from children. 1945—Connecticut first state to institute certification examination for psychologists. 1949—Conference on graduate education in Clinical Psychology held at Boulder, Colorado. o Focused on the scientist-practitioner model for training

The Growth of the Profession (1970-Present)  

1960’s—shift towards focusing on conditioning and altered reinforcement contingencies. Key focus was looking at patient’s behaviors and not their thoughts. People began to question this and turned towards cognitive-behavioral orientation.

The 1988 Schism   

Many critics felt that the APA was being controlled by practitioners that were using it for their own interests; no longer focused on scientific needs. Plan to reorganize APA so that it lessened the gap between the clinical wing and academic-scientific wing failed by a 2-1 vote of membership. American Psychological Society (APS)/Association of Psychological Science—focused on the scientific aspect of psychology. First conference held in June 1988.

Chapter 3: Current Issues in Clinical Psychology pages 59-92 Models of Training in Clinical Psychology The Scientific-Practitioner Model 

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