Clinical Psychology 2301A, Exams of Psychology

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Clinical Psychology 2301A - BA or Masters - Assist individuals groups or communities to restore or enhance capacity for social functioning while creating societal conditions favorable to their goals - Clinical Social Workers the field of clinical psychology involves research, teaching, and services relevant to the applications of procedures for understanding, emotional, biological, and social disability applied to a wide range of client populations - clinical psychology help the mentally ill become productive members of society by teaching them practical skills - help patients regain ability to perform daily and work activities - Occupational Therapists provide recreation with those with illness or disability - recreation therapist work with healthier population, focus on clients strengths, educational and occupational, changing to include more private practice - counselling psychologists - Clinical neuropsychlogy - assessment and treatment of those with brain illness/ injury - Forensic psychology - assessment and treatment of those with the legal system - Health psychology - research and practice contribute to health and well being of patients - Rehabitation psychology - work with those who are physically or cognitively disabled - specialized areas of clinical psychology * - Therapy - most common, different types, individual, couple, family, group, can be short or long terms, different theoretical orientations (most common is eclectic) - Diagnosis/ assessment - various types, interviews (structured vs. non-structured), test batteries (intellectual, cognitive, aptitude, personality, risk assessment), assessment for diagnosis, treatment planning, consultation, recommendations, treatment evaluation - Teaching - full time, part time, can teach undergrad, graduate, one-to-one thesis advisor, clinical supervision - Clinical supervision - - Research - "scientist-practitioner" model (clinical practice is enhanced by knowledge of scientific methods and research is improved by clinical practice) - Consultation - increase effectiveness of those to whom one's efforts are directed by imparting to them some expertise - Administration - committee work ex. managing units in hospital - activities of clinical psych (therapy, diagnosis/assessment, teaching, clinical supervision, research, consultation, administration) * - Psychotherapy: the most frequently engaged and occupies the most time o Therapy often involves a one-on-one relationship between patient and psychologist - Diagnosis and Assessment: This technique involves the effort to better understand an individual so that a more informed decision can be made - teaching: Often clinical psychologists teach courses in psychopathology, psychological testing, interviewing, intervention, personality theory, developmental psychopathology, etc - Clinical Supervision: another form of teaching o More one-on-one teaching, small groups approaches, and other less formal non-classroom varieties of instruction - Research and Writing o Scientist-Practitioner Modal: all clinicians are to be trained as scientists and as practitioners, this model was developed to expect that all clinical psychologists have training in "thinking like a scientist," this model suggests that clinical work is enhanc - activities of clinical psychologists - Boulder Model (Scientist practitioner model (uwo)) o Research/academic + applied skills - Vail Model o Professional model o Emphasizes practice, much less research focus o Development of free-standing professional schools - Advantages of scientist- practitioner model o More comprehensive knowledge clinical research o Better critical eye for research findings o Better able to conduct clinical research o Trained in designing and evaluating assessment tools o Better able to conduct therapy outcome research o Case conceptualization is similar to hypothesis training - Training Models (boulder/scientist practitioner and vail) * Pre-Clinical Psychology: Clinical Psychology as a Profession - History of Treatment - History of assessment - History of Clinical Psychology Ch2 HISTORICALLY: spiritual causes: possession (ghosts) - Ancient Beliefs (Trephining (drill hole in skull) to release evil spirits) - SOMATOGENESIS: development of physical disease (physical cause) - Hippocrates (400 A.D.) (bodily and physical causes) - Medical model --- Some argued emotional cause --- physicians not priests - Balance of bodily humors: -- Blood - unpredictability -- black bile - melancholia (sadness) -- Yellow bile - irritability & anxiousness -- phlegm (thick viscous substance) - apathetic (taking interest) Classification of disorders: Mania, melancholia, phrenitis - Spiritual causes revisited -current trends: biopsychosocial theories marry both somatogenic and psychogenic approaches -As somatogenesis is refined, the developing field of psychiatry closely aligns with this perspective. - what can we learn from this historic overview All branches of psychology have their roots in research modern experimental psychology developed in western Europe and America psychology born 1879 in Leipzig Germany *key date* - pre-clinical years (research) European Events - Psychology developed out of philosophy dept. - Wilhelm Wundt (Germany) 1879 - 1st psych lab - "Mental events" (Sensation & Perception) - structuralism and introspection -1881 - 1st Psychology research journal - 1883 - 1st "experimental psychology" course -1902 - (principles of physiological psychology) textbook American Events - 1875 - James (USA) (Harvard lab) - 1890 - First psychology text (The Principles of Psychology") "the stream of throught" (dynamic consciousness) "The Consciousness of Self," "emotion" (motivation, free will) "Will," and many other topics. - Functionalism - Mind body relationship and philosophy (mind can be reduced to physiological processes) - "psychology of religion" (existentialism) - His ideas later echoed in the work of Jung&Maslow - historical timeline: research Treatment approaches underwent change -Philip Pinel M.D. - moved to Paris to treat the poor - Death of friend with manic-depressive symptoms sparked interest in insanity for Pinel - director of 2 asylums William Tuke - model hospital in England Eli Todd - developed retreat in Hartford - civilized care, respect, morality Dorothea Dix - (1841- 1881 campaign) - lightner Witmer (1896) - U of Penn psychological clinic for children - Influenced later development of school psychology - "psychology as practical combined with research" G. Stanley Hall - founded APA - pre-clinical years: treatment 1850s Hypnosis for hysteria (Charcot) 1890-1950's Freud - psychoanalysis Psychologists began in children's clinics Anna Freud - play therapy 1930's group therapy 1920 Watson and Rayner Behavioural Therapy - psychological interventions In 1949, no state mental hospital set the minimal standards of operation set by the APA" WWII created need for interventions personnel shortage (needed exeseive psychologists) psychologists - Rehab - Returning soldiers to combat 1951 rogers "client-centred therapy" 1950's gestalt and RET - history of clinical psychology CURRENT TRENDS - Time-limited treatment - manualized treatment - eclectic treatments (combining treatments) - Empirically validated treatments - historical timeline: intervention 1882 - Galton - Quantitative methods to understand individual differences 1890 - James Cattell - Intelligence and reaction time 1913 - Emil Kraepelin - first classification system 1905 - Jung (for exam Jung created word association test not Freud who stole it)- word association tests 1914 - Alfred Binet- Interested in norms and deviation from norms - binet-simon : first objective IQ test 1917 - Yerkes (WWI) - army alpha and beta tests Plethora of intelligence, interests, and abilities tests 1921 - Rorschach - inkblots to diagnose psychiatric patients 1935 - Thematic Apperception Test 1943 - MMPI (distinguishing different types of phsychopathology 1970s - behavioural assessment - Structured interviews, neuropsych testing, psychoeducational testing - diagnosis and assessment * Impact of social and political factors: - Health care funding? Ongoing tensions between research & practice - Academia vs. clinicians Theories of mental illness shape treatment & research (psychodynamic...behavioral...cognitive) diversity: cultural and gender issues - themes APA meeting (1947) - program for training in clinical psychology boulder conference in 1949 endorsed scientist-practitioner model with Ph.D Second conference held in Vail in 1973 that: i. sanctioned professional schools ii. Sanctioned the psyD gainsville florida reffirmed the scientific practitioner model in 1990 - practitioners dominate APA - APA was 70% academic in 1940 - it is now 33% academic - Nearly 70% represent themselves as health care providers - science vs. practice Medical model "patient" treated by doctor -Causes: biological: brain anatomy&chemistry -Treatments: RX, lobotomy, ECT Psychological model - "client" treated by specialist - Causes: mental: unconscious, conscious, or learned -Treatments: non-invasive psychotherapy Biopsychosocial model - holistic (connected) treatment - but by whom (psychologists if they could prescribe, backgrounds in sociology and medication) - Biological vs. psychological view of illness * Many "turf" battles with psychiatrists 1. Treatment (medical vs. psychological) Our current health care system (OHIP) Psychotherapy as a "controlled act" 2. Diagnosis both diagnose under controlled act 3. Prescription privileges - turf battles -Ongoing relationship & tensions between research & clinical practice -use of empirically supported treatments -accountability -health psychology (prevention over interpretation) - prescribing privileges -Uniqueness of psychology? - well versed in research, - current themes - Hodgepodge- lots of different specialties and areas of interest (OCD, eating disorders, etc.), discipline lacks coherence - isolated (issue) - Public perception (lol): fear of brainwashing? Fear that psychologists can peer into the mind uninvited. - problems Reform Movements - Moral Treatment -- shift from prison to hospital -- shift from hospital to community -- patient rights - CRITICISMS Maximize benefit / minimize harm care of animals (research) - Principal II: responsible caring * objectivity / lack of bias Straightforwardness / openness avoid conflicts of interest (ex. if student asked for therapy = biased perspective based on knowledge of student)of conflict of interest - Principal III: integrity in relationships * Development of knowledge Respect for ones society Facilitate development of society - Principal IV: responsibility to society * Failure to obtain informed consent Negligent or improper diagnosis negligent treatment Physical or sexual contact with clients breach of confidentiality Undue influence - major areas of liability * Making assumptions -distortions based on simplistic reasoning, incomplete information, or bias e.g., asking a 14 year-old boy if he has a girlfriend versus is he interested in anyone? Overidentification -Lose capacity to keep sufficient emotional distance; can cloud judgment Overinvolvement -dual roles (prohibited by ethical codes) (ex. Treating client don't do other assesments) -advocacy role (why there are patient advocates at hospital) - 3 major threats to objectivity * What do people mean by keeping "clinical distance from clients"? How do you think people actually manage this? why is this important? How can you balance keeping distance with not losing empathy? Can you keep in touch with clients after they have finished therapy? (varies: romantic relationships need two years without treatment same with non romantic relationship) - what are client therapist boundaries -dividing set of entities into subclass based on general attributes - which are defining attributes? - Ch 5 classification: what is it? - when discussing abnormality you must check age - 1. statistical frequency: abnormal = infrequent - 2. violation of cultural norms/roles - 3. personal distress (happening or not) - 4. causing disability or disfunction - 5. unexpected reactions (even expected reactions can be pathological) - defining abnormal behaviour * DSM-IV definition: Syndrome: cluster of abnormal behaviors associated with distress Individual is the problem Society - not all behavior that conflict with society is a disorder - mental illness WHO (World Health Organization) 1948 - international list of causes of death DSM (Diagnostic & Statistical Manual) - development of classification system of mental illnesses Axis 1 - most mental disorders Axis 2 - mental retardation and personality disorders (longer standing disabilities) Axis 3 - general medical conditions (ex.diabetes) Axis 4 - psychosocial factors (ex. person employed, homeless) Axis 5 - Global Adjustment Scale (0 - 100) (0-terrible functioning 100- perfect functioning) - DSM-IV multi-axial * multiaxial system removed Addition of new disorders and re-organization of existing disorders changes: - Autism Spectrum Disorder became more inclusive diagnosis of - Asperger's removed - Gender Dysphoria replaced Gender Identity Disorder - substance use disorders completely reorganized - cannabis withdrawal syndrome - "Addiction" added back in = Gambling Disorder - DSM-V Diagnosis - the determination that a person's particular set of symptoms or problems constitutes a particular disorder. Diagnosis - is a "controlled act" Psychologists & psychiatrists (physicians) only related to "expert witness" (need to be able to diagnose to be expert witness) - diagnosis Symptom presentation Criterion to Make a diagnosis: - sufficient symptoms - over specific period of time - Causes distress and/or dysfunction history of symptoms History of previous treatment - Effective? - Find best diagnostic fit (not better accounted for by a different disorder) thorough - diagnosis as "hypothesis testing" Differential diagnosis - comorbid diagnosis - diagnostic process Communication: summarized/describes many symptoms Etiology: similar symptoms clusters may have similar causes Prognosis: info on course and outcome Treatment: Should generalize to other similar symptoms clusters, response to treatment Research: can investigate and prevent disorders Patient - comfort in having problem identified and known Third party payment - identify disorder & necessary treatment Legal System - Not criminally responsible? Disposition depends in part on diagnosis & prognosis - importance of diagnosis * Labelling Discrimination, stigma May impair assessment Look for diagnosis vs. understanding Comorbidity Patient reactivity - Impaired functioning after diagnosis Victim mentality; sick role Mental health professionals reactivity Expectations related to prognosis - problems with diagnosis Categorical approach: qualitiative distinctions - Each category = distinct class of pathology absent? Present? - Depressed? or Not depressed? (5 symptoms off list to qualify as depressed) Dimensional approach: Psychopathology is extreme form of behaviour common to whole population - a matter of degree - degree of depressed mood - possible systems - Reliability: consistency of results over time - inter-rater reliability: Degree to which two clinicians agree on a diagnosis The greater the degree of agreement; the greater the reliability - Sensitivity: agreement regarding the presence of a diagnosis (ex. Does person have schizophrenia) - Specificity: agreement regarding the absence of a diagnosis - issues with classification * - Validity: does it assess what it has been designed to assess? - Construct validity: does it accurately assess the disorders in question -- If good construct validity: can make accurate statements and predictions Prognosis? DSM-IV - many improvements over previous DSM editions including: Greater description of symptoms of disorders greater attention to how culture impacts symptoms interviewing errors Verbal and nonverbal (leaning forward => interested) Cultural Sensitivity (cultural awareness, use of interpreters) - communication talking face-to-face is an adult way of relating power differential more evident Children may interpret questions quite differently differently (ex. Assume they are in trouble, suggestibility) use simple words, short sentences Props can be useful - interviewing children Flexible Captures client's: interpersonal style, organization/coherence of responses, non-verbal behavior, idiosyncratic behavious problems: Validity: sources of bias, biases in client presentation Inter-rater reliability: different interviewers may get vary different info - unstructured interviews Semi-structured format (adaptive): guidelines for conducting the interview, flexibility in wording, order, etc Highly structured format: follow exact order, wording, and coding for each question, minimize the role of clinical judgment, good for beginner interviewers SCID - Structured Clinical Interview for the DSM-IV Computerized version available version for Axis I and Axis II disorders Axis I - greater reliability and validity - structured interviews * Violence: Actual, attempted, or threatened physical harm that is deliberate and non-consenting Caused by a host of biological, psychological, and social factors neurological insult, hormonal abnormality psychosis, personality disorder exposure to violent models, attitudes that condone violence - assessing risk of violence We never know a person's risk for violence; we merely estimate it assuming certain conditions assuming institutionalization, assuming release with supervision, assuming release without treatment for substance use .. Consequently, relative or conditional risk judgments are more useful than absolute or probabilistic risk judgments - risk is context specific Professional judgment: unstructured or "clinical", structured (HCR-20, SVR-20) Actuarial decision-making: psychological tests (MMPI-2), risk scales (VRAG, SARA) - conventional approaches * Samples: Low level inference - state what we know about client Correlates: Medium level inference - state what one knows about similar clients Signs: High level inference - stating what one thinks may be underlying the client's behavior - levels of interference * Base Rates Prediction - costs/ramifications of being incorrect - Types of errors - false positives/false negatives (miss risks when risks should be apporopriate => chance of harm to public) - factors affecting judgements STATIC FACTORS age (certain groups higher than others 18-20) gender (females attempt, males die) prior suicidal behavior DYNAMIC FACTORS stress symptoms of illness Social support Resources (family, church etc.) Current Suicide Plan (not good sign) - predicting suicide * Availability Bias: memorable cases stand out in memory (ex. Think of friends parents divorces when asked about how many divorces are norm) Anchoring bias: emphasis on early information Theoretical bias: if there's a specific theory favored its going to bias what we actually think Patient Status minority status gender Clinical Experience Confirmatory Bias Hindsight Bias: things seem more probable after they've happened - biases: heuristics *