Clinical Psychology Exam 1 Clinical Psychology Exam 1, Exams of Psychology

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Clinical Psychology Exam 1 What is Clinical Psychology? - -- 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 population - Clinical psychologists are distinguished by their expertise in areas of psychopathology, personality, and their integration of science, theory, and practice. - Their work can involve individuals themselves, families/partners, school personnel, other health care workers, and communities - Clinical psychologists work in a wide range of settings including universities, hospitals, private practice offices, or group medical practices - Promotes humans adaptation, adjustment, and personal development -focuses on •Intellectual •Emotional •Biological •Psychological •Social •Behavioral -factors across the life span, in varying cultures and at all socioeconomic levels Psychiatry - - A psychiatrist is a physician - Accorded the power and status of the medical profession - Psychiatry regards psychopathology as a mental "illness" with discrete (often biologically based) causes that can best be remedied with medical treatment, such as psychotropic medication - Psychiatrists, like all medical doctors, complete general medical school curriculum early in their training; due to their medical training psychiatrists have the skills to function as a physician (prescribe medication, treat physical ailments, and give physical examinations) - Following the completion of the medical degree and medical internship, one receives psychiatry training during a four-year internship • DECLINING FIELD? o Prescription privileges o Decrease in interest o Perceived lack of prestige Counseling Psychology - - Normally work with normal or moderately maladjusted individuals, may involve group counseling or counseling with individuals - Their principal method of assessment is usually the interview, but counseling psychologists also do testing (e.g. assessment of abilities, personality, interests, and vocational aptitude) - The most frequent employment settings for counseling psychologists have been educational settings, especially colleges and universities (they also work in hospitals, rehabilitation centers, mental health clinics and industry) - Counseling psychologists see themselves providing the following services: a) preventative treatment b) consultation c) development of outreach treatment d) vocational counseling and e) short-term counseling/therapy from one to fifteen sessions • in general provides the following services o preventative treatment, consultation, development of outreach programs, vocational counseling, short-term counseling/therapy from one to fifteen sessions Clinical Social Workers - - Many social workers conduct psychotherapy on an individual or group basis and contribute to the diagnostic process as well - "Professional social workers assist individuals, groups, and communities to restore or enhance their capacity for social functioning, while creating societal conditions favorable to their goals. The practice of social work requires knowledge of human development and behavior, of social, economic and cultural institutions, and of the interaction of all these factors" - Training limited to a 2 year masters degree - Intensely involved in the day to day lives of their patients (field work, visit homes, the workplace, and even the streets) • Focus more on the social environmental factor that contribute to their patient's difficulties • (not supposed to diagnos and treat.. just day to day problems that effect) School Psychologists - - Work with students, educators, parents, and school administration to promote the intellectual, social, and emotional growth of school-age children and adolescents - May conduct psychological and educational assessments, develop learning programs and evaluate their effectiveness and consult with teachers, parents and school officials - Might consult with teachers and school officials on the implementation of programs as well as issues of school policy or classroom management - High demand - Work mainly in schools, but can also work in nurseries, day cares centers, hospitals, clinics, and even penal institutions Health and Rehabilitation Psychologists - - Doctoral degree is not required - Health psychologist = those who, through their research and practice, contribute to the promotion and maintenance of good health; also involved in the prevention and treatment of illness - Rehabilitation psychologist = focus on people who are physically or cognitively disabled; the disability may result from a birth defect, or later illness or injury - Help individuals adjust to their disabilities and the physical, social, and environmental barriers that often accompany them, they advocate for the improvement of life conditions for those with disabilities and help develop and promote legislation to promote this cause Psychiatric Nurses - - Work closely with psychiatrists or clinical psychologists to implement the therapeutic recommendations - In most states certified nurse practitioners have prescription privilege ii.Programs not substantially different from Ph.D. programs during the first 2 years of training 1.Increasing experience in therapeutic practice and assessment becomes the rule 2.Clinical emphasis and internships iii.More Psy.D. degrees are awarded than Ph.D. degrees iv.Concerns that they are seen as less qualified 1.Not the case v.Programs accept more applicants each year, enroll more students, have more students in the program, and award more degrees vi.Professional schools 1.Have no affiliation with universities 2.Work with own financial and organizational framework 3.Emphasize clinical functions and have little or no research training 4.Twice as many professional schools 5.60% of doctorates in clinical is awarded by professional schools 6.Instability of funding 4. Scientist practioner model - oPredominant training philosophy in clinical psychology today oRequires that students acquire research competence by contributing to ongoing studies and eventually conducting their own original research project oIntegrate the role of scientist with practioners i.The Training Model 1.Represents an attempt to "marry" science and clinical practice 2.Remains the most popular training model for clinical psychologists ii.Clinical psychology arose where the structure of teaching, research, and other scholarly efforts were prominent 1.Clinical psychology did not receive priority 2.Complaints a.Much of research was trivial b.Students learning too much about statistics, theories, of conditioning, or principles of physiological psychology and too little about psychotherapy and diagnostic testing iii. Boulder Model 1.Came from demand for change 2.Also known as the science-practitioner model 3.Saw a profession comprised of skilled practitioners, who could produce their own research as well as consume the research of others 4.Goal was to create a profession different from any before 5.Clinician would practice with skill and sensitivity but also contribute to the body of clinical knowledge by understanding how to translate experience into testable hypotheses and how to test those hypotheses 6.Systematic union between clinical skill and the logical empiricism of science a.Intended to help students think like a scientist iv.Clinical scientists are split into two groups 1.Those interested primarily in clinical practice 2.Those interested primarily in research •Combined Professional-Scientific Training - i.This model assumes that 1.These specialties share a number of core areas of knowledge 2.The actual practices of psychologists who graduate from each of these specialties are quite similar 3.Emphasize breadth not depth a.Potential weakness oCombined specialty in counseling, clinical, and school psychology assuming that •These specialties share a number of core areas of knowledge •The actual practices of psychologists who graduate from each of these specialties are quite similar oCurriculum focuses core areas within psychology and exposes students to each subspecialty of counseling, clinical, and school psychology. oThis program is better suited for a future practitioner rather than a future academian or clinical scientist Professional Regulation - •Certification oRelatively weak form of regulation •Guarantees that people cannot call themselves "psychologists" while offering services to the public for a fee unless a state board of examiners has certified them. •Sometimes includes an examination, but more often is just a review of applicant's training and professional experience. •Some people believe that this does more to protect the psychologist than to protect the public. •Licensing oStronger form of legalization •Specified the nature of the title "psychologist" and training required to earn title •Defines what activities may be offered to the public for a fee •Most states require applicants for liscensure to take an examination, and the licensing board usually examines the applicant's educational background and sometimes requires several years of supervised experience beyond the doctorate. •Some states also require specific workshops or scientific presentations •Trend toward both clinicians and researchers to be licensed •i.e. researching working with depressed patients must be licensed. •Summary of Typical Requirements for Lisensure •Education - doctoral degree from APA accredited program in professional psychology •Experience - one to two years of supervised postdoctoral clinical experience •Examinations - candidate must pass the examination for Professional Practice in Psychology (EPPP) •Administrative Requirements - additional requirements include citizenship or residency, age, evidence of good moral character, and so on. •Specialties - licensure to practice psychology is generic, psychologists must practice within the scope of their competence, as indicated by their educational background. •American Board of Professional Psychology (ABPP) oOffers certification of professional competence in the field of clinical child and adolescent psychology e. Graduate Programs: Past and Future - i.Oversupply of practice-oriented psychologists given market demands 1.May affect number of students entering and finishing graduate programs 2.More applicants for internships than available ii.Managed health care revolution in this country will affect demand for clinical psychologists in the future 1.More emphasis will be placed involving empirically supported brief psychological interventions and focal assessment iii.May be an undersupply of academic and research-oriented clinical psychologists 1.Then research oriented clinical psychologists will be better able to develop and evaluate effective treatments for psychological problems, evaluate programs for health care settings, etc. III. Private Practice - a.Concerned it may be more about economic privileges than the welfare of patients b.Legislation that restricts entry by others to what they perceive as their professional arena but also protects their interests c.Health care now dominates and affects private practice oAs coverage of mental health costs is evolving due to political decision, the implications of private practice treatment might evolve. oIt may be the case that because of the cost, clinicians might be replaced by tomorrow's masters level mental health professionals. The Costs of Health Care - •The US spends more on health care than any other nation in the world •What does addressing high costs of health care mean for mental health care? oInsurance plans have become more managed •Shifted economic control from the practitioners to those that ultimately pay the bills. •REFER TO TABLE 3-3 •Managed Health Care Systems •HMO = Health Maintenance Organization oEmploys a restricted number of providers to serve those who enroll in the plan; costs for services are fixed. •PPO = Preferred Provider Organization oHas contracts with outside providers (at a discounted rate) to meet the needs of its membership; in exchange for the discounted rate, the providers theoretically receive an increased number of referrals. •POS - combined features of PPO and HMO programs oMembers have more options regarding how "managed" their health care choices are but pay more for these non-managed features. POS pay more if they choose providers that are outside the defined network list and less if the provider is within the network. •Consumer driver health plans are seen as a way to reduce overall costs to institutions - much the same reason that prompted the development of HMO's in the first place. oPrediction of two major models that are likely to be implemented: •Consumer-directed health care plans •Shift the cost and responsibility of behavioral health care services to the consumer. •Individuals will spend more out of pocket and are likely to shop around to find highest quality services for best prices •Pay for performance disease management models 1.Psychologists strive to benefit those they serve and to do no harm ii.Fidelity and responsibility 1.Psychologists have professional and scientific duty to society and establish relationships characterized by trust iii.Integrity 1.In all their activities, psychologists strive to be accurate, honest, and truthful iv.Justice 1.All persons are entitled to access to and benefit from the profession of psychology; should recognize their biases and boundaries of competence v.Respect for people's rights and dignity 1.Respect rights of all people and enact safeguards to ensure protection b.Competence i.Clinicians must always represent their training accurately ii.Have an obligation to actively present themselves correctly with regard to training iii.Should not attempt treatment procedures if they lack training or experience iv.Must be sensitive to treatment or assessment issues that could be influenced by a patients gender, ethnic or racial background, age, sexual orientation, religion, disability, or SES v.Must guard against the adverse influence of their problems on their patients c.Privacy and confidentiality iEthical duty to respect and protect the confidentiality of client info ii.When info is released without consent, the trusting relationship can be harmed iiiTarasoff Case iv.Not only must clinicians decide when and whom to inform and under what circumstances but they must also try to determine whether the Tarasoff decision applies to their state d.Human Relations i.Client welfare 1.Sexual activities with clients, employing a client, selling a product to a client, or even becoming friends Is value in diagnosing? - -Yes- insurance, treatment plan, put a name, communicate w/other people, absences; communication, enables and promotes empirical research, research on etiology possible (helps study causes), diagnosis suggests treatment -no: self-fulfilling prophecy, close mind, obsessed w/label, crutch Diagnosis: the classification of disorders by symptoms and signs Psychopathology: examines the nature and development of abnormal •Behavior •Thoughts •Feelings Definitions of abnormality vary widely and may not capture all aspects of psychopathology Importance of Diagnosis Diagnosis is a type of expert-level categorization that allows us to make important distinctions 4 Advantages of Diagnosis communication enables and promotes more empirical research in psychpathology enables research into etiology (causes) or abnormal behavior may suggest which mode of treatment is likely to be most effective WHAT IS ABNORMAL BEHAVIOR? - Defining abnormal behavior 3 proposed definitions: (1) statistical infrequency or violation of social norms; (2) the experience of subjective distress, and (3) disability, dysfunction, or impairment (1) statistical infrequency or violation of social norms (when someone's behavior becomes apparently deviant, outrageous, or otherwise nonconforming -- as perceived by the observer) Advantages establishment of quantitative "cutoff points" look for "clinically significant" deviances from the mean that signify abnormality intuitive appeal (we believe that we know it when we see it) Disadvantages choice of cutoff points is difficult -- vry few guidelines are available for choosing this the number of deviations -- how many is necessary to identify as abnormal? cultural and developmental relativity (what is deviant for one group is not necessarily deviant for another) the danger here is that every culture can be reduced to a subculture and then to a miniculture and in this pattern we could judge nearly every behavior as normal) 2)the experience of subjective distress (based on subjective feelings and sense of well-being -- as perceived by the affected individual) Advantages it seems reasonable to assume that adults and some children can express this information relieves the clinician of the burden of making an absolute judgement Disadvantages not everyone whom we consider "disordered" reports subjective distress ie those with personality disorders or little contact with reality another problem is how much subjective distress is necessary to be considered abnormal 3) disability, dysfunction, or impairment (the behavior must create some degree of social or occupational problems for the individual) Advantages relatively little interference is required -- when someone is having problems in either of these realms, they usually not Mental Illness - Important to note that abnormal behavior does not necessarily indicate mental illness --> mental illness = a large class of frequently observed syndromes that are comprised of certain abnormal behaviors or features --> the DSM has a clear definition for mental illness that clinicians use so that they're all on the same page (this definition includes all aspects listed above) syndrome must be associated with distress, disability or increased risk of problems a mental disorder is considered to represent a dysfunction within an individual not all deviant behaviors or conflicts with society are signs of mental disorder Diagnostic Systems - Diagnostic Systems • Assume that abnormality can be detected and classified by clusters of symptoms and signs o Each cluster is thought to reflect a different disorder o Each cluster may require a different treatment o DSM-1 (1952) • Glossary.. psych terms defined • Used term "reaction" DSM-11 (1968) • Attempted to be more theory-neutral • Encouraged multiple diagnoses.. co-morbid.. dual diagnosis DSM III (1980) • Defined mental disorder • Descriptive approach/criteria sets • Etiology unknown • Narrowed defintioin of schizophrenia • Broadened defitino of affective disorder • Multiple diagnoses allowed on axis I and II DSM III-R 1987 DSM IV 1994 DSM V 2014 DSM-IV-TR - when this textbook was written, the DSM-IV was the most recent, widely-used diagnostic tool Outlines mulitaxial assessment Axis I: clinical disorders or relevant conditions Axis II: personality disorders and mental retardations Axis III: current medical conditions that may be relevant Axis IV: psychosocial and environmental problems Axis V: GAF (quantitative estimate of an individual's overall level of functioning General issues in classification Categories versus dimensions Based on symptoms or history of, patient is place in a category Can be tendency to confuse categorization with explanation Ex: Person experiencing obsessions because they have OCD Explanation is supplanted by circular form of description Differences between abnormal and normal behavior are on a scale of dimension Difference between psychotic and normal is one of degree, not kind So diagnoses of mental disorder imply categorization (all or none) There are relatively few diagnostic constructs that are categorical in nature 1.Efficacy a.Considered efficacious to the extent that they average person receiving the treatment in clinical trials is demonstrated to be significantly less dysfunctional than the average person not receiving the treatment b.Control internal validity by controlling the types of clients in the study by standardizing the treatment and randomly assigning patients c. Empirical Support for these studies.. 80% of 475 studies had better functioning than those not receiving treatment 2Effectiveness a.Emphasize external validity and the representatives of the treatment that is administered. These studies can look more like "real-world" treatment, as compared to efficacy studies.. basically a client reports significant benefit from it b.Less studies for these.. but.. i.Psychotherapy improved majority of respondents.. and those who started out worse.. reported most improvement ii.Respondents who received psychotherapy... vs. psychotherapy plus meds had same outcome.. iii. Longer sessions.. more improvement a Evidence-based treatment - i.Refers to those interventions or techniques that have produced significant changes in clients and patients in controlled trails 1.These interventions have been shown to be efficacious by comparing those that receive the treatment to those from a control group •APA established criteria for EBTs in 1995 •Combine trails of EBTs through use of meta-analysis.. study of studies -Therapeutic approaches are categorized as "Well Established," Probably Efficacious," Experimental, or "Possibly Efficacoius" -through time there has been less emphasis upon the use of manuals to guide treatment, but the need for internal validity and consistency in how treatments are administered remains b. Evidence-based practice - i.Includes treatments informed by a number of sources, including scientific evidence about the intervention, clinical expertise, and patients needs and preferences •Broader, contains non controlled trials (ex. No control or comparison group) •Question of whether one can scientifically measure effect without a comparison group •Rise in use with healthcare reforms.. insurance companies being more intrusive.. and demanding people be treated in 10-12 sessions.. or no improvemtn.. expectation that use EBT to use faster and more measurable results Features Common to Many Therapies - 1.Relationship/Therapeutic Alliance a.Between patient and therapist i.Accepting, non-judgmental place 2.The expert Role a.Training, knowledge, and experience 3.Building Competence/mastery a.Make patient more competent and effective 4. Nonspecific factors -3 types: supportive, learning, action • support: catharsis (emotional release), identification with therapist (see part in therapist maybe..), mitigation of isolation, positive relationships, reassurance, release of tension, structure (of therapy session etc.. safety), therapeutic alliance (number one successful outcome... on your patient's team..RIDE OR DIE).. how to do that.. set goals.. establish trust.. listening.. value/affirm.. confidentiently, listening.. o , therapist/client active participation, therapist expertness, therapist warmth, respect, empathy, acceptance, genuineness, trust • learning: advice, affective experiencing (learn how to feel your feelings), assimilation of problematic experiences, changing expectations for personal effectiveness, cognitive learning, corrective emotional experience, exploration of internal fram of reference, feedback, insight, rationale • action factors: behavioral regulation, cognitive mastery, encouragement of facing fears, taking risks, mastery effort, modeling (you lead by example), practice, reality testing, success experience, working through Nature of Therapeutic Variables - 1.The degree of the patient's distress 2.Intelligence 3.Age a.Young patients have most success 4.Motivation a.Can be hard to assess motivations 5.Openness 6.Gender a.Not necessarily predicts outcome of therapy 7.Race, ethnicity, and social class (they shouldn't lump these together...) a.Minorities/social class diferences have same outcomes as others b.Hasn't been examined if people should be matched with same race/class i.Culturaly sensitivity on the part of the therapist is important 8.Therapist's reaction to patients Therapist: have traits to affect therapy - 1.age, sex, ethnicity a.isn't related to outcome e 2.Personality a.High levels of dominance in a therapist resulted in better outcomes in cases where they therapist and client were culturally similar, but low-dominance therapists were more effective with culturally dissimilar clients 3.Empathy, Warmth, and Genuineness a.Commitment to patient determines outcomes b.Same with communication in empathy 4.Emotional Well-being 5.Experience and Professional Identification a.No research to suggest the more experience means better outcomes.. Course of Clinical Intervention - 1.Initial Contact 2.Assessment a.Ongoing process 3.Goals of treatment a.Contract 4.Implementing Treatment a.Clinet-centered, cognitive, behavioral.. etc. 5.Terminatoin, evalution, and follow up Stages of Changes - 1.Precontemplation a.Client has no intention of changing ways i.Pressure from family ii.Court order 2.Contemplation a.Client is aware problem exists, but not committing to changing 3.Preparation a.Client intends to make a change in near future 4.Action aChanging maladaptive behaviors emotins etcs 5.Maintenance: a.Clinet works on not relapsing and furthering gains 6.Termination a.Client has made necessary changes and relapse is not a threat o Effect size: - change relative to a comparison group that does not receive treatment - Psychotherapy research - oEfficacy experiments: experimental group gets treatment, control group does not. INTERNAL VALIDITY is stressed and two groups are MATCHED on age, ethnicity, sex etc. and RANDOMLY ASSIGNED. Assessment of patient functioning conducted before, during, and after study