Chapter 2 – Contemporary Clinical Psychology Copyright © 2014 John Wiley & Sons, Inc. All...

Chapter 2 – Chapter 2 – Contemporary Contemporary Clinical Clinical PsychologyPsychology

Clinical psychologists do a variety of Clinical psychologists do a variety of activities including: activities including: – providing psychological assessmentproviding psychological assessment– providing psychological interventionproviding psychological intervention– conducting researchconducting research– providing clinical trainingproviding clinical training– consulting with other professionals and consulting with other professionals and

agenciesagencies Clinical psychologists work with Clinical psychologists work with

– Individuals, couples, families, groups and Individuals, couples, families, groups and organizationsorganizations

– All across the life spanAll across the life span

Activities of Clinical Activities of Clinical PsychologistsPsychologists

Percentage of Psychologists Who Percentage of Psychologists Who Engage in Each ActivityEngage in Each Activity

– Assessment and diagnosis Assessment and diagnosis 5858– PsychotherapyPsychotherapy 7676– ConsultationConsultation 3838– ResearchResearch 47 47 – TeachingTeaching 4949– SupervisionSupervision 4747– AdministrationAdministration 4646

Adapted from Norcross & Karpiak (2012).Adapted from Norcross & Karpiak (2012).

Percentage of Psychologists Time in Percentage of Psychologists Time in Each ActivityEach Activity

– Assessment and diagnosis Assessment and diagnosis 1414– PsychotherapyPsychotherapy 3535– ConsultationConsultation 66– ResearchResearch 15 15 – TeachingTeaching 1111– SupervisionSupervision 66– AdministrationAdministration 1111

Adapted from Norcross & Karpiak (2012).Adapted from Norcross & Karpiak (2012).

Assessment is very common and comes Assessment is very common and comes in many formsin many forms– Evaluating the functioning of an individual Evaluating the functioning of an individual

clientclient– Evaluating a family or social unit of some sortEvaluating a family or social unit of some sort– Diagnosis Diagnosis – Formal standardized testing (cognitive, Formal standardized testing (cognitive,

behavioral or personality)behavioral or personality)– Assessment in psychotherapyAssessment in psychotherapy

PlanningPlanning MonitoringMonitoring Evaluating Evaluating

Activities of Assessment in Activities of Assessment in Clinical PsychologyClinical Psychology

The Assessment process The Assessment process

Assessment is an ongoing process, not Assessment is an ongoing process, not defined by psychometric evaluationsdefined by psychometric evaluations

It is an ongoing process of hypothesis- It is an ongoing process of hypothesis- testingtesting

We adopt both the idiographic approach- We adopt both the idiographic approach- exploring the uniqueness of the particular exploring the uniqueness of the particular person and his/her circumstances person and his/her circumstances

The nomothetic approach: What is The nomothetic approach: What is common to this person and other persons common to this person and other persons of this age and other demographic of this age and other demographic variables? variables?

Steps in the assessment Steps in the assessment process process

1.1. Review referral information Review referral information

2.2. Decide whether to accept Decide whether to accept

3.3. Obtain relevant background information Obtain relevant background information

4.4. Consider the influence of relevant othersConsider the influence of relevant others

5.5. Observe the person in several settings Observe the person in several settings

6.6. Select and administer an Select and administer an assessment test batteryassessment test battery

Steps (cont-d) Steps (cont-d)

1.1. Review referral information Review referral information

2.2. Decide whether to accept Decide whether to accept

3.3. Obtain relevant background Obtain relevant background information information

4.4. Consider the influence of relevant Consider the influence of relevant othersothers

5.5. Observe the child in several settings Observe the child in several settings

6.6. Select and administer an assessment Select and administer an assessment test batterytest battery

Diagnosis Diagnosis

Diagnosis involves assigning the Diagnosis involves assigning the cluster of symptoms to a cat gory cluster of symptoms to a cat gory of mental disorders of mental disorders

Diagnosis is based on the DSM Diagnosis is based on the DSM It enables the planning of It enables the planning of

intervention intervention

Intervention is very common as wellIntervention is very common as well– Psychotherapy: talk therapyPsychotherapy: talk therapy

Most people attend fewer than 10 sessions regardless of Most people attend fewer than 10 sessions regardless of problemproblem

Different approaches (psychodynamic, cognitive-Different approaches (psychodynamic, cognitive-behavioral, experiential, etc) focus on different issues, behavioral, experiential, etc) focus on different issues, (although most challenge thoughts and validate (although most challenge thoughts and validate emotions) emotions)

In North America cognitive behavioral is most common, In North America cognitive behavioral is most common, followed by an integrative approach and psychodynamicfollowed by an integrative approach and psychodynamic

The Prescription Privileges DebateThe Prescription Privileges Debate– Currently only a select few psychologists can Currently only a select few psychologists can

prescribe (in New Mexico and Louisiana)prescribe (in New Mexico and Louisiana)– Highly debatedHighly debated

Activities of Intervention Activities of Intervention in Clinical Psychologyin Clinical Psychology

Prevention is less common but growing Prevention is less common but growing – Primary prevention: prevention of a disease before Primary prevention: prevention of a disease before

it occursit occurs– Secondary prevention: reducing the recurrence of a Secondary prevention: reducing the recurrence of a

diseasedisease– Tertiary prevention: reducing the overall disability Tertiary prevention: reducing the overall disability

that results from a diseasethat results from a disease Prevention usually based in community Prevention usually based in community

settingssettings– Psychologist usually has several roles in preventionPsychologist usually has several roles in prevention

Developing programsDeveloping programs Implementing programsImplementing programs Evaluating outcomes of programsEvaluating outcomes of programs

Activities of Prevention Activities of Prevention in Clinical Psychologyin Clinical Psychology

Consultation Consultation – Clinical consultation: offering advice and Clinical consultation: offering advice and

information for others treatment professionals information for others treatment professionals – Organizational (or community) consultation: Organizational (or community) consultation:

evaluating a service, or providing an opinion on evaluating a service, or providing an opinion on how an organization is doinghow an organization is doing

Usually there is a needs assessment, program Usually there is a needs assessment, program development, program evaluation, and policy development, program evaluation, and policy consultationconsultation

Research Research – All psychologists are trained to conduct and All psychologists are trained to conduct and

evaluate researchevaluate research– APA’s ethics code requires a commitment to APA’s ethics code requires a commitment to

increasing scientific knowledge increasing scientific knowledge

Additional Activities of Additional Activities of Clinical PsychologistsClinical Psychologists

Research (cont)Research (cont)– Small percentage produce researchSmall percentage produce research– Much more common in university settingsMuch more common in university settings– Range and content of research varies dramaticallyRange and content of research varies dramatically

Can be on normal human functioning, psychopathology, Can be on normal human functioning, psychopathology, assessment, intervention or preventionassessment, intervention or prevention

Teaching Teaching – University courses (graduate or undergraduate) in University courses (graduate or undergraduate) in

variety of areas related to clinical psychvariety of areas related to clinical psych– Also can teach in several other settings (e.g., Also can teach in several other settings (e.g.,

community colleges, in clinics training professionals, community colleges, in clinics training professionals, to medical students, in workshops/seminars etc.) to medical students, in workshops/seminars etc.)

Additional Activities of Clinical Additional Activities of Clinical PsychologistsPsychologists

Clinical SupervisionClinical Supervision– Close monitoring of training clinicians Close monitoring of training clinicians – Done in an individual meeting or with a number Done in an individual meeting or with a number

of training clinicians (group supervision)of training clinicians (group supervision)– Some supervisors have supervisees audio or Some supervisors have supervisees audio or

videotape their sessions videotape their sessions Research Supervision Research Supervision

– Assisting in the development and Assisting in the development and implementation of a research study or program implementation of a research study or program

AdministrationAdministration– organization, program development, meetings organization, program development, meetings

in committeesin committees

Additional Activities of Clinical Additional Activities of Clinical PsychologistsPsychologists

Science of Clinical PsychologyScience of Clinical Psychology– Clinical Psychologists must maintain their Clinical Psychologists must maintain their

knowledge of research relevant to their knowledge of research relevant to their activities activities

– This is true for all theoretical orientationsThis is true for all theoretical orientations– However, However, howhow research informs practice research informs practice

differs for many clinical psychologistsdiffers for many clinical psychologists– Balance between open-mindedness and Balance between open-mindedness and

skepticism skepticism

First Pillar of Clinical First Pillar of Clinical Psychology: SciencePsychology: Science

Five general ethical principles of the APA Five general ethical principles of the APA (2010) (2010) – Beneficence and nonmalficenceBeneficence and nonmalficence: help and avoid : help and avoid

doing harmdoing harm– Fidelity and responsibilityFidelity and responsibility: developing trust and : developing trust and

show awareness of their professional responsibilitiesshow awareness of their professional responsibilities– Integrity in professional relationshipsIntegrity in professional relationships– JusticeJustice: all people should have access to benefit : all people should have access to benefit

from the contribution of psychologyfrom the contribution of psychology– Respect for people’s rights and dignityRespect for people’s rights and dignity

Informed consent – all individuals in therapy Informed consent – all individuals in therapy and participants in research must indicate that and participants in research must indicate that they understand and are willing participantsthey understand and are willing participants

Second Pillar of Clinical Second Pillar of Clinical Psychology: EthicsPsychology: Ethics

Ethical, Legal, and Professional Ethical, Legal, and Professional IssuesIssues

Laws: Laws: Imposed by legislative bodies Imposed by legislative bodies Requires interpretation Requires interpretation Distinction between civil and Distinction between civil and

criminal law criminal law Civil law uses less exacting Civil law uses less exacting

Cont-dCont-d

Ethics: Ethics: Derived from philosophical ideas Derived from philosophical ideas

and professional normsand professional norms Imposed on members of a Imposed on members of a

profession profession Has a moral basisHas a moral basis

Ethical Principles Ethical Principles

Autonomy: respect for rights of others Autonomy: respect for rights of others to make their own choices and hold to make their own choices and hold their own beliefstheir own beliefs

Nonmaleficience: do no harm Nonmaleficience: do no harm Beneficence: promoting positive Beneficence: promoting positive

growth & welfare of others growth & welfare of others Justice: acting fair, impartial & Justice: acting fair, impartial &

reasonable reasonable Fidelity: faithful and trusting of othersFidelity: faithful and trusting of others

Con-d Con-d

Develop ethical reasoning skills and Develop ethical reasoning skills and sensitivity sensitivity

Be aware of motivations and interestsBe aware of motivations and interests Exercise power with care Exercise power with care Learn limits of professional role Learn limits of professional role Understand implications of Understand implications of

assessment findings and assessment findings and recommendationsrecommendations

Using client’s language Using client’s language Considering school, Considering school,

environmental, and political environmental, and political factors factors

Eliminating bias, prejudice, and Eliminating bias, prejudice, and discriminatory factorsdiscriminatory factors

Documenting cultural and socio-Documenting cultural and socio-political factorspolitical factors

Training in Clinical Psychology Training in Clinical Psychology – Scientist-practitioner modelScientist-practitioner model (Boulder (Boulder

Model)Model)– Clinical scientist modelClinical scientist model– Practitioner-scholar modelPractitioner-scholar model (Vail Model) (Vail Model)

APA Accreditation in Clinical APA Accreditation in Clinical PsychologyPsychology

Providing services that are competent Providing services that are competent for the larger multicultural community for the larger multicultural community

LicensureLicensure

Additional Aspects to Additional Aspects to Clinical PsychologyClinical Psychology

Ethical Violations Ethical Violations

Misuse of assessment instruments Misuse of assessment instruments Wrongful use of derived data Wrongful use of derived data Performing outside of competence Performing outside of competence Misinterpretations of assessment Misinterpretations of assessment

data data Invasion of privacy Invasion of privacy Violation of confidentiality Violation of confidentiality

Chapter 2 – Contemporary Clinical Psychology Copyright © 2014 John Wiley & Sons, Inc. All...

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