Sample Essay Topics
I.
Clinical problem(s): psychological assessment and
treatment issues for people with serious psychopathological conditions.
II.
Social problems: applying clinical psychology to
understand or deal with crime, suicide, drugs, “sex” offenses, abuse....
III.
Professional issues: past development, present
status, future of the profession internationally, nationally, provincially, locally.
Discussion Group Topics
1.
Does mental illness exist? Szasz vs. Moore
2.
Can we recognize it? Rosenhan vs. Spitzer
3.
Where does it originate? Rimland: biogenesis vs. psychogenesis
Some Good Topics
Factors in the treatment of pedophilia: Etiology, therapeutic approach and sex of the
psychotherapist.
Is megavitamin therapy an effective treatment for Autistic kids?
A report on the rapid cycling variant of bipolar illness.
Bulimia: Analysis of intervention strategies in terms of efficacy and efficiency for reducing
symptoms.
Effects of diet on brain serotonin levels.
Carbamazepin and Valproate: new therapies for mania.
Treatment issues with Obsessive-compulsive disorder.
Clinical intervention and the grieving process.
Should patients be required to receive ECT?
A dilemma: pseudodementia or primary degeneration dementia?
Accounting for the onset and episodic nature of Obsessive-compulsive disorder.
Geneticist and controversy: the etiological concundrum of bipolar disorders and related riskgroups treatment implications.
Are tricyclic antidepressants useful with Major Depressive Disorder in children?
Problems in assessing the presence of psychopathology in mentally retarded individuals.
Psychopathy and the DSM.
Raising the awareness of comorbidity in psychiatric Dx: Anorexia and bulimia, a case in point.
Obsessive-compulsive disorder in children.
Evolution and delusional disorder.
Statistical vs. clinical prediction of dangerousness.
Reasons ADHD has been underdiagnosed in the female population.
Gender differences in the etiology of schizophrenia.
Social support and PTSD: Understanding sexual assault.
Postpartum depression: Multidimensional and multicausal disorder.
Eye movement desensitization and reprocessing: A critique of the evidence and implications for its
use in the Tx of PTSD.
Influence of Bill C-30 on the unfit defendent.
Ethical dilemas for clinical psychologists in reporting child abuse.
Prescription privileges in psychology: Issues and analysis.
Contrasting treatments for ADD in children.
Role of psychology in head injury rehabilitation.
Affective disorder and culdure.
A re-examination of Freuds 6 cases.
Long term consequences of FAS/FAE.
Clinical psychologists as expert witnesses.
Cerebral laterality in affective disorders and schizophrenia.
Post-traumatic stress disorder: Diagnostic, etiological and therapeutic considerations.
Analysis of psychotherapies used by the major theoretical approaches in the treatment of
Anorexia.
CLINICAL PSYCHOLOGY
The Scientist-Practitioner Model
Softheartedness: compassion & caring in clinical practice
Hardheadedness: curiosity & critical thinking in clinical practice
Science and Technology in modern mental health care
History
Understanding and Intervention: the “re-current millennia”
Physical, mental and sociocultural aspects of mental health care
The Mental Hospital movement
The Psychiatric Revolution
The Psychodynamic Model
The Mental Health Movement
The New Psychiatry
The Lesson of History
The Apprenticeship Model of the Health Care professions
The Scientist-Practitioner Model of Clinical Psychology:
Boulder, Colorado (1949) and the limitations of psychological science
Vail, Colorado (1973) and the growth of professional schools
Salt Lake City (1987) and the modern scene
The perils of professionalism
Merging models in the modern era:
Research production and scholarship/consumption
Diversity of training and practice in the modern era
The identity of Clinical Psychology:
“the application of psychology to people with clinical problems”
“Application”:
1. Understanding: description and explanation
2. Intervention: psychotherapy & community intervention
3. Clinical process: human judgment & decision-making
“Psychology”:
I.
The Psychodynamic Model: conflict & its management
II. The Learning Model: adaptation & its methods
III. The Phenomenological/Humanistic Model: growth & its direction
“Clinical Problems”:
A. The Theoretical/absolute criterion (diseases, defects & demons)
B. The Social/relative norm criterion (deviance, difference & disgust)
C. Personal/subjective criterion (distress, dysphoria & despair)
The Common-sense criterion:
Maladjustment/symptoms (disorder, dysfunction & disability)
Some examples: e.g. sexual orientation and the DSM
Clinical psychology, counselling and other professions
The profession of Clinical Psychology: protecting professional practice and the public
A. Protection of Title (Certification/Charter)
e.g. Psychologists Act, 1967 (revised, 1983)
Psychology Profession Act, 1987 (revised, 1992)
B. Protection of Practice (License)
Boards of Professional Psychology
Standards & Guidelines of practice
What should be the minimal requirements?
Ethics of practice
I.
APA principles: then and now
II.
CPA principles:
1.
Dignity of persons
2.
Responsible, caring
3.
Integrity in relationships
4.
Responsibility to society
Some examples:
e.g., Tarasoff case and the duty to warn/protect
Investigation & adjudication of complaints
APPLICATION OF PSYCHOLOGY TO EXPLAIN CLINICAL PROBLEMS
Example: The case of Mr. A (and Assignment 1)
The Models
1. Psychodynamic/conflict model:
...Symptoms serving purposes
2. Learning/adaptation model:
...Symptoms as (mal)adaptations
3. Phenomenological/growth model:
...Symptoms expressing needs
Applying the models to explain Mr. A
(Anxiety Disorders)
1. Psychodynamic (a dispositional
explanation)
e.g., neurosis and defense mechanisms
(displacement)
2. Learning (a situational explanation)
e.g., traumatization and adaptation
a.
classical conditioning: acquiring aversive reactions
b.
operant conditioning: escape & avoidance
c.
cognition: acquiring thoughts & subjective traumatization
(expectancy, value, efficacy)
3. Phenomenological (another dispositional explanation)
e.g., needs and their frustration (conditions of worth)
The limitations of models: Mr. A., reconsidered Procrustes and his bed
APPLICATION OF PSYCHOLOGY TO DESCRIBE PEOPLE WITH CLINICAL PROBLEMS
The Process of Assessment: old and new
1. Data collection: “data-driven” and “theory-driven” procedures
2. Data combination/processing: human
judgment and decision-making
3. Communication:
the example of psychological reports
The Purpose of assessment: answering questions
I.
Classification (diagnosis)
II.
III.
Further description questions:
1.
Other differences that make a difference
2.
Monitoring the course
Prediction (prognosis):
1.
errors (false positives & false negatives)
2.
base rates (the ideal & the reality)
Positive & negative predictive power
Sensitivity & specificity
The Uses of Information: Types of data
1. Simple data: a sample of behaviour (what the client does)
2. Correlates: a descriptive generalization (what the client is)
3. Sign: a theoretical variable (what the client has)
Applying assessment techniques to describe Gary Gilmore (The Personality Disorders)
1. Classification: the modern use of psychological tests in diagnosis
e.g., ASPD and the psychopath
2. Further assessment: differences that make a difference
e.g., the nature of psychopathy
3. Prediction: the implications of errors and base rates
e.g., the prediction of dangerousness
Clinical Assessment
A. The Interview
Types 1. intake, history, mental status,....
2. “pre” & “post” interviews
3. crisis interviews
The Process
1. Beginning: the problem & the person (rapport?)
2. Middle: repeated scanning & focussing (bias?)
3. End: the client & the critique (improvements?)
Issues:
Where, how and what
Clinician’s gratification of self
Client’s “frame of reference”
The example of Gilmore: an interview in forensic practice
B.
Psychological Testing
I.
Intellectual Assessment
1.
The science of intelligence and the abilities
2.
The technology of assessing achievement and aptitude
Construct validity: looking for signs
Criterion validity (concurrent and predictive):
looking for descriptive generalizations
Intelligence A, B and C:
genotype, phenotype and observation
Achievement, aptitude and ability:
sample, correlate and sign
Clinical purposes of intellectual assessment
1.
Classification: Mental retardation
and beyond
2.
Further questions: “general
intellectual level” and other specific applications
3.
Prediction: limitations of aptitude
and “the twisted pear”
Practical vs theoretical questions in intellectual assessment
II.
Personality assessment
1.
The sciences of personality
(temperament/emotion and motivation/needs)
2.
The test technologies for research and practical purposes
The problem of personality theory and assessment
e.g., aggression, suicide & sexual behavior
The solutions
1. The “Scientific”/Objective Test approach:
reliability first, find relevance (validity) later
Examples:
a.
Samples/correlates: MMPI, CPI
b.
Signs: 16PF, EPQ, NEO-PI
The assessment of temperament & emotion (and “response sets”)
Problem:
What good is a highly reliable test if it is not relevant to your
needs?
2. The “Practical”/Projective Test approach:
potential relevance first, improve reliability later
Examples:
a. Associations: Rorschach
b. Constructions: TAT
c. Completions: Sentence Completion
d. Choices/ordering: Q-sort
e. Expressions: DAP, HTP &
beyond
The assessment of needs & motives
(and their “projection”)
Problem:
What good is a highly relevant test if you can’t determine when
and how it is relevant?
Clinical purposes of personality assessment
1.
Classification: Personality disorders and beyond
2.
Further questions: assessing “temperament”, “motivation” and other specific
applications
3.
Prediction:
limitations of predictability and “behavioral specificity”
Practical vs. theoretical questions in personality assessment
The issue of incremental validity
The example of Gilmore: intellectual & personality assessment in forensic practice
1. Classification?
2. Further questions?
3. Prediction?
III.
Observational assessment
Types 1. naturalistic observation
2.
controlled (e.g., ‘reactive/performance” and active/”role-playing”)
observation
3.
self-monitoring
Problems and their solutions
Reliability: standardization of observational
assessments (and “observer drift”)
Relevance/validity:
a.
Observer Bias: Rashomon Effect, “blind”
research and the “Halo Effect” in practice
b.
Reactivity of the Observed: Hawthorne
Effect, “double blind” research and the “Hello/Goodbye Effect”
in practice
Improving the validity of observational assessment: “the law of small numbers”
The issue of ecological validity
The example of Gilmore: observational
assessment in forensic practice
1.
2.
3.
Classification?
Further questions?
Prediction?
CLINICAL PSYCHOLOGY: “the application of
people with
clinical problems”
psychology to
The application to understanding (description and explanation)
The application to intervention (psychotherapy and community intervention)
APPLICATION OF PSYCHOLOGY TO THE PROCESS OF CLINICAL JUDGMENT AND
DECISION-MAKING
“Bounded rationality” and the falliability of human judgments and decision-making (Herb
Simon, Paul Meehl, Kahneman & Tversky)
1. Data collection
2. Data combination/processing
a. Variation & the context of conjecture
b. Selection & the context of confirmation
3. Communication
The falliability of clinical intuition: the illusion of expertise and “the clinician’s
paradox”
The Debate:
Clinical/impressionistic/“intuitive” methods
vs
Statistical/actuarial/“cookbook” methods
Some examples in health care and in daily life
The Research
Clinical judgments in daily practice: too fast, too fixed and too firm
Clinical vs. “actuarial” alternatives: complexity & simplicity in practice
(e.g., moderator variables”)
TYPICAL ERRORS
1.
The Confirmation Bias (and the belief perseverance phenomenon) e.g., evidence
“in support of” belief
2.
Overconfidence (the “optimistic bias”)
A. Irrelevant made relevant (e.g., underestimating risk)
B. Relevant made irrelevant (e.g., confidence intervals)
3.
Framing (the “rhetorical bias”)
4.
Availability Heuristic (and the post hoc explanation fallacy)
A. Samples (e.g., anchoring bias)
B. Correlates (e.g., spurious correlations)
5.
Representativeness Heuristic (“Theoretical Bias”)
e.g., illusory correlations
A. Insensitivity to BR (Prior Probabilities)
e.g., incremental validity and the P.T. Barnum
Effect
B. Insensitivity to N (Law of Small Numbers)
e.g., ecological validity and the FAE
C. Insensititivity to Reliability (vs. Relevance/Validity)
e.g., potential validity of projective/objective tests
D. Insensitivity to Prior Probability in Prediction
(“Regression to the Mean”)
e.g., predictive validity of rare events
Mental Set (and “Functional Fixedness”)
e.g., “pathologizing set” in understanding
e.g., “fixedness” in assessment and therapy
Common Fallacies
6.
mind”)
1.
“Sick-sick”
2.
“Me too”
3.
“Uncle George’s pancakes”
4.
“Multiple Napoleons”
5.
“Understanding makes it normal”
6.
“Confusing content/cause”
7.
Clinical/Statistical significance (“Neglect of overlap”)
8.
Clinicians Gratification of Self (“Hidden decisions”)
9.
Client’s Frame of reference (“Spun-glass theory of the
10. Case/Context (“Uniqueness and probability”)
Communication
Psychological Reports: clear, relevant, useful
1. P.T. Barnum Report
2. Polyanna Report
3. Prosecuting Attorney Brief
4. Madison Avenue Report
5. Cookbook Report
6. Safe-hedge Report
7. Aunt Fanny Description
Primary and secondary receivers
Feedback
APPLICATION OF PSYCHOLOGY TO INTERVENTION WITH
PEOPLE WHO HAVE CLINICAL PROBLEMS:
I.
PSYCHOTHERAPY
Example: The case of Mrs. B. (and Assignment 3)
The Process
1.
Beginning: the problem & the person (and the past?)
2.
Middle: the strategy & the tactics (and tactical
3.
End: evaluation techniques (and was it effective?)
change?)
The Tactics
I.
“The detective” (Exploratory Tactics): the past
e.g. psychoanalysis
II. “The coach” (Directive Tactics): the present
e.g. behavior & cognitive therapies
III. “The friend” (Experiential Tactics): the future
e.g. client centered therapy
Strategy and tactics
Psychotherapy as a relationship and its personal implications
I.
PSYCHODYNAMIC TACTICS
Theory: conflict
Therapy: insight
e.g. analysis of resistance, transference,
etc., to catharsis
Issue: historical/narrative truth
II.
LEARNING TACTICS
Theory: adaptation
Therapy:
a. classical conditioning ? behavior
b. Operant conditioning ? therapy
c. cognitive therapy (“rational restructuring”)
From radical & methodological behaviorism to logical & neo-
behaviorism
From behavior modification to behavior therapy
CONDITIONING/BEHAVIOR THERAPIES
Classical Conditioning
Extinction
Operant Conditioning
Exposure: flooding +
“implosion”
(+ habituation)
Counterconditioning
Aversive conditioning
Appetitive conditioning
Combinations
Systematic
desensitization
“Systematic
sensitization”
R÷SR
Punishment (response
suppression &
penalties)
R÷SP
Reward (shaping &
rehearsal
procedures)
R*÷SR
Contingency
management: “token
economies” and
other contracting
procedures
COGNITIVE THERAPIES
a.
Deductive/logical: “rational restructuring” (e.g., RET)
b.
Inductive/empirical: other cognitive tactics (e.g., CT)
Issue: generalizability (across people and places) and the “Over
Justification Effect”
III.
HUMANISTIC/PHENOMENOLOGICAL TACTICS
Therapy: growth
Therapy: “client-centered” methods (e.g., unconditional positive
regard)
Also, Existential tactics (“Logotherapy”) Gestalt tactics”
Issue: strategy (setting & achieving goals)
INTERPERSONAL & GROUP THERAPIES
1.
Psychodynamic examples:
“transactional analysis”
“psychodrama” and
2.
Learning examples: “social skills training” and “modelling”
3.
Humanistic examples: “encounter groups” and beyond
“The Curative Factors”
Catharsis
Universality
Recapitulation (of the family)
Altruism
Technique
Interpersonal knowledge
Validation
Existential awareness
Guidance
Acceptance (cohesion)
Imitation
New hope
The Evolution of Family Therapy
1. Family ÿ problem?
2. Problem ÿ Family!
3. Person ø Family
EXAMPLE OF PSYCHOTHERAPY:
THE DEPRESSIVE DISORDERS
Cases:
Dx and assessment
Tx and psychotherapy
Diagnostic alternatives
ORGANIC?
÷ OBS?
•
DRUGS?
BIPOLAR? ÷
MD?
•
cyclothymia?
DEEP?
÷
adjustment disorder?
dysthymia?
•
(primary/secondary)
MDD
simple or recurrent episode?
mild, moderate or severe (psychotic
symptoms)?
•
melancholic or non-melancholic?
COMORBIDITY?
e.g. DRUGS?
PERSONALITY?
“DOUBLE DEPRESSION”?
Therapeutic alternatives
BIOMEDICAL? ÷ ECT?
DRUGS?
PSYCHOTHERAPY?
1. Psychoanalytic (personality change by insight)
2. Learning - classical (stimulus ÷ response
change)
operant (response ÷ reward change)
cognitive (belief change)
3. Humanistic (personality change by growth)
Also, Interpersonal therapies (e.g. IPT)
Weeping Widow
Disappointed Decorator
Lonesome Mistress
Learning to cope
Death of a Family
The Bell Jar
Black Bile
Mr. N.
Perpetual Patient
A case of Identity
Sins of the Past
Demented Missionary
Death of a Salesclerk
APPLICATION OF PSYCHOLOGY TO INTERVENTION WITH
PEOPLE WHO HAVE CLINICAL PROBLEMS
II. COMMUNITY INTERVENTION
History: “the recurrent millenia,” revisited
The advent of professional authority and
expertise in mental health care
The First Revolution: The Mental Hospital Movement
The Rise of Psychiatry: “The Psychiatric Revolution”
The Second Revolution: Psychoanalytic
The Third Revolution: (Community) Mental Health
Movement
The Rise of the “New Psychiatry”
The Fourth Revolution? Prevention....
Prevention
Primary: its problems in principle and in practice
Secondary: innovations in crisis intervention and family
therapy
Tertiary: new directions in relapse
prevention and sociotherapy
EXAMPLE OF COMMUNITY INTERVENTION: THE
SCHIZOPHRENIAS AND (ASSIGNMENT 4)
Cases: Dx and assessment
Tx and community interventions
Diagnostic alternatives
SCHIZOPHRENIA
Paranoid, disorganized,
catatonic,
undifferentiated,
residual?
“Positive” or “deficit”
type?
Chronic, episodic?
Therapeutic alternatives
BIOMEDICAL? ÷ Antipsychotics?
Clozapine?
COMMUNITY? ÷ 1. Milieu Therapy (ward)
2. Sociotherapy (world)
3. Family Therapy
(home)
Everything belongs to God
Never Say Die
The Relapsing Patient
Another Dimension
The Road is Long
Star Wars
The Never-ending Story
The Bully
EVALUATION OF PSYCHOTHERAPY (and other interventions)
History
1. Tactic vs. SR: average differences in effectiveness?
e.g. Eysenck, 1952
2. Tactic vs. tactic: differences in variability of effectiveness?
e.g. Temple University, 1975
3. Strategic research: differences that make a difference?
e.g. NIMH, 1987
Incremental effectiveness and efficiency (time, cost)
Methods of evaluation
I.
Within subjects (reversal designs)
II. Between groups (factorial designs)
Internal and external validity (analogue research)
Results: the BIG picture (meta-analysis)
Effect sizes
Statistical vs clinical significance
Ethics in evaluative research
Modern “patched-up” designs
Applications of research