Intro to Clinical Psychology

Chapter 1 –

Introduction

Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

The challenges facing mental health workers

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It is often difficult to put a cut-off line between normal distress and distress that has clinical significance

For example- many of us experience anxiety, or sadness; when is still within the normal range and when is it considered an abnormality?

Is it a matter of intensity? Duration?

Frequency?

More Questions

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Do some mental disorders lend themselves to treatment better than others?

For example, schizophrenia is a chronic condition, whereas anxiety disorders may be more effectively treated.

The expression of the same disorder might take different forms in different people

There is a high incidence of co-morbidity

(occurring together) of mental disorders


Assessment

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The first challenge facing a clinical psychologist is the assessment of a presenting problem

Is the condition fully displayed or is it still in the process of unfolding?

To what extent is there a co-existence of several clinical conditions in the same person? (Co-morbidity).


Importance of Clinical Psychology as a Discipline

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About half of mental disorders begin before age 14

Worldwide 800,000 people commit suicide every year

1 in 4 adult Americans suffers from a mental disorder in any given year

Worldwide more than 450 million people suffer from mental disorders

– Most undiagnosed or misdiagnosed


Defining Scope of Clinical

Psychology

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Early definitions stressed assessment, evaluation and diagnosis

More recent inclusion of intervention in various forms as well as prevention

Evidence-Based Practice

Active debate on the ‘science of clinical psychology’

McFall’s Manifesto for a Science of Clinical

Psychology


McFall’s Manifesto

Toward research-based practice of psychology

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Clinical psychology needs to be based on the results of research

The exact nature of the service needs to be described

The claimed benefits of the service must be described clearly

These benefits must be validated scientifically

Possible negtive side eefefcts must be ruled out empirically


The Shifting Nature of the Field of

Clinical Psychology

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From the focus on one individual the focus has shifted to couples and families, both directly as interventions and indirectly as in prevention activities, consultations, and research

Increasing focus on pharmacological treatment an decrease in traditional activites


The APA Definition of Clinical

Psychology: Research-based

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“ Integrates science, theory and practice to understand, predict, and alleviate maladjustment, disability and discomfort as well as to promote human adaptation, adjustment, and personal development.

Clinical psychology focuses on the intellectual, emotional, biological, social and behavioral aspects of human functioning across the life-span, in varying cultures and

Socio-economic levels.


Elements of the APA Definition of


1. Integration of theory and research – bi-directional relationship: the theory is an attempt to explain the symptoms; it generates research to assess the explanation, and the research results may change the theory- that is –our understanding of the causes of the symptoms (as one example)


Elements of the APA definition

(cont-d)

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2. The goals are on the one hand to remove distress and suffering, but also to promote adaptation; that is- sometimes a conditions may not go away, and the person needs to learn to live with it and to adapt to it.

3. The various aspects of human functioning

(e.g. biological, emotional , intelelctual etc are inter-related and affect one another. They cannot be viewed in isolation .


Importance of Clinical

Psychology as a Discipline

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Evidence-Based Practice (cont.)

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Importance of using only practices empirically found to be effective

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Intuition should not be a part of assessment or treatment

– Critics argue (among other points):

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Group-based data is not always sufficient in working with individuals

Research is not always available for all problems

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Copyright © 2014 John Wiley & Sons, Inc.

All rights reserved.

Each person is unique in many different ways

(culture, class, family etc.)

Counseling vs. Counseling

Psychology

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Counseling is a generic term use d to describe a range of mental health professions with various training and licensure requirements.

Counseling psychology has a great deal in common with clinical psychology

It started in he field of vocational counseling in an attempt to match between traits and aptitudes (skills) and the demands of a given job.


Counseling Psychology (cont-d)

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Today, the focus of clinical psychology is more in treating of more severe conditions of psychopathology, whereas counseling psychology addressed less severe issues, such as all types of life-transitions, and relationships difficulties.


Traditional distinctions between clinical and counseling psychologists are fading

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Today counseling psychologists provide services in more severe cases, such as depression, panic, social phobia or eating disorders

Clinical psychologists have expanded their services to conditions that do not represent psychopathology such as chronic illness or stress- related conditions


Cont-d

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It is difficult to mark professional boundaries on the basis of what constitutes normal vs. abnormal range of distress

Depending on the point in time in which someone seeks help, the same person may present clinical or subclinical symptoms


Other Related Mental Health

Professions (and Differences)

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School Psychology

– Training in both psychology and education

– Work in diverse education-related settings

– There is a natural overlap between school psychology and child clinical-psychology

– Traditionally, school psychologists provided services related to assessment of intellectual functioning, learning difficulties, consultation to teachers on the basis of the assessment of a given child- how to translate the assessment into instructional objectives, and parent consultation.


School Psychology (cont-d)

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Over time, the scope of school psychology has expanded, to include attention to parental psychopathology and stressful family circumstances affecting the learning of children

The legal obligation to provide the most appropriate education to any child, no matter what is the level of the child’s disability, also affected the role of the school-psychologist.

Copyright © 2014 Jowhat is the levels of the child's dsabiluty, hn Wiley & Sons, Inc. All rights reserved.

School Psychologists (cont-d)

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All these changes affected the role of school psychologists, who today deal with a wide range of disorders of childhood as well as with developing school-based and family-based programs such as the promotion of social skills, fighting bullying, conflictresolution and prevention of violence.


Psychiatrists: MD’s who specialize in mental disorders

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Trained as physicians with an additional training in mental disorders

Require 5 years of residency after the regular medical school

Training focuses on biological functioning

Interactions between the physical and the emotional, also the results of medications

Less training in psychological development


Psychiatrists (cont-d)

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More psychopharmacological (medication) therapies

Less trained in conducting psychological assessment

Traditionally leaning toward the psychoanalytic (Freud), psychodynamic models of therapy

Shift toward evidence-based therapies e.g.

Cognitive–Behavioral and Interpersonal


Psychiatrists (con-d)

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Until recently an important distinction between clinical psychologists and psychiatrists has been that only psychiatrists could prescribe medication

This is in general still the case, though in some jurisdictions clinical psychologists are being trained to prescribe psychoactive medication

There is a decline in the number of graduate students wishing to specialize in psychiatry.


Other Related Mental Health

Professions (and Differences)

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Social Work

– Emphasis on social/community conditions

– Different settings than clinical psychologists

(especially community agencies)

– Social conditions that facilitate optimal development

– Program planning and management

– Diversity of settings

– Many function as part of mental-health team


Social Work (cont-d)

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Case-workers and coordinators of services

Help patients navigate in a maze of mental-health services

Need to have either a BSW or MSW and supervise training progarm


History of Clinical Psychology

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Early views that did not include demonic possession or evil spirits causing mental illness were rare

Hippocrates may be first to consider a

“biopsychosocial approach”

– Biological, psychological and social factors all need to be considered.

– S t. Vincent de Paul (late 1500’s) emphasized natural forces and not witchcraft


Other Mental Health Professionals

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Psychiatric nurses: Managing administrative matters in inpatient settings; psychoeducation and counseling.

Child and Youth Care-Workers: Twoyear college training in child development and behavior management

Applied Behavior Analysis: Using behavior modification strategies with autistic children


History of Clinical Psychology

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Enlightenment period (later 1700’s)

– Philippe Pinel – French reformer: humane treatment of the mentally ill

– William Tuke – English reformer: hospitals based on appropriate care

– Benjamin Rush – U.S.: moral therapy

1800’s – neurology as a discipline recognizing hysteria could not be recognized as biological: Charcot, Janet and Freud


History of Assessment in Clinical

Psychology

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Early Clinical Psychology was almost entirely an assessment field

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Late 1800’s – Francis Galton: differences in reaction time as intelligence differences

Wilhelm Wundt (Germany) first psychology laboratory, studied sensation and perception

James McKeen Cattell: studied connection between reaction time and intelligence

– Coined term “mental tests”



Psychology

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Emil Kraepelin (Germany)

– Believed in biological causes to mental illness

– Worked on classifications of syndromes – much of his work formed basis for DSM and ICD (chp 3)

Alfred Binet (France)

– French government asked Binet and collaborator

Theodore Simon to design a measure to assess children with cognitive deficits

– 1908 Binet-Simon scale measured 50 tests of mental skills

– 1916 Lewis Terman (US) modified it, first widely available test of cognitive ability


Psychology

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WWI – APA asked to develop a scale to measure mental functioning of recruits

– Army Alpha Test (verbal abilities)

– Army Beta Test (non-verbal abilities – for those who could not read or spoke limited English)

– These tests and the value they gave recognized clinical psychology as a sub-discipline of psych

Testing began to flourish

– Wechsler-Bellevue intelligence test 1939

(considered the gold standard in IQ tests)

– Projective tests – Rorschach Inkblot 1921,

Thematic Apperception Test (TAT) etc.


Psychology

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WWII – Psychologists again active in tests for armed forces

– MMPI – (personality test) 1943

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Heavy use of statistics and test development

Criticisms of Early Assessment

– Paul Meehl – importance of using statistics to testing viability of hypotheses

– Walter Mischel’s work showing personality traits as having problems with validity

– Behavioral assessment as a field grew in part from these criticisms



Psychology

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1980’s – Diagnostic and Statistical Manual for

Mental Disorders (DSM-III) published

– DSM-III more focused on observable symptoms

– Focus on reliability

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Several changes in psychological assessment have recently occurred

– Clinical utility – does the assessment help with treatment

– Service evaluation – do treatments work


History of Intervention in Clinical

Psychology

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Sigmund Freud

– First elaborated treatment of mental health issues

– Early connection to neurology and work of Charcot

– Focus on role of unconscious

– Many subsequent followers elaborating related psychodynamic theories (e.g., Jung, Adler, etc.)

Lightner Witmer – coined term ‘clinical psychology’ – opened a clinic (1904) to assess and remediate learning difficulities

Demand for therapy increases in 1940’s and

50’s



Psychology

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WWII

– Soldiers needing therapy when returning from war

– Members of public affected by loss

– VA hired many clinical psychologists

Many therapy approaches developed in

1940’s – 60’s

– Carl Rogers Client-centered approach

– Several adaptations to Freud’s model

– Fritz Perls – Gestalt therapy

– Joseph Wolpe – Systematic desensitization


History of Intervention in


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Criticisms of Psychotherapy

– Hans Eysenck 1952

– Levitt, 1957

– Resulting in enormous amount of research on whether psychotherapy works

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Efficacy studies – focus on studies that emphasize internal validity of the study

Effectiveness studies – focus on studies that look at real world conditions

– Meta-analysis – statistical technique combining several studies, showed psychotherapy effective



Psychology

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Contemporary approaches

– Albert Ellis – Rational Emotive Therapy

– Aaron Beck – Cognitive Therapy

– Cognitive Behavioral Therapy

– Short-term Dynamic Therapy

Prevention in Clinical Psychology

– A growing area of Clinical Psychology


Intro to Clinical Psychology

Chapter 1 –

Introduction

Assessment

Importance of Clinical

Psychology as a Discipline

History of Intervention in

Clinical Psychology

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Intro to Clinical Psychology

Chapter 1 –

Introduction

Assessment

Importance of Clinical

Psychology as a Discipline

History of Intervention in

Clinical Psychology

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