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

Clinical psychologists do a variety of activities including: Clinical psychologists do a variety of activities including: –providing psychological assessment –providing psychological intervention –conducting research –providing clinical training –consulting with other professionals and agencies Clinical psychologists work with Clinical psychologists work with –Individuals, couples, families, groups and organizations –All across the life span Activities of Clinical Psychologists Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Percentage of Psychologists Who Engage in Each Activity Percentage of Psychologists Who Engage in Each Activity –Assessment and diagnosis 58 –Psychotherapy76 –Consultation38 –Research47 –Teaching49 –Supervision47 –Administration46 Adapted from Norcross & Karpiak (2012). Adapted from Norcross & Karpiak (2012). Activities of Clinical Psychologists Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Percentage of Psychologists Time in Each Activity Percentage of Psychologists Time in Each Activity –Assessment and diagnosis 14 –Psychotherapy35 –Consultation6 –Research15 –Teaching11 –Supervision6 –Administration11 Adapted from Norcross & Karpiak (2012). Adapted from Norcross & Karpiak (2012). Activities of Clinical Psychologists Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Assessment is very common and comes in many forms Assessment is very common and comes in many forms –Evaluating the functioning of an individual client –Evaluating a family or social unit of some sort –Diagnosis –Formal standardized testing (cognitive, behavioral or personality) –Assessment in psychotherapy Planning Planning Monitoring Monitoring Evaluating Evaluating Activities of Assessment in Clinical Psychology Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

The Assessment process Assessment is an ongoing process, not defined by psychometric evaluations Assessment is an ongoing process, not defined by psychometric evaluations It is an ongoing process of hypothesis- testing It is an ongoing process of hypothesis- testing We adopt both the idiographic approach- exploring the uniqueness of the particular person and his/her circumstances We adopt both the idiographic approach- exploring the uniqueness of the particular person and his/her circumstances The nomothetic approach: What is common to this person and other persons of this age and other demographic variables? The nomothetic approach: What is common to this person and other persons of this age and other demographic variables? Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Steps in the assessment process 1. Review referral information 2. Decide whether to accept 3. Obtain relevant background information 4. Consider the influence of relevant others 5. Observe the person in several settings 6. Select and administer an assessment test battery Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Steps (cont-d) 1. Review referral information 2. Decide whether to accept 3. Obtain relevant background information 4. Consider the influence of relevant others 5. Observe the child in several settings 6. Select and administer an assessment test battery Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Diagnosis Diagnosis involves assigning the cluster of symptoms to a cat gory of mental disorders Diagnosis involves assigning the cluster of symptoms to a cat gory of mental disorders Diagnosis is based on the DSM Diagnosis is based on the DSM It enables the planning of intervention It enables the planning of intervention Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Intervention is very common as well Intervention is very common as well –Psychotherapy: talk therapy Most people attend fewer than 10 sessions regardless of problem Most people attend fewer than 10 sessions regardless of problem Different approaches (psychodynamic, cognitive-behavioral, experiential, etc) focus on different issues, (although most challenge thoughts and validate emotions) Different approaches (psychodynamic, cognitive-behavioral, experiential, etc) focus on different issues, (although most challenge thoughts and validate emotions) In North America cognitive behavioral is most common, followed by an integrative approach and psychodynamic In North America cognitive behavioral is most common, followed by an integrative approach and psychodynamic The Prescription Privileges Debate The Prescription Privileges Debate –Currently only a select few psychologists can prescribe (in New Mexico and Louisiana) –Highly debated Activities of Intervention in Clinical Psychology Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Prevention is less common but growing Prevention is less common but growing –Primary prevention: prevention of a disease before it occurs –Secondary prevention: reducing the recurrence of a disease –Tertiary prevention: reducing the overall disability that results from a disease Prevention usually based in community settings Prevention usually based in community settings –Psychologist usually has several roles in prevention Developing programs Developing programs Implementing programs Implementing programs Evaluating outcomes of programs Evaluating outcomes of programs Activities of Prevention in Clinical Psychology Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Consultation Consultation –Clinical consultation: offering advice and information for others treatment professionals –Organizational (or community) consultation: evaluating a service, or providing an opinion on how an organization is doing Usually there is a needs assessment, program development, program evaluation, and policy consultation Usually there is a needs assessment, program development, program evaluation, and policy consultation Research Research –All psychologists are trained to conduct and evaluate research –APA’s ethics code requires a commitment to increasing scientific knowledge Additional Activities of Clinical Psychologists Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Research (cont) Research (cont) –Small percentage produce research –Much more common in university settings –Range and content of research varies dramatically Can be on normal human functioning, psychopathology, assessment, intervention or prevention Can be on normal human functioning, psychopathology, assessment, intervention or prevention Teaching Teaching –University courses (graduate or undergraduate) in variety of areas related to clinical psych –Also can teach in several other settings (e.g., community colleges, in clinics training professionals, to medical students, in workshops/seminars etc.) Additional Activities of Clinical Psychologists Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Clinical Supervision Clinical Supervision –Close monitoring of training clinicians –Done in an individual meeting or with a number of training clinicians (group supervision) –Some supervisors have supervisees audio or videotape their sessions Research Supervision Research Supervision –Assisting in the development and implementation of a research study or program Administration Administration –organization, program development, meetings in committees Additional Activities of Clinical Psychologists Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Science of Clinical Psychology Science of Clinical Psychology –Clinical Psychologists must maintain their knowledge of research relevant to their activities –This is true for all theoretical orientations –However, how research informs practice differs for many clinical psychologists –Balance between open-mindedness and skepticism First Pillar of Clinical Psychology: Science Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Five general ethical principles of the APA (2010) Five general ethical principles of the APA (2010) –Beneficence and nonmalficence: help and avoid doing harm –Fidelity and responsibility: developing trust and show awareness of their professional responsibilities –Integrity in professional relationships –Justice: all people should have access to benefit from the contribution of psychology –Respect for people’s rights and dignity Informed consent – all individuals in therapy and participants in research must indicate that they understand and are willing participants Informed consent – all individuals in therapy and participants in research must indicate that they understand and are willing participants Second Pillar of Clinical Psychology: Ethics Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Ethical, Legal, and Professional Issues Laws: Imposed by legislative bodies Imposed by legislative bodies Requires interpretation Requires interpretation Distinction between civil and criminal law Distinction between civil and criminal law Civil law uses less exacting standards Civil law uses less exacting standards Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Cont-d Ethics: Derived from philosophical ideas and professional norms Derived from philosophical ideas and professional norms Imposed on members of a profession Imposed on members of a profession Has a moral basis Has a moral basis Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Ethical Principles Autonomy: respect for rights of others to make their own choices and hold their own beliefs Autonomy: respect for rights of others to make their own choices and hold their own beliefs Nonmaleficience: do no harm Nonmaleficience: do no harm Beneficence: promoting positive growth & welfare of others Beneficence: promoting positive growth & welfare of others Justice: acting fair, impartial & reasonable Justice: acting fair, impartial & reasonable Fidelity: faithful and trusting of others Fidelity: faithful and trusting of others Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Con-d Develop ethical reasoning skills and sensitivity Develop ethical reasoning skills and sensitivity Be aware of motivations and interests Be 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 assessment findings and recommendations Understand implications of assessment findings and recommendations Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Using client’s language Using client’s language Considering school, environmental, and political factors Considering school, environmental, and political factors Eliminating bias, prejudice, and discriminatory factors Eliminating bias, prejudice, and discriminatory factors Documenting cultural and socio- political factors Documenting cultural and socio- political factors Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Training in Clinical Psychology Training in Clinical Psychology –Scientist-practitioner model (Boulder Model) –Clinical scientist model –Practitioner-scholar model (Vail Model) APA Accreditation in Clinical Psychology APA Accreditation in Clinical Psychology Providing services that are competent for the larger multicultural community Providing services that are competent for the larger multicultural community Licensure Licensure Additional Aspects to Clinical Psychology Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

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 data Misinterpretations of assessment data Invasion of privacy Invasion of privacy Violation of confidentiality Violation of confidentiality Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.