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Clinical Psyhology
Midterm Exam
| Question | Answer |
|---|---|
| Characteristics of Clinical Psychology | • Emphasis on science • Emphasis on maladjustment • Emphasis on the individuals • Emphasis on Helping |
| Characteristics of a Clinical Psychologist | • Clinical Attitude • Strong & Companionate Interest in Human Beings |
| Requirements to be a Clinical Psychologist | -It is regulated and requires licensure or certification Education -Experience - Testing of Competence (not in Cyprus) -Good Character Full License - Ph.D.’s and Psy.D’s can practice independently |
| Activities of Clinical Psychologists | • Research • Teaching • Psychotherapy • Psychologicalassessment • Consultation • Administration |
| Training in Clinical Psychology | 1. Undergraduate preparation 2. Graduate School 3. Continuing Professional Education |
| Getting into Graduate School | • GradePointAverage • Graduate Record Exams (USA) • Researchexperience • Clinically-relevantexperience • Letters of recommendation • Interview |
| Scientist-Practitioner Training | • Training in three broad areas: • Advanced education in core areas of psychology • Experiential learning |
| Training in three broad areas: | – Research – Assessment – Intervention |
| Advanced education in core areas of psychology | – Biological bases – Learning and cognition – Social influences – Individual differences |
| Experiential learning | – Clinical practica (leading to pre-doctoral internship) – Research mentoring (leading to doctoral dissertation) |
| Phineas Gage | suffered brain damage when an iron pole pierces his brain. His personality was changed but his intellect remained intact suggesting that an area of the brain plays a role in personality. |
| Charles Darwin | published the On the Origin of Species, detailing his view of evolution and expanding on the theory of 'Survival of the fittest.' |
| Wilhelm Wundt | ounded the first formal laboratory of Psychology at the University of Leipzig, marking the formal beginning of the study of human emotions, behaviors, and cognitions. |
| Ligthner Witmer | The first psychological clinic was developed at the University of Pennsylvania marking the birth of clinical psychology |
| The Major Approaches in Clinical Psychology | • The Psychodynamic Approach • The Humanistic Approach • The Behavioral Approach • The Cognitive Approach • The Cognitive Behavioral Approach • Group, Family, Marital and System Approaches |
| Prescription Privileges | • Three states have granted prescription privileges to appropriately trained psychologists – New Mexico (2002) – Louisiana (2004) – Illinois (2014) |
| Why psychologists should prescribe: | – Shortage of psychiatrists • Especially in rural areas • Important factor in NM and LA decisions • Dentists, podiatrists, optometrists, and some nurses, among others – Convenience for clients |
| Why psychologists should not prescribe | – Training issues • Which courses? When? Taught by whom? – Threats to psychotherapy • Would medication replace talk therapy? – Identity confusion • Especially when only some CPs prescribe – Influence of pharmaceutical industry |
| Evidence-Based Practice/ Manualized Therapy | • Hans Eysenck( 1952) claimed Therapy wasn’t beneficial • When researchers measure therapy outcome, they often use therapy manuals • When outcome data support the use of a manualized therapy, the treatment is known as “evidence based” |
| Disadvantages of Evidence-Based Practice/Manualized Therapy | • Threats to the psychotherapy relationship • Diagnostic complications – “Textbook” cases vs. “real world” cases • Restrictions on practice – Mandated manuals vs. creatively customized treatments |
| Overexpansion of Mental Disorders | • Size and scope of the DSM increases with each new edition • New disorders and new definitions of old disorders – Introduction of new disorders to capture experiences once considered normal – “Lowering the bar” for existing disorders |
| The Influence of Technology: Cybertherapy and More | • Inrecentyears,clinicalpsychologistshaveincreasinglyused technology in the direct delivery of psychological services – Assessment – Treatment Cybertherapy can replace ors upplement face-to-face meetings |
| Applications of Technology in Clinical Psychology: Examples | • Videoconferencing to interview or treat • Email or text psychotherapy • InteractiveInternetsites • Onlinepsychotherapyprograms • Virtual reality therapeutic experiences |
| How Well Does Cybertherapy Work? | • Appears to work about as well as in-person psychotherapy • Examples include – CBT for anxiety disorders – Internet-based therapy for PTSD – Internet-based depression treatments |
| Professional Issues in Clinical Psychology | • Professional Training • Professional Regulation • Professional Ethics • Professional Independence • Professional Multicultural Competence |
| Ethics code | • Psychologists have to follow these codes • Not knowing the ethical code is NO excuse for lack of compliance. • First, do no harm |
| Boundaries of Competence | ▪ Work within what you have trained to do: education, supervision, consultation, study, or professional experience. ▪ If you have similar knowledge and it would hurt client to refer out you can work with them. |
| Providing Services in Emergencies | May provide services even without training if refer out ASAP. |
| Maintaining Competence | Must keep learning as new information is available. |
| Multiple Relationships | ▪ Past, present, and/or future (expected) relationships ▪ If can expect impaired objectivity or effectiveness ▪ If can harm the other person in any way |
| ▪ Informed Consent | To provide any services must have it documented ▪ In understandable language (and level) |
| Maintaining Confidentiality | – Take reasonable precautions (in all mediums) to maintain confidentiality |
| Discussing the Limits of Confidentiality | – Discuss these with client ahead of time. – If through electronics, must describe how this changes confidentiality. |
| In-Person Solicitation | – Do not engage in in-person solicitation of business to those who are vulnerable to undue influence. – Except: to provide disaster or community outreach – Except: implementing collateral contacts to benefit an already engaged client |
| THE FUTURE OF CLINICAL PSYCHOLOGY | • Positive Psychology • Technology • Interdisciplinary Science |
| Clinical Assessment Process | • The referral Question • Planning Data collection procedures – Interview, behavioral observation, psychometric tests, case history data • Collecting Data • Processing Data and Forming Conclusions • Communicating Assessment Results |
| Essential Qualities of Assessment Techniques | – Validity—measures what it claims to measure – Reliability—yields consistent, repeatable results – Clinical utility—benefits the clinician and ultimately the client |
| Standardization and Norms | – Ensures consistency in the use of a technique – Provides population benchmarks for comparison – Examples include structured administration, scoring, and evaluation procedures |
| Clinical Interview | – Most common clinical assessment method – Structured or semi-structured |
| Mental Status Exam | – Appearance and behavior – Thought processes – Mood and affect – Intellectual functioning – Orientation |
| • Behavioral Assessment | – Focus on the present – Here and now – Direct observation of behavior-environment relations – Purpose is to identify problematic behaviors and situations – Identify antecedents, behaviors, and consequences |
| The DSM-5 | – Clear inclusion and exclusion criteria for disorders – Disorders are categorized under broad headings – Empirically-grounded, prototypic approach to classification |
| The Problem of Comorbidity | – Defined as two or more disorders for the same person – High comorbidity is the rule clinically – Threatens the validity of separate diagnoses |
| Types of Interviews | • Intake Interviews • Problem-Referral Interviews/Diagnostic interviews • Orientation Interviews |
| Unresolved Issues in the DSM-V | • The Problem of Comorbidity • Labeling Issues and Stigmatization |
| Purpose of Assessment | • Treatment Planning • Prediction –Prognosis –Predicting Future Performance –Predicting Dangerousness |
| CLINICAL INTERVIEW SITUATIONS | • Termination and Debriefing Interviews • Crisis Interviews • Ethnic and Cultural Issues in the Clinical Interview |
| INTERVIEW STRUCTURE | • Nondirective Interviews • Semistructured Interviews • Structured Interviews |
| Advantages of Structured Interviews | • Advantages: Correct – Information variance: how a question is asked – Patient variance: how a question is answered – Criterion variance: how an answer is understood |
| Disadvantages of Structured Interviews | • Disadvantages – Becoming “protocol bound” – Alienation of clients – Reliance on clients’ memory, candor, and descriptive abilities |
| Stage 1: Beginning the Interview | – Setting – Opening – Frame setting |
| Stage 2: The Middle of the Interview | – Nondirective techniques (paraphrasing, active listening) – Directive techniques – Combination |
| Stage 3: Closing the Interview | -Finishing up with the client |
| Communication in the Interview | – Encoding – Transmitting – Decoding |
| Nonverbal Communication | – Physical appearance – Movements – Posture – Eye contact – Facial expressions – Emotional arousal – Speech variables |
| General skills: The Interviewer | – Quieting yourself – Being self-aware • Know how you tend to affect others interpersonally, and how others tend to relate to you – Develop positive working relationships • Can segue into psychotherapy • Respectful and caring attitude is key |
| Specific behaviors: The Interviewer | –Listening • the primary task of the interviewer, consisting of numerous building blocks of attending behaviors: –Eye contact –Body language –Vocal qualities –Verbal tracking –Referring to client by proper name |
| Components of the Interview | • Rapport • Technique |
| Open-ended questions | • Allow individualized and spontaneous responses from clients • Elicit long answers that may or may not provide necessary info |
| Closed-ended questions | • Allow less elaboration and self-expression by the client • Yield quick and precise answers |
| Specific Interviewer Responses | • Clarification • Confrontation • Paraphrasing • Reflection of feeling • Summarizing |
| Pragmatics of the Interview | • Note-taking • Audio- and Video-recording • The Interview Room |
| Psychotherapy Client:Characteristics and their relationship to outcome | – Age – Level of distress – Ethnic Minority – SES – Cooperation vs. resistance – Openness vs. defensiveness |
| Psychotherapists Characteristics | • Nonjudgmental • Empathic • Warm • Caring • Place client’s needs above their own • Genuine |
| Psychotherapists Characteristics and Outcome | • Training – unrelated to outcome • Experience – unrelated to outcome • Gender – unrelated to outcome • Age – unrelated to outcome • Well-being – correlated with outcome |
| Psychotherapy Relationship | • Takes place in a socially sanctioned place of healing • Frequency and length of meetings planned and limited • Goals of relationship are specified • Therapeuticalliance • Confidential |
| THE GOALS OF CLINICAL INTERVENTIONS | • Reducing Emotional Discomfort • FosteringInsight • Encouraging Catharsis • Providing New Information (Education) • Assigning Extratherapy Tasks (Homework) |
| The Four Horsemen of Ethics in Psychotherapy | – Confidentiality – Competency – Informed consent – Conflict of interest |
| PRACTICAL ASPECTS OF CLINICAL INTERVENTION | • Treatment Duration and Fees • Record Keeping • Case Formulation and Treatment Planning • Therapist Objectivity and Self-Disclosure • Termination |
| Does Psychotherapy Work? | • Hans Eysenck concluded that therapy was of little benefit • His finding has since been overturned, but his study inspired decades of research on therapy outcome |
| Efficacy | – In controlled outcome studies – Therapists’ methods are controlled or manualized – Clients are selected for diagnostic criteria – Better internal validity than external validity |
| Results of efficacy studies | – Overall result: psychotherapy works – Hundreds of meta-analyses and thousands of individual studies support this finding – Average person receiving therapy is better off than 80% – Benefits last and exceed placebo effect |
| Effectiveness | – Greater variability in therapists’ methods – Greater variability in clients’ issues and diagnoses – Better external validity than internal validity |
| Results of effectiveness studies | – Not as many studies as efficacy studies, but similar results: psychotherapy works – Consumer Reports study is example of a large scale effectiveness study |
| What Format of Psychotherapy Do Clinical Psychologists Practice? | • Individual therapy is most common by far • A sizable number of clinical psychologists also practice group, family, marital |
| Psychodynamic psychotherapy | refers broadly to Sigmund Freud’s approach to therapy and all subsequent efforts to revise and expand upon it |
| Goal of Psychodynamic Psychotherapy | The primary goal of psychodynamic psychotherapy is to make the unconscious conscious – “Insight” into thoughts, feelings, and other mental activity previously outside of awareness |
| Defense Mechanisms | • When ego blocks pleasurable pursuits of id, person feels anxiety • Defense mechanisms are ego’s protective methods for reducing anxiety by unconsciously distorting reality |
| Psychoanalysis: Techniques | • Transference and Countertransference • Psychic Determinism (Freudian Slip) • Resistance • Interpretation • Free Association • Analytic Incognito • Dreams |
| Carl Jung –Analytical psychology | – To fully develop one’s unconscious capacity – Through insight freeing oneself to express one’s innate capacity for creativity and expression |
| Alfred Adler- Individual psychology | – Overcome feelings of inferiority – Social motives and social behavior |
| Ego Psychologists | – Bolster client’s ego strength (reality testing, impulse control, judgment |
| Ego psychology (Erik Erikson) | – Emphasizes social relationships over psychosexual stages |
| Object relations (Melanie Klein) | – Emphasizes relationships between internalized “objects” |
| Self-psychology (Han Kohut) | – Emphasizes parental roles in the development of the self, with special attention to narcissism |
| Brief Psychodynamic Psychotherapies | –Narrow problems, quick alliance, focus on present as well as past, therapists are more active, pathology is less severe |
| Interpersonal Therapy (IPT) | – Designed to treat depression in 14–18 sessions – Improving interpersonal relationships will alleviate depression – Emphasis on role expectations |
| Interpersonal and Social Rhythm Therapy (IPSRT) | – Variation of IPT for clients with bipolar disorder – Control and stabilize daily rhythms, sleep cycles, social interactions |
| Evaluation of Psychoanalytic Therapies | • Interesting and popular • Not much evidence of their efficacy ot traditional psychoanalysis • Not listed among empirically supported treatments – Exception is Interpersonal Psychotherapy • Traditional psychoanalysis – economically not feasible |
| Humanistic Psychotherapies | • Person-Centered psychotherapy • Gestalt therapy • Existential therapy • Motivational Interviewing • Emotionally Focused Therapy |
| Humanistic Concepts: Clinical Implications | • People have an inborn tendency toward self-actualization • People also have a need for positive regard—warmth, acceptance, “prizing” • People are forced to sacrifice self-actualization in order to obtain positive regard from important others |
| Elements of Humanistic Psychotherapy | – Empathy – Unconditional Positive Regard (UPR) – Genuineness |
Created by:
theofficialjurnee