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PSY 275 Ch. 3 and 4
Clinical Psych.
| Question | Answer |
|---|---|
| 5 Current Issues in Current Controversies and Directions in Clinical Psych. | 1. The Influence of Tech. Before and After COVID: Telepsych. 2. Prescription Privileges 3. Evidence-Based Practice/ Manualized Therapy 4. Overexpansion of Mental Disorders 5. Payment Methods: 3rd-Party Payment vs. Self-Payment |
| The Influence of Tech. Before and After COVID: Telepsych. | Potential to increase access and affordability for many populations that have been underserved -Regarding issues like encryption that relate to confidentiality -Limit the extent to which nonverbal communication takes place |
| Prescription Privileges | the ability to prescribe meds -The root of the movement were established in the 1980s. Scored victories in two states-New Mexico and Louisiana- became the first to grant privileges in 2002 and 2004 -Illinois followed then Iowa and Idaho |
| Prescription Privileges movement also followed the creation of | APA Dividion 55 in 2000 as well as psychopharmacology training programs in the U.S Military |
| Why Clinical Psychologists Should Prescribe | shortage of psychiatrists, more expert than primary care physicians, other nonphysician professionals already have privileges, convenience for clients, professional autonomy and identification, evolution of the profession and revenue |
| Why Clinical Psych. Should Not Prescribe | training issues, threats to psychotherapy, identity confusion, potential influence of the pharmaceutical industry, medication may not work anymore effectively than psychotherapy |
| Evidence-Based Practice/ Manualized Therapy | Therapy manual, exposure and response prevention, dialectical behavior therapy, evidence-based practice -Division 12 (Clinical Psych.), Division 53 (Clinical Child and Adolescent Psych.) |
| Therapy manual | provides detailed instructions for all phases of the treatment of a specific disorder; typically used in treatment outcome studies -one purpose is to keep variability among therapists to a minimum, if effective, it can be shared with others |
| Exposure and Response Prevention | a specific form for behavior therapy for the treatment of OCD |
| Dialectical Behavior Therapy (DBT) | treatment of borderline personality disorder and specific cognitive therapy techniques for depression |
| Evidence-Based practice | "the integration of the best available research with clinical expertise in the context of pt. characteristics, culture, and preferences" |
| The first list of empirically validated treatments was published in | 1995 |
| Advantages of Evidence-based practice | scientific legitimacy, establishing minimal levels of competence, training improvements, decreased reliance on clinical judgement |
| Disadvantages of evidence-based practice | threats to the psychotherapy relationship, diagnostic complications, restrictions on practice, debatable criteria for empirical evidence, concerns about diversity and equity |
| Overexpansion of Mental Disorders | concerns about the expanding definition of mental illness were around long before DSM 5 |
| The expansion of the scope of mental disorders happens in at least 2 ways | 1. introduction of new disorders to capture experiences once considered normal 2. "lowering the bar" for existing disorders so that more people meet the criteria |
| When DSM 5 TR arrived in 2022, it included 1 new disorder: | prolonged grief disorder, in which the person continues to grieve or mourn for a lost loved one much more intensely and for a much longer time than would be expected |
| A diagnosis can help some people with problems get treatment they need but can also help people with problems get treatment they don't need- | meds. have harmful side effects or unnecessary therapy that undermines a person's ability to use his or her own coping skills |
| The overexpansion of mental health diagnosis has been connected to | the possible influence of pharmaceutical industry |
| Cosgrove and Wheeler (2013) have since argued that the pharmaceutical industry is trying to "colonize" psychiatry- | that is, attempting to control the mental health field, beginning with a deep connection between its core diagnostic manual and their financial interests |
| Payment Methods: 3rd party payment vs. self-payment | Psychologists in private practice describe managed care as having a negative impact and quality of therapy -they exercise too much control over clinical decisions -confidentially was specifically noted as an ethical concern |
| The downside of working with managed care companies: | lower pay than from clients who pay directly, taking time away from direct clinical work to spend on paperwork, phone calls, interaction with managed-care company, denial of care |
| An empirical study on the topic indicated that when they learned about psychologists' negative reactions to managed care, | many individuals thought more negatively about therapy than they had before |
| The way clients pay for therapy also influences the | diagnostic process |
| Most health insurance and managed-care companies require a | DSM diagnosis for treatment |
| Early in the history of clinical psych. clients paid for services | directly out of pocket |
| Applications of Tech. in Clinical Psych Examples | videoconferencing to interview or treat, email or text, websites, VR, online programs, hand-held devices, computer-based self-instruction |
| How well does Cybertherapy work? | appears to work about as well as in-person psychotherapy Ex: CBT for anxiety, PTSD , depression treatments |
| Emerging Professional Issues for Use of Tech. | obtain informed consent about the tech., follow telehealth laws, follow APA ethics code, ensure confidentiality via encryption, obtain relevant training, know client's local emergency resources, monitor changes in laws, ethical, tech. |
| Tech: Additional Potential Issues | confirming the identity of the client, confidentiality across electronic transmission, making interpretations in the absence of nonverbal cues that would be present face to face, competence in technical as well as clinical skills |
| Websites such as ______________ and __________ best illustrate the continued growth of and focus on evidence-based practice in clinical psych. | psychologicaltreatments. org and effectivechildtherapy.org |
| Multiculturalism as the "Fourth Force" | identified multiculturism as a defining issue of the current era of psych. -takes place with 3 previous movements that have been recognized as dominant paradigms -shapes the way the client understands the very problem for which they are seeking help |
| What are the three other forces | 1. psychoanalysis 2. behaviorism 3. humanism/ person-centered psych. |
| A wide variety of books now offer education and guidance to psychologists working with diverse populations | Division 35- society for psych. of women, 36-for the psych. of religion and spirituality, 44- psych. of sexual orientation and gender, 45- psych. study of culture, ethnicity and race, 51-study of men and masculinist, 52- international psych. |
| APA Ethical Code | Principle E: respect of people's rights and dignity Standard 2.01 Boundaries of competence -Standard 3.01 Unfair Discrimination -Standard 9.06 Interpreting Assessment results |
| In the APA (2015) standards of accreditation, "Commitment to Cultural and Individual Differences and Diversity" is one of the | 5 principles that guide the accreditation decision |
| Research suggesting that culture influences the experience or expression of a variety of psychological problems, including | anxiety, eating disorders, substance abuse etc. |
| Cultural Concepts of Distress | list of terms that represent psych. problems observed in groups from various parts of the world ex: taijin kyofusho-person anxiously avoids interpersonal situations because believe their looks, actions or odor will offend other people (Japanese), susto |
| What Is Cultural Competence | the ability to work sensitivity and expertly with culturally diverse members of a heterogenous competence |
| 3 capabilities to achieve multicultural competence: | 1. awareness 2. knowledge 3. skills |
| Cultural Self-Awareness | comes to understand their own viewpoint and recognize that is unique and idiosyncratic-several conclusions are within reach -first step is self-exploration |
| Key to achieving cultural self-awareness is | cultural humility: an attitude about diversity centered on the recognition of the limits of your own knowledge and an openness to learning about the identities and experiences of other people |
| Cultural Knowledge | who appreciates the cultural group norms but also appreciates the heterogeneity inherent in every culture -can gain knowledge by reading, direct experience, relationships asking client to explain cultural meaning |
| Dynamic Sizing | the ability to know the norm for a group and understand that the norm might not apply to every person within the group |
| Acculturation | people find themselves in a new cultural environment, they may respond in a variety of ways, especially when regard to adopting elements of the new culture or retaining elements of their original culture |
| 4 Separate acculturation strategies | 1. assimilation 2. separation 3. marginalization 4. integration |
| Assimilation | person adopts much of the new culture and abandons original |
| Separation | person rejects new culture and retains original |
| Marginalization | person rejects both new and original culture |
| Integration | person adopts new culture and retains much of the original |
| Cultural Skills | Cultural adaptations to evidence-based therapies produce positively therapy outcomes -the language in which the therapist talks with the client -Microaggressions |
| Microaggressions | comments or actions made in a cross-cultural context that convey prejudicial, negative, or stereotypical beliefs and may suggest dominance or superiority of one group over another |
| Etic Perspective | emphasizes the similarities between all people -it assumes universality among all people and generally does not attach importance to difference among cultural groups -defining psych. health, identifying and labeling psych. disorders |
| Emic Perspective | it recognizes and emphasizes culture-specific norms -more opportunities to appreciate and understand how the client might be viewed by members of their own cultural group |
| Tripartite Model of Personal Identity (3 Levels) | 1. Individual: every person is, in some ways, like no other person 2. group: every person is, in some ways, like some other people 3. universal: every person is , in some ways, like all other people |
| The ADDRESSING Model | developed by Pamela Hays created this model as a list of variables designed to heighten clinicians' awareness and appreciation of their client's cultural and diversity factors |
| ADDRESSING Acronym | Age/guardian, Disabilities present since birth, disabilities acquired later in life, religion/ spiritual orientation, ethnicity/ race, socioeconomic status, sexual orientation, indigenous heritage, national origin, gender |
| Intersectionality | the unique interaction of a person's combination of diversity and cultural factors, especially as related to discrimination or inequitable treatment |
| Fouad and Arredondo (2007) identify 7 specific "critical elements of multiculturally infused psych curriculum" will improve the training of psych. working as practioners, teachers, or researchers | 1. explicitly state a commitment to diversity, 2. make an effort to recruit graduate students from diverse backgrounds, 3. effort to recruit and retain diverse faculty, 4. make admissions process fair and equitable, |
| Part 2 of the 7 specific critical elements of a multiculturally infused psych curriculum | 5. students gain awareness of their own cultural values and biases, 6. examine all courses for an infusion of a culture-centered approach throughout the curriculum, 7. evaluate students on their cultural competence on a regular basis |
| Revisions of prominent assessment methods | MMPI-2, Wechsler Intelligence tests |
| What does culturally in-competent practice look like? | making assumptions, microaggressions, using invalid tools, missing key info., offending client |
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