Download Intro to Clinical Psychology

Chapter 1 –
Introduction
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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
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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).
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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
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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
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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
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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
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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.
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Elements of the APA Definition of
Clinical Psychology
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)
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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 .
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Importance of Clinical
Psychology as a Discipline
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Evidence-Based Practice (cont.)
Importance of using only practices empirically
found to be effective
 Intuition should not be a part of assessment or
treatment
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– Critics argue (among other points):
Group-based data is not always sufficient in
working with individuals
 Research is not always available for all
problems
 Each person is unique in many different ways
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All rights reserved.
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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.
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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.
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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
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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
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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.
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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.
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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.
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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
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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
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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.
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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
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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
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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
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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
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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
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1800’s – neurology as a discipline
recognizing hysteria could not be
recognized as biological: Charcot, Janet
and Freud
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History of Assessment in Clinical
Psychology
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Early Clinical Psychology was almost
entirely an assessment field
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”
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History of Assessment in Clinical
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)
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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
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available test of cognitive
History of Assessment in Clinical
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
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Testing began to flourish
– Wechsler-Bellevue intelligence test 1939
(considered the gold standard in IQ tests)
– Projective tests
– Rorschach Inkblot 1921,
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Thematic Apperception
Test (TAT) etc.
History of Assessment in Clinical
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
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History of Assessment in Clinical
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
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History of Intervention in Clinical
Psychology
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Sigmund Freud
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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
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History of Intervention in Clinical
Psychology
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WWII
– Soldiers needing therapy when returning from war
– Members of public affected by loss
– VA hired many clinical psychologists
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Many therapy approaches developed in
1940’s – 60’s
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Carl Rogers Client-centered approach
Several adaptations to Freud’s model
Fritz Perls – Gestalt therapy
Joseph Wolpe – Systematic desensitization
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History of Intervention in
Clinical Psychology
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Criticisms of Psychotherapy
– Hans Eysenck 1952
– Levitt, 1957
– Resulting in enormous amount of research on
whether psychotherapy works
Efficacy studies – focus on studies that
emphasize internal validity of the study
 Effectiveness studies – focus on studies that
look at real world conditions
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– Meta-analysis – statistical technique combining
several studies, showed psychotherapy effective
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History of Intervention in Clinical
Psychology
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Contemporary approaches
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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
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