Midterms Clinical Psychology

CLINICAL PSYCHOLOGY WEEK 1: INTRODUCTION TO CLINICAL PSYCHOLOGY WHAT IS CLINICAL PSYCHOLOGY? WHAT CLINICAL PSYCHOLOGISTS DO? Psychotherapy requires 31-37% of work hours Diagnosis and assessment as second most time-consuming Teaching and supervision future psychologists Research and writing to contribute to scientific knowledge Consultation in advising organizations or professionals Administration in managing programs, clinics, or departments The term clinical psychology was first used in print by Lightner Witmer in 1907. Witmer believed clinical psychology could apply to people of all ages and with diverse problems. The field of Clinical Psychology 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, psychological, social, and behavioral aspects of human functioning across the life span, in varying cultures, and at all socioeconomic levels. (APA, 2012a) 1 3 Main Training Models SCIENTISTPRACTITIONER (BOULDER MODEL) 1949 PRACTITIONER -SCHOLAR (VAIL MODEL) 1973 CLINICAL SCIENTIST MODEL (1990s onwards) Emphasizes balance between practice and research. Students trained in clinical methods (assessment, therapy) + research methods (statistics, thesis/dissertation). Dominated training for decades; still widely used. Created due to dissatisfaction with heavy research focus. Emphasizes clinical practice skills more than research. PsyD doctoral degree. More practice-oriented, less statistics/research. Popular among those aiming mainly for practice. Strongly emphasizes science and empiricism. Argues scientific method is the foundation of clinical psychology. Degree awarded = PhD (same as Boulder), but with heavier research focus. Programs stress evidence-based methods and rigorous research. Supported by the Academy of Psychological Clinical Science (founded 1990s). 1 2 HOW CLINICAL PSYCHOLOGIST DIFFER COUNSELING PSYCHOLOGIST PSYCHIATRIST Worked with less disturbed clients because clinical psychologists work more with severe cases Counseling - university counseling centers (more humanistic/clientcentered) Clinical - hospital, inpatient psychiatric units (more behaviorist) They are medical doctors and specialize in psychiatry. Can prescribe medication View disorders mainly as biological/brain abnormalities They may use therapy but medication is their primary tool. ↔ Focus: link individuals society (poverty, racism, abuse, gender roles). Help clients access social services (housing, welfare, job training). SOCIAL Often visit clients’ WORKERS homes/workplaces; arrange community transitions after inpatient V. THE ENLIGHTENMENT care. & 18TH CENTURY Therapy approach: emphasizes social & environmental factors. SCHOOL PSYCHOLOGIST Work mainly in schools (also day-care, correctional facilities). Focus on enhancing students’ intellectual, emotional, social, developmental lives. Conduct testing (intelligence, achievement diagnose learning disorders, ADHD). Develop programs, consult with teachers/parents, some direct counseling. → CLINICAL PSYCHOLOGY WEEK 1: INTRODUCTION TO CLINICAL PSYCHOLOGY PROFESSIONAL COUNSELORS (LPCs) High acceptance rates, focus on counseling skills (not research/testing). Help with life problems, mild mental illness. More oncommunity agencies, private practice. Specializations: career, school, addiction, couples/family, college counseling. MARRIAGE AND FAMILY THERAPIST (MFTs) Focused on couples and families, sometimes individuals with familyrelated issues Less emphasis on research and assessment, more on relational therapy. 1 CLINICAL PSYCHOLOGY WEEK 2: EVOLUTION OF CLINICAL PSYCHOLOGY Date: 1 February 10, 2026 Origins of the Field Early Pioneers 2 1 I. William Tuke II. Philippe Pinel III. Eli Todd IV. Dorothea Dix 3 Witmer and Creation of Clinical Psych 4 Assessment 5 Psychotherapy WILLIAM TUKE (1732-1822) Origins of the Field Psychology has a long and rich history, tracing back to ancient philosophers such as Socrates, Plato, and Aristotle. Clinical psychology also has a rich history but is much younger than psychology itself. In recent decades, the clinical specialization has become very popular and widely recognized among both psychologists and the general public. Today, when people hear the word “psychologist,” they often think of a clinical psychologist who provides psychotherapy or psychological assessment. However, this assumption was inaccurate before the early 1900s. Clinical psychology did not exist as a discipline until around the turn of the 20th century. It took several decades after its emergence to become prominent in the field of psychology. 2 Early Pioneers Even before clinical psychology formally existed, many influential individuals worked to improve the lives of people with mental illness. Their efforts created the environment that allowed clinical psychology to develop later. During the 1700s and 1800s, people with mental illness were treated much more poorly than today. In many regions, especially in the Western Hemisphere, mental illness was believed to be caused by possession by evil spirits. Others believed sufferers deserved their condition because of immoral behavior or bad character. People with mental illness were often rejected by society. They were placed in institutions that resembled prisons rather than hospitals. Many professionals from Europe and North America worked to improve how mentally ill individuals were treated and perceived. Their efforts helped the Western world adopt a more humane approach to mental illness. These reforms paved the way for the development of clinical psychology as a formal discipline. The achievements of these early pioneers helped shape the future of mental health care. PHILIPPE PINEL (1745-1826) 2 William Tuke was an English reformer who worked to improve the treatment of people with mental illness. He learned about the poor and inhumane conditions in asylums in England and visited them to see the situation firsthand. After seeing the conditions, he was appalled and dedicated much of his life to improving them. Tuke raised funds to establish the York Retreat, a residential treatment center for the mentally ill. Calling it a “retreat” reflected a more humane and compassionate approach, unlike the harsh treatment common at the time. The York Retreat became a model of humane mental health care. Similar institutions later opened across Europe and the United States. After Tuke’s death, his family continued supporting the York Retreat and efforts to improve treatment for the mentally ill. Philippe Pinel in France played a role similar to William Tuke in England— both helped liberate and reform the treatment of the mentally ill. Pinel worked to remove mentally ill individuals from dungeons in Paris, where they were treated as prisoners instead of patients. He argued that mental illness was not caused by devil possession. He believed people with mental illness deserved compassion, dignity, and hope instead of abuse and ridicule. He introduced more systematic patient care, including: Case histories for each patient Ongoing treatment notes Classification of illnesses These practices showed his goal was to understand and help patients rather than simply confine them. CLINICAL PSYCHOLOGY WEEK 2: EVOLUTION OF CLINICAL PSYCHOLOGY Date: 1 February 10, 2026 Origins of the Field Early Pioneers 2 1 I. William Tuke II. Philippe Pinel III. Eli Todd IV. Dorothea Dix 3 Witmer and Creation of Clinical Psych 4 Assessment 5 Psychotherapy WILLIAM TUKE (1732-1822) Origins of the Field Psychology has a long and rich history, tracing back to ancient philosophers such as Socrates, Plato, and Aristotle. Clinical psychology also has a rich history but is much younger than psychology itself. In recent decades, the clinical specialization has become very popular and widely recognized among both psychologists and the general public. Today, when people hear the word “psychologist,” they often think of a clinical psychologist who provides psychotherapy or psychological assessment. However, this assumption was inaccurate before the early 1900s. Clinical psychology did not exist as a discipline until around the turn of the 20th century. It took several decades after its emergence to become prominent in the field of psychology. 2 Early Pioneers Even before clinical psychology formally existed, many influential individuals worked to improve the lives of people with mental illness. Their efforts created the environment that allowed clinical psychology to develop later. During the 1700s and 1800s, people with mental illness were treated much more poorly than today. In many regions, especially in the Western Hemisphere, mental illness was believed to be caused by possession by evil spirits. Others believed sufferers deserved their condition because of immoral behavior or bad character. People with mental illness were often rejected by society. They were placed in institutions that resembled prisons rather than hospitals. Many professionals from Europe and North America worked to improve how mentally ill individuals were treated and perceived. Their efforts helped the Western world adopt a more humane approach to mental illness. These reforms paved the way for the development of clinical psychology as a formal discipline. The achievements of these early pioneers helped shape the future of mental health care. PHILIPPE PINEL (1745-1826) 2 William Tuke was an English reformer who worked to improve the treatment of people with mental illness. He learned about the poor and inhumane conditions in asylums in England and visited them to see the situation firsthand. After seeing the conditions, he was appalled and dedicated much of his life to improving them. Tuke raised funds to establish the York Retreat, a residential treatment center for the mentally ill. Calling it a “retreat” reflected a more humane and compassionate approach, unlike the harsh treatment common at the time. The York Retreat became a model of humane mental health care. Similar institutions later opened across Europe and the United States. After Tuke’s death, his family continued supporting the York Retreat and efforts to improve treatment for the mentally ill. Philippe Pinel in France played a role similar to William Tuke in England— both helped liberate and reform the treatment of the mentally ill. Pinel worked to remove mentally ill individuals from dungeons in Paris, where they were treated as prisoners instead of patients. He argued that mental illness was not caused by devil possession. He believed people with mental illness deserved compassion, dignity, and hope instead of abuse and ridicule. He introduced more systematic patient care, including: Case histories for each patient Ongoing treatment notes Classification of illnesses These practices showed his goal was to understand and help patients rather than simply confine them. CLINICAL PSYCHOLOGY WEEK 2: EVOLUTION OF CLINICAL PSYCHOLOGY In Treatise on Insanity (1806), Pinel criticized the cruel treatment of the mentally ill and advocated empathy instead of harsh control. According to Allen Frances, Pinel treated patients with humanity and respect. Pinel even declined an offer to become personal physician to Napoleon Bonaparte, choosing to remain caring for his patients. During the late 18th and early 19th centuries in Europe, attitudes toward mental illness were shifting toward recognizing human rights and social responsibility. The reform efforts of Pinel and Tuke helped lead this humanitarian movement in mental health care. ELI TODD (1769-1833) Eli Todd helped promote humane treatment of the mentally ill in the United States. Todd was a physician in Connecticut at a time when only three U.S. states had hospitals for the mentally ill. Most mentally ill individuals were cared for by their families, who often hid them due to shame or embarrassment. Todd learned about the reforms of Philippe Pinel in France and shared these ideas with other American physicians. His colleagues supported him ideologically and financially. With this support, Todd raised funds to establish The Retreat in 1824. At this institution, patients were treated with humanity, dignity, and respect. Todd and his staff focused on patients’ strengths rather than weaknesses. Patients were given significant input in their own treatment decisions. DOROTHEA DIX (1802-1887) 2 Despite the reforms of Eli Todd, the United States still lacked enough hospitals for the mentally ill. As a result, many mentally ill individuals were placed in prisons or jails instead of hospitals. In 1841, Dix was working as a Sunday school teacher in a jail in Boston. She observed that many inmates were imprisoned because of mental illness or intellectual disability rather than crime. This experience led her to dedicate her life to improving treatment for the mentally ill. Dix would: Travel to different cities Collect data on how the mentally ill were treated Present the evidence to local leaders Persuade them to provide more humane and adequate care She repeated this process in many cities with great success. Her efforts helped establish more than 30 state institutions for the mentally ill in the United States, and additional institutions in Europe and Asia. These institutions provided more compassionate and humane treatment for people with mental illness. William Tuke, Philippe Pinel, Eli Todd, and Dorothea Dix did not create clinical psychology, but they led a major reform movement in the 1700s–1800s. Their work promoted the belief that people with mental illness deserve respect, understanding, and help instead of punishment and fear. This humanitarian movement prepared the foundation for the development of clinical psychology, later advanced by Lightner Witmer. CLINICAL PSYCHOLOGY WEEK 2: EVOLUTION OF CLINICAL PSYCHOLOGY 3 Lightner Witmer and Creation of CP Lightner Witmer (1867–1956) was born in Philadelphia and earned a business degree from University of Pennsylvania. He later earned a PhD in psychology in 1892 in Germany under Wilhelm Wundt, considered the founder of experimental psychology, and also studied with James McKeen Cattell. In the late 1800s, psychology was mainly an academic research field, not an applied profession. Psychologists studied psychology rather than practiced it. In 1896, Witmer founded the first psychological clinic at the University of Pennsylvania, marking the first systematic application of psychology to real human problems. At the American Psychological Association meeting in 1896, he encouraged other psychologists to open clinics, though many were initially unenthusiastic. By 1914, about 20 psychological clinics existed in the United States, many modeled after Witmer’s. By 1935, the number had grown to more than 150 clinics. Witmer and his team mainly treated children with learning and behavioral problems related to school. He emphasized that clinical psychology could also apply to adults and to problems beyond school settings. He emphasized that clinical psychology could also apply to adults and to problems beyond school settings. In 1907, Witmer founded the first clinical psychology journal, The Psychological Clinic. In its first issue, he published the article “Clinical Psychology,” which first introduced and defined the term “clinical psychology.” He described clinical psychology as related to medicine, education, and social work, but requiring specialized training beyond these professions. Clinical psychologists should collaborate with professionals in related fields. His early definition did not emphasize Sigmund Freud’s ideas or psychotherapy. Surprisingly, his treatment methods did not include clear plans for empirical evaluation, despite his experimental training. 4 Assessment DIAGNOSTIC ISSUES Classifying mental illness has been a central issue in clinical psychology since Lightner Witmer defined the field, though the debate began long before him. Early Classification In the 1800s, early systems grouped mental illness into two broad categories: Neurosis – psychiatric symptoms (e.g., anxiety, depression) but reality remains intact. Psychosis – loss of contact with reality, including hallucinations, delusions, or disorganized thinking. 2 Emil Kraepelin (1855–1926) is known as the “father of descriptive psychiatry.” He proposed two categories: Exogenous disorders – caused by external factors and often more treatable. Endogenous disorders – caused by internal factors. He also introduced early diagnostic terms such as: Dementia praecox (similar to modern Schizophrenia) Paranoia Manic depressive psychosis Involutional melancholia Cyclothymic personality Autistic personality Although many terms were later replaced, his work set the foundation for modern diagnostic systems. In 1840, the United States Census Bureau recorded one category: “idiocy/insanity.” By 1880, the number increased to seven categories. Later, the American Medical Association and the United States Army also attempted early classifications. Development of the DSM The Diagnostic and Statistical Manual of Mental Disorders (DSM) was first published in 1952 by the American Psychiatric Association. Major editions: DSM-II (1968) – similar to the original. DSM-III (1980) – major shift with specific diagnostic criteria and a multiaxial system. Later revisions: DSM-III-R (1987), DSM-IV (1994), DSM-IV-TR (2000). Current edition: DSM-5 (2013). DSM-III (1980) introduced the multiaxial system, which allowed clinicians to categorize different aspects of a person’s mental health on separate “axes”. The system included five axes (used in DSMIII through DSM-IV-TR): Axis I – Clinical disorders and other conditions that may be a focus of treatment (e.g., depression, schizophrenia). Axis II – Personality disorders and intellectual disabilities. Axis III – General medical conditions relevant to mental disorders. Axis IV – Psychosocial and environmental problems (stressors). Axis V – Global Assessment of Functioning (GAF) – overall level of functioning. The multiaxial system was later removed in DSM-5 (2013), but it remained a core part of DSM Diagnostic Criteria - lists indicating exactly what symptoms constitute each disorder The number of disorders increased by over 300% from 1952 to 1994, reaching 368 diagnoses. Two major explanations on why it increased: Scientific discovery – psychology is identifying previously unrecognized disorders. Social invention – some normal behaviors are being labeled as disorders. CLINICAL PSYCHOLOGY WEEK 2: EVOLUTION OF CLINICAL PSYCHOLOGY Proposed Disorders Internet Gaming Disorder a condition where a person becomes addicted to playing online or video games, causing problems in daily life like school, work, sleep, or relationships. Attenuated Psychosis Syndrome a condition where a person experiences mild or early signs of psychosis, such as unusual thoughts or mild hallucinations, but they still know these experiences might not be real. Persistent Complex Bereavement where a person experiences very intense and longlasting grief after someone dies, making it hard to continue normal life. Non-suicidal Self Injury when someone intentionally hurts their own body (like cutting or burning) without wanting to die, usually to cope with strong emotional pain. ASSESSMENT OF INTELLIGENCE Assessment of Intelligence became central to clinical psychology at the turn of the 20th century. Debate on nature of intelligence: Edward Lee Thorndike – multiple, independent intelligences. Charles Spearman – single general intelligence (“g”) overlapping many abilities. Impact: This debate shaped how early clinical psychologists assessed intellectual abilities, which dominated the field more than psychotherapy Binet-Simon Scale (1905) Developed by Alfred Binet and Theodore Simon to help French schools identify students needing special services. Introduced mental age vs. chronological age comparison, leading to the intelligence quotient (IQ). Later revised by Lewis Terman in 1937 as the Stanford-Binet Intelligence Scales. Wechsler Scales 1939: David Wechsler created the WechslerBellevue test for adults. Adult intelligence scale revisions: WAIS (1955), WAIS-R (1981), WAIS-III (1997), WAIS-IV (2008). 1949: Released Wechsler Intelligence Scale for Children (WISC), with verbal, performance, and total IQ scores. WISC revisions: WISC-R (1974), WISC-III (1991), WISC-IV (2003), WISC-V (2014). 1967: Introduced Wechsler Preschool and Primary Scale of Intelligence (WPPSI) for young children. WPPSI revisions: WPPSI-R (1989), WPPSI-III (2002), WPPSI-IV (2012 2 ASSESSMENT OF PERSONALITY Origin of “mental test”: Term first used by James McKeen Cattell (1890) in “Mental Tests and Measurements”. Initially measured reaction time, memory, and sensation/perception, later expanded to include intelligence and personality tests. Projective Personality Tests Early 20th century: Initial empirical attempts to measure personality had limited impact. Rorschach Inkblot Method (1921) Created by Hermann Rorschach based on the idea that people project personality onto ambigous stimuli. Popular with psychodynamic practitioners; early scoring systems varied. Thematic Apperception Test (1935) Created by Christiana Morgan and Henry Murray in which respondents told stories about ambiguous scenes or situations instead of inkblots. Other projective methods included: Draw-a-Person test – infer personality from human figure drawings. Julian Rotter’s Incomplete Sentence Blank (1950) – assess personality via sentence completions. Popularity decline: Projective tests questioned for reliability and validity in recent decades. Objective Personality Tests Offered a scientifically stronger, pencil-andpaper approach. Clients answer multiple-choice or true/false questions. Scoring and interpretation more straightforward than projectives. Could focus on specific traits or comprehensive personality overview. Minnesota Multiphasic Personality Inventory Developed by Starke Hathaway and J. C. McKinley (1943). 550 true/false items. Compared responses to standardization sample representing diagnostic categories. Included validity scales to detect random or misleading responses. By 1959, over 200 separate scales derived from MMPI items. MMPI-2 (1989): updated norms including minorities and regional diversity, modernized language. MMPI-A (1992): adolescent version. Key qualities: easy administration, scoring, reliable, valid, clinically useful. Other objective tests: NEO Personality Inventory (NEO-PI, NEO-PI-R, NEO-PI-3): measures universal personality traits, less focused on pathology. Beck Inventories: Beck Depression Inventory (BDI) Beck Anxiety Inventory (BAI) Measure specific states or traits. Modern Uses and Controversies Personality assessments now used for: Job screenings Forensic evaluations (e.g., child custody) Controversy emphasizes importance of validity and reliability in testing. CLINICAL PSYCHOLOGY WEEK 2: EVOLUTION OF CLINICAL PSYCHOLOGY Other objective tests: NEO Personality Inventory (NEO-PI, NEO-PIR, NEO-PI-3): measures universal personality traits, less focused on pathology. Beck Inventories: Beck Depression Inventory (BDI) Beck Anxiety Inventory (BAI) Measure specific states or traits. Modern Uses and Controversies Personality assessments now used for: Job screenings Forensic evaluations (e.g., child custody) Controversy emphasizes importance of validity and reliability in testing. 5 Psychotherapy Most clinical psychologists worked in academia, not as practitioners. Psychotherapy was not a major activity; psychological testing was the primary focus. Psychologists operated in a medicaldominated field—treatment was considered the physician’s role. During World War II, psychological consequences for U.S. soldiers created demand for psychotherapy. This contributed to psychotherapy gaining prominence in the 1940s–1950s. Mid-20th century: Psychodynamic therapy dominated. 1950s–1960s: Behaviorism emerged. Behavioral approach focused on empirical, observable, and measurable progress. Reaction against lack of empiricism in psychodynamic therapy. 1960s: Humanistic / client-centered therapy (Carl Rogers) Emphasized relationship- and growthoriented approach. Family therapy revolution: 1950s–1970s Viewed individual symptoms in context of family/system issues. Understanding mentally ill individuals as symptomatic of a flawed system had become a legitimate-and, by some clinicians, the preferred therapeutic perspective. Cognitive therapy: Emphasizes logical thinking as foundation of psychological wellness. Currently the most popular singular therapy orientation (excluding eclectic/integrative approaches). Modern therapy landscape: Wide range of therapy approaches now exist. Graduate textbooks often cover dozens of distinct approaches, each with variations. Recent trends: Eclectic/integrative therapy combining methods. Emphasis on cultural competence in all approaches. Key point: Today’s plethora of therapy options evolved over time, often as reactions to previous approaches. 2 CLINICAL PSYCHOLOGY WEEK 3: CURRENT CONTROVERSIES IN CLINICAL PSYCHOLOGY Date: 1 February 17, 2026 1 Prescription Privileges 2 Evidence-Based Practive/Manualized Therapy 3 Overexpansion of Mental Disorders 4 Payment Methods: Third Party Payment Versus Self-Payment 5 Influence of Technology Prescription Privileges Prescription privileges (ability to prescribe medication) have historically been a major distinction between psychiatrists and psychologists and are widely seen by the public as a defining difference. In recent decades, some clinical psychologists have pursued the right to prescribe medication. Since 2002, 2 states have agreed to grant prescription privileges to appropriately trained psychologists. New Mexico (2002) Louisiana (2004) Many other states have considered similar legislation Why they should prescribe? Shortage of psychiatrists Some areas, especially rural regions, have too few psychiatrists to meet mental-health needs. This argument helped psychologists gain prescribing rights in New Mexico and Louisiana due to low psychiatrist-topopulation ratios. Increasing trained prescribers would help underserved populations. Clinical Psychologists are more expert than primary care physicians Over 80% of psychoactive medication prescriptions are written by primary care physicians, not psychiatrists. Clinical psychologists have more specialized training in mental health, so they may be better at diagnosing disorders and choosing appropriate medications. Other non-physician professionals already prescribe Some non-physicians—such as dentists, podiatrists, optometrists, and advanced practice nurses—already have prescription privileges. This sets a precedent for specially trained psychologists to prescribe as well. Convenience for clients Clients who need both psychotherapy and medication currently must see two professionals (psychologist + physician). If psychologists could prescribe, clients could receive therapy and medication from one provider, saving time, money, and reducing miscommunication. 3 Professional autonomy Prescription privileges would allow psychologists to provide a wider range of services independently. They could treat both psychological and physical aspects of mental disorders without relying on physicians. Professional identification Prescribing ability would distinguish psychologists from other nonprescribing therapists (e.g., counselors or social workers). Evolution of the profession Clinical psychology has continuously evolved by adopting new techniques. Many argue that prescription privileges are the next logical step, expanding roles such as direct medication treatment and consultation with physicians. Revenue for the profession Prescribing rights could increase income for psychologists, especially as salaries have declined due to managed care systems. There is financial competition with psychiatrists, since medication treatment is common. Example: In the 1990s, antidepressant use for depression increased from 37% to 74%, and by 2007 antidepressants were the most prescribed drug category in the U.S.. Why they should not prescribe? Training Issues Which course? When? Taught by whom? Threats to psychotherapy Critics worry psychologists might shift from psychotherapy (“talk therapy”) toward medication-based treatment. Clients might expect medication, and psychologists may find prescribing more profitable than therapy. The profession could shift focus from behavioral, cognitive, and emotional processes to symptom reduction through drugs. Identity confusion Not all psychologists would prescribe medication. Differences in training background and prescribing ability could create confusion within the profession. Clients might be uncertain whether their psychologist can or will prescribe medication. Influence of the pharmaceutical industry Drug companies have been criticized for offering gifts, funding research, and influencing publication of results to increase profits. If psychologists prescribe medications, they may become targets of pharmaceutical marketing and pressure. Some psychologists propose formal ethical guidelines to regulate interactions with drug companies. WEEK 3: CURRENT CONTROVERSIES IN CLINICAL PSYCHOLOGY 2 3 CLINICAL PSYCHOLOGY Evidence-Based Practice/Manualized Therapy When researchers measure therapy outcome, they often use therapy manuals To ensure uniformity across therapists To minimize variability When outcome data supports the use of a manualized therapy, the treatment is known as "evidence-based" Treatments formerly called "empirically validated" and "empirically supported". "Evidence-based practice" includes the treatment and factors related to people providing and receiving the treatment. Advantages of Evidence-Based Practice/Manualized Therapy Scientific legitimacy Before manualized, evidence-based therapies, clinical psychology was criticized as a “cottage industry,” where each therapist used their own unique therapy style. Treatment varied widely depending on the psychologist’s training or personal preference. Evidence-based therapies promote standardized treatments supported by research, making clinical psychology more scientific. Similar to medicine, where doctors follow established treatments for diseases, psychology can apply consistent treatments for specific disorders under the medical model. Establishing minimal levels of competence If therapists use completely individualized methods, some may provide ineffective or harmful treatment. Manualized, evidence-based treatments ensure therapists are trained in methods proven to work. These treatments can become professional standards, increasing accountability among psychologists. Clients receive more consistent and effective care. Training improvements Training for psychologists varies across graduate programs. Evidence-based therapies can be integrated into training curricula. The American Psychological Association considers evidence-based training when evaluating program accreditation. As a result, future psychologists are more likely to learn therapies with proven effectiveness for specific disorders. Reduced reliance on subjective clinical judgment Clinical judgment can be biased and flawed, affecting treatment decisions. Research shows psychologists often rely more on personal judgment than on empirical data. Manualized therapies encourage use of research-supported techniques instead of subjective decisions. This shift toward evidence-based methods may improve therapy outcomes. Disadvantages of Evidence-Based Practice/Manualized Therapy Threats to the therapeutic relationship Research suggests therapy success depends largely on the therapist–client relationship (therapeutic alliance) rather than techniques alone. Therapy manuals emphasize specific techniques (“what therapists do”) rather than relationship quality (“how therapists relate to clients”). Therapists who follow manuals mechanically may neglect meaningful human connection with clients. Diagnostic complications Evidence-based manuals usually target specific disorders. Clinical trials often include clients with “textbook” cases and no additional disorders. In real-world settings, clients often have comorbidity (multiple disorders or complications). Treatments proven effective for simple cases in research may not work as well for complex real-world cases. Restrictions on clinical practice Some interpret evidence-based practice to mean only therapies with empirical support should be used. Therapies not on the list may be considered unfounded or even malpractice. This can reduce therapists’ clinical judgment, creativity, and professional autonomy. Mandated manuals vs. Creatively customized treatments Some research shows rigidly following manuals may not produce the best outcomes. Therapists who use manuals flexibly often achieve better engagement and outcomes. The concept of “flexibility within fidelity” means following a manual while adapting it to the client’s culture, preferences, and unique symptoms. Debatable criteria for empirical evidence Critics argue the criteria for labeling treatments “evidence-based” are controversial. Therapies like psychodynamic or humanistic therapy may be underrepresented because their outcomes are harder to quantify. Balanced perspective Evidence-based practice should not be viewed as an “either/or” choice. Effective psychotherapy requires a balance of scientific research, clinical expertise, and individualized understanding of clients. CLINICAL PSYCHOLOGY WEEK 3: CURRENT CONTROVERSIES IN CLINICAL PSYCHOLOGY 3 Overexpansion of Mental Disorders DSM size and scope has increased from 1950s to present Overdiagnosis, diagnostic expansion, diagnostic inflation, diagnostic creep, medicalization of everyday problems, false positives, false epidemics? Minimizing the chance that people struggling with mental illness fall through the cracks vs. overdiagnosis of normal life experiences If diagnoses continue to expand, can anyone be diagnosed with a mental disorder? 4 Effects of Third-Party Payment on Therapy Surveys of psychologists suggest that third party payment can result in: Negative impact on quality Too little control over clinical decisions Ethical problems, including confidentiality Confusion about informed consent (what to tell clients about payment method) Greater affordability for many clients Effects of Third-Party Payment on Diagnosis Surveys of psychologists suggest that third party payment can result in: Increased likelihood of being diagnosed with a mental disorder Certain diagnostic categories being used more or less often Premenstrual Dysphoric Disorder (new disorder)  evere versions of the symptoms of S premenstrual syndrome Binge Eating Disorder (new disorder) Effects of Third-Party Payment on Psychologist's Experienec Out-of-control overeating at least once per week Lower pay Time required for paperwork, phone calls, etc. Frustration due to denial of care psychologists believes to be necessary In recent years, clinical psychologists have increasingly used technology in the direct delivery of psychological services. Assessment Treatment Cybertherapy can replace or supplement face-to-face meetings Benefits include accessibility, affordability, and anonymity, and more. Attention-Deficit/Hyperactivity Disorder (lowered diagnostic thresholds) Out-of-control overeating at least once per week Age of symptom onset changed from 7 years to 12 years Bulimia Nervosa (lowered diagnostic thresholds) Required binge frequency reduced from twice per week to once per week. Risks of Overdiagnosis Unnecessary medication - harmful side effects Unnecessary therapy - undermine coping skills Negatively impact self-image and selefficacy via stigma Adversely affect health insurance enrollment and rates Legal ramifications Overdiagnosis and Pharmaceutical Industry More mental disorders, more potential pharmaceutical customers? Significant numbers of psychiatrists involved in the creation of the DSM had financial ties to major pharmaceutical companies – 69% for DSM-5 Payment Methods: Third-Party Payment vs. Self-Payment Early in the history of clinical psychology, clients paid for services directly out of pocket With time, health insurance companies began covering mental health Today, many clients use health insurance/managed care benefits to pay for services – Often called “third-party payers” New Disorders, New Definitions Expansion of mental disorder diagnoses occurs in two main ways: Introduction of new disorders to describe experiences previously considered normal. Lowering diagnostic thresholds for existing disorders so more people meet criteria. 3 How well does cybertherapy works? Appears to work about as well as in-person psychotherapy Specific examples include CBT for anxiety disorders Health psychology Headaches Pain 5 Influence of Technology Confirming the identity of the client Confidentiality across electronic transmission Making interpretations in the absence of nonverbal cues that would be present faceto-face Competence in technical as well as clinical skills CLINICAL PSYCHOLOGY ETHICAL AND PROFESSIONAL ISSUES Date: 1 March 03, 2026 1 APA Code of Ethics 2 Confidentiality 3 Informed Consent 4 Boundaries and Multiple Relationships 5 Competence 6 Ethics in Clinical Research 7 Contemporary Ethical Issues APA Code of Ethics The APA first published its Code of Ethics in 1953, during the rise of professional psychology. Since then, nine revised editions have been released, with the most recent major edition published in 2002. Ethical Decision Making Celia Fisher, former chair of the APA Ethics Code Task Force, proposed an ethical decision-making model in the book Decoding the Ethics Code (2017) Steps in Ethical Decision Making 1. Commit to ethical behavior before any dilemma occurs. 2. Become familiar with the APA Code of Ethics. 3. Consult relevant laws and professional guidelines related to the situation. 4. Consider the perspectives of all affected parties and consult colleagues for guidance while maintaining confidentiality. 5. Generate and evaluate possible alternatives. 6. Select and implement the most ethical course of action. 7. Monitor and evaluate the effectiveness of the decision. 8. Modify and reassess the plan if necessary. Psychologist's Ethical Beliefs Behaviors widely considered unethical Sexual relationships with current or former clients. Socializing with current clients. Revealing confidential information without cause or permission. Behaviors widely considered ethical Shaking hands with clients. Addressing clients by their first name Breaking confidentiality if a client is suicidal or homicidal. Aspirational and Enforceable The APA ethical code (2002) has two main sections: General Principles Ethical Standards General Principles (Aspirational) These principles describe the ideal ethical behavior psychologists should strive for. They are aspirational, meaning they guide professional values but are not enforceable rules. They do not define specific ethical violations. Instead, they provide broad descriptions of exemplary professional conduct. There are five general principles that outline ethical ideals for psychologists. Ethical Standards (Enforceable) These are specific rules of professional conduct. If a psychologist commits an ethical violation, it is an Ethical Standard—not a General Principle—that is violated. Standards are more specific than the principles, though still broad enough to apply to many professional activities. The Ethical Standards are organized into 10 categories, containing 89 individual standards. 4 2 Confidentiality Confidentiality is a core ethical principle in clinical psychology. Emphasized in the American Psychological Association Code of Ethics (2002): Mentioned in Principle E: Respect for People’s Rights and Dignity. Included in Ethical Standard 4.01 – Maintaining Confidentiality, which requires psychologists to protect confidential information. The public trusts psychologists to keep personal information private during professional services. Tarasoff Case and the Duty to Warn Tatiana Tarasoff case (1969) established legal limits to confidentiality. Prosenjit Poddar, a student at University of California, Berkeley, became obsessed with Tarasoff. During therapy with psychologist Lawrence Moore, Poddar stated his intention to kill Tarasoff. Dr. Moore believed the threat was credible and informed campus police. Police released Poddar after he promised to stay away. Poddar stopped therapy. Two months later, he murdered Tarasoff. Tarasoff’s parents sued for wrongful death. The court ruled the therapist had a duty to warn the potential victim. A later ruling expanded this to a “duty to protect.” The ruling established the principle that confidentiality must yield when public safety is at risk. CLINICAL PSYCHOLOGY ETHICAL AND PROFESSIONAL ISSUES 3 Informed Consent Informed consent is an ethical process where individuals are given clear information about a psychological activity before agreeing to participate. It allows people to make an educated decision and refuse participation if they wish. Required in research, psychological assessment, therapy, and other professional activities. 4 Boundaries and Multiple Relationships A multiple relationship (also called dual relationship) occurs when a psychologist has more than one type of relationship with the same person. Romantic or sexual, friend, business, etc. Boundary Crossing Minor, sometimes harmless departure from strict professional boundaries. Example: small personal disclosure or brief nonprofessional interaction. Boundary Violation Serious ethical breach that harms or exploits the client. Examples: Romantic or sexual involvement Financial exploitation Social relationships that interfere with therapy. Boundary Erosion (“Slippery Slope”) Ethical violations sometimes develop gradually. Small boundary crossings may lead to bigger unethical actions. Example scenario: Therapist gives a client a ride to class. This sets a precedent for nonprofessional interaction. Later it may lead to socializing or dating, which is unethical. 5 Competence Competence refers to the psychologist’s ability, skills, knowledge, and expertise to perform professional tasks effectively. Boundaries of Competence: Psychologists should only provide services within areas of their competence. Psychologists must continually develop and maintain their competence, continuing education can maintain competence. Clinical psychologists must also demonstrate cultural competence. This means understanding how factors such as age, gender, race, culture, religion, language, etc. Psychologists must monitor their own mental and emotional condition. Burnout is a state of emotional exhaustion from prolonged stressful work. Psychologists should practice self-care to maintain competence. 6 4 Ethics in Clinical Assessment Psychologists must ensure that assessments are: Appropriate for the purpose of the evaluation Suitable for the population being tested 1. Proper Test Selection When selecting psychological tests, psychologists must consider competence, culture, test's reliability, valitidy, language, and age. 2. Test Security Psychologists must protect the security and integrity of psychological tests. This means preventing test materials from entering the public domain, such as test questions, test items, stimuli or prompts used in testing. 3. Release of Test Data Psychologists are generally required to release test data to clients upon request. Test data includes raw answer, notes, and client responses and must withold test is information is misused and could harm the client. 7 Contemporary Ethical Issues Managed care systems strongly influence modern mental health services. These systems are run by healthcare organizations that control costs and approve treatment services. Managed care can create ethical dilemmas for clinical psychologists. Managed-care companies usually require a diagnosis from the Diagnostic and Statistical Manual of Mental Disorders (DSM) before they will pay for treatment. Technology and Ethics Technological advances have changed how psychologists assess and treat clients, creating new ethical challenges. Many online tests claim to measure intelligence, personality, and other traits, but: Validity and reliability may be poor Feedback may be inaccurate or distressing Using unscientific tests can be unethical. Online Therapy; Limits full observation of nonverbal cues and body language Raises confidentiality and client identity concerns Requires psychologists to ensure secure communication and informed consent Ethics in Small Communities Small communities present unique ethical challenges for clinical psychologists. Rural areas/small towns, ethnic, religious, or LGBTQ, military bases or small colleges. Multiple relationships are almost inevitable (friendships, family, coworkers) Boundaries can easily blur due to close-knit nature Nonsexual overlapping relationships are common and sometimes unavoidable CLINICAL PSYCHOLOGY WEEK 5: THE CLINICAL INTERVIEW Date: 1 March 03, 2026 1 The Interviewer 2 Components of the Interview 3 Pragmatics of the Interview 4 Types of Interviews 5 Cultural Components The Interviewer Assessment is closely linked with the identity of clinical psychologists No other mental health profession incorporates assessment into their work as clinical psychologists do Clinical interviews are the most frequent asssessment tool more than any specific test Vast majority of practicing clincial psychologists use interviews. Essential Qualities of Assessment Techniques All assessment techniques (including interviews) should have adequate Validity - measures what it claims to measure Reliability - yields consistent, repeatable results Clinical utility - benefits the clinician and ultimately the client Feedback - common to all kinds of psychological assessment Provide results of tests or interviews May be face-to-face, a report, etc. The interviewer must have general skills of quieting yourself, minimize excessive internal, self-directed thoughts that detract from listening, and being self-aware. Quieting Yourself Minimize excessive internal, self-directed thoughts that detract from listening. Being SelfAware Know how you tend to affect others interpersonally, and how others tend to relate to you. Develop positive working relationships Can sague into psychotherapy Respectful and caring attitude is key. 5 Specific Behaviors Effective interviewing requires mastering specific behaviors after developing selfawareness, good relationships, and listening skills. Listening is the interviewer’s primary task, supported by several attending behaviors. Eye Contact Eye contact helps interviewers listen and shows the client they are being heard. Appropriate eye contact makes clients feel understood and attended to. Cultural differences matter: Too much eye contact may signal threat, aggression, or seduction in some cultures. Too little eye contact may appear inattentive or disrespectful. Body Language Interviewers should face the client, appear attentive, minimize restlessness, and use appropriate facial expressions. Vocal Qualities Skilled interviewers pay attention to how words sound, not just what is said. Important vocal elements includes pitch, tone, volume, and voice fluctuation. These help communicate understanding and empathy. Verbal Tracking Interviewers repeat key words or phrases used by the client to show understanding. This should be done naturally, not mechanically. They also follow the client’s train of thought, allowing smooth topic transitions. Referring to client by proper name Correctly using a client’s preferred name and title is essential. Mistakes such as using unwanted nicknames, shortening names incorrectly. Addressing clients too informally can make clients feel disrespected or uncomfortable. For some clients, these mistakes may be perceived as microaggressions. Interviewers should ask how clients prefer to be addressed, especially in the first session. Observing Client Behavior Interviewers must observe how the client behaves during the interview, not just what they say. Client behaviors may vary widely, such as: Calm or nervous Friendly or hostile Focused or easily distracted Emotional or reserved Observations help psychologists understand the client better and adjust their responses. CLINICAL PSYCHOLOGY WEEK 5: THE CLINICAL INTERVIEW 2 Components of the Interview Rapport - positive, comfortable relationship between interviewer and client How an interviewer is with clients Technique - what an interviewer does with clients. Technique Directive Style The interviewer asks specific, targeted questions to obtain needed information. Client responses are usually short and direct (often “yes” or “no”). Useful for gathering important clinical data, such as: Past suicide attempts Family history of disorders (e.g., schizophrenia) Symptoms of disorders Frequency of behaviors (e.g., panic attacks) Duration of problems (e.g., hyperactivity) Nondirective Style The interviewer allows the client to guide the conversation. Clients can choose which topics to discuss and how much detail to provide. Questions are open-ended, such as: “Can you tell me more about your feelings of sadness?” This approach allows clients to share: Symptoms Background information Personal experiences Issues the interviewer may not have thought to ask about 3 Pragmatics of the Interview Note-taking - little consensus about notetaking is that it provides a reliable written record, but can be distracting to client and interviewer. Audio-and-Video-recording - also provide a reliable record, but can be inhibiting to client and you must obtain permission. The Interview Room - professional yet comfortable, there must be couch, something to make them at ease. Confidentiality - explain confidentiality and its limits to clients (e.g., child abuse, intention to harm) 4 Types of Interview Intake interviews Diagnostic interviews Specific Interviewer Responses Open-ended questions allow individualized and spontaneous responses from clients. Elicit long answers that may or may not provide necessary info. Confrontation - for discrepancies or inconsistencies in a client's comments. Paraphrasing - restatement of client's comments to show they have been heard. Reflection of feeling - echo client's emotions, even if not explicitly mentioned. Summarizing - tie together various topics, connect statements that may have been made at different points, and identify themes. To determine whether to "intake" the client into the agency or refer elsewhere. Determine whether a client needs treatment, what type (inpatient, outpatient, specialized), and whether the facility can provide it. To provide DSM diagnosis. It used approached such as structured interviews (preplanned, follow DSM criteria; highly reliable and reduce subjective bias) and unstructured interviews (improvised questions; flexible but less standardized). Typically used in medical Mental Status setting to quickly assess how Exam (MSE) a client is functioning at that time. Closed-ended questions Allow less elaboration and self-expression by the client Yield quick and precise answers Clarification - questions to make sure the interviewer accurately understands the client's comments. 5 Crisis interviews 5 Assess problem and provide immediate intervention (e.g., clients considering suicide or self-harm). Cultural Components Appreciating the cultural context Knowledge of the client's culture, as well as the interviewer's own culture For behavior described or exhibited during interview. Acknowledging cultural differences Wise to discuss cultural differences rather than ignore Sensitive inquiry about a client's cultural experiences can be helpful