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Lecture 2

Psychology 46-333 Lecture 2: Lectures 2,3 on Contemporary Issues and Controversies

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Kenneth Hart

Lecture 2,3 on Contemporary Issues and Controversies 4 Contemporary Issues 1. Evidence-based treatments/manualized therapy 2. The influence of technology 3. Ethnics 4. Postmodern Developments Issue #1: Evidence-based Treatments/Manualized Therapy  Assumption: Practice should be based on science (EBT)  Important to base practice (the profession of CP) on science (the discipline of CP) o Scientific research generating factual knowledge  Research to asses treatment effectiveness often uses therapy manuals  Pros: ensures uniformity across therapists  Q: What is "evidence-based treatment" and why is it important? o Treatment based on evidence driven from scientific research o Licensed professionals must use techniques that are evidence-based which are proven to be effective o It is unethical to use other techniques o **therapy combine with drugs o A: is when research findings supports the use of a manualized therapy; avoids ineffective or unethical treatment  Pros o Scientific legitimacy (grounded in scientific evidence) o Establishing minimal levels of competence o Training improvements (ex. education) o Decreased reliance on clinical judgement (ex. impression)  relying more on research than one's own beliefs o Increased exportability of treatment (useful for patients around the world)  Cons o Threats to the psychotherapy relationship  they tend to be humanistic therapists; they think sticking to the treatment manual too much might be inhuman or too mechanical, need to have a trusting bond between therapist and patient (patients must be respected) o Restrictions on practice  humanists respect the freedom o Debatable criteria for empirical evidence Issue #2: The Influence of Technology  Increased use of technology in the direct delivery of psychological services o Ex. 1  assessment (online diagnosis) o Ex. 2  treatment delivered by the internet (Brief Motivational Intervention)  increasing problem awareness  **only about 2-3% of the gamblers would seek treatment o Website and telehealth (Skype) can replace or supplement face-to-face meetings  Multiple Benefits to technology mediated clinical practice o Accessibility o Affordability o Anonymity  anonymous makes people more likely to seek help  Applications (examples) o Videoconferencing to interview or treat o Email psychotherapy  therapy through email o Interactive Internet sites o Online psychotherapy programs o Virtual reality therapeutic experiences  systematic desensitization (virtual experience of what they fear) o Computer-based self-instruction (not always empirically proven) o Therapist/client interaction through hand-held devices (ex. cell phones, Smartphone apps) o "6 Pillars of Self Esteem" by Nathaniel Branden o **some of the examples are new thus might not be empirically validated  Suggestions for Emerging Professional Issues o Obtain client informed consent about the use of technology (risks of using technology) o Follow relevant telehealth laws (must meet legal requirements) o Follow APA ethical code (the Canadian one is very similar) o Ensure confidentiality using encryption o Make efforts to appreciate culture o Obtain relevant training o Know client's local emergency resources Issue #3: Ethics  Ethics and science called "the 2 pillars" of clinical psychology  The 2 Pillar's of Clinical Psychology o Science Q1: What is the evidence-base for what I am planning to do with my clients? o Practice Q1: What are the risks to my client of the course of action I am planning?  Ethical Questions o Ethics to protect the welfare of the client o It is ethically required that professional services be informed by research evidence o Potential harm can come to client when there is no science to guide practice o Need to balance offering no service rather than risk providing wrong or harmful treatment  In clinical decision making, a balancing is needed o The balance of excessive open mindedness vs. excessive caution and scepticism o Balance between intuition (one's own subjective impression) and evidence (scientific research to support intuition) o Blend them through experience  Example of treatment arachnophobia  Historical Roots of Concern with ethical codes to guide professional practice o Psychologists are almost obsessed with ethics because there were misconducts o Revelations of misconduct discovered during Nuremberg war crime trials after WW2  Principle of "Informed Consent" o Cornerstone of the professional code of ethics o Therapist must ensure that the client:  Understands the treatment  Exercises volition when agreeing to participate (coerced treatment unethical)  Canadian Code of Ethical Practice o Adopted by CPA in 2000 o If violated, license will be taken away o 4 Principles therapists must adhere t
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