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Textbook Notes for 46-333

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University of Windsor
Kenneth Hart

Chapter 1 Notes Clinical Psychology: Definition and Training  The term clinical psychology was first used in print by Lightner Witmer in 1907.  A clinical psychologist, therefore, was a person whose work with others involved aspects of treatment, education, and interpersonal issues. At his clinic, the first clients were children with behavioral or educational problems.  Division 12 of APA  "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."  The most common specialty areas are clinical child, clinical health, forensic, family, and clinical neuropsychology.  Scientist- practitioner model (1949 conference in Boulder, Colorado)  Training in clinical psychology should jointly emphasize both practice and research. In other words, graduate students would ( under supervision) conduct both clinical work and their own empirical research ( thesis and dissertation).  practitioner- scholar model (after conference in 1973)  birth of PsyD for those who only want to practice Psychology (directly related to practice and fewer related to research and statistics)  clinical scientist model  implies a very strong emphasis on the scientific method and evidence- based clinical methods o Richard McFall's article in 1991 and a conference years after  **the traditional, middle- of- the- road Boulder model; the Vail model, emphasizing clinical skills; and the clinical scientist model, emphasizing empiricism  Growing emphasis in training  technology and specific competence (skills the students must be able to demonstrate)  Getting into the Grad Programs o Know your professional options o Take, and earn high grades in, the appropriate undergraduate courses o Get to know your professors o Get research experience o Get clinically relevant experience o Maximize your GRE score o Select graduate programs wisely o Write effective personal statements o Prepare well for admissions interviews o Consider your long- term goals  Predoctoral Internship  consists of a full year of supervised clinical experience in an applied setting— a psychiatric hospital, or another agency where clinical psychologists work  Postdoctoral internship (lasts 1-2yrs)  a step up from predoctoral internship (must accumulate the required number of supervised hours and pass the applicable licensing exams until they practice on their own)  Licensure  Examination for Professional Practice in Psychology ( EPPP) and a state- specific exam on laws and ethics  Once licensed, one must accumulate continuing education units ( CEUs) to renew the license from year to year  Clinical psychologists mostly work in private practices (30-41%), then university psychology departments (19%), 15% in others  Clinical psychologists do mostly psychotherapy (76-87%; 31-37% of their time); mostly individual therapy (76%)  Counseling different from Clinical: o Clinical psychologists were more likely to work with seriously disturbed individuals, whereas counseling psychologists were more likely to work with (“ counsel”) less pathological clients o But same internship sites, often earn the same degree ( the PhD), and obtain the same licensure status o Both endorse the eclectic orientation more than any other, but clinical psychologists tend to endorse behaviorism more strongly, and counseling psychologists tend to endorse humanistic/ client- centered approaches more strongly o Counseling tend to be more interested in vocational testing and career counseling, whereas clinical psychologists tend to be more interested in applications of psychology to medical settings  Psychiatrists o psychiatrists go to medical school and are licensed as physicians o Emphasize biology (psychiatrists tend to fix the brain by prescribing medication)  Social workers o social workers have focused their work on the interaction between an individual and the components of society that may contribute to or alleviate the individual’s problems o They emphasize on social and environmental factors and only need a master's degree  School psychologists o Goal: to enhance the intellectual, emotional, social, and developmental lives of students. o Work in schools, day-cares  Professional Counselors o Earn a master's degree and complete training within 2yrs o generally involves counseling, with very little emphasis on psychological testing or conducting research o specialize in such areas as career, school, addiction, couple/ family, or college counseling Chapter 3 Notes Prescription Privileges  Granting trained psychologists to prescribe safely and effectively  Why psychologists should prescribe: o Shortage of psychiatrists, more expert than primary care physicians, other non- physicians have prescription privileges (ex. dentists, optometrists), convenience for clients, professional autonomy (wider range of service), professional identification (easier for clients to identify), evolution and revenue  Why they should NOT prescribe: o Training issues, threats to psychotherapy, identity confusion, potential influence in pharmaceutical industry  Lack of uniformity across therapists, one needs therapy manual; hence, therapists try different therapies and prove them work based on empirical evidence  evidence-based practice/manualized therapy  “ the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences" o First list of empirically validated treatments was published in 1995 o Advantages: scientific legitimacy, establishing minimum levels of competence, training improvements, less reliance on clinical judgement, o Disadvantages: Threats to psychotherapy relationship, diagnostic complications, restrictions on practice, debatable criteria for empirical evidence  Payment methods o Managed care (insurance companies) has negative impact on quality of therapy o Won't pay unless clients are diagnosed  Influence of technology o cognitive- behavioral treatment of anxiety disorders was equally effective whether the treatment was delivered in person or via computer o The issue of confidentiality when using technology for therapy Chapter 4 Notes  Multiculturalism as a 4th force  1970s  beginning of educating and training therapists the importance of race and ethnicity  Emergence of APA divisions  APA Ethnical code improved with cultural sensitivity and competence o Principle E: Respect for People's Rights and Dignity o Standard 2.01 (Boundaries of Competence), 3.01 (Unfair Discrimination), 9.06 (Interpreting Assessment Results)  DSM-IV Efforts towards multiculturalism o Pointing out that same disorder might have different symptoms in different cultures o A list of culture-bound syndromes  Revisions of assessment due to multiculturalism (ex. MMPI and WAIS)  Cultural Competence  the counselor's acquisition of awareness, knowledge, and skills needed to function effectively  Cultural self-awareness  seek to understand the client's culture and be less egocentric and more appreciative  Latino/Latina Clients (Dr. Melba Vasquez)  Relevant generational history; citizenship/residency status; fluency in "standard" English or other languages  Asian and Asian America (Dr. Frederick Leong)  intro-group heterogeneity; emphasis on connectedness of the family (collectivistic) whereas European Americans on separateness (Individualistic)  American Indian/Alaska Native (Dr. Joseph E. Trimble)  effective counseling is counselor internalizing and using empathy, genuineness, respect, warmth, congruence, concreteness in counseling settings; clients must be adaptive and flexible in their personal orientations and use of conventional counseling techniques  African American (Dr. Robert L. Williams)  self-knowledge in gaining cultural competence; accept that "cultural difference is not a deficiency"  differences b/w cultures exist, but not one is better/worse than other  Irish American (Dr. Monica McGoldrick)  seem afraid of emotional issues; have long history to hide emotions  Female Clients (Dr. Nadya A. Fouad)  important to understand how a client's gender is interwoven in his/her culture; beware of one's own gender bias  Middle Eastern (Dr. Karen Haboush)  first step is to examine their own attitude and knowledge; welfare of family is more important than individual autonomy and independence (emphasis on well-being of family)  LGBT (Dr. Kathleen J. Bieschke)  more attention on development of a productive therapeutic relationship (ex. having a pink triangle in one's office) Jewish American (Dr. Lewis Z. Schlosser)  foster a safe environment to Jews feel more  comfortable disclosing their identity Knowledge of Diverse Cultures  Acknowledging cultural differences with clients; every session aims knowledge of client's cultural background  Cultural knowledge should also include, group's history (social and political)  Cannot assume everyone is typical within the cultural group (heterogeneity)  Acculturation  people respond differently in a new cultural environment o Assimilation  individual adopts much of new culture and abandons the original o Separation  individual rejects new culture and retains the original o Marginalization  individual rejects both new and original culture o Integration  individual adopts much of new culture and retains the original Skills  To develop suitable strategies for assessment and treatment  Some cultures respond better to talk therapy or action-oriented therapies with short-term focus  Microaggressions  comments/actions made cross-culturally that convey prejudicial, negative, or stereotypical beliefs and may suggest dominance of one group over another  Cultural adaptation  lists of treatments that work and cultural bias free  Etic perspective  emphasizes similarities between all people  Emic perspective  recognizes and emphasizes cultural norms  Tripartite Model of Personal Identity (middle ground for etic and emic; all levels hold some degree of importance) o Individual level  everyone, in some aspects, is unique o Group level  all individuals are in some aspects like other individuals o Universal level  all in some aspects are the same  Definition of culture  cultural characteristics (narrow) vs. "any group that shares a theme or issues" (broad) Training Psychologists in Cultural Issues  Educational  specific courses to address culture in grad programs; real-world experience with individuals of diverse cultures  Fouad and Arredondo  7 elements of a multicultural psychology curriculum o State a commitment to diversity o Make effort to recruit grad students from diverse populations o Make effort to recruit and retain a diverse faculty o Make effort to make admissions fair o Ensure students gain awareness of own cultural values and biases, knowledge of other groups, and skills to work with diverse POP o Examine all courses for an infusion of culture-centered approach o Evaluate students on their cultural competence on regular basis Chapter 7 Notes Definition of Abnormal  Jerome Wakefield (1990s)  harmful dysfunction theory  consider both scientific (ex. evolutionary) data and the social values in the context of which the behavior takes place  In general, it is personal distress to the individual ( as in severe depression or panic disorder), deviance from cultural norms ( as in many cases of schizophrenia), statistical infrequency ( as in rarer disorders such as dissociative fugue), and impaired social functioning ( as in social phobia and, in a more dangerous way, antisocial personality disorder)  The DSM definition  a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and is associated with present distress (ex. a painful symptom) or disability (ex. impairment in one or more important areas of functioning) or with a significantly increased risk of suffering, death, pain, disability, or an important loss of freedom.  Important to professionals because if a disorder is not listed on the DSM, they would not study it and more people would be diagnosed  Important to clients because the label carries a stigma Before DSM: History  Hippocrates ( 460– 377 BCE)  pointed to an imbalance of bodily fluids ( blood, phlegm, black bile, and yellow bile) as the underlying reason for various forms of mental illness  19th century in in Europe and US  asylums established  Emil Kraepelin (father of current diagnostic system)  labeled specific categories such as manic- depressive psychosis and dementia praecox (roughly equivalent to bipolar disorder and schizophrenia, respectively)  During the late 1800s and early 1900s, the primary purpose of diagnostic categories was the collection of statistical and census data  Mid- 1900s, the U. S. Army and Veterans Administration developed their own early categorization system in an effort to facilitate the diagnosis and treatment of soldiers returning from World War II (with significant impact of the first edition of DSM)  DSM-I (1952) and DSM-II (1968)  contained only three broad categories of disorders: psychoses (today’s schizophrenia), neuroses (mood and anxiety disorders), and character disorders (personality disorders)  were not scientifically or empirically based; with psychoanalytic approach; symptoms were in paragraphs and not listed  DSM-III (1980)  with 265 disorders compared to 182 in DSM-II and 106 in DSM-I o Replied more on empirical research and less on clinical consensus o Had specific diagnostic criteria o Based on different approach and not one single school of thought o Introduction of multiaxial system  DSM-IV (1994)  16 categories; moved some disorders from Axis 2 to 1, leaving only PDs and mental R; took cultural considerations: o Disorder now includes comments on cultural variations (the way a disorder may be expressed differently in different cultures) o A detailed list of culture- bound syndromes o an outline for cultural formulation to facilitate clinicians’ attempts to evaluate and report the importance of the cultural context of an individual who may exhibit mental disorder symptoms (encourages clinicians to include a narrative summary of numerous aspects of a client’s culture)  DSM-IV-TR (2000)  only the text surrounding the diagnostic criteria, not the diagnostic
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