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What is clinical psychology?
- Involves research, teaching, and services relevant to application of principles, methods, and procedures
- Helps understand, predict, and alleviate intellectual, emotional, biological, psychological, social, and behavioral maladjustment, disability, and discomfort
- Applied to a wide range of client populations
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Traits: Of clinical Psych
- Clinical attitude: be able to combine knowledge from research on human behavior and mental processes with effort on human assessment in order to understand and help a particular person
- Emotionally stable
- Compassionate
- Intellectually curious about what makes humans tick
- Trustworthy (has integrity)
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Legal/Educational for Clinical Psychologist
- Have a doctoral degree from an APA accredited institution
- Be licensed by state/national agencies (limited vs. full)
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Mental Health Parity and Addiction Act
- requires that health insurers provide the same level of coverage for mental illness as they do for physical illness (2008)
- Pros: more people get care
- Cons: need diagnosis, insurance companies and treatment decide what you get, providers get paid lower rate
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Managed Care
- a set contract between insurance and providers that gives providers a set rate
- Lower than it should be
- Group practices: practicing in a suite with multiple clinicians to help pay the rent
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What is the empirical, psychometric and clinical tradition? How did it influence clinical psychology?
- Empiricism: gaining knowledge by means of direct and indirect observation and experience
- Empirical Tradition: Wilhem Wundt
- “Father of experimental psych”
- 1879- set up first lab devoted to studying mental processes in Germany by doing experiments
- Psychometrics: practice of measuring people’s physical and mental abilities
- Because clinical psych deals with the individual, it couldn’t appear as a discipline until differences among humans were identified and systematically measured
- Psychometrics: Franz Gall
- German anatomist
- Thought he saw a relationship between people’s mental characteristics and shapes of their heads
- Phrenology: each area of the brain associated with a different function (ex. Self-esteem, language)
- Clinical tradition: trying to explain and treat behavior that is bizarre/irrational
- Early explanations=magical forces, possessed by demons (1500s-1600s)
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Trephination
drilling holes in the skull to release evil spirits
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Exorcism:
expelling demons from possessed with rituals
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Exorcism : Clinical-
- Clinical: Sigmund Freud
- Proposed the first stage of a theory in which behavior disorders were seen not as the result of organic (medical) problems
- Psychoanalysis: reconciling once-unconscious urges/desires with demands of life
- **First person to treat in an office**
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Empirical vs. Psychometric vs. Clinical
- Empirical=testing, hypotheses, collecting data, making a diagnosis
- Psychometric=individual differences--how are we different? What is the norm?
- Clinical=try to understand and treat behavior
- Understanding that we can treat conditions
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IQ Testing
- First practical intelligence test created by Alfred Binet
- Helped to determine school placement
- IQ tests were given for 2 main reasons--war and special education placement
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What is a DSM Disorder
- Symptoms of mental illness covaried together that result in different syndromes
- Interfere with routine and way of life
- Emil Kraeplin--cluster of symptoms=diagnosis/classification
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Difference Between DSM-I and DSM-II
- DSM-I and DSM-II are based on psychoanalysis and inferred causes of disorders/symptoms
- DSM-5 got rid of multi-axial system and added Substance Use Disorder and Autism Spectrum Disorder
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Steps in Assessment Process
- Receive/clarify referral question
- Plan data collection procedures
- Collect assessment data
- Process data and form conclusions
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Goals of Clinical Assessment
- Diagnosis
- Description of behavior (strengths, weaknesses, etc.)
- Treatment planning (affected by personality, culture, circumstances)
- Prediction (prognosis, dangerousness, and future performance)
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Reliability and Validity
- Test-retest reliability: similar score across time
- Inter-rater reliability: similar score across raters
- Internal consistency: odd and even questionnaire items give you a similar score
- Standardization: test creators have given it to a large, representative sample of persons and analyzed the scores
- They put the scores on the same scale for everyone – that way you can compare your client’s scores to other people’s given their age, gender, etc.
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Types of interviews
- Intake
- establish nature of problem, figure out if the person has come to the right place
- Many include mental status examination (MSE); a planned sequence of questions designed to assess basic mental functioning in a number of areas
- Problem-referral: goal is to address the referral questions; clinicians serve as diagnostic consultants to physicians, psychiatrists, courts, schools, employers
- Orientation: explain to clients what to expect and what is expected of them, especially when they’re new to the process
- Encourage clients to ask questions
- Correct misconceptions about therapy
- Ex. explaining what CBT is and that the client will have to do homework, etc.
- Debriefing/Termination:
- Debriefing:
- Helping client experiencing a specific event better understand it
- Explaining assessment results to the client, including summary and interpretation
- Termination:
- Wrapping up therapy
- Reviewing progress client has made
- Creating closure
- Crisis: within a short time frame…
- Provide support/assistance
- Collect assessment data
- **work on the immediate problem**
- Put client in touch with other services if needed
- Often related to life-threatening situations (ex. Natural disasters, sexual assault, other criminal victimizations, suicidal/homicidal intent, death of loved one, divorce)
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Mini-Mental State Examination (MMSE)
- A planned sequence of questions designed to assess basic mental functioning in a number of areas
- Done during intake interview
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Semi-Structured Interview
- Assessment of specific conditions or situations
- Gives interviewer flexibility in:
- Wording questions
- Interpreting answers
- Guiding decisions about what to address next
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Structured Interview
- Series of specific questions phrased in a standardized fashion and presented in established order
- Used to make an accurate diagnosis
- **involve decision trees**
- Pros:
- Less prone to information variance (if two clinicians ask a question differently, they might get two different answers from the same client)
- Less prone to criterion variance (disagreements that occur when clinicians apply different standards to the same set of client answers)
- Cons:
- Protocol-bound
- Depends on degree of memory, openness, and descriptiveness of clients
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Who were the early pioneers?
- Empirical Tradition: Lightner Witmer
- Credited as the “founder of clinical psych”
- Made psych clinically useful
- Worked with James McKeen Cattell to study individual differences in reaction time at U Penn
- Wundt’s assistant for a year in Germany
- Taught child psych classes
- Founded first psych clinic at U Penn (1896) to help kids with learning/behavior problems
- Chronic Bad Speller: assessed problem and tried to help him improve; emphasized prevention of future problems by early diagnosis and immediate treatment; argued that clinical psych should be based on experimental psych principles
- Psychometrics: Sir Francis Galton
- British founder of eugenics
- Improving genetic quality of human population
- Influenced by Charles Darwin
- Argued that intelligence is genetically determined, not environmentally
- Intelligence tests used to make sure potential soldiers were intellectually sound enough to fight in war
- Psychometrics: James McKeen Cattell
- First psych professor in the US
- Tested simple mental processes
- Chose 10 tests that reflected then-prevalent tendency to use sensorimotor functioning as an index of mental capacity
- Sensorimotor mental tests=adopted at universities but also criticized because of their low correlations with most other mental ability criteria
- Psychometrics: Alfred Binet
- Created first practical intelligence test
- Believed intelligence is learned
- Binet-Simon scale made up of various tasks representative of children’s abilities at different ages
- Help to determine school placement
- Scores determined whether “mental age” based on tests was greater than, the same as, or less than chronological age
- **IQ tests were given for 2 main reasons--war and special education placement
- Psychometrics: Emil Kraepelin
- Classification of mental disorders
- Schizophrenia vs. Manic Depressive Disorders
- Examined how symptoms of mental illness covaried together, resulting in different syndromes (disorder
- Humanistic: Carl Rogers
- People have an innate motive toward growth called the actualizing tendency
- A person’s experiences are evaluated as positive or negative by themselves, but this perception is influenced by others
- Condition of worth: regard that is conditional (love, acceptance, etc.)
- Behavioral Approach: Mary Cover Jones
- Pioneer of behavior therapy
- Grew out of empirical tradition of classical/operant conditioning
- Focus is changing observable behavior through reinforcement
- Developed desensitization=repeated viewing of fear-inducing stimuli until phobia decreases
- Cured “Little Peter” of his fear of rabbits using desensitization paired with reward
- Cognitive Approach: Aaron Beck and Albert Ellis
- Thoughts important for development of disorders
- Modify irrational, unrealistic cognitions to reduce distress and maladaptive behaviors
- Cognitive Triad of Depression (Beck): negative views about self, world, and future
- Starting in the 1960s, many cognitivists and behaviorists joined forces to create CBT
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What are the basic assumptions underlying the psychodynamic, humanistic, behavioral, cognitive, biological, and systems approach (theory)?
- Psychodynamic
- Relationships are key to self-development (ego)
- Id, ego, and superego
- Humanistic
- People have an innate motive toward growth called the actualizing tendency
- It’s about current perceptions, not past one
- Show clients unconditional positive regard in therapy to help them grow towards authentic self
- Behavioral
- Focus is changing observable behavior through reinforcements
- Desensitization: repeated viewing of fear-inducing stimuli until phobia decreases
- Cognitive
- Thoughts are important for development in disorders
- Cognitive Triad of Depression
- Modify irrational, unrealistic cognitions to reduce distress and maladaptive behaviors
- Biological
- Diathesis stress model: biological defect and environment
- Vulnerability
- Systems
- Human behavior develops through social context
- Interlocking patterns (family dynamics)
- Therapists attempt to influence and change specific patterns
- **people become distressed due to what they go through in life
- **how society affects the client
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Psychodynamic
- Relationships are key to self-development (ego)
- Id, ego, and superego
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Humanistic
- People have an innate motive toward growth called the actualizing tendency
- It’s about current perceptions, not past one
- Show clients unconditional positive regard in therapy to help them grow towards authentic self
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Behavioral
- Focus is changing observable behavior through reinforcements
- Desensitization: repeated viewing of fear-inducing stimuli until phobia decreases
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Cognitive
- Thoughts are important for development in disorders
- Cognitive Triad of Depression
- Modify irrational, unrealistic cognitions to reduce distress and maladaptive behaviors
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Biological
- Diathesis stress model: biological defect and environment
- Vulnerability
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Systems
- Human behavior develops through social context
- Interlocking patterns (family dynamics)
- Therapists attempt to influence and change specific patterns
- **people become distressed due to what they go through in life
- **how society affects the client
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