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Quiz 1
Psychologist -
- Term reserved for those who have completed a doctoral training program. (PhD or Psy.D., not MA) Clinical Scientist -
- Strong emphasis on scientific research Practitioner Scholar -
- Strong emphasis on clinical service delivery; less emphasis on scientific training. Common in PsyD programs And the most common model for Ph.D. programs.... - Scientist-Practitioner Model The scientist-practitioner model - is reflected in more clinical psychology training programs than any other model. Internship & Dissertation requirements -
- Almost all graduate programs in clinical psychology require their students to complete a full- time, one-year clinical internship.
- Most APA-accredited programs require that this internship also be one that is APA-approved.
- Dissertation - Research Question
- Literature review, problem statement, research methodology, findings and discussion with applications as well as a critique of the study limits. Professional Regulation - Purpose to protect the public from unauthorized or incompetent practice of psychology
- State Psychology Boards
- Continuing Education requirements (per 2 year licensing cycle)
Certification - limits the title "psychologist" to those who have met certain requirements specified in the law Licensure -
- Professional regulation through laws that define the services a psychologist is authorized to offer Association of State & Provincial Psychology Boards (ASPPB) - coordinates state boards of psychology in order to encourage uniform standards & procedures. (Differences exist however that can make reciprocity difficult) Standardized EPPP national examination - (content knowledge & professional skills0. State board oral examinations. What do Ethics exist in Psychology? Purposes include..... -
- Guide professionals - rules to govern their behavior
- Provide summary of responsibilities to the public (reassuring)
- Protect clients from inadequate services or harm
- Helps protect the professional/profession APA's Ethical Principles of Psychologists and Code of Conduct (Ethics Code) and Ethical Standards of the American Psychological Association -
- Ethical principles describe the highest ideals to which psychologists aspire, and provide guidance to psychologists.
- Legally enforceable, apply to all members of the APA and may be used by other organizations, such as state boards of psychology and the courts to judge and sanction the behavior of a psychologist.
- Describes what is ethical & unethical behavior by psychologists in ten specific domains..... (includes assessment, education & training, Advertising, among others) Main Code of Ethics Themes (Koocher & Keith-Spiegel, 2008) -
- Practice within scope of competence
- Do no harm
- Promote client welfare
- Determine the nature and dimensions of the dilemma:The nature and dimensions of the dilemma are to be analyzed within the context of principle ethics as cited by Kitchener (1984) to include justice, non- maleficence, beneficence, autonomy, and fidelity.
- Generate potential courses of action.
- Consider the potential consequences of all options and determine a course of action.
- Evaluate the selected course of action.
- Implement the course of action. mental status exam - a set of interview questions and observations designed to reveal the degree and nature of a client's abnormal functioning MSE: Appearance -
- "such that a portrait..."
- Eye contact
- Dress and grooming
- Age/appearance MSE: Motor Behavior -
- Freedom of movement
- Firmness and strength of handshake
- Any involuntary or abnormal movements
- Pace of movements
- Purposefulness of movements
- Degrees of agitation MSE: Speech -
- Spontaneity
- Intonation
- Volume
- Defects MSE: Attitudes -
- "degree of cooperativeness"
- Evaluator's attitude MSE: Emotion-> Mood and Affect - Mood
- Patient report versus inference
- Euthymic
- Angry
- Euphoric
- Apathetic
- Dysphoric
- Apprehensive Affect
- Appropriateness
- Intensity
- Mobility
- Range
- Reactivity MSE: Thought-> Process & Content - Process
- Manner of organ./form. thought.
- Stream of Thought
- Goal directedness/Continuity
- Other Abnormalities of Thought Process
Reliability -
- Intellect
- honesty and motivations
- psychosis/organic defects
- magnification/understatement Confidentiality Exceptions - Psychologists may disclose private information without consent when.... -Clear & imminent suicidal or homicidal intent
- Ongoing domestic violence, abuse or neglect of children, the elderly or people with disabilities
- Receive a court order Health Insurance Portability and Accountability Act (HIPAA) - -Rules and Regulations for clinicians in medical settings or those who bill insurance companies
- HIPAA is a Law - contains a privacy rule that creates national standards to protect individuals' medical records and personal health information, including information about psychotherapy and mental health.
- The HIPAA Privacy Rule is designed to be a minimum level of protection
- Confidentiality Other ethical standards -
- state laws
- malpractice litigation State Laws -
- If state laws are more stringent than APA standards, MUST follow state law.
- Most state laws have adopted the decision in Tarasoff, that clinicians have a Duty to Warn, which refers to a duty to breach confidentiality and warn third parties of potential danger from clients Malpractice Litigation -
- State laws govern how clients may sue for negligence of clinician.
- Both state psychology boards and the national APA Ethics Committee consider cases wherein violations are alleged and determine whether punishment is warranted. Positive Psychology -
- The scientific study of human flourishing, and an applied approach to optimal functioning.
- Has been applied to preventing psychological problems before they occur, especially through making social and environmental changes Spirituality -
- Recent research has shown the value of prayer and spirituality in dealing with many problem areas, such as coping with cancer and HIV/Aids and as a protective factor for youth living in harsh environments.
- More research on topics related to spirituality will give clinicians a broader understanding of religious clients' coping resources. Technology -
- Innovations such as virtual-reality-assisted treatments, technology-based assessment and treatment, and
- Neuroimaging will expand the scope of clinical services. Psychological test - - systematic procedure for observing & describing a person's behavior in a standard situation Two Impt. Features of psychological tests: -
- Objective measures of psychological characteristics
- Standardization - same materials & evaluation criteria What 4 factors led to the decline of testing in the late 1960s - 1970s? -
- Poor reliability & validity
- Concern about Bias: discrimination problems
- Privacy concerns
- Results can be misinterpreted & misused
•Norms and internal consistency •Test-retest and interrater Reliability - Consistency or Similarity of results across same person and across multiple raters •Content, convergent, discriminant Validity - Looks at how well the test measures what it is supposed to measure! •Diagnostic or clinical utility - Leads to specific diagnoses or treatments; measures outcome changes reliably. 10 Fallacies in Psychological Assessment - -Mismatched Validity -Confirmation Bias -Unstandardizing Standardized Tests -Ignoring the Effects of Low Base Rates -Misinterpreting Dual High Base Rates -Perfect Conditions Fallacy -Ignoring Effects of Audio-recording, Video-recording or the Presence of Third-party Observers -Financial Bias mismatched validity - Psychometric properties might be adequate for a test in task for a population in a certain context (e.g., reliability, validity, sensitivity, specificity), but might not apply to the evaluee being assessed (e.g., validity) Confirmation bias - a tendency to search for information that supports our preconceptions and to ignore or distort contradictory evidence
Unstandardizing Standardized Tests - When we change the instructions, or the test items themselves, or the way items are administered or scored, we depart from that standardization and our attempts to draw on the actuarial base become questionable. •Clinical Interpretation of Scores - •WAIS, WISC, or SB provide a general measure of intellectual functioning (g or Full-Scale IQ) and amultifaceted description of a person's cognitive strengths and weaknesses. Other Intelligence Tests - •Kaufman Assessment Battery for Children - fluid and crystalized intelligence •Peabody Picture Vocabulary Test, Leiter International Performance Scale, and Raven's Progressive Matrices -assess intellectual functioning in the young and those with impaired verbal ability IQ Tests and Bias - IQ Tests may be reflecting unfairly different education & intellectual opportunities afforded across different racial, ethnic & socioeconomic groups (e.g., lower quality ed, poverty) rather than unfair bias inherent to the tests themselves. (p. 164 in text) Aptitude and Achievement Tests - predict success in an occupation or ed program vs. proficiency at certain tasks Aptitude and Achievement Tests - Tests of Attitudes, Interests, Preferences, and Values - •Strong Interest Inventory (career paths) •Study of Values - General life orientation •Acceptable validity and reliability, good content validity Objective Tests of Psychopathology - •Minnesota Multiphasic Personality Inventory (MMPI-2-RF)**** •Personality Assessment Inventory (PAI) •Millon Clinical Multiaxial Inventory (MCMI-IV) •Eysenck Personality Questionnaire (EPQ-R) (p. 172 Activity)
•Concern for others' welfare - Do no harm! •Social responsibility - Take care with sharing test material; prevent others' misuse of when possible •Limit access to test materials - Protect content New Roles and Goals for Psychological Tests - •Even valid personality and psychopathology tests may not have much clinical utility. •Identify the most important treatment variables and develop tests specifically to measure these. •Tests that have survived decades of scrutiny will continue to be used. •Tests that show unacceptably low levels of reliability, validity, and utility will see diminished use (projective tests). •Psychological tests will become ever more technologically sophisticated. •Testing designed to aid in treatment planning and treatment outcome measurement will flourish. CLINICAL PSYCHOLOGY - The field of Clinical Psychology involves research, teaching and services relevant to the applications of principles, methods, and procedures for understanding, predicting, and alleviating intellectual, emotional, biological, psychological, social and behavioral maladjustment, disability and discomfort, applied to a wide range of client populations. In theory, training, and practice, Clinical Psychology strives to recognize the importance of diversity and strives to understand the roles of gender, culture, ethnicity, race, sexual orientation, and other dimensions of diversity.
- Psychiatrist - medical school (doctorate level), residency, certification
- Psychologist - doctorate degree (Psy.D. or Ph.D.) and licensing
- Clinical Social Work - master's degree and licensing
- Psychiatric Nurse -
- bachelor's degree, RN registration, specialized training
- Marriage & Family Therapist -
- Licensed Professional Counselor -
- Clinical Psychologist -
- School Psychologist -
- Mental Health Counselor -
- Certified Alcohol and Drug Abuse Counselor -
- master's or doctorate degree, as well as specific certification
- Pastoral Counselor - master's degree and ministry experience
- Specialized Therapists (art, music, equine, etc) -
- varies, although a bachelor's degree with certification is generally the minimum requirement
- (19%) Administration
- Supervision
- Consultation - schools, business organizations, sports teams *Clinical research distinction - theory and practice based on evidence vs. subjective impressions and case study evidence. Clinical Psychologist should base practice decisions on - a combo of best available scientific evidence, personal judgment and experience, and the clients' characteristics, preferences and needs! Scientific evidence - Depends on the quality of research designs (internal validity) and the applicability of the evidence (external validity) Internal Validity - •Conclusions are warranted Controls extraneous variables - •Eliminates alternative explanations
- Focus on accuracy and strong research methods External Validity - •Findings can be generalized
- Results apply to the world at large & can be translated to another context Outcomes apply to practical situations Scientist Practitioner Model (Boulder model) -
- emphasizes preparation for clinical research over clinical practice
- The scientist-practitioner model is also known as the Boulder Model, after the 1949 Boulder Conference on Graduate Education in Clinical Psychology in which it was first created. Scientist- practitioner programs train students in both science and practice. Students earn Ph.D.s and learn how to design and conduct research, but they also learn how to apply research findings and practice as psychologists. Graduates have careers in academia and practice. Some work as researchers and
professors. Others work in practice settings, such as hospitals, mental health facilities, and private practice. Some do both.
- The scientist model emphasizes training students for research. Students earn a Ph.D., a doctor of philosophy, which is a research degree. Like other science Ph.Ds., clinical and counseling psychologists trained in scientist programs focus on conducting research. They learn how to ask and answer questions through conducting carefully designed research. Graduates of this model get jobs as researchers and college professors. Students in scientist programs are not trained in practice and, unless they seek additional training after graduation, they are not eligible to practice psychology as therapists. Practitioner-Scholar Model (Vail model) - •emphasizes preparation for clinical services over clinical research
- The practitioner-scholar model is also referred to as the Vail model, after the 1973 Vail Conference on Professional Training in Psychology, when it was first articulated. The practitioner-scholar model is a professional doctoral degree that trains students for clinical practice. Most students earn Psy.D. (doctor of psychology) degrees. Students learn how to understand and apply scholarly findings to practice. They are trained to be consumers of research. Graduates work in practice settings in hospitals, mental health facilities, and private practice Clinical science model -
- All study based on scientific evidence Mental health parity - legal requirement that health insurers cover treatment for psychological disorders to the same extent as for physical disorders Managed Health Care considerations -
- Access Issues
- Managed care systems primarily use business principles to make treatment decisions -Mental health parity Biological Approach -
- Biopsychologists look at how your nervous system, hormones and genetic makeup affect your behavior. Biological psychologists explore the connection between your mental states and your brain, nerves and hormones to explore how your thoughts, moods and actions are shaped.
- you are the sum of your parts. You think the way you do because of the way your brain is built and because of your body's needs. All of your choices are based on your physical body. The biological
- Humanistic psychologists believe that you're essentially good and that you're motivated to realize your full potential. Psychologists from this camp focus on how you can feel good about yourself by fulfilling your needs and goals. The prominent humanistic psychologist Carl Rogers called his patients 'clients' and offered a supportive environment in which clients could gain insight into their own feelings.
- In contrast to the behavioral approach, the humanistic approach works on individual empowerment. Whether you are right or not, in a larger sense, you are motivated to be the best person you can be. All your choices come from trying to improve your life. So, if you're trying to cut back on your nightly wine consumption, a humanistic therapist would be encouraging and supportive but won't directly advise you to quit or try to analyze why you drink in the first place. Interviews and observations are central - •to clinical assessment and play prominent roles in psychological treatment. •Essential to diagnosis and treatment planning. Intake Interviews: 3 main assessment areas... -
- presenting problem - identify and explore the main complaint,
- psychosocial history - personal history (, 3) current situation and functioning Intake Interviews - •May be gathered in a variety of ways ranging from unstructured to very formal/structured. •Goals include gather info needed to create a case formulation and treatment plan, building rapport, and increasing commitment to treatment. •Should answer the referral question and help clinician decide whether this is the right place for the client or not (refer out?) •Table 3.6, p. 96 Basic intake report outline •My intake guide Basic intake report outline - presenting problem: -nature of problem -history -specific problematic situations
-cognitive factors -dimensions of problem -consequences of problem Other problems:
- assertiveness
- forgetfulness Personal strengths Targets for treatment Recommended treatment approach motivation for treatment prognosis priority for treatment clients expectancies Mental status examinations - Often part of the intake interview; can stand alone in various medical settings (e.g, inpatient unit) wherein the symptom related data collected is used to communicate info to colleagues. Common MSE domains: - Appearance, Behavior/Psychomotor activity, Attitude toward examiner, Affect & Mood, Speech & Thought, Perceptual disturbances, Speech & Orientation, Memory & Intelligence, Reliability, judgment & insight Ethical and Cultural Issues in Clinical Interviews - •Required sensitivity to differing racial, ethnic and cultural backgrounds •Members of racial and ethnic minority groups generally receive less mental health care and lower- quality mental health care than does the general population.
•Clinicians need to be trained in cultural sensitivity and competence. •Need awareness of cultural variations across populations
