Careers in Clinical Psychology: Licensing and Ethical Considerations, Exams of Nursing

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Exam 1 Intro to Clinical & Counseling

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Clinical Psychology - correct answer ✔✔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. Clinical Psychologist - correct answer ✔✔-PhD or PsyD -4 years+1 predoc+1-2 postdoc

• About 3,000 awarded each year
• Many specialty tracks, e.g. clinical child, clinical health, forensic, family, clinical neuropsychology -Assessments, diagnosis, psychotherapy, teaching, supervision, research Counseling Psychologist - correct answer ✔✔- Typically PhD
• Tend to work with less seriously disturbed populations in locations such as university counseling centers
• After eclectic orientation, prefer humanistic/client-centered approaches to behaviorism Psychiatrist - correct answer ✔✔- Medical Dr.
• Prescribe medication, do not conduct therapy
• See disorders primarily as physiological abnormalities of the brain -Emphasize biology & physiology as root of disorders. LMFT (Licensed Marriage and Family Therapist) - correct answer ✔✔- Master's degree
• Focus on relationships, work mainly with couples and families
• Can work in private practice, clinics, agencies

• Less emphasis on research/assessment -Board of behavioral science license. LCSW (Licensed Clinical Social Worker) - correct answer ✔✔- Master's degree
• Focused on social factors (e.g. racism, poverty), help connect clients with resources
• Often work within systems of care -Can be clinician LPCC (Licensed Professional Clinical Counselor) - correct answer ✔✔- Master's degree from program in counseling or professional counseling
• Focused on individual adults, not children/couples/families/etc.
• Counsel people with mild problems such as personal growth, adjustment to disability, crisis intervention, psychosocial and environmental problems Licensed Professional Counselor (LPC) - correct answer ✔✔-Masters degree -Less severe diagnosis -Help with career, education, family, addiction, couples. Licensed Educational Psychologists. School Psychologists - correct answer ✔✔- Master's degree, usually within the school of education
• Work in schools (mainly), day-care centers, correctional facilities
• Do educational evaluation, identifying special needs, developing treatment programs, etc. (all related to education) Psych Tech - correct answer ✔✔- Programs typically offered through community college, 1-2 years
• Carrying out medical orders of psychiatrists -- medication administration
• Work in hospitals, psychiatric hospitals, state/prison hospitals Nurse Practitioners and Physicians Assistants - correct answer ✔✔- Work under psychiatrists and focus their practice on psychotropic medication

Boulder Model - correct answer ✔✔- Scientist-practitioner model (PhD) 1949.

• Joint emphasis on practice/clinical and science/empirical research
• Many programs in US, but small cohort (hard to get in)
• Smaller classes, more funding, better placement into internships Vail Model - correct answer ✔✔- Practitioner-scholar model (PsyD) 1973
• Emphasis on practice/clinical, fewer courses on research
• Fewer programs, but more graduates (more in each program)
• Less competitive, more expensive, larger classes Clinical Scientist Model - correct answer ✔✔- PhD Early 1990s.
• Strong emphasis on scientific method and evidence-based clinical methods
• Tend to train researchers, not clinicians
• Minority of graduate programs follow this model Timeline for Doctoral Program - correct answer ✔✔4 years coursework including thesis/dissertation → 1 year predoctoral internship → get degree → 1-2 years postdoctoral internship → licensing exams Predoctoral Internship - correct answer ✔✔- Full year of supervised clinical experience in applied setting
• Transition between roles of "student" and "professional"
• Must apply to internships, similar to grad school Postdoctoral Internship - correct answer ✔✔- 1-2 years of supervised experience, but with more responsibilities, that occurs before licensing exams Licensing to Practice Requirements - correct answer ✔✔- Need to do 3,000 supervised hours
• Have to take Examination for Professional Practice in Psychology (EPPP) and state-specific laws and ethics exam
• Many states require continuing education units (CEUs) to renew license

Who can prescribe? - correct answer ✔✔- Historically, psychiatrists and other doctors have prescription privileges

• Some clinical psychologists are pursuing prescription privileges (prescription privilege movement), including prominent figures
• Some states have granted this right (with training), including New Mexico (2002), Louisiana (2004), Illinois (2014) What is the percentage of GPs vs Psychiatrists who prescribe? - correct answer ✔✔- About 80% of prescriptions written for psychoactive medications come from GPs Pros of Clinical Psychologists gaining prescription privileges - correct answer ✔✔- Shortage of psychiatrists, especially in rural areas
• Clinical psychologists are more experts in mental health issues than primary care physicians, who can prescribe psychoactive medications
• Other non-physician professionals already have prescription privileges, such as dentists, podiatrists, optometrists, and advanced practice nurses
• E.g. dentist prescribing anti-anxiety medication to take before appointment
• Convenience for clients
• Professional autonomy -- ability to provide wide range of services
• Professional identification as distinct from counselors
• Evolution of the profession -- many see this as next logical step
• Revenue for the profession -- potential for increased income Cons of Clinical Psychologists gaining prescription privileges - correct answer ✔✔- Training issues -- what education/training should be required, and what would the logistics be?
• Threats to psychotherapy -- drifting away from "talk therapy" and towards medication only
• Identity confusion, especially when only some clinical psychologists prescribe
• Potential influence of the pharmaceutical industry Evidence Based Practice - correct answer ✔✔The integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences.

Advantages of Evidence-Based Practice - correct answer ✔✔- Scientific legitimacy

• Establishing minimal levels of competence, greater standard of accountability for the profession overall
• Training improvements -- incorporating more evidence-based therapies into graduate programs
• Decreased reliance on clinical judgment, which can be susceptible to bias Disadvantages of Evidence-Based Practice - correct answer ✔✔- Threats to the psychotherapy relationship
• Diagnostic complications -- real people are not textbook cases of a disorder
• Comorbidities
• Research is extremely white, often on college campuses
• Restrictions on practice
• Flexible application of manuals may be best
• Debatable criteria for empirical evidence -- what defines a technique as evidence-based Critiques of the DSM - correct answer ✔✔- Number of people with mental disorders has grown
• Some believe that many of today's disorders actually describe normal life experiences, especially in DSM-5 (2013)
• May threaten validity of "mental disorders" concept
• Unneeded diagnoses can lead to:
• Overprescribed medications with harmful side effects
• Unnecessary therapy that undermines personal coping skills and takes resources away from others
• Hit to self-image/self-esteem because of stigma
• Influence on health insurance
• Influence on how a court of law views the person in terms of guilt regarding a crime, suitability for child custody, etc. How do third-party payers influence the practice of care? Effects on therapy - correct answer ✔✔- Negative impact -Too little control over clinical decisions

-Ethical problems, confidentiality -Confusion about informed consent -Greater affordability How do third-party payers influence the practice of care? Effects on a diagnosis - correct answer ✔✔- Increase likelihood of being diagnosed -Some criteria being used less or more How do third-party payers influence the practice of care? Effects on psychologists' experience & clients - correct answer ✔✔-Lower pay -More paperwork/billing and time required -Frustration due to denial of care that psychologists believe necessary.

• If Affordable Care Act gets repealed and preexisting conditions are no longer protected, people with extreme diagnoses may be denied future care/have to pay more What is cybertherapy? - correct answer ✔✔- Cybertherapy: using technology in the direct delivery of psychological services. Benefits of cybertherapy - correct answer ✔✔- Accessibility -Affordability -Appears to work as well as face to face therapy. Ethical issues to cybertherapy - correct answer ✔✔- Level of confidentiality
• Hacking, access to passwords, location therapy occurs
• Crisis situations -- must have knowledge about emergency resources, e.g. for suicide, psychosis
• Laws and guidelines on telehealth and telemedicine, including those related to practicing across state lines
• Confirming the identity of the client
• Making interpretations in the absence of nonverbal cues that would be present face-to-face
• Competence in technical as well as clinical skills

Demographics in US - correct answer ✔✔- Cultural diversity in the US has increased dramatically in the last few decades

• 20% of US schoolchildren speak a language other than English at home
• In Miami, Detroit, and Washington DC, a single ethnic minority group represents over half of the population Demographics of California LMFT - correct answer ✔✔In California, about 80% of LMFTs are white "Major Forces" in Clinical Psychology - correct answer ✔✔1. Psychoanalysis
  2. Behaviorism
  3. Humanism/person-centered psychology
  4. Multiculturalism Multicultural Counseling Competence - correct answer ✔✔Counselor's acquisition of awareness, knowledge, and skills needed to function in pluralistic democratic society Multicultural Counseling Competence: Awareness - correct answer ✔✔-Learning about own culture, values, assumptions, & biases -Explore personal reactions to differences Multicultural Counseling Competence: Knowledge - correct answer ✔✔-Acknowledge differences -No assumptions
• Psychologist should know as much as possible about client's culture, including both current lifestyle and history (including social and political issues)
• Acknowledge cultural differences
• Should not assume every individual has all the typical features of their cultural group Multicultural Counseling Competence: Clinical Skills - correct answer ✔✔- Approaches and techniques should be consistent with values/experiences of client
• Therapists should be sure to not use microaggressions

• Use cultural adaptation of treatments
• Keep language effects in mind and be aware of other resources, including therapists who speak other languages, and refer clients when appropriate
• Important to have cultural humility and realize that we are not experts on others' experiences Homogeneity - correct answer ✔✔Every member of a group is the same Heterogeneity - correct answer ✔✔-Every member of a group is different
• Should not assume every individual has all the typical features of their cultural group
• There is heterogeneity in all cultures Four parts of acculturation - correct answer ✔✔- Assimilation: high new culture low original culture
• Separation: low new high original
• Marginalization: low new and original
• Integration (bicultural): high new and original Etic - correct answer ✔✔Etic perspective emphasizes similarities between all people
• Assumes universality, downplays culture-based differences
• More dominant in early psychology when most people involved in the discipline were European males of middle- or higher class Emic - correct answer ✔✔Emic perspective recognizes and emphasizes culture-specific norms Tripartite Model - correct answer ✔✔Three-Level Model -- Individual level: all individuals are, in some respects, like no other individuals
• Group level: all individuals are, in some respects, like some other individuals
• Universal level: all individuals are, in some respects, like all other individuals Dates of APA Code of Ethics and Current Revision - correct answer ✔✔- APA published first code of ethics in 1953, most recent published in 2002

• Amendments in 2010 and 2016 Sections of the Ethical Standards. - correct answer ✔✔Enforceable Rules
• Resolving ethical issues
• Competence
• Human relations
• Privacy and confidentiality
• Advertising and other public statements
• Record keeping and fees
• Education and training
• Research and publication
• Assessment
• Therapy Ethical Principles - correct answer ✔✔Rules to strive for -Beneficence & non Maleficence -Fidelity and responsibility -Integrity -Justice -Respect for people's rights & dignity Fisher's ethical - correct answer ✔✔ 2017

1. Make commitment to acting ethically
2. Be familiar with APA ethical code
3. Consult relevant law and/or professional guidelines
4. Understand the perspectives of those affected by your actions a. Consult with colleagues and/or lawyers if needed
5. Generate and evaluate alternatives
6. Choose course of action that seems most ethically appropriate

7. Monitor and evaluate effectiveness of your course of action
8. Modify and continue to evaluate ethical plan as necessary Confidentiality - correct answer ✔✔- The public trusts psychologists to provide professional services without sharing private/personal details

• There are situations where psychologists are obligated to break confidentiality.
• Including any harm to minors, harm to self, harm to others Suspected Child Abuse Report (SCAR) - correct answer ✔✔-Immediate telephone report -Follow up w/written report w/in 36 hours. Informed Consent - correct answer ✔✔- Required for research, assessment, therapy, and other professional activities.
• For research, informed consent should include purpose, procedures, length of time, risks, incentives, right to decline/withdraw Informed Consent. Research - correct answer ✔✔- For research, informed consent should include purpose, procedures, length of time, risks, incentives, right to decline/withdraw Informed Consent. Assessments & Therapy - correct answer ✔✔- For assessment and therapy, informed consent should include nature and purpose of assessment/treatment, fees, involvement of other parties, limits of confidentiality
• Informed consent to therapy may be more of an ongoing process than informed consent for research or assessment
• Should send them ahead of time and go over in first 10 minutes of first appt
• Should always give client/patient opportunity to ask questions Competent - correct answer ✔✔Sufficiently capable, skilled, experienced, and expert to complete professional tasks Psychologists Competence - correct answer ✔✔- Psychologists should only work within boundaries of competence based on education, training, experience, cultural competence, etc.

• Burnout can impair competence
• Burnout can be minimized by balanced and healthy lifestyle
• Psychologists' personal problems can lessen their competence
• Clinical psychologists are vulnerable to burnout Issues of Multiple Relationships - correct answer ✔✔- Multiple relationships: psychologist currently in or promising to be in non-professional role with a client or client's close friend/relative
• Romantic/sexual, friendship, business, work, religious, etc.
• Therapist-client relationship is characterized by unequal power