Chapter 1: Introduction and the Evolution of Clinical Psychology

Question 1

Evidence-Based Practice

Answer 1

a practice model that involves the synthesis of information drawn from research and systematically collected data on the patient in question, the clinician’s professional experience, and the patient’s preferences when considering heath care options

Question 2

Counselling Psychologists

Answer 2

traditionally, counselling psychologists were most commonly found in educational settings, such as university clinics

Question 3

School Psychologists

Answer 3

school psychologists now take into account the social, emotional, and physical influences on student’s learning and development

Question 4

Psychiatric Services

Answer 4

psychiatric services often emphasize both psychopharmacological and psychological treatments

Question 5

Psychiatric Nurses

Answer 5

psychiatric nurses often provide direct services, such as home care

Question 6

Biopsychosocial Approach

Answer 6

a theoretical framework that takes into account biological, psychological, and social influences on health and illness

Question 7

Wilhelm Wundt

Answer 7

established the first psychology laboratory

Question 8

Syndrome

Answer 8

group of symptoms that frequently co-occur

Question 9

Clinical Utility

Answer 9

usefulness of assessment data to provide information that leads to a clinical outcome (or faster or less expensive) then would be the case if the psychologist did not have the assessment data

Question 10

Service Evaluation

Answer 10

activities designed to examine whether or not services work

Question 11

Meta-analysis

Answer 11

a review technique by which groups of studies are statistically combined and compared

Question 12

Efficacy

Answer 12

evidence that a treatment has been shown to work under research conditions that emphasized internal validity

Question 13

Effectiveness

Answer 13

evidence that a treatment has been shown to work in real-world conditions

Question 14

What is clinical psychology?

Answer 14

the application of psychological principles and theories of the assessment and treatment of conditions which compromise the functioning, comfort, safety, and stability of individuals and/or (usually small) groups

Question 15

How prevalent are mental health conditions?

Answer 15

about half of mental disorders begin before age 14

877,000 individuals commit suicide yearly

16 to 11% of individuals presenting to hospital emergency units do so for reasons reflecting mental disorders

despite our best efforts, there is still great stigma associated with the pursuit of mental health care

mental health services are not equally available to all members of society

mental disorders are far from uncommon, have the potential to be severely debilitating, cause both personal and social disruption

they are less frequently addressed than physical disorders, and access to qualified professionals can be limited

Question 16

What practice like before evidence-based practice?

Answer 16

previously, practice was largely predicted on theory and experience

this can be dangerous given that clinicians, despite their level of experience, can be frankly incorrect in their understanding of patient needs and presenting concerns

Question 17

What are the four criteria for psychological services outlined by McFall (1991)?

Answer 17

1: the exact nature of the service must be described clearly
2: the claimed benefits of the service must be stated explicitly
3: the claimed benefits must be validated scientifically
4: possible side effects that might outweigh any benefits must be ruled out emperically

McFall was strongly of the opinion that it is not only unsound scientifically, but also unethical to deliver services in the absence of these conditions

Question 18

What are the arguments against evidence-based practice?

Answer 18

research findings reflect the group results may or may not be useful to a certain individual

it takes considerable time to translate research findings into practical therapeutic interventions; it is inappropriate to ignore the immediate distress and concerns of clients while waiting for rigorous research to unfold in some cases

findings reflecting broad psychological principles are unlikely to be of assistance in dealing with unique individuals in particular combinations of circumstance

there are many psychological disorders for which there is no evidence-based research, and we cannot ignore individuals struggling with those issues

Question 19

What professional group do Canadians consult for mental health issues?

Answer 19

according to the Canadian Community Health Survey (2002), Canadians consult their primary care physicians more than any other professional group

psychologists and psychiatrists are second from the bottom, ahead only of self-help groups

most respondents reported they prefer to consult chiropractors, acupuncturists, and dieticians over specialists

Question 20

What are counselling psychologists?

Answer 20

used to do less work with more severe psychopathology and more with day-to-day adaptive functioning and challenges such as uncomplicated grief, adjustment, lifestage issues, etc.

not a huge difference between clinical psychologists

can be deceptive because symptom severity waxes and wanes

grad programs are often jointly clinical/counselling

have to meet the same registration criteria in both cases

specialty registers in Canada are relatively rare, and psychology is a self-governing profession (only recognizes psychiatry and psychologist, while you can specialize it is not protected)

distinction diminishing on both sides

Question 21

What are school/educational psychologists?

Answer 21

focus is on diagnosing learning disabilities/giftedness and optimizing learning

distinct from guidance counselors who tend to focus on emotional/behavioral issues, but smaller school systems often expect school psychologists to do both

Question 22

What are psychiatrists?

Answer 22

medical doctors with specialized training in the diagnosis and treatment of mental disorders

compared to psychologists, tend to have limited training in non-drug therapies, research methods, personality, development, cognition, stats, learning processes

heavy emphasis on pharmacotherapy

training programs are getting better at emphasizing evidence-based approaches

outnumber psychologists in Australia and the UK, but not in North America

Question 23

What are (clinical) social workers?

Answer 23

tend to have excellent knowledge of resources, school systems, and community services providers

very helpful with case management, discharge planning, advocacy, program planning and implementation

have training in individual, couples, family, and group counselling

less emphasis on direct treatment of more severe psychopathology

Question 24

What are psychiatric nurses?

Answer 24

RN (4 year degree) or RPN (usually 2 year diploma)

often found in hospital settings working under the authority of a psychiatrist

emphasis is usually on serving inpatients on psychotropics

have training in basic counseling skills; some gain considerably more

Question 25

What are marriage and family therapists?

Answer 25

no regulatory bodies in most Canadian jurisdictions at present; may be registered (sometimes) under another provincial body such as CAP or ACSW

establishing eligibility can be highly problematic

some graduate programs operate Canadian satellite campuses; often criticized for lack of core faculty and on-site training facilities

some will come under CAP next year

Question 26

What are counselling therapists?

Answer 26

Alberta government announced that this new designation will be under the auspices of CAP

separate from psychologists

likely to be about a year from now

minimum of a masters degree in a counselling field

Question 27

What are psychological/clinical associates?

Answer 27

Ontario and BC allow individuals with masters level training in psychology to register, but not as full psychologists

they have a similar scope of practice but can’t use the title

Question 28

What are psychological assistants?

Answer 28

no longer a regulated group in Alberta

used to require registration in Alberta; this ended with HPA because they were no longer governed by CAP

must work under the supervision of a registered psychologist, who is ten responsible for their work

Question 29

What are the historical roots of psychological treatment?

Answer 29

demons, witchcraft, lunar phases, or other paranormal phenomena (treatment: exorcism, torture)

crude physical explanations: black bile, yellow bile, blood, phlegm imbalances (treatment: isolation/chaining to bed, ice bath, blood draining by leeches or incisions)
if they were effective at calming patients it was probably due to fear/punishment effects

a number of asylums, e.g., Bedlam, were established, but treatment of patients was atrocious (torture under modern standards)

Question 30

What was Vincent de Paul (1500s) idea of natural forces?

Answer 30

advocated for reform and pursuit of scientific understanding of mental illness

fluid dynamics: exchange of energy

Question 31

What was the treatment of mental illness in the Enlightenment (late 1700s)?

Answer 31

prevailing notion was that the scientific method could be applied to the understanding of mental disorders

different factors influence people differently

Question 32

What is the biopsychosocial model of psychopathology?

Answer 32

understanding that social, physical and psychological factors all combine interactively in the expression of mental disorders

Question 33

Who was Philippe Pinel?

Answer 33

ordered that asylum inmates be unchained and not treated so brutally

Question 34

Who was William Tuke?

Answer 34

argued that mental patients should be hospitalized and cared for according in the same spirit that physically ill patients were

Question 35

Who was Benjamin Rush?

Answer 35

“moral therapy”

compassion replacing harshness and chaining

father of modern psychology

Question 36

What are the main branches of clinical psychology?

Answer 36

1. assessment
2. interventions (treatment)
3. prevention

various authorities differ on the basis of specificity

Question 37

What is the College of Alberta Psychologists (CAP)?

Answer 37

is the body responsible for licensing and regulating the practice in the province

Question 38

What is assessment?

Answer 38

first domain of clinical psychology

grew from systematic investigations of basic psychological processes such as sensation

a systematic documentation and survey of how the patient is functioning

Question 39

What was Emil Kraepelin’s idea of assessment?

Answer 39

mental disorders based on biological factors

recognized that they may be subtle and not with the grasp of medicine then; so subtle that even if we can detect them we can’t translate that to treatment

realized that systematic documentation and classification would advance the field significantly; large groups of similar patients could provide insight as to origins and treatment of mental illness

syndromes: based on system clusters, we still use this approach

Question 40

What is the difference between a sign and a symptom?

Answer 40

symptom: observable to person experiencing it

sign: observable to people outside

Question 41

How is intelligence testing related to psychological testing?

Answer 41

intellectual testing has continued to refine and is a pillar of modern psychological assessment

tests are now available for a broad range of attributes, abilities, interest, and other constructs

Question 42

What was Alfred Binet’s idea of assessment?

Answer 42

early 1900s: measurement of intellectual ability to hone teaching method and optimize outcomes

norm-based testing: compared to a large group of people

if you can find what they are good at you can teach them

Question 43

What was intellectual assessment in WWI?

Answer 43

Army Alpha (literate) and Beta (illiterate) tests

used to assess the intellectual abilities of recruits

identified candidates for officer’s training

group administered and norm-based

Question 44

What are non-normed tests?

Answer 44

non-normed tests, such as projectives also continue to grow but not at the same rate

involve taking things that are intrinsic and projecting that onto something physical

originally mostly for personality; now there are non-projectives for personality assessment as well

low level of inter-rater reliability, lots of subjectivity

automated projective scoring schemes (e.g. Exner

Question 45

What are the different approaches that psychiatry and clinical psychology take to assessment?

Answer 45

psychiatry, based in medical tradition, has historically gravitated toward a discrete, categorical conceptualization of mental illness; either you have it or you don’t

clinical psychology, owing to its strong psychometric tradition, has adopted more a dimensional approach

Question 46

Why is standardization of mental conditions important to assessment?

Answer 46

it was long recognized that some way of standardizing the description of various mental illness was necessary to promote research and communication among practitioners

until them, people used highly idiosyncratic approaches and often drew (sometimes very) different conclusions

hence the DSM, although inconsistencies continued

with DSM-III there was also encouragement to gather data according to standardized protocols, to ensure that adequate information was available to score each criterion

Question 47

What is best practice in assessment?

Answer 47

dictates that the best available instrument and procedures be used

facilitated by diagnostic consistency

also, should be collecting data that informs treatment planning and evaluation

Question 48

What is clinical utility in assessment?

Answer 48

the degree to which the data collected or instruments used, lead to improved clinical outcomes

do patients do any better after test is given?

Question 49

What is service evaluation in assessment?

Answer 49

demonstration of the effectiveness of treatment

often part of program evaluation

constantly making measurements on how effective your treatment is

Question 50

What is intervention?

Answer 50

probably goes back as far as human civilization

modern intervention is often said to have begun with Freud

others were also involved in verbally-delivered therapies at time however

Question 51

What was intervention like in the early 1900s?

Answer 51

rapid influx of (predominantly) psychodynamic intervention models

heavy emphasis on unconscious processes such as defense mechanisms, in the manifestation of psychopathology

some of those ideas gave way to a growing recognition of the role of social processes

Question 52

What was Witmer’s idea of intervention?

Answer 52

mostly interested in assessment, but, to a degree, also incorporated knowledge from memory and learning psychology to interventions

Question 53

What was intervention like in the 1920s?

Answer 53

Watson: Little Albert, demonstration of the role of learning in development of phobias

Cover-Jones: tole of extinction in eliminating them

Question 54

What was intervention like in the 1940s and 50s?

Answer 54

soldier returning from war traumatized sought psychological help in record number

so did traumatized citizens

bolstered the status of clinical psychologists

Question 55

What is the Humanistic school of therapy (Rogers) and its view on intervention?

Answer 55

Rogers was strongly committed to science and research despite the outwardly unstructured-seeming approach

the relationship with the patient is what matters most

Question 56

What was Eysenck’s (1952) rule of thirds and how does it relate to intervention?

Answer 56

Eysenck’s idea that after interventions, 1/3 get better, 1/3 stay the same, and 1/3 get worse

later meta-analytic studies showed that psychotherapy is very effective for some conditions, with about 80% of patients (vs. 1/3) doing better than their untreated controls

the beginning of evidence-based work

distinguished between efficacy (improvement under research conditions) and effectiveness (real-world improvement)

Question 57

What was Wolpe (1958) contribution to intervention?

Answer 57

systematic desensitization (behavioral)

expose person to non-threatening version of phobia, once they become calm you up the threatening level (fear hierarchy)

Question 58

What was Michenbaum (1977) contribution to intervention?

Answer 58

published the first book on cognitive-behavioral therapy for depression

manualized treatments started becoming readily available

Question 59

What is treatment fedelity?

Answer 59

the accuracy and completeness with which a therapist gives a certain treatment

Question 60

What is prevention?

Answer 60

more recent arrival to clinical psychology, at least in its formal sense

based on the recognition that dealing with conditions preemptively leads to superior outcomes, reduced total suffering, and lowered costs

emphasis is on large-scale screening and public education