Chapter 1 - The Evolution of Clinical Psychology

Question 1

Why Care About Clinical Psychology

Answer 1

As a future…
- clinical psychologist/ mental health expert
- colleague of clinical psychologists (e.g. family physicians, social workers, psychiatrists, etc.)
- manager of clinical psychologists (admin)
- a tax-payer
- consumer of psychological services (education counts)

Question 2

The definition of Clinical Psychology

Answer 2

The application of psychological knowledge to alleviate distress and promote psychological and physical well-being.

A broad field of practice and research that applies psychological principles to the assessment, diagnosis, consultation, treatment and intervention of psychological distress.

Question 3

Ethics

Answer 3

Rules that prevent harm by balancing effectiveness of treatment/intervention with discomfort.
(e.g. exposure therapy causes momentary discomfort but has long-term benefits)

Question 4

The Four Principles of Ethical-Decision Making

Answer 4

I. Respect for dignity of persons*
II. Responsible caring
III. Integrity in relationships
IIII. Responsibility to society

Question 5

Principle I: Respect for dignity of persons

Answer 5

Respecting one’s (i.e. the patient’s) self worth, autonomy, dignity, rights, etc. Weighted most heavily when making ethical decisions, unless in circumstances where there is clear and imminent risk of harm (to someone).

Question 6

Principle II: Responsible caring

Answer 6

Competence (via training), maximizing benefit and minimizing harm when treating a patient; and carrying out treatment in ways that respect’s the patient’s dignity.

Question 7

Principle III: Integrity in Relationships

Answer 7

The expectation of psychologists to maintain the highest integrity in their relationships with their colleagues, patients, and community. Don’t act in ways that would disgrace the profession and with respect to Principles I and II.

Question 8

Principle IIII: Responsibility to Society

Answer 8

The well-being of an individual/group should not be sacrificed for the benefit of society, so this principle is weighted lowest (but is still important). Psychologists should find ways to work for the benefits of society that do not violate dignity (I), responsible caring (II), or integrity (III).

Question 9

Evidence Based Practice Model (EBP)

Answer 9

A practice model that involves the synthesis of the latest, most sound research, professional experience, and client information (+preferences & needs) to guide clinical decision making.

Clinical practice would be considered unethical without EBP.

Question 10

Problems with Evidence-Based Practice

Answer 10

• Group-based data is not always applicable to individual cases (research often rules out comorbid participants, further limiting nature of results)
• Clients cannot wait for the latest research when the current research cannot meet their needs (i.e., current intervention models are ineffective)
• “File Drawer Problem”: studies that don’t find significant results are often not published, preventing the replication of their methodology (Type II errors could have yielded insignificant result!)

Question 11

Why do we need mental health professionals?

Answer 11

• Large % of world population diagnoses with a mental disorder (excluding those who are undiagnosed… a lot more!)
• Lifestyle factors, such as chronic stress, SES, diet/sleep/exercise habits, and disabilities, often produce mental and physical health problems
• Mental health services have a high cost/year (for population), these services help people get back to work (return on investment)

Question 12

Types of Mental Health Professionals

Answer 12

• Psychiatrists: medical degrees, specialize in biological basis of mental health
• Psychiatric nurses: treat emergency mental health cases at hospitals and psyc wards
• Clinical social workers: dealing with mental health concerns at a societal level, counselling and supportive roles
• Counsellors: variety of types, do not provide psychotherapy (reserved for clinical levels of distress),”counsellor” often an unregulated term, deal with subthreshold cases (day-to-day stressors)
• Psychologists: title reserved for those with a PhD (depending on province)

Question 13

Types of Psychologists

Answer 13

• Counselling Psychologist: deals with more normative day-to-day struggles (such as transitions, interpersonal stressors) and work in non-clinical settings
• School Psychologist: hired by school boards to look at student’s well-being and learning in the learning and developmental context, can provide Dx for learning/developmental disorders
• Clinical Psychologist: can diagnose across the DSM and provide interventions for more severe cases
• Clinical Neuropsychologist: same as clinical psychologist but with expertise in cognition
• Health Psychologist: looks at how mental health impacts physical health (vice versa)
• Forensic Psychologist: work in prisons with offenders/felons

Question 14

What is the general availability of psychologists in all of Canada compared to in rural areas?

Answer 14

Only 58 psychologists per 100,000 people in Canada; varies around the world and by SES; only 1 psychologist/psychiatrist/social worker per 100,000 people in rural areas!

One psychologist can only take on so many clients at a time.

Question 15

Origins of the Biopsychosocial Approach

Answer 15

• Hippocrates (Greek physician, ~500-300 BCE) emphasized the influence of biological, psychological, and social factors on mental illness
• 4 Fluid Theory: an imbalance of black bile, blood, piss, or phlegm is responsible for emotional disturbance

Question 16

Mental health treatments in ~1500s

Answer 16

• mental and physical illness caused by natural forces and extreme manifestations of psychotic behaviour was from the devil
• mental asylums, isolation
• Inhumane treatments, often equating to torture

Question 17

Changes in treating mental health during the Enlightenment Period (mid-late 1700s)

Answer 17

• Mental asylums to treat patients humanely
• Development of hospitals and retreats for the mentally ill (to receive appropriate care)
• Development of therapeutic treatments rather than torture (i.e., moral therapy)

Question 18

European Psychiatry (i.e., Freud)

Answer 18

Using the power of the mind to treat mental conditions, not all biological. E.g. hypnosis to reach the “unconscious mind”

Question 19

The history of Assessment

Answer 19

The foundation of clinical psychology today
- Kraepelin: developed a classification and diagnostic system for mental disorders through clustering various symptoms together based on co-occurrence; influenced how the DSM is formatted
- Binet: standardized intelligence testing
- Rorschach: Personality testing: developed the “inkblot test” subjective/projective testing that looks at how the patient interprets the ambiguous inkblot; said to reveal their mental functioning. Subjective testing seen as controversial, shifting into preference for objective testing

Question 20

How to assess mental health disorders

Answer 20

1. Gather data from multiple sources/ methods
   - Self-reporting from patient
   - Interviews with family members, teachers, etc.
   - Standardized testing
2. Know what measures to use and ensuring that they are supported by science (which measures will map onto the diagnosis we are targeting, looking for alternative explanations, looking at all facets of the individual)
3. Assessment should drive treatment/recommendations/intervention
   - follow up assessments to track the response to treatment (is it working?)

Question 21

History of Intervention (the 3 waves)

Answer 21

Development of various theoretical orientations:
1st wave: Psychoanalysis
- Freud: the unconscious is the source of all psychic energy and holds all of our negative emotions and aggression, which drives our behaviours. Need to uncover the unconscious to gain insight into the origin of the problem via free association

2nd wave: Behaviourism (e.g., exposure therapy)
- Favours the scientific method
- Observing overt behaviours and use of self-reporting
- Reinforcement models (conditioning)

3rd wave: Humanism
- Carl Rogers: Cognitive Behavioural Therapy (CBT); person-centered treatment (patient is the expert)

Question 22

History of Prevention

Answer 22

• Psychology only brought into the discussion of prevention in the last ~20-30 years (limited focus).
• There is a growing number of evidence-based prevention programs, takes a while for benefits to be seen.
• Funding often difficult to obtain due to moral panics (parents) and government funding (shifting government ideologies based on political party)