Chapter 2: The Contemporary Practice of Clinical Psychology Flashcards
Clinical Consultation
the provision of information, advice, and recommendations about how best to assess, understand, or treat a client
Organizational Consultation
services to an organization focused on developing a prevention or intervention program, evaluating how well an organization is doing in providing a healthcare or related service, or providing an opinion on policies on heath care services set by an organization
Practicum
the initial supervised training in the provision of psychological services that is a requirement of the doctoral degree
usually part-time
Intermship/Residency
the period of supervised training in the provision of psychological services that is a requirement of the doctoral degree
sometimes referred to as residency
usually a one-year, full-time period
Informed Consent
an ethical principle to ensure that the person who is offered services or who participates in research understands what is being done and agrees to participate
Scientist-Practitioner Model
a training model that emphasizes competencies in both research and provision of psychological services
Clinical Scientist Model
a training model that strongly promotes the development of research skills
Practitioner-Scholar Model
a training model that emphasizes clinical skills and competencies as a research consumer
Accreditation
a process designed to ensure that training programs maintain standards that meet the profession’s expectations for the education of clinical psychologists
License
regulation to ensure minimal requirements for academic and clinical training are met and that practitioners provide ethical and competent services
regulation of the profession helps to ensure the public is protected when receiving services
Where do clinical psychologists work?
hospitals
community clinics
residential clinics
child protection agencies
prisons
family practice
private mental health practice
universities
Where are psychologists rated in terms of helpfulness?
despite the public tendency to avoid specialists such as psychologists and psychiatrists, a 2004 study rated psychologists at the top of the list (29%) for helpfulness
psychiatrists scored only 19%
What is the monetary situation of many people in Canada in regards to psychologists and psychiatrists?
regrettably, the situation in Canada is that many people cannot afford the private services of psychologists
psychiatrists bill the health care system directly, and are therefore more affordable
consequently, many clinical psychologists have chosen employment within public facilities
What are the general activities of psychologists?
assessment
intervention
research
clinical supervision
administration
How did clinical psychology grow from the field of assessment?
shift following the second world war
sharp increase in demand for psychotherapy
paralleled by diversification in professional activities
What are assessment and diagnosis?
necessary steps preceding any form of treatment
it is neither practical, scientifically sound, or ethically correct to engage in therapy before an adequate evaluation of presenting problems has been undertaken
“assessment” is an extremely broad term
What is formal assessment?
more structured, comprehensive enquiries involving detailed interviewing, reviewing collateral information, psychological testing, formulation and diagnosis
testing is only one part of this enterprise
a common error is to refer to a test as an “assessment”
What is the difference between an assessment and a test?
an assessment is a professional activity/service
a test is a tool
What is informal assessment?
usually occurs in the course of a less structured interview
little emphasis on testing
sometimes includes collateral interviews: information from individuals in their life and other psych professionals
Why are formal and informal assessments used?
both are done with the intention of formulating an understanding of the presenting issues, and to guide interventions
How do assessments vary in focus?
assessments can vary broadly in focus
they can be as specific as determining eligibility for special funding, or as broad as untangling complicated relationships within families or other larger units
should always be guided by the referral question, patient characteristics. and potential sources of information
How is assessment an evidence-based undertaking?
quite apart from simply being a data-gathering mission, it draws heavily on the psychologist’s understanding of pathology, personality structure, cognitive processes, development, learning, and available treatment and resources
assessment results are communicated to the patient and/or referral source in various ways; generally this involves written reports accompanied by debriefing sessions
this is where you would typically introduce your treatment plan
What is intervention?
encompasses comprehensive, lengthy services as well as shorter, less formal activities
despite Eysenk’s conclusions, there is a wealth of responsibly-collected data attesting to the effectiveness of psychotherapy applied to a variety of mental health conditions
most often, interventions involve 5 to 13 clinical contacts and typically involve discussion of patients’ immediate concerns. relationships, sources of stress, and other difficulties
How can CBT techniques be “eclectic/integrative” or have “syncretism”?
“ecletic/integrative”: deliberate intention in how you combine therapy to lessen interaction effects
“syncretism”: just randomly putting therapies together
What are the pros of giving psychologists prescriptive authority?
brain-behavior links
psychologists could be as competent as other health-care providers
offer comprehensive services
especially helpful in remote or underserved areas
What are the cons of giving psychologists prescriptive authority?
may lead to greater prescribing as it is quicker in short-term
psychologists should focus only on psychological interventions
extend training or drop something else?
What should psychologists know about drugs?
classes of drugs for different problems
efficacy of drugs and of drugs in combination with psychological treatment
side-effects
What is prevention?
two (or three) main forms: primary and secondary (+ tertiary)
What is primary prevention?
any measures taken to prevent a disorder from manifesting
screen for things and intervene before it manifests
is unique in that it only targets the reduction of risk factors, but also building on strengths, or protective factors
What is secondary prevention?
directed at reducing the risk for recurrence in an individual who has already experienced a given disorder
prevent from getting worse or going back
What is tertiary prevention?
arguably a misnomer
directed at reducing the effects of a disorder, once it has manifested
a special case of secondary intervention
What is a risk factor?
simply anything that increases the probability that a particular disorder will manifest
examples: exposure to bullying, violent media programming, poor parental coping
What are the advantages of primary prevention?
can be carried out in the community, can benefit a much larger number of people, more cost effective, can reduce overall prevalence of a condition (which may be more difficult to manage later on)
these programs often take the form of broad screening, and/or public education
What is consultation?
psychologists are frequently called upon by other members of a multidisciplinary team, or outside agencies, to provide guidance regarding the diagnosis, or management of clinical conditions
it is important that practicing psychologists seek consultation from their colleagues, as well as members of different disciplines when they encounter clinical questions outside their area of expertise
What is research in professional activities of psychologists?
development of strong research skills is integral to traditional graduate school training
some newer training models place less emphasis on those skills, and that may eventually prove to be a detriment to the development of clinical psychology
given that our code of ethics requires us to constantly evaluate the effectiveness of our interventions as well as claims reported in the academic literature, these skills are indispensable
HPA requires us to continually expand and maintain competence (CC) in the interest of delivering the best available professional services
research and CC activities are best incorporated into day-to-day practice
What is teaching and supervision in the professional activities of psychologists?
a natural extension of clinical practice
in addition to teaching university courses, there is great need for practicum and residency supervisors who will monitor the practice of psychologists in training
this applies not only to clinical techniques, but also to outcome evaluation and consultation skills
joint goals are to provide “safe” delivery of services and facilitate training
supervisees have typically completed all, or significant portions of their education but lack practical experience
How important is experience?
Garb (1998) presented evidence that inexperienced (but academically prepared) clinicians are comparable to experienced clinicians in their ability to make clinical decisions which are both valid and accurate
does not equate to saying they’re equally effective practitioners
What is administration in the professional activities of psychologists?
psychologists employed in community or hospital settings often find their way into management and administrative roles
subject to less pressure than private practitioners to preserve billable hours
Humble et al (2004) reported that only 1/5 of Canadian hospitals still had an autonomous psychology departments
What are program-based management structures in psychology?
organized by service, not by discipline
What are hybrid management structures in psychology?
combine administrative oversight (often by non-psychologists) with guidance from senior members of one’s own profession
in Alberta, this became popular in the mid-1990s
What is an ethical dilemma?
arises whenever two or more moral principles are in potential conflict
e.g., it is inherently unethical to inflict suffering or discomfort; on the other hand, the best available treatment methods are sometimes uncomfortable
the risks and benefits associated with each imperative must be carefully assessed and balanced against one another
it is impossible to do ethically in the absence of scientific information concerning outcomes; likewise, scientifically desirable outcomes must not come at the cost of unacceptable suffering
What are the four codes of ethics in psychology?
respect for the dignity of persons
responsible caring
integrity in relationships
responsibility to society
What about the psychologist’s theoretical orientation?
strict adherence to any particular theory may limit the scope of inquiry a clinician employees
for theory to be useful, it must be testable (i.e., capable of generating testing hypotheses) and falsifiable
What is the funneling effect in training in clinical psychology?
clinical psychology is a popular and highly competitive graduate training program
entrance requirements tend to be very high, even more so than medical school and law school
What is the Boulder (Scientist-Practitioner) Model?
named after an APA training conference held in Boulder, Colorado
based on a view of psychologists as joint scientists and practitioners
inherently involves a strong research component (dissertation)
underlying premise: clinical psychologists should be both in a position to contribute to the academic literature, and to skillfully carry out evidence-based clinical activities
What is the Practitioner-Scholar Model?
emphasizes clinical skills and critical evaluation (not contribution to) academic literature
often results in a Psy.D. as opposed to Ph.D
many Psy.D programs also train students in naturalistic rather than experimental designs
What is the Clinical Scientist Model?
less emphasis on practice, more on clinical research
not usually licenses as practitioners
there has been a recent influx of “professional school” programs
tend to offer only Masters rather than Ph.D. programs
graduates may nevertheless be eligible for licensure
What is the concern over “professional school” programs?
numerous psychologists have expressed concern over these programs
they fear that the quality of instruction and opportunities to gain practical experience are highly variable
these programs tend to employ relatively few full-time staff and their dependence on external practicum supervisors is potentially problematic
What safeguards are in place to assure the quality of graduate programs in Clinical Psychology?
governmental regulations and CPA/APA accreditation
in 1980, there were only four APA and six CPA accredited Canadian universities
APA stopped accrediting schools outside the US in 2008, the CPA had established a similar process in Canada in 1984
CPA is strongly committed to the Boulder Model
How important is it to attend an accredited program?
simplifies licensing
“ensures” a certain standard of education including coursework in ethics and cultural factors
important because definitions of psychopathology often reference cultural standards
note that all schools produce a range of graduates
What is the Health Professions Act (HPA)?
in Alberta, all healthcare professionals are governed by the Health Professions Act (HPA)
replaced the Psychology Profession Act, and all other separate pieces of professional legislation
What is the AIT?
in addition to HPA, a number of inter-jurisdictional agreements such as AIT allow for license-to-license registration within Canada, and between Canada and many of the United States
governmental initiatives to facilitate labour mobility
tied to an aging professional workforce
AIT replaced the 2001 Mutual Recognition Agreement
What is a problem with licensing and professional regulation in psychology?
some provinces, such as Alberta, allow registration at the Masters level; most provinces ad US states require a doctorate
those provinces will, most likely, be legally required to register Masters trained Alberta psychologists due to AIT
in Ontario and British Columbia, a different form of registration is possible with a Masters degree, but does not allow full title
hence a Masters level BC registrant may be licensed at a lower level than a Masters level AIT transfer
What is the debate surrounding Masters level registration?
CPA conducted a literature review previously comparing outcomes between Masters and PH.D. psychologists
there was no evidence that Masters level practitioners were any less effective, or that they placed their patients at higher risk
you can’t raise the requirement for a profession unless you can demonstrate that failing to do so would put the public at risk
What are the licensing requirements for psychologists?
criminal record check
professional references
payment of fees (yearly)
present evidence of malpractice insurance
continued competence program (new under HPA)
