Chapter 2: The Contemporary Practice of Clinical Psychology

Question 1

Clinical Consultation

Answer 1

the provision of information, advice, and recommendations about how best to assess, understand, or treat a client

Question 2

Organizational Consultation

Answer 2

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

Question 3

Practicum

Answer 3

the initial supervised training in the provision of psychological services that is a requirement of the doctoral degree

usually part-time

Question 4

Intermship/Residency

Answer 4

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

Question 5

Informed Consent

Answer 5

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

Question 6

Scientist-Practitioner Model

Answer 6

a training model that emphasizes competencies in both research and provision of psychological services

Question 7

Clinical Scientist Model

Answer 7

a training model that strongly promotes the development of research skills

Question 8

Practitioner-Scholar Model

Answer 8

a training model that emphasizes clinical skills and competencies as a research consumer

Question 9

Accreditation

Answer 9

a process designed to ensure that training programs maintain standards that meet the profession’s expectations for the education of clinical psychologists

Question 10

License

Answer 10

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

Question 11

Where do clinical psychologists work?

Answer 11

hospitals
community clinics
residential clinics
child protection agencies
prisons
family practice
private mental health practice
universities

Question 12

Where are psychologists rated in terms of helpfulness?

Answer 12

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%

Question 13

What is the monetary situation of many people in Canada in regards to psychologists and psychiatrists?

Answer 13

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

Question 14

What are the general activities of psychologists?

Answer 14

assessment
intervention
research
clinical supervision
administration

Question 15

How did clinical psychology grow from the field of assessment?

Answer 15

shift following the second world war
sharp increase in demand for psychotherapy
paralleled by diversification in professional activities

Question 16

What are assessment and diagnosis?

Answer 16

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

Question 17

What is formal assessment?

Answer 17

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”

Question 18

What is the difference between an assessment and a test?

Answer 18

an assessment is a professional activity/service

a test is a tool

Question 19

What is informal assessment?

Answer 19

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

Question 20

Why are formal and informal assessments used?

Answer 20

both are done with the intention of formulating an understanding of the presenting issues, and to guide interventions

Question 21

How do assessments vary in focus?

Answer 21

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

Question 22

How is assessment an evidence-based undertaking?

Answer 22

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

Question 23

What is intervention?

Answer 23

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

Question 24

How can CBT techniques be “eclectic/integrative” or have “syncretism”?

Answer 24

“ecletic/integrative”: deliberate intention in how you combine therapy to lessen interaction effects

“syncretism”: just randomly putting therapies together

Question 25

What are the pros of giving psychologists prescriptive authority?

Answer 25

brain-behavior links

psychologists could be as competent as other health-care providers

offer comprehensive services

especially helpful in remote or underserved areas

Question 26

What are the cons of giving psychologists prescriptive authority?

Answer 26

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?

Question 27

What should psychologists know about drugs?

Answer 27

classes of drugs for different problems

efficacy of drugs and of drugs in combination with psychological treatment

side-effects

Question 28

What is prevention?

Answer 28

two (or three) main forms: primary and secondary (+ tertiary)

Question 29

What is primary prevention?

Answer 29

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

Question 30

What is secondary prevention?

Answer 30

directed at reducing the risk for recurrence in an individual who has already experienced a given disorder

prevent from getting worse or going back

Question 31

What is tertiary prevention?

Answer 31

arguably a misnomer

directed at reducing the effects of a disorder, once it has manifested

a special case of secondary intervention

Question 32

What is a risk factor?

Answer 32

simply anything that increases the probability that a particular disorder will manifest

examples: exposure to bullying, violent media programming, poor parental coping

Question 33

What are the advantages of primary prevention?

Answer 33

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

Question 34

What is consultation?

Answer 34

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

Question 35

What is research in professional activities of psychologists?

Answer 35

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

Question 36

What is teaching and supervision in the professional activities of psychologists?

Answer 36

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

Question 37

How important is experience?

Answer 37

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

Question 38

What is administration in the professional activities of psychologists?

Answer 38

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

Question 39

What are program-based management structures in psychology?

Answer 39

organized by service, not by discipline

Question 40

What are hybrid management structures in psychology?

Answer 40

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

Question 41

What is an ethical dilemma?

Answer 41

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

Question 42

What are the four codes of ethics in psychology?

Answer 42

respect for the dignity of persons

responsible caring

integrity in relationships

responsibility to society

Question 43

What about the psychologist’s theoretical orientation?

Answer 43

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

Question 44

What is the funneling effect in training in clinical psychology?

Answer 44

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

Question 45

What is the Boulder (Scientist-Practitioner) Model?

Answer 45

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

Question 46

What is the Practitioner-Scholar Model?

Answer 46

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

Question 47

What is the Clinical Scientist Model?

Answer 47

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

Question 48

What is the concern over “professional school” programs?

Answer 48

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

Question 49

What safeguards are in place to assure the quality of graduate programs in Clinical Psychology?

Answer 49

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

Question 50

How important is it to attend an accredited program?

Answer 50

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

Question 51

What is the Health Professions Act (HPA)?

Answer 51

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

Question 52

What is the AIT?

Answer 52

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

Question 53

What is a problem with licensing and professional regulation in psychology?

Answer 53

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

Question 54

What is the debate surrounding Masters level registration?

Answer 54

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

Question 55

What are the licensing requirements for psychologists?

Answer 55

criminal record check

professional references

payment of fees (yearly)

present evidence of malpractice insurance

continued competence program (new under HPA)