Chapter 1: The Evolution of Clinical Psychology
Chapter 1 – The Evolution of Clinical Psychology Chapter Overview A strong foundation of knowledge is the cornerstone for mastering a subject. Chapter 1 provides the foundation for the next fourteen chapters by defining key terminology and presenting notable facts about mental illness. The chapter explores the issue of evidence-based psychology and the issue of overreliance on science. Students are introduced to the various professions within the field and potential career options. A brief, yet thorough history of clinical psychology, assessment, intervention, and prevention is presented.
Chapter Contents •
Introduction
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Defining the Nature and Scope of Clinical Psychology
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Evidence-Based Practice in Psychology
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Mental Health Professions ▪
Counseling Psychology
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School Psychology
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Psychiatry
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Clinical Social Work
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Other Mental Health Professions
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Availability of Mental Health Service Providers
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A Brief History of Clinical Psychology ▪
The Roots of Clinical Psychology
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The History of Assessment in Clinical Psychology
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The History of Intervention in Clinical Psychology
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The History of Prevention in Clinical Psychology
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The Future
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Summary and Conclusions
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Chapter 1: The Evolution of Clinical Psychology
Learning Objectives 1. What are the various mental disorders and the prevalence rates in America? 2. How does mental illness impact daily functioning, the economy, and communities? 3. What is clinical psychology? What are its limitations? 4. Why is evidence-based practice beneficial and why do some disagree about its usefulness? 5. Define and discuss the various mental health professions and career opportunities. 6. What is the availability of mental service providers across the world? 7. What are the roots of clinical psychology? 8. How has assessment played a vital role in clinical psychology? 9. Who are the major figures in assessment? 10. Define and discuss the history of intervention in clinical psychology. 11. What are the various forms of psychotherapy? 12. Describe the history of prevention in clinical psychology. 13. What does the future hold for clinical psychology?
Up for Discussion 1. Are mental health problems as serious as physical health problems? 2. Think about the challenges and stressors that you have faced and faced by those you care about. Can you identify the things that made your distress worse? On the other hand, what helped you in dealing with difficulties? 3. Do you think it is responsible to offer services that have no evidence of effectiveness? When effective treatments exist, it is reasonable to continue to offer services of undocumented effectiveness? If you were advising a friend to seek services, would you suggest looking for services
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Chapter 1: The Evolution of Clinical Psychology
that have been shown to be helpful for similar problems? If not, then why not? 4. In what ways is clinical psychology similar to other mental health professions? 5. In what ways has scientific thinking shaped the evolution of clinical psychology?
Out-of-Class Activities 1. Have students visit the National Alliance on Mental Illness (NAMI) website (http://www.nami.org/) and research topics such as stigma, the various disorders, the purpose of NAMI, and what information they could share with others. 2. Ask students to consider what the impact of mental illness, such as depression or an anxiety disorder) would be on their own life. Ask them to write a one-page discussion on their feelings, concerns, and questions. You may expand this as a multiple week project or full semester project and require students to keep a journal about their particular illness. The purpose is to help students gain awareness and understanding not only of the complexities of the disorder but the impact on all aspects of their lives. 3. Ask students to visit various websites on assessments such as MultiHealth Systems, Western Psychological Services, and Pearson Assessments to gain an understanding of the complexity and large array of tests available. Have students discuss the various qualifications needed to administer these tests and tie into the various health professions. 4. Ask students to develop a plan for reducing homelessness for the mentally ill. Students should consider cost, feasibility, urban versus rural areas, various disorders, as well as community impact.
Web Links The website of the Canadian Psychological Association provides information on the diverse sections of psychology, accreditation, and licensure: www.cpa.ca
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Chapter 1: The Evolution of Clinical Psychology
The website of the American Psychological Association includes information related to the sciences and practice of psychology: www.apa.org Psychologist Kenneth Pope’s website provides resources on ethics, intervention, and critical thinking: www.kspope.com The website for the National Institute of Mental Health provides information on diagnosis and treatment of mental disorders: www.nimh.nih.gov The website of the UK National Institute for Health and Care Excellence provides clinical guidance on health issues: www.nice.org.uk
Suggested Readings Barlow, D. H. (Ed.). (2011). Oxford handbook of clinical psychology. New York: Oxford University press.
Cautin, R. L., & Lilienfeld, S. O. (Eds). 2015. Encyclopedia of psychology. Hoboken, NJ. Wiley-Blackwell.
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Chapter 2: Contemporary Clinical Psychology
Chapter 2 – Contemporary Clinical Psychology Chapter Overview Clinical psychology is one of the most popular professions in psychology, and the one for which most people are familiar with when you mention psychology. The public typically assumes clinical psychologists provide only one-on-one therapy with patients and clients; however, we know that clinical psychologists provide a wide array of services such as assessment, consultation, research, teaching, supervision, and administrative duties. As the field is diverse, so are the theoretical orientations of clinical psychologists as well as the training programs. This chapter provides students with an overview of the state-of-the-field in clinical psychology. It offers the opportunity for students to broaden their scope and consider new directions for their academic as well as career pursuits. The three profiles of actual clinical psychologists give students a real-world taste of clinical psychology in an honest, unbiased fashion.
Chapter Contents •
Introduction
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Activities of Clinical Psychologists ▪
Assessment and Diagnosis
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Intervention
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Prevention
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Consultation
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Research
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Teaching and Supervision
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Administration
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Employment Settings
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The Two Pillars of Clinical Psychology: Science and Ethics
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Training in Clinical Psychology ▪
Models of Training in Clinical Psychology
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Accreditation of Clinical Psychology Programs
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Chapter 2: Contemporary Clinical Psychology
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Licensure in Clinical Psychology
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Summary and Conclusions
Learning Objectives 1. What are the major professional activities of clinical psychologists? 2. What is the major diagnostic system in the United States? 3. What are the various forms of interventions? 4. Describe the various theoretical orientations of clinical psychologists. 5. Generally speaking, what do prevention activities tend to focus on? 6. Describe the role of a consultation psychologist. 7. Discuss the role of professors of clinical psychology in teaching and supervision. 8. What is the difference between clinical supervision and research supervision? 9. Describe the administrative activities of the clinical psychologist. 10. Discuss the various work settings in which clinical psychologists might be employed. 11. How do ethics play a role in every aspect of a psychologist’s career? 12. Discuss the issues of stress in a psychologist’s life. 13. What are the various models of training in clinical psychology? 14. Why is accreditation of a clinical psychology program important? 15. How does a clinical psychologist obtain licensure?
Up for Discussion 1. To what extent do you think you would welcome the challenge of conducting psychological assessments? What would you find most interesting about assessment activities? Are you the kind of person who enjoys addressing questions by gathering and integrating diverse data?
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Chapter 2: Contemporary Clinical Psychology
2. What are the advantages and disadvantages of psychologists having the privilege of prescribing psychoactive medication? 3. Do you find the idea of offering psychological interventions appealing? Are you surprised to learn that most clients attend very few sessions? Does the idea of helping clients to learn ways to change the ways they think, feel, and behave interest you? 4. Can you recall any prevention programs that were offered when you were in school? What features of the prevention programs did you like, and what features do you think might make the programs effective? 5. How interested are you in consultation services? In what way do you think consultation skills may be similar to and different from, the skills required in providing direct services like psychotherapy? 6. Think of your research experiences thus far in your psychology training. Which parts of the research process were most challenging? Which were most rewarding? Are you a person who enjoys formulating testable questions and gathering the data to answer them? 7. What are the qualities that make an excellent teacher? What do you think would be the rewards of teaching others about clinical psychology? 8. In considering professors who may supervise your honours thesis in psychology, have you thought of asking their current students to describe their professors’ research supervision skills? 9. How do theories inform the practice of clinical psychology? 10. What role should intuition play in the practice of clinical psychology? 11. How willing are you to put your cherished beliefs to the test? What do you think it requires to submit for evaluation an intervention that you have spent years developing? As a psychologist, would you be willing to gather the data that may show you were wrong? As a consumer of psychological services, would you prefer to see a psychologist who was 100% convinced that his or her approach is the best, or a psychologist who was willing to examine the evidence?
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Chapter 2: Contemporary Clinical Psychology
12. How easy is it for you to maintain a healthy balance in your life? Which coping strategies do you find helpful in dealing with stress? Are there other coping strategies that you would need to develop if you were to become a clinical psychologist? 13. How does training in the different models of clinical psychology (scientistpractitioner, clinical scientist, and practitioner-scholar) prepare students for different types of positions in clinical psychology? 14. Which training model appeals most to you? How do you weigh the benefits of higher acceptance rates against the disadvantages of lower funding in free-standing professional programs? If you were seeking services, would it matter to you whether the psychologist was trained in a university-based program or in a free-standing professional school? 15. How can a psychologist prepare for all the diversity he or she will encounter in a professional career?
Out-of-Class Activities 1. Have students select a professional activity that they would like to pursue as a clinical psychologist and ask them to explain why they find it interesting. This should be a written assignment although the length is at the instructor’s discretion. 2. Ask students to look up prescribing privileges for psychologists on the internet and document what they find in order to present an argument for or against prescriptive authority. The class can be divided into teams for or against prescriptive authority. The instructor will serve as the moderator. Additionally, the instructor may want to add another team to play the role of a state licensing board for added discussion. This team would have to research the respective state licensing board ahead of time. 3. Ask students to research the prescriptive privileges for psychologists in New Mexico and Louisiana and discuss the qualifications for obtaining a license to prescribe. Students should focus on training, background, and clinical supervision. This can be a written exercise or discussed in class. In class, you can encourage discussion as to whether the requirements are too stringent, too weak, or adequate.
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Chapter 2: Contemporary Clinical Psychology
4. Ask students to think about why they are considering a career in the mental health field and to complete a chart detailing the pros and cons of working with patients. Students should consider stress, malpractice, educational requirements, their own personal issues, and work-life balance. Students should be honest with themselves and consider what parts of clinical psychology are truly attractive and what parts are not. The purpose is not to discourage students from the field, but to give them a realistic view of what their career path may be. 5. Have students visit the American Psychological Association website to review the Ethical Principles of Psychologists and the Code of Conduct. Have them choose a section, explain how one could violate a code, and discuss the consequences of such a violation. Have them consider why this particular section is there.
Web Links Ethics and other research topics are discussed at the APA website. http://www.apa.org/ethics/code/index.aspx The American Board of Professional Psychology provides information on a variety of post-doctoral specialty designations. http://www.abpp.org The website of the American Psychological Association includes information related to the science and practice of psychology and provides information on accreditation as well as listing accredited programs. Provides links to licensing organizations in the United States. www.apa.org The Association of State and Provincial Psychology Boards is the association of Canadian and U.S. licensing boards in psychology. http://www.asppb.org The Australian Psychological Society provides information on licensure in Australia, including an assessment of psychology qualifications for candidates from overseas who wish to be registered as a psychologist in Australia. http://www.psychology.org.au/ The British Psychological Society is the representative body for psychology and psychologists in the United Kingdom. Information is available for both the public and for psychologists. http://www.bps.org.uk
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Chapter 2: Contemporary Clinical Psychology
The Canadian Psychological Association provides information on accreditation as well as a list of accredited programs. Links to licensing organizations in Canada are provided. http://www.cpa.ca The New Zealand Psychological Society provides links to the regulatory body, the New Zealand Psychologists Board. http://www.psychology.org.nz This is the home page of the American Psychiatric Association, the publishers of the DSM-5. You will find links to the various sections, journals, and online resources about education, practice, and self-help resources. Most psychiatrists belong to this organization. http://www.psych.org/
Suggested Readings Evans, D. R. (Ed.). (2011). The law, standards, and ethics in the practice of psychology (3rd ed.). Toronto, ON: Carswell Publications. Sturmey, P., & Hersen, M. (Eds.). (2012). Handbook of evidence-based practice in clinical psychology. Volume 1: Child and adolescent disorders. New York: John Wiley and Sons, Inc. Sturmey, P., & Hersen, M. (Eds.). (2012). Handbook of evidence-base practice in clinical psychology. Volume 2, Adult disorders. New York: John Wiley and Sons, Inc. Truscott, D., & Crook, K. H. (2013). Ethics and the practice of psychology in Canada 2nd ed. Edmonton, AB: University of Alberta Press.
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Chapter 3: Classification and Diagnosis
Chapter 3 – Classification and Diagnosis Chapter Overview Classification and diagnosis is the heart of what most clinical psychologists do. Without accurate diagnosis, one is unable to provide proper treatment, and the patient is unable to assume an active role in their recovery. However, classification of mental illness may contribute to stigma, helplessness, and in some cases, secondary gain. Formal diagnostic criteria date back to 1952 when the first edition of the DSM was published. Each edition of the DSM reflects the status of diagnosis at the time of its publication. The American Psychiatric Association released the DSM-5 at its annual convention in 2013. Although most new DSM editions have sparked controversy in the mental health field, there was unparalleled criticism leveled at the DSM-5 and the process underlying its development. We must keep in mind that the field of mental health continues to evolve and involves not just clinicians and researchers, but patients, families, communities, and government. While some may argue we are better off without the DSM, without a classification system to aid in diagnosis, we would have to rely on assessing individuals on important dimensions of functioning, in particular internalizing and externalizing problems. This chapter explores the positives and negatives of the DSM, diagnostic reliability and validity, and other classification systems.
Chapter Contents •
Introduction
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Defining Abnormal Behavior and Mental Disorders
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▪
Developmental Psychopathology
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Diagnosis
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Defining Disorder
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Prevalence of Mental Disorders
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Understanding the Development of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders (DSM)
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Chapter 3: Classification and Diagnosis
System
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▪
The Evolution of the DSM
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The DSM-5
The International Statistical Classification of Diseases and Related Health Problems (ICD) System
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•
Limitations of Diagnostic Systems ▪
Defining Abnormality (Revisited)
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Diagnostic Reliability
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Heterogeneity of Symptom Profiles
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Diagnostic Validity
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Comorbidity
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Categorical versus Dimensional Classification
Summary and Conclusions
Learning Objectives 1. What is the difference between a categorical versus a dimensional approach? 2. What are the uses of a diagnostic system? 3. How do we define abnormal behavior? 4. Why is developmental psychopathology important? 5. Discuss what is meant by diagnosis. Why is it based on a cluster of symptoms? 6. How do we define disorder? How does culture play a part in the definition? 7. What is the prevalence of mental disorders? 8. How do mental disorders develop? 9. Discuss the effects of PTSD on the patient and on loved ones. 10. What is the DSM approach to diagnosis? 11. How has the DSM evolved? 12. What are the differences between the DSM-IV-Text Revision and the DSM-5? 13. What are the benefits and limitations of the DSM-5?
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Chapter 3: Classification and Diagnosis
14. Discuss the use of the ICD system. 15. Why is diagnostic reliability important for assessment? 16. Why is diagnostic validity important for assessment? 17. How does comorbidity impact diagnosis and prognosis? 18. Describe categorical versus dimensional classification.
Up for Discussion 1. Why should we care about whether a behavior is abnormal or not? 2. How does culture influence definitions of normality and abnormality? 3. What is the role of basic research in psychology in informing the diagnosis of mental disorders? How can we make sense out of differing prevalence rates of mental disorders among countries? 4. Refer to the Case Example: Noah. What are the advantages and disadvantages for a young person such as Noah receiving a diagnosis of a mental disorder? 5. Based on information presented about Noah in the Case Example, look over Exhibit 3.2 in the text and think about what diagnostic class or classes might contain diagnoses consistent with his symptoms. 6. How does low reliability for the presence of a diagnosis affect the validity of a diagnosis?
Out-of-Class Activities 1. Encourage students to visit a mall, park, or another public place and observe the people around them. They should note what they see, the verbal and non-verbal interactions, and the thoughts and reactions that may occur to them. Have students discuss how their own feelings and reactions could affect diagnosis. 2. Ask students to write up their own ideas to replace or enhance the DSM. Ask them to provide rationales and justifications for the omission or additions. 3. Divide students into two teams. Team 1 would research the pros of the DSM, and team 2 would research the cons of the DSM. The following
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Chapter 3: Classification and Diagnosis
week have the team debate the issues of the DSM with the instructor serving as the moderator. 4. Have students watch a movie or television program and write up an assessment of the main characters. Students should provide clinical terminology, demonstrate a clear understanding of the limitations of their assessment, and formulate questions they would ask the character in a real interview. 5. Have students practice their interviewing skills on a friend or family member, noting both their reactions and the reactions of the “patient.” Ask students to discuss why treating a family member or friend is not advised. Discuss the boundaries and limitations as well as social desirability of the friend or family member. Also, discuss the impact this would have on therapy.
Web Links Information on the DSM-5, including its history and use, can be found at this American Psychiatric Association site: http://www.psychiatry.org/practice/dsm Information on the development of the DSM-5 can be found on this American Psychiatric Association site: http://www.dsm5.org/about/Pages/DSMVOverview.aspx For information on the World Health Organization’s International Classification of Diseases, go to: http://www.who.int/classifications/icd/en/ The National Institute of Mental Health provides a wealth of data on the prevalence of mental disorders: http://www.nimh.nih.gov/index.shtml
Suggested Readings American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Publishing. Frances, A. (2013b). Saving normal. New York: William Morrow. Maddux, J. E. & Winstead, B. A. (Eds). (2015). Psychopathology: Foundations for a contemporary understanding. (4th ed). New York: Routledge.
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Chapter 4: Research Methods in Clinical Psychology
Chapter 4 – Research Methods in Clinical Psychology Chapter Overview Research methods are discussed, in one form or another, in nearly every course in psychology. The importance of a solid research foundation for the practice of clinical psychology cannot be underestimated; it is how our field continues to grow. This growth is essential, not just for new treatments and entries on one’s résumé , but also for continued justification for treatment plans, modifications of existing scales, and new insights into various disorders. This chapter covers ethics in research and the protection of research participants. The selection of research designs are covered in detail allowing students to understand the strengths and weaknesses of each as well as the appropriate usage of employing the various research methods. Analyzing the data as well as understanding statistical and clinical significance round out the chapter to give students the primer they need to logically review and analyze journal articles as assignments. More importantly, students will be able to communicate with their instructor knowing the research terminology, and the instructor will be able to challenge students with relevant first-tier journal articles.
Chapter Contents •
Introduction
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Generating Research Hypotheses
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Ethics in Research
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Research Designs ▪
Case Studies
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Single Case Designs
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Correlational Designs
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Quasi-Experimental Designs
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Experimental Designs
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Chapter 4: Research Methods in Clinical Psychology
•
Selecting Research Participants and Measures ▪
Selecting the Sample
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Selecting the Sampling Strategy
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Setting the Sample Size
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Measurement Options and the Importance of Psychometric Properties
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Analyzing the Data ▪
•
•
Statistical and Clinical Significance
Research Syntheses ▪
Systematic Reviews
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Meta-Analysis
Summary and Conclusions
Learning Objectives 1. What is evidence-based practice? 2. What are the most common errors in thinking? 3. How are research hypotheses generated? 4. What are the sources of research ideas? 5. Discuss the importance of ethics in research. 6. Discuss the APA ethical principles for research and publication. 7. What are the common threats to the internal validity of a study? 8. What are the common threats to the external validity of a study? 9. Define and discuss each of the various research designs. 10. When are quasi-experimental studies performed? 11. How do we select research participants? 12. How do we assign participants to various treatments? 13. How do we select the correct sample size? 14. What are the various measurement options? 15. How is data analyzed? 16. Explain statistical and clinical significance. 17. What is effect size, and why is it important?
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Chapter 4: Research Methods in Clinical Psychology
Up for Discussion 1. What are the differences between evidence-based practice and eminencebased practice? 2. How do theories affect the research process? 3. How is the science of clinical psychology different from the science of other types of psychology? What ethical issues are particularly important in the science of clinical psychology? 4. How are different research designs suitable at different stages of the development of knowledge in a field? 5. If you wanted to examine the link between mental disorders and stigma, what kind of hypotheses might you generate? 6. Are the findings of experimental studies more convincing than the results of other types of research designs 7. How does a psychologist decide whether to maximize internal validity or external validity? 8. If a psychologist wants to study people diagnosed with a specific disorder, why does it matter how they are recruited into the study?
Out-of-Class Activities 1. Have students design a research study on a mental disorder of their choice. They should write up an introduction, hypotheses, and a methodology along with references. Students should have an inclusion/exclusion criterion as well. If students are advanced, they may wish to include a mock results section and a discussion section. Students can turn this in for credit or present in class for discussion. 2. Ask students to think about what extraneous variables there are in a depression, bipolar, or schizophrenia study. Have them consider how they can control for these variables and which ones they would not be able to control. 3. Have students review Exhibit 4.4 on the APA Ethical Principles for Research and Publication and choose one or two of the principles to write up real-world examples of how the ethics could be violated.
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Chapter 4: Research Methods in Clinical Psychology
4. Have students design an informed consent form for a clinical research trial on any disorder. Students should research the elements of informed consent and include these elements in their own form. 5. Have students research the Nuremberg trials, the Tuskegee Syphilis Experiment, and the use of Thalidomide. Students should reflect on how these events changed research and why we have numerous safeguards in place. 6. Ask students to write a 2-3 page paper on someone they would feel would make for an excellent case study. The person could be living or dead, but ultimately someone of interest to the student. Have students consider the limitations and advantages of such a case study. 7. Have students go to the library, select a major psychological or psychiatric journal article, and write up a review of the article demonstrating understanding of the material. Students can then discuss in class as well as hand in their review for credit. 8. Have students review a meta-analysis article, noting the flaws, limitations, and disadvantages. Students should also note the purpose of the metaanalysis and whether or not it elaborates on the particular problem or disorder. 9. Ask students to create a set of ten questions for a new assessment on any type of psychological disorder of interest to them. Students should decide whether their questions will be used for diagnostic and assessment purposes, be clinician administered or self-administered, be open-ended, closed-ended, structured, semi-structured, etc.
Web Links The American Psychological Association has a number of sources of information and links to resources for conducting research: www.apa.org/research/tools/index.aspx Although the focus of the Social Psychology Network is on social psychology, this is a wonderful website that contains numerous links to resources on research methodology, research ethics, and statistics: www.socialpsychology.org/methods.htm The VassarStats website has extensive resources for understanding statistical procedures commonly used in psychology, along with online calculators that provide you with the option of conducting statistical analyses: vassarstats.net
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Chapter 4: Research Methods in Clinical Psychology
The British Medical Journal provides a collection of short, easy-to-read articles on statistics: www.bmj.com/about-bmj/resources-readers/publications/statistics-square-one A good introduction to systematic reviews can be found at: http://www.ebbp.org/course_outlines/systematic_review/ If you are interested in learning more about meta-analysis, free meta-analysis software is available at several sites: ericae.net/meta/metastat.htm www.lyonsmorris.com/ma1/index.cfm You can access the Tri-Council policy on ethical conduct of research involving humans at the following website: www.pre.ethics.gc.ca/eng/policy-politique/initiatives/tcps2-eptc2/Default/
Suggested Readings Books Kazdin, A. E. (2003). Research design in clinical psychology (4th ed.). Needham Heights, MA: Allyn & Bacon. Kazdin, A. E. (Ed.). (2016). Methodological issues and strategies in clinical research (4th ed.). Washington, DC: American Psychological Association. Kratochwill, T. R., & Levin, J. R. (Eds.). (2014). Single case intervention research: Methodological and statistical advances. Washington, DC: American Psychological Association. McKay, D. (Ed.). (2008). Handbook of research methods in abnormal and clinical psychology. Thousand Oaks, CA: Sage Publications, Inc. Thomas, J. C., & Hersen, M. (Eds.). (2011). Understanding research in clinical and counseling psychology (2nd ed.). New York: Routledge. Journals Multivariate Behavioral Research Psychological Methods
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Chapter 5: Assessment: Overview
Chapter 5 – Assessment: Overview Chapter Overview The next five chapters in the text focus on assessment. Assessment is a part of our everyday lives. We are assessed to some degree at work, at school, by our friends, by our family, and possibly even by our pets! Yet, clinical assessment is much different, as it is a formal, decision-making process that includes a great deal of information gathering. When we assess a patient for the first time, we gather not just the presenting symptoms, but the pertinent medical, social, psychiatric, work, sexual, and family histories as well. We may need to corroborate certain elements with a patient’s family or friends, especially if the patient is a poor historian. Clinical assessment is not just another skill to be taught. This is where art and science come into play. Anyone can read off a checklist, but it is the skillful clinician who can “think on their feet” and probe, paraphrase, and extract the necessary information that separates an average assessment from a great assessment. We do not make excellent diagnosticians of our students. Our students have these skills or they do not. However, it is our job to perfect their skills and abilities.
Chapter Contents •
Introduction
•
Psychological Assessment
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▪
Evidence-Based Assessment
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The Purposes of Psychological Assessment
Psychological Testing ▪
Assessment Versus Testing
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Psychometric Considerations
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Testing Practices in Clinical Psychology
•
Ethical Considerations
•
Summary and Conclusions
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Chapter 5: Assessment: Overview
Learning Objectives 1. What is psychological assessment? 2. What are the recommendations for a model curriculum for clinical psychology assessment? 3. What is evidence-based assessment? 4. What are the core competencies in psychological assessment expected at the point of licensure? 5. List and describe the purposes of psychological assessment. 6. Discuss the difference between assessment-focused versus interventionfocused services. 7. Discuss how assessment formulates diagnosis. 8. Discuss how assessment aids in prognosis. 9. Discuss how assessment plays a role in treatment planning. 10. How does assessment monitor the impact of treatment? 11. What are psychological tests? 12. What is difference between assessment and testing? 13. Why is standardization crucial for a psychological test? 14. Discuss the importance of reliability and validity. 15. What are the various forms of reliability? 16. What are the various forms of validity? 17. How is a test normed? 18. What are the most commonly taught tests in clinical psychology programs? 19. What are the ethical considerations in psychological testing and assessment?
Up for Discussion 1. How is psychological assessment different from other types of assessment?
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Chapter 5: Assessment: Overview
2. Although screening is useful in identifying those at risk, it is important to remember that screening tools are not the same as tools used in diagnosis. So, for example, if you score high on a depression-screening instrument, it does not mean that you would necessarily meet diagnostic criteria for depression. 3. If you are considering psychological testing on the Internet, you need to be just as careful as if you were seeking psychological testing in a traditional format. Consider the credentials of the organization that is offering services and the scientific basis of the tools. No score should ever be interpreted in isolation. To be useful, it must be considered part of the information gathered in the process of psychological assessment. 4. What are the essential ingredients of a useful psychological test? 5. Most students find that psychometric considerations are not as interesting as case material. However, before you skip over them, it may be useful to imagine that you are in the emergency room, having broken your hand in a fall on the ice. Would you wish to have your X-ray read by a person who has aced the anatomy course, or by someone who had skipped the anatomy class that covered the bones in the hand because it was simply too boring? To conduct competent, evidence-based assessments, psychologists must have a sound understanding of psychometrics. 6. What problems might there be with basing decisions on unstandardized tests? 7. How would you feel if a psychologist made decisions about your psychological adjustment based on an untested and unstandardized scoring system? 8. Why is it important for clinical psychologists to understand psychometric considerations? 9. Why do psychologists collect multiple types of information in their assessments? 10. People considering a psychological assessment should ensure that they receive sufficient details about the assessment to be able to make an
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Chapter 5: Assessment: Overview
informed decision about participation. They require information about the nature and purpose of the assessment, the fees, the involvement of other parties in the assessment, and any limits to confidentiality.
Out-of-Class Activities 1. Have students consider and write up all of the ways psychological tests and assessments can be biased. Have them discuss how to control for these biases. 2. Ask students to consider why a psychological test normed in the United States and given to immigrants entering the U.S. would not be appropriate, even if translated into the respective foreign language. 3. Divide students into three to five teams, depending on your class size. You may also assign individually. Each of the teams or the individual would be presented with a real or mock case and would be instructed to research which psychological tests they would want to incorporate into their treatment plan and the tests they would use for follow-up assessment. The following week the teams would discuss in class or the individual would hand in their write-up. 4. Have students search for psychological tests on the internet. Have them present the pros and cons of the test, noting also the limitations and psychometric properties. Have students discuss the norms, reliability, and validity of the test and compare to another non-internet-based test. Have them note the differences. 5. Have students consider what they would do if they had a patient disclose homicidal or suicidal ideation during a diagnostic or follow-up assessment. Students should review the Tarasoff vs. the Regents of the University of California case regarding the duty to disclose. They should discuss their own obligations, feelings, and their legal, ethical, and moral considerations of disclosure.
Web Links The Buros Center for Testing provides listings of tests and test reviews: www.buros.org The American Psychological Association has a research database, PsycTESTS, that covers many types of psychological tests: www.apa.org/pubs/databases/psyctests/index.aspx
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Chapter 5: Assessment: Overview
There are several websites with information on screening for psychological problems. National Alcohol Screening Day and National Depression Screening Day: www.mentalhealthscreening.org/programs/Initiatives Self-screening for anxiety and depression: www.adaa.org/living-with-anxiety/ask-and-learn/screenings www.heretohelp.bc.ca/screening/online/?screen=anxiety
Suggested Readings Books Groth-Marnat, G., & Wright, A. J. (2016). Handbook of psychological assessment (6th ed.). Hoboken, NJ: John Wiley & Sons Inc. Haynes, S. N., Smith, G., & Hunsley, J. (2011). Scientific foundations of clinical assessment. New York: Taylor & Francis. Hogan, T. P. (2014). Psychological testing: A practical introduction (3rd ed.). Hoboken, NJ: John Wiley & Sons Inc. Hunsley, J., & Mash, E. J. (Eds.). (in press). A guide to assessments that work (2nd ed.). New York: Oxford University Press. Journals Assessment Journal of Personality Assessment Journal of Psychopathology and Behavioral Assessment Psychological Assessment
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Chapter 6: Assessment: Interviewing and Observation
Chapter 6 – Assessment: Interviewing and Observation Chapter Overview Chapter 6 explores the many facets of interviewing and observation. Notably, unstructured and structured interviews are examined, with a reemphasis given to confidentiality. Students are introduced to proper interviewing skills across cultures and populations. The importance of solid interviewing skills may mean the difference between life and death for a suicidal or homicidal patient. A diagnostic assessment should neither be rushed nor should a clinician infer anything about their patients until they have completed a thorough assessment. One should also emphasize the need for careful administration of the assessments discussed in the chapter as improper administration not only weakens the rapport and invalidates the findings, but also does a disservice to the entire assessment process. This chapter may also serve as a reference chapter for next three chapters on the various assessment tools.
Chapter Contents •
Introduction
•
Ethical Issues: Limits of Confidentiality
•
Unstructured Assessment Interviews
•
Semi-Structured Diagnostic Interviews
•
General Issues in Interviewing ▪
Attending Skills
▪
Contextual Information
▪
Culturally Sensitive Interviewing
▪
Defining Problems and Goals
▪
Assessing Suicide Risk
▪
Interviewing Couples
▪
Interviewing Families
▪
Interviewing Children and Adolescents
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Chapter 6: Assessment: Interviewing and Observation
•
Observations
•
Self-Monitoring
•
Summary and Conclusions
Learning Objectives 1. Discuss the limits of confidentiality and when confidentiality can be broken. 2. What are unstructured assessment interviews? 3. What are the differences between clinical interviews and social conversations? 4. What is the difference between open- and closed-ended questions? 5. What is the purpose of a semi-structured diagnostic interview? 6. Discuss the importance of listening skills. 7. How does contextual information play a role in assessment? 8. How can culture affect assessment of the patient? 9. Provide three examples of problem-defining questions. 10. Provide three examples of goal-definition questions. 11. What are the empirically informed suicide risk assessment questions? 12. Discuss the challenges to interviewing couples. 13. Discuss the challenges to interviewing families. 14. Discuss the challenges to interviewing older adults. 15. How is interviewing a child or an adolescent different from interviewing an adult? 16. What are the challenges faced by psychologists when interviewing children and adolescents? 17. How do observations sometimes provide more information than direct interviewing? 18. How can self-monitoring be beneficial to a patient’s overall therapy?
Up for Discussion
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Chapter 6: Assessment: Interviewing and Observation
1. What are some of the major goals of assessment interviews? 2. What is your reaction to the information provided in Exhibit 6.2 in the text? How would this affect your views of psychological services? What kinds of skills does it require to begin a conversation this way? 3. If you choose a career in clinical psychology because you always like talking to people and are considered by your friends to be a good listener, you may be surprised to discover that you will need to learn to interact in a very different way in your future role as a psychologist. 4. Pay attention to your usual style of questioning in your conversations with friends. Do you notice any difference in the impact on the conversation when you use open and closed questions? If you have a favourite interviewer or talk show host, notice the type of questions that person uses and the way the questions alter the conversation. 5. What are the advantages and disadvantages of semi-structured and diagnostic interviews? 6. Do you respond differently to an interview administered by a person versus one administered by a computer? Why? 7. How do you think it would feel to have a conversation focus entirely on you for almost an hour? Would you feel comfortable, or awkward, or maybe intimidated? If you were in training as a psychologist, how easy would it be for you to modify your natural conversation style? 8. How can psychologists conduct culturally sensitive interviews? 9. How have psychologists adapted interview techniques to take into account developmental issues? Imagine having a psychologist observe your interactions while you are having a meal at home. How might you behave differently? Even if you were initially self-conscious about what you were doing and saying, how long do you think this would affect you? 10. How can self-monitoring strategies add useful data to an assessment?
Out-of-Class Activities 1. Have students write up the various verbal and non-verbal ways a clinical
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Chapter 6: Assessment: Interviewing and Observation
interview can capture information. Have students bring this to their next class to discuss. This assignment may tie in nicely with a mock demonstration of the difference between verbal and non-verbal communication. 2. Have students research the various structured and semi-structured assessment tools that exist in the field. Students should focus on one particular area such as diagnostics, depression, anxiety, bipolar etc. Students should provide a write up of the assessment(s) highlighting the assessment’s utility, administration time, who can administer it, and reliability and validity data. 3. Divide students into three to five teams, depending on your class size. You may also assign individually. Each of the teams or the individual should be given two weeks to work on this assignment. Students are to create a series of both open-ended and closed-ended questions for a particular disorder. They then will present to the class or provide a write up of the questions. Students should focus on cultural sensitivity and overall feasibility of the questions. 4. Have students pair up inside of class or pair up with a friend outside of class and have a normal discussion with that person, noting the nonverbal communication throughout the conversation. Have the students write up their reactions and findings. Use this exercise to stimulate more discussion in class. 5. Have students look up the following suicide risk assessments and provide a critique of them: Columbia Suicide Severity Rating Scale (C-SSRS) and the Beck Scale for Suicide Ideation (BSS). 6. Have students self-monitor their eating, drinking, smoking, or exercising habits for two weeks. Have them record their findings and write up the challenges and difficulties, and then have them apply their understanding to how their experiences are similar to what patients face.
Web Links You can find information about the Structured Clinical Interview for DSM Disorders (SCID) here: www.appi.org/products/structuredclinical-interview-for-dsm-5-scid-5 You can find information about the Dominic Interactive here: www.dominicinteractive.com For information on risks for suicide and understanding more about suicide prevention:
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Chapter 6: Assessment: Interviewing and Observation
www.livingworks.net www.canadiancrc.com/Youth_Suicide_in_Canada.aspx Numerous websites provide examples of self-monitoring forms and procedures for personal concerns such as mood and weight loss. Here are just some examples: www.psychology.tools/depression.html www.web4health.info/en/answers/bipolar-self-monitor.htm
Suggested Readings Books McLeod, B. D., Jensen-Doss, A., & Ollendick, T. H. (Eds.) (2013). Diagnostic and behavioral assessment in children and adolescents. New York: Guilford Press. Segal, D. L., & Hersen, M. (Eds). (2010). Diagnostic interviewing (5th ed.). New York: Springer. Sommers-Flanagan, J., & Sommers-Flanagan, R. (2015). Clinical interviewing (5th ed.). New York: John Wiley & Sons, Inc. Sue, D. W., & Sue, D. (2015). Counseling the culturally diverse: Theory and practice (6th ed.). New York: John Wiley & Sons, Inc.
5
Chapter 7: Assessment: Intellectual and Cognitive Measures
Chapter 7 – Assessment: Intellectual and Cognitive Measures Chapter Overview Chapter 7 explores the fascinating, complex, and sometimes controversial topic of intelligence and cognitive assessment. Our society tends to put great emphasis on intelligence and some people even go so far as to state their IQ. The chapter defines intelligence, and the various theories of intelligence are covered in detail. The most well-known and popular intelligence scales, the Wechsler intelligence scales, are the primary focus of the remainder of this chapter. Assessment issues are discussed throughout with an emphasis on administration, scoring, and interpretation. Students should come away with a strong base of knowledge for further study in undergraduate psychometrics and assessment, and they should also be prepared to critically evaluate the strengths and weaknesses of the various intelligence tests.
Chapter Contents •
Introduction
•
Defining Intelligence
•
Theories of Intelligence
•
Assessing Intelligence: The Clinical Context
•
The Wechsler Intelligence Scales ▪
Background Issues
▪
Administration, Scoring, and Interpretation Issues
▪
Canadian Normative Data
▪
Wechsler Adult Intelligence Scale – Fourth Edition (WAIS-IV)
▪
Wechsler Intelligence Scale for Children – Fifth Edition (WISC-V)
•
Wechsler Preschool and Primary Scale of Intelligence – Fourth
Edition (WPPSI-IV) •
Other Intelligence Scales
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Chapter 7: Assessment: Intellectual and Cognitive Measures
•
Selected Cognitive Assessment Scales ▪
Wechsler Memory Scale – Fourth Edition (WMS-IV)
▪
Weschler Individual Achievement Test- Third Edition (WIATIII)
•
Summary and Conclusions
Learning Objectives 1. How do we define intelligence? 2. Discuss Spearman’s general factor or g. 3. Discuss Cattell’s theory of intelligence. 4. What is the difference between fluid intelligence and crystallized intelligence? 5. How do we clinically assess intelligence? 6. Who was David Wechsler? 7. Discuss the background and history of the Wechsler tests. 8. What are the administration, scoring, and interpretation issues of the Wechsler scales? 9. Who is qualified to administer intelligence tests? 10. Discuss the main features of the WAIS-IV. 11. Discuss the main features of the WISC-V. 12. Discuss the main features of the WPPSI-IV. 13. What is the Flynn Effect? 14. Describe the Stanford-Binet Intelligence Scales. 15. Discuss the main features of the WMS-IV. 16. Discuss the main features of the WIAT-III.
Up for Discussion 1. A number of websites purport to provide online evaluations of intelligence or to provide “brain training.” The Latin phrase caveat emptor means “buyer beware” and is as relevant for anyone taking self-administered
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Chapter 7: Assessment: Intellectual and Cognitive Measures
intelligence tests or attempting to improve cognitive abilities as it is for purchasing clothing, diet products, used cars, or anything that sounds like a deal that is just too good to pass up. 2. What are the problems in defining intelligence in terms of academic performance? 3. Consider for a moment the following set of people: an Olympic athlete, an expert interpreter, a talented musician, a skilled carpenter, a popular comedian, and a successful fishing guide. To what extent are their different abilities reflective of intelligence, effort and practice, and/or biological predispositions? How broadly should we define intelligence and intelligent behaviour? 4. What types of questions can assessment of intelligence and cognitive functioning address? 5. What is the significance of having an appropriate normative group for a psychological measure? 6. Why have psychologists developed Canadian versions of tests of intelligence and achievement? 7. What are some of the limitations of the Wechsler scales? 8. Early in this chapter, we encouraged you to adopt an attitude of caveat emptor when examining self-administered IQ tests. One of the most important ways that you can evaluate the quality of any psychological test is by considering the strength and extent of the reliability and validity evidence for the test. This is why we provide this kind of technical information about the Wechsler scales. If a family member was being assessed to determine whether he or she was eligible for admission to a giftedness program, you would probably want to be sure that he or she was assessed using the most valid measure possible. 9. How do the Kaufman intelligence tests differ from the Wechsler intelligence scales?
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Chapter 7: Assessment: Intellectual and Cognitive Measures
10. What kind of information can psychologists obtain by comparing a person’s results on an intelligence test with those on an achievement test?
Out-of-Class Activities 1. Have students research the Stanford-Binet and the Kaufman Brief Intelligence Test 2 (K-BIT-2). Students should provide a write up of each of the intelligence tests highlighting the administration, scoring, and interpretation issues. They should also note the qualification requirements of the tests. 2. Have students research the issue of cultural bias in intelligence testing. They should discuss the history; the past, present, and future ways to remedy bias; and provide their own opinion. Use this exercise to stimulate more discussion in class. 3. Have students create a biased test by developing a set of questions on their state, city, or town and administering these questions to someone unfamiliar with that place. Students should be able to discuss and write up a reaction paper about the difficulties the person had and how biased tests can negatively affect an individual’s life.
Web Links Information on Mensa can be found on the Mensa International and Mensa Canada pages: www.mensa.org www.mensacanada.org/home.htm Take the Mensa workout (not an intelligence test!): www.mensa.org/workout.php The Learning Disabilities Association of Canada website offers detailed information on learning disabilities: www.ldac-acta.ca Pearson Canada Assessment is the publisher of the Wechsler scales. Visit their website for information on these scales and other measures of cognitive functioning: www.pearsonclinical.ca/en/ psychology/cognition--intelligence.html The following website provides information on research on emotional intelligence. It also lets you see sample reports and learn about what a person might be encouraged to do based on the
4
Chapter 7: Assessment: Intellectual and Cognitive Measures
results of the Mayer-Salovey-Caruso Emotional Intelligence Test: www.unh.edu/emotional_intelligence/index.html
Suggested Readings Books Hunt, E. (2011). Human intelligence. Cambridge, UK: Cambridge University Press. Sternberg, R. J., & Kaufman, S. B. (Eds.). (2011). The Cambridge handbook of intelligence. Cambridge, UK: Cambridge University Press. Journals Intelligence
5
Chapter 8: Assessment: Self-Report and Projective Measures
Chapter 8 – Assessment: Self-Report and Projective Measures Chapter Overview Chapter 8 provides an in-depth exploration of the variety of self-report and projective measures available. Students are probably familiar with the Rorschach inkblots from other classes, and they may have seen them discussed in the popular media. However, this may be the first time that students have the opportunity to learn about the many facets of both objective and subjective personality instruments. The MMPI-2 and MMPI-A are two such self-report instruments that have a rich developmental background in terms of their psychometric development. In addition, the MMPI series of assessments are well regarded and widely used beyond their original clinical roots. Self-report measures are becoming more widely used, as third-party payers increasingly want objective documentation of illness and treatment response. The Beck Depression Inventory-II, the SCL-90-R, and the Outcome Questionnaire 45 are self-report measures designed to obtain information in a quick, less burdensome manner. The chapter concludes with a well-rounded discussion of the Rorschach Inkblot Test.
Chapter Contents •
Introduction
•
The Person-Situation Debate
•
Self-Presentation Biases
•
Developing Culturally Appropriate Measures
•
The Clinical Utility of Self-Report and Projective Measures
•
Self-Report Personality Measures
•
▪
MMPI-S and MMPI-A
▪
Other Clinical Measures of Personality Functioning
▪
Self-Report Measures of Normal Personality Functioning
Self-Report Checklists of Behaviors and Symptoms
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Chapter 8: Assessment: Self-Report and Projective Measures
•
▪
Achenbach System of Empirically Based Assessment
▪
SCL-90-R
▪
Outcome Questionnaire 45
▪
Beck Depression Inventory-II
▪
Children’s Depression Inventory 2
Projective Measures of Personality ▪
•
Rorschach Inkblot Test
Summary and Conclusions
Learning Objectives 1. What is the difference between objective and projective personality tests? 2. Discuss the person-situation debate. 3. What are self-presentation biases? 4. Discuss malingering and how this affects assessment. 5. Discuss the reasons why personality measures must be relevant and unbiased across cultures. 6. How can culture affect assessment of the patient? 7. How should a clinician conduct an assessment with someone from an ethnic minority background? 8. What is the clinical utility of self-report and projective measures? 9. What are the most commonly used self-report and projective measures? 10. Discuss the background issues of the MMPI-2 and MMPI-A. 11. Discuss the MMPI-2 validity scales and their importance to assessment. 12. Discuss the MMPI-2 clinical scales and their importance to assessment. 13. What are the content scales of the MMPI-2? 14. What are the administration, scoring, and interpretation issues of the MMPI-2 and MMPI-A? 15. Discuss the code types of the MMPI-2. 16. Discuss the Million measures. 17. What is the Personality Assessment Inventory and how was it normed? 18. Why are self-report checklists becoming more widely used?
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Chapter 8: Assessment: Self-Report and Projective Measures
19. What is the Achenbach system of empirically based assessment? 20. Discuss the purpose of the SCL-90-R. 21. Discuss the purpose of the Outcome Questionnaire 45. 22. What is the benefit of using the Beck Depression Inventory-II and the Children’s Depression Inventory 2? 23. What are the limitations of the projective measures of personality? 24. Discuss the positives and negatives of the Rorschach Inkblot Test.
Up for Discussion 1. Is there consistency between your behaviour and emotional reactions? In reviewing your own psychological reactions, how important do you think your personality is in determining your responses? How important are the demands of the situation you find yourself in, such as the expectations of others? 2. Can you think of times when you deliberately underemphasized or overemphasized physical problems or emotional difficulties that you were experiencing? Did this seem justified to you at the time? Did your presentation of your problems have the effect on other people that you hoped it would have? Are there times when you think other people are downplaying or highlighting their problems? 3. How can we ensure that tests are culturally sensitive and appropriate? 4. What are criteria by which we can judge whether a test is useful? 5. Trainees learning to use the MMPI-2 (or the MMPI-2-RF) often complain about the number of scales to score and consider. Aside from the challenge of learning what all the different scales are meant to assess, can you see other difficulties stemming from this “embarrassment of riches”? 6. How do some tests overpathologize test takers, and why is that a problem? 7. What are the main differences between objective personality tests and symptom checklists? 3
Chapter 8: Assessment: Self-Report and Projective Measures
8. What are the shortcomings of current practice in projective assessment? .
Out-of-Class Activities 1. Have students research the issue of malingering and the ramifications on clinical assessment. Have them write up their findings and discuss in class. 2. Students should reflect on the steps they would take to handle a patient who was malingering. Consider extreme values on the self-report tests, non-existent symptoms, etc. They should discuss their own internal feelings and how this could affect their clinical judgment. They then will present to the class or provide a write up of the questions. 3. Students should write up to ten questions on a topic that is uncomfortable such as sex, politics, religion, prejudice, etc. Have students pair up inside of class or pair up with a friend outside of class and present the questions to the person as a self-report. They then should personally administer these same questions to someone they know and someone they do not know very well. Students should note the differences in responses and the tie-in with social desirability. Have the students write up their reactions and findings. Use this exercise to stimulate more discussion in class. 4. Have students look up the following assessments and provide a critique of them: the Beck Depression Inventory-II and the Children’s Depression Inventory 2.
Web Links MMPI-2, the publisher’s site: www.pearsonclinical.ca/en/products/ product-master/item-134.html MCMI-IV, the publisher’s site: www.pearsonclinical.ca/en/products/ product-master/item-211.html PAI, the publisher’s site: www4.parinc.com/Products/Product.aspx? ProductID=PAI The International Personality Item Pool Representation of the NEO PI-R (including two versions of a five-factor personality test that can be taken online) can be found at: www.personal.psu.edu/~j5j/IPIP ASEBA, the publisher’s site: 4
Chapter 8: Assessment: Self-Report and Projective Measures
www.aseba.org
Suggested Readings Books Antony, M. M. & Barlow, D. H. (Eds.). (2010). Handbook of assessment and treatment planning for psychological disorders (2nd ed.). New York: Guilford Press. Butcher, J. N. (Ed). (2009). Oxford handbook of personality assessment. New York: Oxford University Press. Wood, J. M., Nezworski, M. T., Lilienfeld, S. O., & Garb, H. N. (2003). What’s wrong with the Rorschach? Science confronts the controversial inkblot test. San Francisco: Jossey-Bass. Journals Assessment Journal of Personality Assessment Journal of Psychopathology and Behavioral Assessment Psychological Assessment
5
Chapter 9: Integration and Clinical Decision Making
Chapter 9 – Assessment: Integration and Clinical Decision Making Chapter Overview Chapter 9 provides a wonderful integration of the four previous chapters and leads us into the final phase of the assessment process – integration. Students have learned how and why data is obtained, but in this chapter, they learn what do with the data. As has been the theme throughout a number of chapters, validity is discussed from the perspective of the patient and the clinician. Critical thinking is often mentioned and may run as a theme in a number of psychology courses; however, the emphasis on judgment and decision-making plays a crucial role in both the work-up of the patient as well as the treatment plan. This chapter stresses the importance of sound clinical judgment and clinical standards. Students who pursue a career in psychology will be challenged ethically, morally, and professionally everyday. This is an opportunity to provide a model of the clinical skills necessary which will help carry them in their future career.
Chapter Contents •
Integrating Assessment Data ▪
•
•
Threats to the Validity of Assessments and Case Formulations ▪
Patient/Client Factors
▪
Clinician Factors
▪
Improving the Accuracy of Clinical Judgment
Psychological Assessment Reports and Treatment Plans ▪
•
Case Formulation
Assessment Feedback
Summary and Conclusions
Learning Objectives 1. How do clinical psychologists integrate assessment data?
1
Chapter 9: Integration and Clinical Decision Making
2. What is the value of assessing and then integrating data from multiple informants? 3. What are the benefits of clinical case formulation? 4. What are the steps in developing a case formulation? 5. Discuss the errors associated with retrospective recall. 6. How does a patient’s memory impact assessment? 7. What does the research tell us about people’s ability to recall events? 8. What are the most common clinician errors in judgment? 9. What is the self-serving attributional bias? 10. What are the most common decision-making biases and heuristics? 11. How can we improve the accuracy of clinical judgment? 12. What are the principles of report writing? 13. What are the main sections of an assessment report focused on psychological functioning issues? 14. What are the main elements of an assessment report focused on treatment planning issues? 15. What are the purposes of providing assessment feedback? 16. Discuss Finn’s therapeutic model of assessment.
Up for Discussion 1. What are the challenges involved for psychologists in synthesizing all of the information collected as part of a psychological assessment? 2. In what ways is the process of developing a case formulation a scientific endeavour? 3. Does it feel to you that your memories of recent and more distant events might be flawed? Can you think of examples of memories you have that seem very clear but you know are not entirely accurate? 4. What common heuristics are operating when we assume that a person who has been exposed to trauma is likely to be psychologically vulnerable?
2
Chapter 9: Integration and Clinical Decision Making
5. A friend has just told you that someone she knows named Chris is interested in switching to psychology as a major. Without asking your friend any questions, do you assume that Chris is female or male? Obviously, the person’s name can be either a man’s or a woman’s, so this doesn’t give you any clues. However, you do know something about the base rate of men and women in psychology courses. For many years now, the majority of students majoring in psychology have been women. So, using this base rate information, your best guess about Chris’s gender should be that Chris is a woman. 6. What are the advantages of reviewing reports with clients? 7. If you had been assessed by a clinical psychologist, would you want to receive a copy of the report? Are there any reasons why you wouldn’t want a copy?
Out-of-Class Activities 1. Have students watch any cable television news show, preferably where there is a psychologist speaking about a celebrity. They could also watch an episode of Dr. Phil. The objective is for the students to comment on the “advice” and “assessment” that the psychologist provides to the individual or about the celebrity. Students should refer to Exhibit 9.3 to defend their critique. Students should also discuss how this type of television advice and assessment is not only detrimental to the individual but to the field as a whole. Have them write up their findings and discuss in class. 2. Students should research a sample psychological report and provide a critique of it noting how it matches up with Exhibit 9.6. 3. Students should write up a treatment plan for a mock psychiatric case. They should include the elements discussed in Exhibit 9.7. 4. Students should practice presenting cases to one another either in class or out of class. Students could also write a brief biography about another person and present to the class. This is an excellent opportunity to highlight positives and provide constructive feedback.
3
Chapter 9: Integration and Clinical Decision Making
Web Links If you would like more information on decision-making biases and heuristics, including some examples you can try that illustrate various biases and heuristics, look at the following websites: www.nku.edu/~garns/165/pptj_h.html www.prioritysystem.com/reasons1a.html In 2002, the cognitive psychologist Dr. Daniel Kahneman won the Nobel Prize for Economics for his research on how people make decisions under conditions of uncertainty. You can read his Nobel Prize lecture on his research here: www.nobelprize.org/nobel prizes/economics/laureates/2002/kahnemannlecture.pdf Many websites provide examples of psychological assessment reports written for different purposes. Here are some, including sites that have computer-based interpretative reports for specific assessment instruments: www.msresource.com/format.html www.behaviordata.com www4.parinc.com/WebUploads/samplerpts/PAI32.pdf www.pearsonclinical.com/psychology/products/100000509/ millon-inventories.html#tab-scoring www.pearsonclinical.com/psychology/products/100000631/ minnesota-multiphasic-personality-inventory-2-rf-mmpi-2-rf. html#tab-scoring
Suggested Readings Books Antony, M. M., & Barlow, D. H. (2010). Handbook of assessment and treatment planning for psychological disorders (2nd ed.). New York: Guilford Press. Eells, T. D. (Ed.). (2006). Handbook of psychotherapy case formulation (2nd ed.). New York: Guilford Press. Garb, H. N. (1998). Studying the clinician: Judgment research and psychological assessment. Washington, DC: American Psychological Association. McLeod, B. D., Jensen-Doss, A., & Ollendick, T. H. (Eds.). (2013). Diagnostic
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Chapter 9: Integration and Clinical Decision Making
and behavioral assessment in children and adolescents. New York: Guilford Press.
5
Chapter 10: Prevention
Chapter 10 – Prevention Chapter Overview Prevention of illness and disease is equally, if not more important than, treatment itself. Prevention programs first began with physical health problems in response to various outbreaks and to promote general community health. A healthy body is only half the battle if one does not have a healthy mind. Prevention programs for the mentally ill evolved into what is known as community psychology. Community psychologists are established within the communities in which they work and have a long history of providing interventions for vulnerable populations. Chapter 10 explores the various prevention programs for violence, anxiety, depression, substance abuse, and trauma or loss. An ounce of prevention is truly worth more than the cure. Given the rising costs of health care and the burden of care for the various disorders, prevention of illness tends to be a more affordable option for patients, clinicians, and communities.
Chapter Contents •
Introduction
•
Approaches to Prevention
•
Promoting Evidence-Based Parenting
•
•
▪
Home Visiting Programs
▪
Incredible Years
▪
Triple P
Prevention of Violence ▪
Physical Abuse of Children
▪
Youth Violence: Bullying and Conduct Disorder
Prevention of Internalizing Disorders ▪
Anxiety Disorders
▪
Depression
•
Prevention of Substance Abuse
•
Prevention of Problems in Those Exposed to Trauma or Loss
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Chapter 10: Prevention
•
Summary and Conclusions
Learning Objectives 1. What do community psychologists do? 2. What is health promotion? 3. Discuss the differences and similarities between universal, selective, and indicated preventative interventions. 4. What are modifiable risk factors? 5. How do parenting programs help vulnerable populations? 6. What were the results of the Olds home visiting program? 7. Discuss Webster-Stratton’s Incredible Years Program. 8. What is the Triple P Positive Parenting Program designed to do? 9. What are the different forms of child abuse? 10. How can bullying be prevented? 11. How can anxiety disorders be reduced or prevented? 12. How can depression be reduced or prevented? 13. Discuss the various prevention programs for substance abuse. 14. What is critical incident stress debriefing?
Up for Discussion 1. What are the similarities and differences between prevention programs for physical health problems and programs for mental health problems? 2. Have you considered a professional role in which you would not necessarily be the direct service provider? How important is it to you that your work could affect a large number of people? 3. If you were asked to design a program to prevent the development of behavioural problems using a risk reduction model, you would need to target risk and protective factors that are modifiable. Which of the factors listed in Exhibit 10.1 and Exhibit 10.2 are most likely to be modifiable?
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Chapter 10: Prevention
4. Why is long-term systematic evaluation so important in prevention science? 5. Prevention programs seem to be relatively effective for many psychological problems, so why aren’t such programs more commonly used in our health care and educational systems? 6. When you have had painful experiences, who did you turn to for support? What do you think it would be like to have a stranger tell you what you need to do to cope with a painful situation?
Out-of-Class Activities 1. Have students watch the local news or read a newspaper article on some community issue involving children, adolescents, the elderly, substance abuse, etc. The objective is for the students to design and develop their own prevention program focusing on community needs, limitations, goals, and realistic expectations. Students should refer to Exhibit 10.3 in the text for guidance. Students should also discuss why they chose their specific prevention plan. Have them write up their findings and discuss in class. 2. Students should research bullying and discuss why bullying is so prevalent in our school systems. They should pretend they are a principal of a junior high school and outline a plan of action for prevention of bullying. 3. Students should research a specific prevention plan that was successful in the United States and discuss the reasons why it succeeded. 4. Students should research a specific prevention plan that was unsuccessful in the United States and discuss the reasons why it failed.
Web Links An American website providing information on the Incredible Years Program: www.incredibleyears.com An Australian website providing information on Triple P: www.triplep.net/glo-en/home/ The website for the Blueprints for Violence Prevention programs that 3
Chapter 10: Prevention
identifies efficacious prevention programs: www.colorado.edu/cspv/blueprints A website providing reviews of research on number needed to treat in interventions for physical problems: www.thennt.com
Suggested Readings Doll, B., Pfohl, W., & Yoon, J. (Eds.). (2010). Handbook of youth prevention science. New York: Routledge. Greenwood, C. R., Kratochwill, T. R., & Clements, M. (Eds). (2008). Schoolwide prevention models: Lessons learned in elementary schools. New York: Guilford. Tolan, P., Szapocznik, J., & Sambrano, S. (Eds). (2006). Preventing youth substance abuse: Science-based programs for children and adolescents. Washington, DC: American Psychological Association Press.
4
Chapter 11: Intervention: Overview
Chapter 11 – Intervention: Overview Chapter Overview Once an accurate and thorough assessment has been performed, and we have a diagnosis, we move on to providing intervention. There are various forms of interventions: psychopharmacological, psychotherapy, herbal, self-help, and other alternative modes of treatment. While students will not be formally practicing for quite some time, this introduction into intervention allows them to consider the menu of treatment choices to promote their academic journey. Ethical considerations, a theme throughout the text, are discussed and are a guide to the delivery of psychological services. Chapter 11 introduces us to empirically based interventions and provides the backbone for the next three chapters. Students should begin to consider how these interventions affect the lives of patients and impact clinicians as well.
Chapter Contents •
Introduction
•
The Ethics of Intervention
•
Theoretical Approaches ▪
Short-Term Psychodynamic Psychotherapies
▪
Interpersonal Psychotherapy for Depression
▪
Process-Experiential Therapies
▪
Cognitive-Behavioural Therapies
•
Seeking Psychological Treatment
•
The Duration and Impact of Psychotherapy
•
Alternative Modes of Service Delivery
•
Summary and Conclusions
Learning Objectives 1. What are the ethical considerations of intervention? 2. Discuss the benefits of short-term psychodynamic psychotherapies.
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Chapter 11: Intervention: Overview
3. Define interpersonal psychotherapy. 4. Discuss the role of interpersonal psychotherapy for depression. 5. What are the roots of the process-experiential therapies? 6. Why has there been a resurgence of the process-experiential therapies? 7. Why are cognitive-behavioural therapies so popular? 8. What are the phases of cognitive-behavioral therapy? 9. Who seeks psychological treatment? 10. What does psychotherapist mean? 11. How can patients be sure their therapist is qualified? 12. How long does psychotherapy last and does it work? 13. What other modes of service delivery are there for therapies?
Up for Discussion 1. The next time you seek any type of health service, pay attention to informed-consent issues. How does the service provider explain the options to you? Does it make a difference to you whether the service provider ensures you understand your choices? 2. Once people have decided to begin therapy, what kinds of questions should they raise in their first appointment with a psychologist? 3. Think about a health service you have received recently. It might have been treatment for an infection, orthodontic services or chiropractic services. How did the health care provider monitor the effectiveness of the services in helping you? It is important to you to know that the service is making a difference in your life? 4. Recall what you have read in the sections on the different theoretical orientations. Try to imagine what it would be like to receive the different forms of treatments and how you might respond to the different emphases across orientations. 5. Imagine that you were seeking services to deal with conflicts that you are experiencing with one of your parents or someone in your family. How would the focus of services differ in STPP from IPT? Which one would 2
Chapter 11: Intervention: Overview
focus more on altering the way you interact with that parent or that person? Which one would focus more on how you feel about that person and how being with him or her makes you feel? 6. Where would you place the four main evidence-based approaches to therapy presented in this chapter on a continuum with intrapsychic and interpersonal as endpoints? 7. What may account for the difficulty many people experience in deciding to seek psychological services? 8. Compared with individual treatment, do you think that there might be some disorders for which group treatment might be especially helpful? 9. How do you feel about receiving psychological treatment based on a computer program provided under the supervision of a psychologist? Would you reaction change if you were able to start the computer-based treatment immediately, rather than having to wait weeks or months on a waiting list to receive therapy from a psychologist? 10. For some considering psychological treatment, what might the advantages be in considering self-administered treatments? What drawbacks might there be?
Out-of-Class Activities 1. Have students visit the American Psychological Association website on the Ethical Principles of Psychologists and the Code of Conduct. Have them select the sections relevant to treatment and therapy, explain how one could violate a code, and discuss the consequences of such a violation. Have them consider why these particular sections are there. 2. Have students research a therapy of their choice and provide an analysis of why this treatment would be effective and for which disorders. They should be prepared to defend their choice in class. 3. Psychotherapy can be challenging for a patient. Students should assume the role of therapist and write up ways in which they can encourage patients to stay with their treatment. They should try to incorporate prevention techniques from Chapter 11 in their answer.
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4. Students can look up numerous group therapies and may want to attend one, with the permission of the group facilitator. They should write up their reactions, the effectiveness of the group, the group support, and the overall differences and similarities to one-on-one counseling.
Web Links Information about research-supported psychological treatments from the Society of Clinical Psychology: www.div12.org/psychologicaltreatments/ The Reading Well site for suggested self-help books: www.readingwell.org.uk/ The FearFighter Internet-based treatment of phobias and panic, and other Internet-based treatments: ccbtmain.cbtprogram.com/ products/fearfighter/ Some websites describing virtual reality treatments and treatment related research (keep in mind the importance of empirical evidence in reviewing selfhelp books and websites offering treatment options): www.virtuallybetter.com www.vrphobia.com
Suggested Readings Books Lambert, M. L. (Ed.). (2013). Bergin and Garfield’s handbook of psychotherapy and behavior change (6th ed.). Hoboken, NJ: John Wiley & Sons. Norcross, J. C., Campbell, L. F., Grohol, J. M., Santrock, J. W., Selagea, F., & Sommer, R. (2013). Self-help that works: Resources to improve emotional health and strengthen relationships. New York: Oxford University Press. Journals Annual Review of CyberTherapy and Telemedicine CyberPsychology & Behavior
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Chapter 11: Intervention: Overview
Journal of Telemedicine and Telecare Psychotherapy Psychotherapy Research
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Chapter 12: Intervention: Adults and Couples
Chapter 12 – Intervention: Adults and Couples Chapter Overview Adults and couples therapy can be quite rewarding but also highly challenging for the clinician. There are numerous therapies, some effective, others not. This chapter explores the evidence-based treatments that work for adults and couples. Cognitive-behavioral therapy is a focus for depression and prolonged exposure is explored for PTSD. The chapter discusses why evidence-based treatments are not widely accepted or slow to catch on. This chapter is a strong primer into adult psychotherapy and provides a base of knowledge for future study.
Chapter Contents •
Introduction
•
Does Psychotherapy Work? A Controversy and Its Impact
•
Meta-Analysis and Psychotherapy Research
•
Evidence-Based Treatments: Initiatives and Controversies
•
Clinical Practice Guidelines
•
Examples of Evidence-Based Treatments ▪
CBT for Depression
▪
Prolonged Exposure CBT for PTSD
▪
EFT for Couple Distress
•
Effectiveness Trials
•
Adoption of Evidence-Based Treatments
•
Summary and Conclusions
Learning Objectives 1. Does psychotherapy work? 2. What are the strengths and weaknesses of meta-analysis? 3. What are the controversies surrounding psychotherapy?
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Chapter 12: Intervention: Adults and Couples
4. Discuss the evidence-based treatments. 5. What are the controversies surrounding evidence-based treatments? 6. What is the purpose of the clinical practice guidelines? 7. What are the criteria for empirically supported treatments? 8. Discuss the criticisms and responses of the EST initiative. 9. What are the evidence-based treatments for the common adult disorders discussed in this chapter? 10. Discuss the principal recommendations for the treatment choice in therapies and counseling. 11. What is the Stepped Care Model for the management of depression? 12. How does CBT for depression work? 13. Discuss the purpose of prolonged exposure CBT for PTSD. 14. Describe the process-experiential treatment for couple distress. 15. What is a benchmarking strategy? 16. What factors influence a clinician’s treatment selection?
Up for Discussion 1. How important is it for you that psychological treatments be empirically evaluated? If you were considering seeking treatment (or were making recommendations to family members or friends about therapy), would it matter to you whether the support for the treatment was based on a clinician’s experience or on the results of several large-scale RCTs? 2. How has meta-analysis affected the field of psychotherapy? 3. Should authors of treatment studies be required to report on the proportion of potential participants who were excluded from the studies and the proportion of participants who failed to complete treatment? What differences might these data make in interpreting the results of the study? Should this type of information influence a clinical psychologist when deciding on treatment options for a patient?
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Chapter 12: Intervention: Adults and Couples
4. What are the advantages to the client of receiving evidence-based services? 5. What are the challenges in establishing a list of evidence-based treatments? 6. What do you think of the NICE depression guideline especially in terms of its emphasis on the provision of psychotherapy? What about the recommendations with respect to the use of antidepressants? If a friend of yours was looking for information about treatment of depression would you find this kind of information helpful? 7. How can the results of effectiveness studies add to our knowledge of the impact of psychological treatments? 8. Do you think that knowing that a treatment has supporting evidence in effectiveness studies is important? Are such data more important than data from efficacy studies? How do you think practicing clinicians might view the relevance of effectiveness data? 9. Now that you know that clinical programs differ in the extent to which they provide training in evidence-based practice, if you were applying to graduate programs, how important would it be for you to find a program that has a strong commitment to training in evidence-based practice? 10. If we know that a treatment is successful in research studies, what are the barriers to its routine implementation?
Out-of-Class Activities 1. Have students research a meta-analysis paper on depression from a respected journal. Students should analyze and critically evaluate the findings citing both the positives and negatives of a study. Students should reiterate why meta-analyses must be viewed with caution. 2. Students should pretend they are working for an insurance company and pick one of the disorders and the respective evidence-based treatments in Exhibit 12.2. After researching the treatments, they should discuss why each of the treatments would be accepted are reimbursable by insurance noting efficacy and treatment duration.
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3. Students can research eye movement desensitization and reprocessing (EMDR) and provide a reaction paper to the controversial treatment. 4. Students should research additional treatments for PTSD and evaluate them against prolonged exposure for PTSD.
Web Links There are many reputable sources of information on evidence-based psychotherapies. Here are some of the best websites available: The Society of Clinical Psychology’s site on Psychological Treatments: www.div12.org/psychological-treatments/ NICE Clinical Guidelines: www.nice.org.uk/guidance/published American Psychiatric Association Practice Guidelines: www.psychiatry.org/psychiatrists/practice/clinical-practice-guidelines Centre for Evidence-Based Mental Health: www.cebmh.warne.ox.ac .uk/cebmh/cebmh.htm BMJ Clinical Evidence (for mental health conditions, from the British Medical Journal): www.clinicalevidence.bmj.com/x/index.html Evidence-Based Behavioral Practice: www.ebbp.org
Suggested Readings Books First, M. B., & Tasman, A. (2004). DSM-IV-TR mental disorders: Diagnosis, etiology, and treatment. New York: John Wiley & Sons, Inc. Nathan, P., & Gorman, J. M. (Eds.). (2015). A guide to treatments that work (4th ed.). New York: Oxford University Press. Roth, A., & Fonagy, P. (2005). What works for whom? A critical review of psychotherapy research (2nd ed.). New York: Guilford Press. Journals American Journal of Psychiatry Behavior Therapy
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Chapter 12: Intervention: Adults and Couples
Clinical Psychology: Science and Practice JAMA Psychiatry Journal of Consulting and Clinical Psychology
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Chapter 13: Intervention: Children and Adolescents
Chapter 13 – Intervention: Children and Adolescents Chapter Overview Students now have a good familiarity with adults and couples therapy so we turn our discussion to child and adolescent therapy. As any child and adolescent clinician will tell you, treatments can be as complex as those for family dynamics. The treatments employed for children and adolescents vary from those for adults yet there are basic similarities as well. This chapter will explore which treatments work, and will provide examples and discussion of evidence-based treatments for children and adolescents.
Chapter Contents •
Introduction
•
Who is the Client in Psychological Services for Childhood
Disorders? •
Landmarks in the Evolution of Evidence-Based Psychological
Services for Children and Adolescents ▪
Do Psychological Treatments for Children and Adolescents Work?
•
•
▪
Which Treatments Work for Specific Disorders?
▪
Clinical Practice Guidelines
Examples of Evidence-Based Treatments ▪
Disruptive Behavior Disorders
▪
Adolescent Depression
Efficacy, Effectiveness, and the Dissemination of Evidence-Based
Treatments •
Summary and Conclusions
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Chapter 13: Intervention: Children and Adolescents
Learning Objectives 1. Who is the client in psychological services for children and adolescents? 2. What are the dynamics involved in treating children and adolescents? 3. How do parents play both a positive and negative role in treatment? 4. Discuss the efficacy of psychological treatments for children and adolescents. 5. Which treatments are effective for specific child and adolescent disorders? 6. What are the evidence-based treatments for children and adolescents by disorder? 7. What are the limitations of child and adolescent treatments? 8. Discuss the purpose of clinical practice guidelines for children and adolescents. 9. What is the purpose of parent management training? 10. How does parent management training encourage and promote the work performed in psychotherapy sessions? 11. Discuss the core parenting skills. 12. Describe Multisystemic Therapy (MST). 13. Discuss the prevalence of adolescent depression. 14. What is the psychoeducational approach? 15. How can clinicians determine the best form of treatment for the patient and the patient’s family? 16. What are the strategies to facilitate the dissemination of evidence-based treatment?
Up for Discussion 1. What are some of the major differences for children and adolescents and services for adults? 2. What are some of the reasons why there is less research on treatment of youth than on treatment of adults?
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Chapter 13: Intervention: Children and Adolescents
3. To get a sense of the challenges faced by those seeking information about efficacious treatments for youth, check out the self-help sections of an online bookstore. Pick a childhood problem that interests you. How easy is it for you tell whether the book is evidence based? 4. Why is it so important to have parents involved in many forms of treatment for children? 5. Imagine that you are a parent whose child is having psychological problems. How would you feel when the psychologist informs you that you will be expected to play an important role in the services your child will receive? What you see as the advantages and disadvantages of being involved in the services? 6. If you check practice guidelines, you will notice that they, like many products in the grocery store, are identified with a best before date. This is an explicit acknowledgement that although they represent the best recommendation based on available knowledge at the time they are released, research is ongoing, our understanding is constantly evolving, and guidelines must not be seen as the final word. Thus, ongoing updates of clinical practice guidelines based on new research are essential to the promotion of evidence-based practice. 7. The grocery store provides a great opportunity for naturalistic observation of parenting. The next time you are shopping, keep in mind the core skills and see if you can identify examples of parents using any of the five core skills of effective parenting. 8. Think of times when you have been responsible for looking after children. What combination of social reinforcers, tangible reinforcers, and privileges did you find most helpful in encouraging the children to behave well? 9. How do services for children and services for adolescents differ?
Out-of-Class Activities
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Chapter 13: Intervention: Children and Adolescents
1. Have students research a meta-analysis paper on adolescent depression from a respected journal. Students should analyze and critically evaluate the findings citing both the positives and negatives of a study. Students should reiterate why meta-analyses must be viewed with caution. 2. Students should pretend they are working for an insurance company and pick one of the disorders and the respective evidence-based treatments in Exhibit 13.1. After researching the treatments, they should discuss why each of the treatments would be accepted and reimbursable by insurance noting efficacy and treatment duration. 3. Students should refer to Exhibit 13.2 to review the core parenting skills. They should compare their own upbringing to that of the list. This is an opportunity for self-exploration, identification, and empathy. This assignment could be a journal project or one that is handed in. It does not need to be shared with the class; however, the learning opportunities are beneficial if students share in small groups with one another. 4. Students should research adolescent depression and suicide noting warning signs, prevalence, and current prevention and intervention techniques. 5. Students should design their own psychoeducation program for both a parent and their child who is suffering from either an anxiety or depressive disorder. Students can choose the disorder and must justify their psychoeducation program with adequate references and support.
Web Links Information on evidence-based treatments, sponsored by the Society of Clinical Child and Adolescent Psychology: www.effectivechildtherapy.com/content/about-child-adolescent-symptoms The British Medical Journal provides reviews of the literature on the treatment of physical and mental disorders: www.clinicalevidence.org The American Academy of Child and Adolescent Psychiatry Practice Parameters: www.aacap.org/AACAP/Resources_for_Primary_Care/Practice_ Parameters_and_Resource_Centers/Practice_Parameters.aspx Canadian Psychological Association fact sheets: www.cpa.ca/psychologyfactsheets
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Chapter 13: Intervention: Children and Adolescents
Multisystemic Therapy: www.mstservices.com
Suggested Readings Books Fonagy, P., Cottrell, D., Phillipps, J., Bevington, D., Glaser, D., & Allison, E. (2015). What works for whom? A critical review of treatments for children and adolescents (2nd ed). New York: Guilford Kendall, P. C. (Ed.). (2012). Child and adolescent therapy: Cognitive behavioral procedures (4th ed). New York: Guilford Press. Weisz, J. R., & Kazdin, A. E. (Eds.). (2017). Evidence-based psychotherapies for children and adolescents (3rd ed). New York: Guilford Press.
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Chapter 14: Intervention: Identifying Key Elements of Change
Chapter 14 – Intervention: Identifying Key Elements of Change Chapter Overview Continuing with the emphasis that clinical psychology is an evidence-based profession, Chapter 14 examines the large body of evidence that focuses on patient/client, therapist, and therapeutic process variables that influence treatment outcome. There are numerous studies which have examined the multiple relationships between therapist and patient, patient and response to psychotherapy, and the alliance of the patient to the therapist. This chapter explores what can be learned about psychotherapy from process research and process-outcome research. These findings from treatment outcome research have been used to develop evidence-based recommendations for the treatment of specific disorders and conditions. The results of process research and process-outcome research have also been used to formulate clinical guidelines for psychologists and, in the final part of this chapter; these guidelines are examined in detail.
Chapter Contents •
Introduction
•
Psychotherapy Process and Process-Outcome Research
•
▪
Examining Client Factors
▪
Examining Therapist Factors
▪
Examining Treatment Factors
▪
Some Methodological Cautions
Common Factors in Psychotherapy ▪
Research Perspectives on Common Factors: The Therapeutic Alliance
▪
Research Perspectives on Common Factors: Psychotherapy Equivalence
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Chapter 14: Intervention: Identifying Key Elements of Change
•
Evidence-Based Psychotherapy Relationships ▪
Task Force Recommendations
•
Empirically Based Principles of Therapeutic Change
•
Summary and Conclusions
Learning Objectives 1. Describe the relationship between the psychotherapy process and process-outcome research. 2. What are the levels of analysis for the psychotherapeutic process and outcome studies? 3. What are the evaluable client factors to consider? 4. Discuss the client variables that influence treatment. 5. How do therapists tailor their treatment plans for the individual client? 6. Discuss the therapist variables that influence treatment. 7. How can therapists negatively affect their clients? 8. Discuss interpretation. 9. What is directiveness and why is it useful? 10. How does insight impact treatment response? 11. Why are between-session assignments supported by research? 12. Discuss the methodological cautions involved in process-outcome research. 13. What are the common factors in psychotherapy? 14. What is the therapeutic alliance? 15. Discuss the demonstrably effective, probably effective, and promising but insufficient research to judge treatment elements of a therapy relationship. 16. Discuss how empathy and client reactance may impact the therapeutic alliance. 17. Describe the empirically based principles of therapeutic change.
Up for Discussion 2
Chapter 14: Intervention: Identifying Key Elements of Change
1. Think about an “intervention” you have begun recently. It could be yoga for relaxation, physiotherapy for knee pain, strips to whiten your teeth, or spinning to improve your cardiovascular fitness. If you were to experience sudden gains after a few session, how would that affect your likelihood of persisting with the intervention? 2. How important is it that clients and therapists be similar in terms of key demographic variables? Can a male therapist possibly help a female client or can a young therapist possibly help an older adult client? 3. Given what you learned in Chapter 9 about the possible effects of heuristics and biases in clinical decision-making, do you think that there are any dangers associated with using research on client factors to guide treatment planning for a specific client? What steps can a psychologist take to ensure that the research information is used in an appropriate manner? 4. If you were seeking psychological services, how important would it be to gain an understanding of why you were having a particular problem? If you were able to get over the problem without fully understanding why it occurred, would that be sufficient for you? 5. Were you aware that clients are often required to do homework between sessions? How can homework completion affect treatment outcome? 6. Have you developed the habit of carefully reviewing the method and results sections of scientific articles? How easy is it for you to generate hypotheses about the ways that the methods of the study may have influenced their results? 7. How should the therapeutic alliance evolve over the course of a successful psychological intervention? 8. It is fairly easy to understand how a good alliance can positively influence the outcome of treatment. So, how is it possible that treatments delivered without any apparent therapeutic alliance can be successful? What does
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Chapter 14: Intervention: Identifying Key Elements of Change
this mean, if anything, about the role of therapeutic alliance in promoting change in therapy? 9. Are good therapists born or trained? 10. How can we explain the apparent effectiveness of different types of treatments for some specific disorders (such as depression)?
Out-of-Class Activities 1. Have students consider the differences between an actual therapeutic relationship and the “advice” given on talk shows and call-in phone lines. Why is the latter potentially dangerous and what are the ethical considerations? Why would people call-in or go on these shows? Is there a true relationship, is there empathy, and is there any form of alliance? How can insight be determined? Have students write up a few paragraphs and discuss in class or turn in. 2. Students should provide a reflection paper on their therapeutic stance, their preference for short-term or long-term therapy, what patients they would like to work with, and the patients they prefer not to work with. Students should defend their answers and provide reasons why they would not want to work with some patients over others. Students should consider what they would do if they had to work with patients they did not like. What would be their reaction? How would they deal with it in a professional way? 3. Students should discuss a time when they were empathic and discuss how this is related to empathy in the therapeutic process.
Web Links Information on evidence-based therapy relationships: citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.463.7645&rep=rep1&type=p df The Society for Psychotherapy Research (a multidisciplinary organization that encourages research on all forms of psychotherapy): www.psychotherapyresearch.org The Society for the Exploration of Psychotherapy Integration (an organization for mental health professionals interested in exploring the interface between differing approaches to psychotherapy): 4
Chapter 14: Intervention: Identifying Key Elements of Change
www.sepiweb.com
Suggested Readings Books Castonguay, L. G. & Beutler, L. E. (Eds.). (2006a). Principles of therapeutic change that work. New York: Oxford University Press. Lambert. M. J. (Ed.). (2013). Bergin and Garfield’s handbook of psychotherapy and behavior change (6th ed). Hoboken, NJ: John Wiley & Sons, Inc. Norcross, J. C. (Ed.). (2011). Psychotherapy relationships that work: Evidencebased responsiveness (2nd ed.). New York: Oxford University Press. Journals Journal of Clinical Psychology Journal of Consulting and Clinical Psychology Psychotherapy Psychotherapy Research
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Chapter 15: Clinical Health Psychology, Clinical Neuropsychology, and Forensic Psychology
Chapter 15 – Clinical Health Psychology, Clinical Neuropsychology, and Forensic Psychology Chapter Overview This final chapter explores three fascinating areas of psychology and is a terrific way to end the course. This is also a wonderful opportunity to promote additional career options for students. You may also want to highlight the assessment and intervention roles that both clinical health psychology and clinical neuropsychology involve, and have students refer back to the previous chapters. Neuropsychology has been a steadily growing area as baby boomers age and Alzheimer’s rates increase. Students will especially enjoy the forensic psychology discussion as they are most likely familiar with television shows such as Criminal Minds, Law and Order: Criminal Intent and Dexter. You may wish to refer to such programs in your lectures and highlight the difference between dramatization and actual practice in forensic psychology.
Chapter Contents •
Introduction ▪
•
•
Clinical Health Psychology •
Definitions of Health and Disability
•
Activities of Clinical Health Psychologists
•
Assessment and Intervention Related to Pain
Clinical Neuropsychology •
Activities of Clinical Neuropsychologists
•
Assessment
•
Intervention
Forensic Psychology •
Activities of Forensic Psychologists
•
Assessment
•
Intervention
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Chapter 15: Clinical Health Psychology, Clinical Neuropsychology, and Forensic Psychology
•
Summary and Conclusions
Learning Objectives 1. What is clinical health psychology? 2. Define disability and the effects on quality of life. 3. Discuss the roles and activities clinical health psychologists are involved in. 4. How is the biopsychosocial model applied? 5. How is pain assessed and treated? 6. What are methods to manage acute pain in children? 7. Discuss the various psychological approaches to the management of chronic pain. 8. What is clinical neuropsychology? 9. Discuss the roles and activities clinical neuropsychologists are involved in. 10. What are the purposes of the neuropsychological assessment? 11. Discuss the interventions available in neuropsychology. 12. What is forensic psychology? 13. Discuss the roles and activities forensic psychologists are involved in. 14. What are the purposes of the forensic assessment? 15. Discuss the interventions in correctional psychology.
Up for Discussion 1. How does the role of a clinical health psychologist differ from that of a physician? 2. What are the requirements to practice health psychology in the province or territory in which you live? If you do not know the name of the licensing body for psychologists where you live, you can look it up on the website of the Canadian Psychological Association: www.cpa.ca/public/whatisapsychologist/regulatorybodies.
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Chapter 15: Clinical Health Psychology, Clinical Neuropsychology, and Forensic Psychology
3. With the advent of advanced imaging techniques in neurology, what can clinical neuropsychologists contribute to the care of those patients with neurological impairments? 4. What are the roles for psychologists in dealing with those involved in the criminal justice system? 5. Do you think it could be possible for a clinical psychologist to be a generalist who covers the areas of health psychology neuropsychology, and forensic psychology? What would be the challenges involved for such a professional? 6. Across the different applied areas of practice described in this chapter, what knowledge and skill elements are common to all?
Out-of-Class Activities 1. Have students choose a general medical condition such as diabetes or hypertension and develop an intervention plan for a patient. Students will have to research the disorder of choice as well as write up their intervention plan. 2. Patients with schizophrenia have poor diets and eating habits. They tend to eat high-caloric, fast food items. Ask students to develop an intervention plan for a patient. Students should consider who they would consult with, the barriers to implementation for the patient, and overall utility of the plan. Students will need to write up their intervention plan. 3. Have students research some of the commonly used neuropsychological tests and tools for Alzheimer’s. They should write up the advantages and disadvantages of these tools. 4. Have students write up an intervention plan for a caregiver of an Alzheimer’s patient who is currently overworked and quite stressed. Students should consider all factors such as the caregiver’s well-being, the needs of the Alzheimer’s patient, and the feasibility of their plan. 5. Have students watch any popular crime drama such as Criminal Minds or Dexter and ask them to write a reaction paper regarding the realism of the events on the show compared to what they have learned about forensic psychology. Have them compare the similarities and differences.
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Chapter 15: Clinical Health Psychology, Clinical Neuropsychology, and Forensic Psychology
Web Links Information on the IWK Health Centre and the Pediatric Pain Laboratory of the Psychology Department of Dalhousie University: www.pediatric-pain.ca American Board of Clinical Health Psychology: www.abpp.org/i4a/pages/index.cfm?pageid=3308 American Board of Clinical Neuropsychology: www.theabcn.org American Board of Forensic Psychology: www.abpp.org/i4a/pages/index.cfm?pageid=3356 The Oliver Zangwill Centre for Neuropsychological Rehabilitation website provides resources on assessment and rehabilitation for people with brain injuries: www.ozc.nhs.uk Details on the Canadian National Crime Prevention Strategy: www.publicsafety.gc.ca/cnt/cntrng-crm/crm-prvntn/strtg-en.aspx
Suggested Readings Books Baum, A., Revenson, T. A., & Singer, J. (Eds.). (2012). Handbook of health psychology (2nd ed.). New York: Taylor & Francis Group. Craig, L. A., Dixon, L., & Gannon, T. A. (Eds.). (2013). What works in offender rehabilitation: An evidence-based approach to assessment and treatment. Hoboken, NJ: Wiley-Blackwell. Lezak, M. D., Howieson, D. B., Bigler, E. D., & Tranel, D. (2012). Neuropsychological assessment (5th ed.). New York: Oxford University Press.
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