Chapter 1 Introduction Copyright 2014 John Wiley Sons

Chapter 1 – Introduction Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

The challenges facing mental health workers n n n It is often difficult to put a cut-off line between normal distress and distress that has clinical significance For example- many of us experience anxiety, or sadness; when is still within the normal range and when is it considered an abnormality? Is it a matter of intensity? Duration? Frequency?

More Questions n n Do some mental disorders lend themselves to treatment better than others? For example, schizophrenia is a chronic condition, whereas anxiety disorders may be more effectively treated. The expression of the same disorder might take different forms in different people There is a high incidence of co-morbidity (occurring together) of mental disorders Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Assessment The first challenge facing a clinical psychologist is the assessment of a presenting problem n Is the condition fully displayed or is it still in the process of unfolding? n To what extent is there a co-existence of several clinical conditions in the same person? (Co-morbidity). n Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Importance of Clinical Psychology as a Discipline About half of mental disorders begin before age 14 n Worldwide 800, 000 people commit suicide every year n 1 in 4 adult Americans suffers from a mental disorder in any given year n Worldwide more than 450 million people suffer from mental disorders n – Most undiagnosed or misdiagnosed Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Defining Scope of Clinical Psychology Early definitions stressed assessment, evaluation and diagnosis n More recent inclusion of intervention in various forms as well as prevention n Evidence-Based Practice n Active debate on the ‘science of clinical psychology’ Mc. Fall’s Manifesto for a Science of Clinical Psychology Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Mc. Fall’s Manifesto Toward research-based practice of psychology n n n Clinical psychology needs to be based on the results of research The exact nature of the service needs to be described The claimed benefits of the service must be described clearly These benefits must be validated scientifically Possible negtive side eefefcts must be ruled out empirically Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

The Shifting Nature of the Field of Clinical Psychology From the focus on one individual the focus has shifted to couples and families, both directly as interventions and indirectly as in prevention activities, consultations, and research n Increasing focus on pharmacological treatment an decrease in traditional activites n Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

The APA Definition of Clinical Psychology: Research-based n n “ Integrates science, theory and practice to understand, predict, and alleviate maladjustment, disability and discomfort as well as to promote human adaptation, adjustment, and personal development. Clinical psychology focuses on the intellectual, emotional, biological, social and behavioral aspects of human functioning across the life-span, in varying cultures and Socio-economic levels. Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Elements of the APA Definition of Clinical Psychology 1. Integration of theory and research – bi-directional relationship: theory is an attempt to explain the symptoms; it generates research to assess the explanation, and the research results may change theory- that is –our understanding of the causes of the symptoms (as one example) Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Elements of the APA definition (cont-d) n n 2. The goals are on the one hand to remove distress and suffering, but also to promote adaptation; that is- sometimes a conditions may not go away, and the person needs to learn to live with it and to adapt to it. 3. The various aspects of human functioning (e. g. biological, emotional, intelelctual etc are inter-related and affect one another. They cannot be viewed in isolation. Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Importance of Clinical Psychology as a Discipline n Evidence-Based Practice (cont. ) n Importance of using only practices empirically found to be effective n Intuition should not be a part of assessment or treatment – Critics argue (among other points): n Group-based data is not always sufficient in working with individuals n Research is not always available for all problems n Each person is unique in many different ways Copyright © 2014 John Wiley & Sons, Inc. (culture, class, family etc. ) All rights reserved.

Counseling vs. Counseling Psychology n n n Counseling is a generic term use d to describe a range of mental health professions with various training and licensure requirements. Counseling psychology has a great deal in common with clinical psychology It started in he field of vocational counseling in an attempt to match between traits and aptitudes (skills) and the demands of a given job. Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Counseling Psychology (cont-d) n Today, the focus of clinical psychology is more in treating of more severe conditions of psychopathology, whereas counseling psychology addressed less severe issues, such as all types of life-transitions, and relationships difficulties. Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Traditional distinctions between clinical and counseling psychologists are fading Today counseling psychologists provide services in more severe cases, such as depression, panic, social phobia or eating disorders n Clinical psychologists have expanded their services to conditions that do not represent psychopathology such as chronic illness or stress- related conditions n Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Cont-d It is difficult to mark professional boundaries on the basis of what constitutes normal vs. abnormal range of distress n Depending on the point in time in which someone seeks help, the same person may present clinical or subclinical symptoms n Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Other Related Mental Health Professions (and Differences) n School Psychology – Training in both psychology and education – Work in diverse education-related settings – There is a natural overlap between school psychology and child clinical-psychology – Traditionally, school psychologists provided services related to assessment of intellectual functioning, learning difficulties, consultation to teachers on the basis of the assessment of a given child- how to translate the assessment into instructional objectives, and parent consultation. Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

School Psychology (cont-d) n n Over time, the scope of school psychology has expanded, to include attention to parental psychopathology and stressful family circumstances affecting the learning of children The legal obligation to provide the most appropriate education to any child, no matter what is the level of the child’s disability, also affected the role of the school-psychologist. Copyright © 2014 Jowhat is the levels of the child's dsabiluty, hn Wiley & Sons, Inc. All rights reserved.

School Psychologists (cont-d) n All these changes affected the role of school psychologists, who today deal with a wide range of disorders of childhood as well as with developing school-based and family-based programs such as the promotion of social skills, fighting bullying, conflictresolution and prevention of violence. Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Psychiatrists: MD’s who specialize in mental disorders n n n Trained as physicians with an additional training in mental disorders Require 5 years of residency after the regular medical school Training focuses on biological functioning Interactions between the physical and the emotional, also the results of medications Less training in psychological development Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Psychiatrists (cont-d) n n More psychopharmacological (medication) therapies Less trained in conducting psychological assessment Traditionally leaning toward the psychoanalytic (Freud), psychodynamic models of therapy Shift toward evidence-based therapies e. g. Cognitive–Behavioral and Interpersonal Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Psychiatrists (con-d) n n n Until recently an important distinction between clinical psychologists and psychiatrists has been that only psychiatrists could prescribe medication This is in general still the case, though in some jurisdictions clinical psychologists are being trained to prescribe psychoactive medication There is a decline in the number of graduate students wishing to specialize in psychiatry. Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Other Related Mental Health Professions (and Differences) n Social Work – Emphasis on social/community conditions – Different settings than clinical psychologists (especially community agencies) – Social conditions that facilitate optimal development – Program planning and management – Diversity of settings – Many function as part of mental-health team Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Social Work (cont-d) Case-workers and coordinators of services n Help patients navigate in a maze of mental-health services n Need to have either a BSW or MSW and supervise training progarm n Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

History of Clinical Psychology n n Early views that did not include demonic possession or evil spirits causing mental illness were rare Hippocrates may be first to consider a “biopsychosocial approach” – Biological, psychological and social factors all need to be considered. – S t. Vincent de Paul (late 1500’s) emphasized natural forces and not witchcraft Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Other Mental Health Professionals n n n Psychiatric nurses: Managing administrative matters in inpatient settings; psychoeducation and counseling. Child and Youth Care-Workers: Twoyear college training in child development and behavior management Applied Behavior Analysis: Using behavior modification strategies with autistic children Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

History of Clinical Psychology n Enlightenment period (later 1700’s) – Philippe Pinel – French reformer: humane treatment of the mentally ill – William Tuke – English reformer: hospitals based on appropriate care – Benjamin Rush – U. S. : moral therapy n 1800’s – neurology as a discipline recognizing hysteria could not be recognized as biological: Charcot, Janet and Freud Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

History of Assessment in Clinical Psychology n n Early Clinical Psychology was almost entirely an assessment field Late 1800’s – Francis Galton: differences in reaction time as intelligence differences Wilhelm Wundt (Germany) first psychology laboratory, studied sensation and perception James Mc. Keen Cattell: studied connection between reaction time and intelligence – Coined term. Copyright “mental tests” © 2014 John Wiley & Sons, Inc. All rights reserved.

History of Assessment in Clinical Psychology n Emil Kraepelin (Germany) – Believed in biological causes to mental illness – Worked on classifications of syndromes – much of his work formed basis for DSM and ICD (chp 3) n Alfred Binet (France) – French government asked Binet and collaborator Theodore Simon to design a measure to assess children with cognitive deficits – 1908 Binet-Simon scale measured 50 tests of mental skills – 1916 Lewis Terman (US) modified it, first widely Copyright © 2014 John Wiley & Sons, Inc. All rights reserved. ability available test of cognitive

History of Assessment in Clinical Psychology n WWI – APA asked to develop a scale to measure mental functioning of recruits – – Army Alpha Test (verbal abilities) Army Beta Test (non-verbal abilities – for those who could not read or spoke limited English) – These tests and the value they gave recognized clinical psychology as a sub-discipline of psych n Testing began to flourish – Wechsler-Bellevue intelligence test 1939 (considered the gold standard in IQ tests) – Projective tests –© Rorschach Inkblot 1921, Copyright 2014 John Wiley & Sons, Inc. All rights reserved. Thematic Apperception Test (TAT) etc.

History of Assessment in Clinical Psychology n WWII – Psychologists again active in tests for armed forces – MMPI – (personality test) 1943 n n Heavy use of statistics and test development Criticisms of Early Assessment – Paul Meehl – importance of using statistics to testing viability of hypotheses – Walter Mischel’s work showing personality traits as having problems with validity – Behavioral assessment as a field grew in part from these criticisms Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

History of Assessment in Clinical Psychology n 1980’s – Diagnostic and Statistical Manual for Mental Disorders (DSM-III) published – – n DSM-III more focused on observable symptoms Focus on reliability Several changes in psychological assessment have recently occurred – Clinical utility – does the assessment help with treatment – Service evaluation – do treatments work Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

History of Intervention in Clinical Psychology n Sigmund Freud – – n n First elaborated treatment of mental health issues Early connection to neurology and work of Charcot Focus on role of unconscious Many subsequent followers elaborating related psychodynamic theories (e. g. , Jung, Adler, etc. ) Lightner Witmer – coined term ‘clinical psychology’ – opened a clinic (1904) to assess and remediate learning difficulities Demand for therapy increases in 1940’s and 50’s Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

History of Intervention in Clinical Psychology n WWII – Soldiers needing therapy when returning from war – Members of public affected by loss – VA hired many clinical psychologists n Many therapy approaches developed in 1940’s – 60’s – – Carl Rogers Client-centered approach Several adaptations to Freud’s model Fritz Perls – Gestalt therapy Joseph Wolpe – Systematic desensitization Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

History of Intervention in Clinical Psychology n Criticisms of Psychotherapy – Hans Eysenck 1952 – Levitt, 1957 – Resulting in enormous amount of research on whether psychotherapy works Efficacy studies – focus on studies that emphasize internal validity of the study n Effectiveness studies – focus on studies that look at real world conditions n – Meta-analysis – statistical technique combining several studies, showed psychotherapy effective Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

History of Intervention in Clinical Psychology n Contemporary approaches – – n Albert Ellis – Rational Emotive Therapy Aaron Beck – Cognitive Therapy Cognitive Behavioral Therapy Short-term Dynamic Therapy Prevention in Clinical Psychology – A growing area of Clinical Psychology Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.