PSY 401 Lesson 03.ppt

LECTURE 3
How a Clinical
Psychologist Thinks
Linking Science & Practice Together

2
 Clinical Psychology, branch of psychology
devoted to the study, diagnosis, and treatment of
people with mental illnesses and other
psychological disorders.
 This course will consist of 45 lectures, and will
be divided into four parts:
 1. Foundations of Clinical Psychology
 2. Clinical Assessment.
 3. Clinical Interventions.
 4. Specialties in Clinical Psychology

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Brian’s Case; an example
Imagine that you are working as a clinical psychologist, and
an adolescent is referred to you for help. Brian is 16 years
old. Approximately one year ago his parents went through a
very difficult divorce. Following his parents' divorce, Brian,
his mother, and younger sister moved to a new town in order
for his mother to begin a new job and for the family to try to
"start over". Because Brian's father did not provide regular
financial support, the family was faced with significant
economic difficulties as they tried to get by on his mother's
salary. Brian did not adjust well either to his parents' divorce
or to the move to a new school and town. He had difficulty
making new friends at school and became progressively
more withdrawn and lonely. Three months before coming to
see you, Brian became severely depressed and made a
serious, but uncompleted, suicide attempt.

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 You are faced with a number of important questions in your
initial meetings with him. Is there a specific pattern of
behaviors, thoughts, or feelings that characterize the
difficulties that Brian is experiencing? Are these problems
unique to him, or are they similar to difficulties experienced
by other people?
 After some initial information is obtained, the questions
should focus on Brian’s personal details including his
strengths, competencies, and motivations etc.
 Answers to these questions are part of the task of
developing a careful, detailed description of the scope and
nature of Brian's problems, his strengths and capabilities,
and the environment or context in which he lives.
 Such description places Brian's problems into a broader
context (the nature of depression during adolescence).

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b) Explanation:
 Description of an individual or a psychological problem is not
adequate for complete understanding of that person or
problem.
 It is imperative that clinical psychologists develop careful
models to explain how or why the problem developed, either
in an individual or in people in general.
 This task includes the development and testing of models of
etiology or cause, including but not limited to the use of
experimental methods to test causality.

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 For example, the following questions need explanation:
 Why did Brian attempt to take his life?
 Why has he sunk into a behavioral pattern in which he is
overwhelmed by daily responsibilities and feels that he
has lost control over his own life?
 These questions lead to an answer: because of his
parents' divorce. But this answer again leads to more
general questions such as
 "what are the psychological consequences of the
parental divorce and the losses and stresses that are
associated with divorce?" and "what is the relationship
between such a loss and later depression, suicidal
ideation, or suicide attempts?"

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 The answers to these questions lie beyond information that
you can obtain by examining a single case such as Brian's.
From here, the process of research begins, that attempts to
focus on all possible dimensions of the problem.
 The clinical psychologists develop explanations of
problematic behavior using these questions as guidelines
for research.
 They may explain psychological problems emphasizing the
role of biological factors, cognitive schemas and networking,
conditioning and learning processes, interpersonal
relationships, and an integration of one or more of these
factors.

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c) Prediction:
 The most stringent and necessary test of any explanation is
to see if it leads to predictions that are supported by
empirical research.
 The importance of prediction, like description and
explanation, is evident in the work of psychologists helping
individuals as well as in the work of clinical researchers
trying to understand a problem in the general population.
 Prediction is possible only through repeated observations in
which conditions are either controlled or well understood.

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 In Brian’s example, it is important to predict the course of his
symptoms e.g.,
 Is he likely to make another suicide attempt?
 What factors would be useful in trying to predict subsequent
suicidal thinking or attempts?
 Are his problems likely to continue? Will they remit on their
own, or is psychological treatment or medication necessary?
 Are there certain psychological treatments that are likely to
be effective in treating his depression?

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 In clinical psychology research, prediction is tested in
two ways:
 (a) longitudinal studies of the course of problems as they
occur in real life; and
 (b) experimental studies testing specific predictions or
hypotheses under controlled circumstances.
 In both methods, the goal of clinical psychologist is to try
to identify cause-and-effect relationships regarding
important clinical problems.

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d) Change:
 Because clinical psychology involves the application of
psychological knowledge to alleviate human problems, it is
not enough for clinical psychologists to describe, explain, or
predict human functioning.
 Clinical psychologists must also be concerned with
producing change in people's lives. Specifically, clinical
psychologists develop and carry out planned and controlled
interventions for the treatment and prevention of
psychopathology, for coping with and prevention of some
forms of physical illness, and for the promotion of
psychological and physiological health.
 Facilitating change is a goal of researchers and practicing
clinicians alike.

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 Efforts to change people's lives must be based on research
evidence that allows the clinician to make reasonable
predictions about the effects of specific interventions.
 For example, it may be important to change how Brian
thinks about his parents, about himself, and about the
reasons for his parents' divorce.
 If Brian learns to think about his parents' divorce in a
different way, this new way of thinking may lead to
meaningful changes in his emotions and behaviors.
 Alternatively, if Brian is systematically encouraged and
rewarded for increasing his involvement in pleasant and
constructive activities involving school, sports and friends, it
may be sufficient to alleviate his deep feelings of loss
related to his parents' divorce.

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 Clinical psychologists are concerned with developing
much more than a set of techniques for helping people
change.
 They are committed to developing a broad set of
principles to understand how and why people change.
 Without this type of comprehensive understanding of the
mechanisms of how people change, psychologists
cannot continue to systematically improve the ways that
they can help people, and they may be unaware of ways
to generalize their current methods to different people or
problems.

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To summarize,
We can say that,

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 Although clinical psychologists function both as
scientists and as practitioners, their work in these
two realms is unified by a systematic way of thinking
about people and psychological problems.
 Thus, a psychologist – whether trying to help an
individual cope with a traumatic event in his or her
life or trying to arrive at a broader understanding of
how people in general cope with trauma – must
engage in careful description, explanation,
prediction, and change of the person or problem.

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CLINICAL PSYCHOLOGY
EMPLOYMENT SETTINGS.

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 Clinical psychologists are found in a number of service
settings, including the following:
 General Hospitals and Medical Clinics;
 Mental Health Clinics and Psychiatric Hospitals;
Rehabilitation Hospitals and Clinics;
 Community Service Agencies;
 Private Practice;
 Universities and Colleges;
 Industry;
 The Military;
 Prisons and Correctional Facilities;
 Private and Government Research Agencies; and
 Schools.

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 Research on the employment settings of clinical
psychologists reveals that the most frequent
employment setting for clinical psychologists is
private practice.
 University settings are the second most common
employment sites.
 The following table shows the different
employment sites for clinical psychologists in the
United States during year 1995.

LECTURE 3
Employment Site Percentage in Year: 1995
Psychiatric hospital 05 %
General hospital 04 %
Outpatient clinic 04 %
Community mental health center 04 %
Medical school 09 %
Private practice 40 %
University settings 19 %
Other settings 11 %
Source: Adapted from Norcross, Karg, & Prochaska (1997a).

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PRIVATE PRACTICE:
 About 40% of clinical psychologists work in solo or group
private practices.
 As a private practitioner, the clinical psychologist offers
certain services to the public, as much as a dentist or
general medical doctor does.
 Office hours are established and patients (i.e. clients)
are seen for assessment, diagnosis and psychotherapy.

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 Fees are charged for services rendered.
 Many psychologists are drawn to independently
providing direct clinical, consultation and other
professional services to their clients and enjoy being
their own boss and setting their own hours and policies.
 Research supports that, private practitioners report more
job satisfaction (Norcross& Prochaska, 1983; Norcross,
Karg & Prochaska 1997a) and less job stress than other
psychologists.

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COLLEGES AND UNIVERSITIES:
 About 20% of clinical psychologists are employed in academic
environments (American Psychological Association , 1993a).
 Most of these psychologists work as Professors. They generally
teach psychology courses, supervise the clinical and or research
work of psychology students and conduct both independent and
collaborative research.
 They also typically serve on various college or university
committees, providing leadership and assistance with the academic
community.
 Some clinical psychologists work in academic clinical settings, such
as student counseling centers, providing direct clinical services to
students.

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HOSPITALS:
 Many clinical psychologists work in hospital settings.
They may conduct psychological testing, provide
individual, family or group psychotherapy act as a
consultant to other mental health or medical
professionals on psychiatric or general medical hospital
units, and may serve in administrative roles such as unit
chief on a psychiatric ward.
 Many states now allow psychologists to become full
members of the medical staff of hospitals. In California,
for example, psychologists are allowed to have full
admitting, discharge and treatment privileges which
allow them to treat their patients when they are
hospitalized and to participate in hospital committees.

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MEDICAL SCHOOLS:
 Clinical psychologists serve on the faculties of many medical
schools. They typically act as “clinical faculty”, which generally
involves several hours (i.e., two to four) per week of pro bono time
contributed to the training of medical center trainees.
 These trainees might include psychiatry residents, other medical
residents (e.g., pediatric residents), medical students, nursing
students or non medical hospital trainees such as psychology
interns or postdoctoral fellows ,social work interns, nursing students
etc.
 These psychologists might conduct seminars & workshops or
provide individual case supervision and consultation.
 Psychologists may also serve as academic or research faculty at
medical schools.

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OUTPATIENT CLINICS:
 Many psychologists work in various outpatient clinics such as
community mental health centers.
 These psychologists often provide a range of clinical services to
other professionals and organizations.
 For example, these psychologists might provide psychotherapy for
children who have been abused or group therapy for adult
substance abusers. They might also provide parent education
classes.
 While psychologists in these settings may conduct research, direct
clinical service is often the primary activity and priority of these
settings

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BUISNESS AND INDUSTRY:
 Many clinical psychologists working in business and industry
settings offer consultation services to management, assessment and
brief psychotherapy to employees, and conduct research on various
psychosocial issues important to company functioning and
performance.
 For example, these psychologists might consult with the human
resource department, provide stress management workshops, or
conduct interpersonal skills building workshops.
 Psychologists might help managers learn to improve their ability to
motivate and supervise their employees.
 They may assist in developing strategies for interviewing and hiring
job applicants.

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MILITARY:
 Many clinical psychologists are employed by one of the
branches of the military such as the Navy, Air Force, or
Army. They often provide direct clinical services.
 Some conduct research while others act as
administrators in military hospitals and clinics.
 Other psychologists are civilians working in military
hospitals.
 Typically psychologists working in the military hold an
officer rank such as captain.

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FORENSIC PSYCHOLOGIST (PRISON
AND PROBATION SERVICES):
 Forensic psychology is concerned with the behavior of individuals
within the judicial and penal systems, such as offenders, victims,
witnesses, judges, juries, prisoners and prison staff.
 Much of the work of a clinical forensic psychologist focuses on
therapy in correctional settings where specific activities include:
 a) Carrying out one-to-one assessments - often to assess the risk
of re-offending) or to assess the risk of suicide or self-injury;
 b) Developing and evaluating the contribution of assessment
techniques such as psychometrics;

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 c) Undertaking research projects to evaluate the contribution of
specific service elements, policy initiatives or group program
developments, e.g. exploring probation 'drop-out' rates or evaluating
a group program;
 d) Participating in the delivery of, or acting as coordinating
'Treatment Manager' for, nationally recognized cognitive-behavioral
group programs, e.g. Enhanced Thinking Skills or Sex Offender
Treatment Program;
 e) Overseeing the training of prison/probation service staff.
 f) Dedicating time to the preparation of court reports.

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OTHER LOCATIONS:
 This category includes
 Professional schools
 Correctional facilities
 Managed care organizations
 Nursing homes
 Child and family services
 Rehabilitation centers
 School systems
 Health maintenance organizations, and so on.

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Pros and Cons of a Career
in Clinical Psychology

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Some key points to consider in support of Clinical psychology:
 Personal Fulfillment Working with and helping clients can bring a
great deal of personal satisfaction.
 Making a Difference Unique feelings come when you see a client
make changes in their lives because you have helped them.
 Being Your Own Boss In private practice, clinical and counseling
psychologists are often their own bosses and set their own hours.
 Changing Environment Each client provides different and
interesting information about themselves; therefore, the psychologist
is rarely bored from doing routine work.
 Learning Experience Clients' diagnoses and therapeutic plans
tend to be at least somewhat unique, providing ongoing learning
opportunities.

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Some cautions
 The education and training is very demanding
and prolonged.
 There are cases when treatment may produce
little or no improvement in the client’s condition.
 Paperwork associated with each client requires
enormous care. Health insurance companies
alone require a lot of detailed documentation
about clients.

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Conclusion
Clinical psychologists are unique from other
mental health professionals in their provided
services, service settings, populations seen,
and knowledge base.

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 Populations Seen
Clinical psychologists work with a broad range of populations,
including the following: individuals (infants, children, adolescents,
adults, and the elderly); couples (regardless of gender
composition); families (traditional, multi- generational, and blended
families); groups; organizations; and systems.
 Service Settings
Clinical psychologists are found in a number of service settings,
including the following: General Hospitals and Medical Clinics;
Mental Health Clinics and Psychiatric Hospitals; Rehabilitation
Hospitals and Clinics; Community Service Agencies; Private
Practice; Universities and Colleges; Industry; the Military; Prisons
and Correctional Facilities; Private and Government Research
Agencies; and Schools.

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 Services Provided
The typical services provided by clinical psychologists include:
assessment and measurement; diagnosis; treatment;
consultation: teaching and supervision; policy planning; research;
program evaluation; and, administration.
 Knowledge Base
The knowledge base within clinical psychology is so broad that no
individual clinical psychologist can become competent in all areas
of clinical psychology. Therefore, clinical psychologists must
function within the specific limits of their competence (i.e.,
knowledge and expertise), and are expected to clearly
acknowledge the limitations of their scope of practice. Clinical
psychologists are responsible for referring to others (either within
or outside the area of clinical psychology) when they are faced
with a task outside of the limits of their knowledge and skill.

PSY 401 Lesson 03.ppt

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