Clinical Psychology

What are Psychiatrists?

CLP3305

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Chapter 1: Clinical Psychology - Introduction  

Psychiatrists vs. Psychologists  

• Psychiatrists

o Different than a psychologist

o A physician

o ***Rooted in the medical tradition*** ???? Biggest difference

o Medical model: biochemical

o Should be used if life threatening  

o Treated medically with medicine ???? Most people think this is the  

difference between psychiatry and psychology but that’s NOT correct

• Psychologists  

o NOT treated medically

o A more proactive approach

o Traditionally work with normal or moderately maladjusted 

o Psychology model: social, economical  

Counseling vs. Clinical Psychology

• Both are very similar  

Clinical: works with people who are having  

suicidal thoughts, suffering from PTSD ???? more  

Clinical  Counseling Other mental heath professions

Other mental heath professions

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Counseling: working with people suffering from  family issues, interracial issues, etc.

• School counselor: usually do what their boss say (principles), works a lot  with administration

• School psychologist: does a lot of assessments, works a lot with one student  and then moves on to the next, makes recommendations to the parents, very  intense BUT brief We also discuss several other topics like stage of prophase at which nuclear membrane dissolves.... bio301

• Mental health tech: what you get trained for, short course and then hired  right out of college

The Clinical Psychologist

Clinical Psychology

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The Clinical Psychologist  

• Makes up 50% of grad school majors, most of these descriptions apply to  MOST but not all psychologists  

• Activities of a clinical psychologist  

o ***Therapy/Intervention*** 

▪ Usually individual: what most people do

▪ Group Therapy: a little more difficult ???? everyone wants  

something different (meeting times, etc.)

• Most effective when there are captive groups like in  

prison or hospitals

▪ Varies amount different dimensions or orientations

• Symptom substitution

o Freud believes in this (NOT skinner)

o It depends on the therapist AND client  

o There is NO major bullet

o You have to match your counseling styles with  

the clients and then decide which route you want  

to take

o ***Diagnosis/Assessment*** 

▪ MOST do this at the beginning to decide which route to take

▪ Trying to understand the client and decide on the best course  of action

• Ex: Court experts practice diagnosis and assessment.  

This is basically all they do

▪ Chief element of the clinical psychologist’s identity

• HISTORY: clinical psychology originates from the  If you want to learn more check out psyc 311 study guide

military  

o ***Administration*** 

▪ You are ONLY as good as your records

▪ Record security is also very important

o **Consultation** 

▪ When you talk a case over with another professional 

▪ Should be someone you don’t have a close relationship with

• Ex: NOT a husband, boyfriend, family member, CAN BE  

a friend

▪ Should be in the right setting, secure location

Clinical Psychology

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• Example: If you are counseling a client that is dealing with the death of her  grandma and your grandma passes too, would you refer the client? o There are two questions to consider.  

1. How are you doing with the death of your grandma? Were you close  with her? Were you expecting it?

2. How is your relationship with that client? How long have you been  counseling her?

a. If you just started, maybe you should refer her. If you have  

been meeting with her for a while and are nearing the end, you  

should maybe stick with it. All depending on how well you are  

taking the death

• 1-3 are very rare and NOT as important as the first four activities  o Teaching

o Clinical supervision We also discuss several other topics like anthropology study guide

o Research

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Employment sites

• #1 Private Practice

o You have a license and you work along side with insurance companies • University settings: counseling centers, psychology department  • Others: military, criminal justice system, prison system

Demographic Notes

• The percentage of women is dramatically rising (34%)

o Its getting harder and harder to find older female therapists and  younger male therapists

• Orientations

o Integrative (29%)

▪ Or “flexible”

▪ Take your personality and problem and match it to a specific  therapy technique

▪ Different for each person

o Cognitive (28%)  

▪ Common and effective for clients who suffer from anxiety and  depression

▪ Very popular today

o Psychodynamic (15%)

▪ Freud  

▪ People with family and early childhood issues

Clinical Psychology

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▪ Lengthy, clinical

o Behavioral

▪ Skinner If you want to learn more check out if a bank reconciliation included a deposit in transit of​ $790, the entry to record this reconciling item would include a

▪ Works well with children and pet therapy

• Some say they are dissatisfied with they job as a clinical psychologist (12%) o Mostly because of the money

• Research and scientific tradition

o Where the research and application collide

o Have to understand the research and then be able to apply it o Mostly focusing on studying groups during research  

o Statistical significance

▪ There will be times when the group differences will be  

different and its assumed that it is because of the treatment  

Training  

PhD vs. PsyD

• PhD: Doctor of Philosophy 

o Emphasis on the scientist (research)

o Scientist (75%) and Practitioner (25%)

o Will mostly focus on research  

o More difficult to get into than medical school

o Less money because the school usually pays some

o Usually one more year

o Want to work at major research universities  

o Focus of research and publications

o MORE important emphasis of orientation

▪ Want to focus on applying based on research (need to be 100%  certain the university is doing the research you are interested  

in ???? narrow your options, match research interests)  

• PsyD: Doctor of Psychology 

o Emphasis on the practitioner (applied)

o Practitioner (75%) and Scientist (25%)

o Will focus more on the applied part

o Easier to get into  

o Cost more money because they are usually private schools

o Wants to work with people

o Don’t emphasize on research and publications

o Emphasis of orientation  

▪ Since working with people, you want to keep in mind which  

type of people you want to work with (children, elderly, etc.)

Clinical Psychology

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▪ Have to also keep in mind the languages you want to be around  (if you speak French, Spanish, etc.), or if you want to work with  

people who are in military  

• Masters level

o Terminal masters: that’s all you want  

▪ Clinical social worker

▪ Mental heath worker

• Working in grad school isn’t really harder BUT there is so much more to do  o Very difficult on relationships: NO time, moving a lot  

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Clinical Training Programs

• **Scientist-practitioner model** all APA programs have to adopt this model o A mix of scientist (research) and practitioner (applied)

o At least 75% of one and 25% of the other but have to adopt BOTH o Completed in 5 years (including internship)

• Coursework

o Full term, usually starting in Aug

o Usually very flexible, they will work with you

• Practicum work

o Basically a pre-internship

• Research

o Important for schools practicing more of the scientist model  o PhD

• The qualifying exam  

o PsyD: usually a case study where you take info about a client, assess  them and then come up with a solution

o PhD: usually a written exam  

• Internship

o One year of supervised work to get experience  

o Mandatory for ALL APA accredited schools

Clinical Psychology

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Martin Luther King Day (No school)

1/20/16

Appendix: A Primer for applying to graduate programs in clinical psychology  Applying to PhD programs  

• “Professional Schools of Psychology”

o More of a safety net, tier 3 school

o NOT all schools are APA accredited

o More expensive

o NOT apart of a major University  

o Be extremely cautious of these schools

ets.org: company that owns the GRE

• 1. GPA** 

o Overall GPA

o Major GPA or the students GPA from the last 2 years

o Drawback to GPA 

▪ Numbers can be manipulated (school attended, classes taken, NOT comparing apples to apples)

▪ Someone can have a 4.0 GPA in psychology courses vs.  

someone else having a 3.5 GPA in engineering courses (the  

psychology courses may be easier than the engineering  

courses, not really comparing the same thing)

▪ Someone may have a great GPA at a community college while  someone else may have a lower gpa at FSU (the level of  

difficulty of the courses at the university have to also be taken  

in effect)

• 2. GRE** ???? You do not study for the GRE, you prepare for it!

o “Graduate Study in Psychology”: book that the APA offers that  includes the acceptance rates  

o You should apply for top, middle, bottom: safety net schools)

• 3. Resume/CV** 

o Contact the Career Center for guidance in writing your resume/CV o The difference between the two

▪ The CV is a more extensive resume that includes your research  information  

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Clinical Psychology

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• 4. Letter of Recommendation** 

o First ask if the person is willing to write you a “strong letter of  recommendation”

o Most schools ask for 3 letters of recommendation  

o Should be from people who know you very well and can describe you  in detail

• 5. The Personal Statement** 

o Applied: can talk about why you want to do into that specific field ▪ A little self disclosure

o Research: NO self disclosure, want to focus more on research  experience

o Be careful in mentioning first/last names (nothing negative) ▪ Only do this when you have a well known mentor and you are  saying something very nice and respectful

Personal Statement Assignment 

• Start with 25 points (-2pts per day if late, -5 if you email it)

• Just have to turn it in online and printed = 25 points  

• Doesn’t have to be APA style BUT spell out numbers less than 10, there vs.  their, to vs. too, “FLOW” or transitioned statements

2 Step Process for applying for Graduate School 

1. The numbers: GPA and GRE

2. The personal side: Resume/CV, Letter of Recommendation, and Personal  Statement

Clinical Psychology

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Chapter 3: Current issues in clinical psychology  

Professional Regulation (myflorida.com)

• Licensing  *** 

o Allows you to practice therapy with a legal protection

o That person is a professional and has an education  

o Some people pretend to be people they are NOT

▪ Helps us to know that people are who they say they are  

o Requirements:  

1. Doctoral Degree: APA accredited  

2. Postdoctoral experience: additional year of training after you  graduate and did your internship

3. An exam (EPPP): everyone takes the same exam but different  states require different requirements  

4. Administrative requirement 

5. Oral Exam: some states how this extra requirement but NOT  Florida

o Additional requirements: An extra 30 hrs.

▪ Sex therapy  

▪ Hypnosis  

o You can only be licensed in one state

o Provisional License: VA; can be licensed and transferred but have to  be a license in that state soon  

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Private Practice  

▪ Usually a session is listed as an hour, but its really 45-50 minutes ▪ The therapist would make $120 per hour

o This is hard to do

• So they can also choose to pair up with an insurance company  o In Florida, BCBS and Florida Blue are the popular ones

• With this option, the patient pays the therapist a $20 copay and the  insurance company pays $80 = $100

o With this option the therapist makes $100

o This is less than the $120, BUT it sets them up with a large pool of  patients  

▪ Yes, it is less money but the therapist has access to more  

patients that they wouldn’t have had

Trade off: Less money per session but more clients

Clinical Psychology

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• Also with the pairing up with the insurance companies, there is an increases  focus on accountability

o Insurance companies are the “gatekeepers”

o They make sure the therapist is following the rules  

o The therapists tell the insurance companies what the diagnosis is o The insurance companies then tell the therapists how long it should  take to treat the patient

o Prevents the therapist from milking to patient along and getting more  money for their service

o Ex: seeing them for 2 yrs when in reality it should be a 3 wk session ▪ Insurances help keep this truthful and fair to the patient

Prescription Privileges  

• Trade offs 

• Pros:

o More variety of treatments  

o Easy to access and cost efficient for the patient

o Helpful for rural communities  

o Advantage over other healthcare providers

• Cons:

o Takes away from psychological treatment

o Biological over psychological  

o Gets in the way of the relationship between psychiatry and medicine o Malpractice increases  

Not going to be tested on the technological innovation 

• Intake: find out what’s going on, first meeting

• Collusion: Ignoring the elephant in the room  

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Ethical Standards  

• Can lose your license when you violate the ethical standards • APA Publication for psychologists  

o Beneficence and non-maleficence: “Do no harm”

▪ Doing nothing at all or making them worse than they already  are  

o Integrity and Justice

o Respect for individuals rights

o Responsibility  

• Competence

Clinical Psychology

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o “You represent you”

▪ Ex: If a client calls you a doctor and you really aren’t, you have  an obligation to correct that person

▪ You want to represent yourself in the best manor possible o Be sensitive to different race, genders, ethnicities, backgrounds,  culture, age, sexual preferences, etc.

• Privacy and Confidentiality ** 

o Client-therapist relationship

o Tarasoff case: Anytime you have a client that threatens someone else,  you have to inform that person

▪ National standard

o Baker act: Anytime a client threatens to harm themselves or have to  be hospitalizes

▪ State wide standard

▪ Florida

o Suspected child abuse, suicide, murder, elder abuse (in Florida)

• Human Relations ** 

o Also called dual relationships, conflict of interest, hidden agenda,  boundary issues

o You want to be friendly but keep it strictly professional  

▪ Sexual activities, employing a client, selling a product to a  client, becoming friends with a client

• All are stickily prohibited  

▪ If you see a client in public, let them acknowledge you first! o Can lead to termination of therapy

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Most common ethical incidents

1. Confidentially 

2. “Boundary Issues”: blurred, dual or conflicted relationships

3. Payment: You can charge them for a “no show” fee as long as you let them  know before charging and  it is clearly stated in the documents they  signed

Professional Issues

• If you have a friend or family member that you are concerned about, “plant  the seed”

o Let them know the specific resources available for them to get help • Three steps

1. Plant the seed

2. Gain that person’s trust

3. Don’t judge

Chapter 4: Research methods in clinical psychology  

Research and ethics (in relation to adults)

• Must be interesting to you

• Choose something timely (something in the news that matters) o Ex: autism, bullying, sexual harassment  

• IRB: your study has to be submitted to IRB and they have to approve it before  you start

• Informed consent ** 

o The researcher is required to inform the participant of any risk,  limitations, discomforts, etc.

o The researcher is also required to inform the participant that they  have the freedom to withdraw from the study

• Confidentiality ** 

o The only place you have the participant’s name is on the informed  consent agreement

o Everywhere else in the study, the participant’s identity will be  protected  

• Deception/Lying

o The research is allowed to lie, BUT only when the IRB approves • Debriefing  

o The researcher is required to inform the participant the idea behind  the study, why it is important and what they were specifically testing • Fraudulent Data

o Common

o Some people submit made up findings

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o But very counterproductive because you want to publish the  experiment so other people can replicate it and get close to the same  results

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Chapter 5: Diagnosis and classification of psychological problems Abnormal Behavior

• Statistical infrequency (#s) or violation of social norms ** 

o Advantages of this definition  

▪ Cutoff points

▪ Appeal  

• We like #s (ex: IQ)

o Problems with this definition  

▪ Choice of cutoff points  

• Ex: at what point do you get a ticket when the speed  

limit is 70? 71? 75? 85?

• Close calls are so frustrating

▪ Number of deviations

• Ex: why is a 90 an A?

▪ Cultural and development relativity  

• #s are good but they aren’t everything

o We need to pay attention to the #s but also the culture (BOTH)

• Subjective distress 

o Keyword - Subjective: exactly how much stress so you need and  everyone has a different threshold

o Advantages of this definition  

▪ It seems reasonable to think that adults can assess when they  are stressed and that they can share this information AND ARE  

MOTIVATED TO DO SO  

• Works when people are motivated to make a change 

• When the patient is stressed, they will be more  

motivated to fix the problem and more likely to change  

with therapy

o Problems with this definition  

▪ Not everyone that is diagnosed as “disordered” reports they  

are stressed

• Doesn’t work for people that don’t care, people that are  

delusional, and people that are in denial 

o Schizophrenic: these people know there is a  

problem, but they think the problem is YOU (not  

themselves)

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o Substance Abuse/Eating Disorder: People  

diagnosed with either of these are in denial, “If I  

wanted to quit, I could”

o Antisocial people: People that don’t care about  

anyone but themselves  

▪ How mush stress is abnormal?

• Disability, dysfunction, or impairment  

o Must create some degree of social or occupational problems with the  person

▪ “Be all that you can be”

▪ People fitting in this category are NOT being all that they can  be  

▪ They are hurting themselves

o Advantages of this definition  

▪ Little inference required

o Problems with this definition  

▪ Who establishes the standards for social or occupational  

dysfunction?

• “Are you playing God”

• It’s your views to think the patient is at fault for hurting  

himself or herself. Who says he/she needs  

family/friends, social atmosphere, school, work, etc?

• Take home message: Abnormal behavior does not necessarily indicate  mental illness 

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Mental illness

• DSM5: updated version of the book that all psychologists follow (Basically a  book of all the disorders and their numbers)

o The syndrome, cluster of abnormal behaviors

o A mental disorder represents a dysfunction within an individual ▪ This means it is not a societal issue

o Not all “outliers” (both ends of the bell curve) are signs of mental  disorders  

• The importance of diagnosis  

1. Treatment has to match the problem

▪ Shows what mode of treatment would be most effective

2. Insurance purposes 

3. Communication: 

▪ Between professionals: when one uses a term in the book and  the other knows exactly what he/she is referring to

Clinical Psychology  

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▪ Between client and therapist: as a therapist, you are required  to tell the client what their diagnosis is but sometimes you  

would rather not because the client may start to fill that role

4. “Normalizing”: Lets the patient know that other people feel exactly  what and how they feel. Shows them that they are not alone

5. Allows distinctions to be made

6. Research  

• Co-morbidity:  multiple diagnosis  

**DON’T have to know the multiaxal assessment system of diagnosis**

• General Issues in classification  

o Quality vs. Quantity  

▪ Quality: “black vs. white,” you either have it or you don’t  

▪ Quantity: the reality is that everyone experiences it, BUT the  key is how much you experience it  

• “Quantity is the key”

o Bases of categorization

▪ Classify psychiatric patients  

▪ Heterogeneity: sometimes can be a problem because most of  the time when someone is diagnosed with a problem they are  

grouped within that category

• You have to be careful. Everyone in a category isn’t the  

same

o Pragmatics of classification  

▪ Everything in the DSM5 is covered by insurance. So you have to  be careful what you classify as a condition  

o Reliability  

▪ Goes hand in hand with validity

▪ Refers to consistency of diagnosis

• Key word – Consistency: basically a second opinion  

o Both people should come up with the same  

diagnosis  

• Negatives to Diagnosing  

o For some clinicians classifying people may become more satisfactory  than trying to relieve their problems *** 

o Classifications can be harmful

▪ Self Fulfilling Prophecies: the diagnosis becomes the clients  

identity, consumes their life, becomes who they are  

▪ Gives the client an excuse: “No, I cant do this because I am  

Schizophrenic”

• Diathesis-stress model: works under all models and included BOTH nature  and nurture

o Environmental stress then causes the disorder