WEEK 2 NOTES
Career Activities of Clinical Psychologists
∙ Clinical Practice: Tremendous diversity
∙ Areas of specialization: adults, children, trauma victims, organizational consulting, LGBTQ issues, ect.
∙ Most practicing psychologists are specialists and generalists. ∙ Forensic psychology
o Areas of specialization within this field.
∙ Teaching, research and publication: usually associated with academic psychologists at universities. Some clinical psychologists are full-time faculty members, most teach as adjuncts because of their clinical time commitments.
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∙ Private practice, institutional setting, or both.
Daily Practice Issues of Clinical Psychologists
∙ Where do patients come from?
o Hospital referrals: less common for psychologists that for psychiatrists. o Insurance company referrals.
o Advertising (Including websites): inconsistent effectiveness.
o Other professionals: physicians, attorneys, other psychologists: depends on your specialties.
o Word-of-mouth: former and current patient referrals.
∙ Record keeping
o Record keeping style may vary, but must include some basic elements :
Enable a reader to track what patient said and what you did. Include an intake history, diagnosis, and treatment plan.
o Current move is from paper records to electronic records: each has its own advantages and drawbacks.
o Mental health practitioners have always sought to maintain the highest standards of confidentiality. If you want to learn more check out What is the difference between general jurisdiction and limited jurisdiction?
o 1996- Health Insurance Portability and Accountability Act (HIPAA): applied standards to all medical and clinical practices.
o 1996- Jaffee v. Raymond: U.S. Supreme Court ruling created psychotherapist-patient privilege, on a par with lawyer-client privilege. o Fiduciary relationship: who is the patient or client?
o Mandated or third-party referrals, e.g. pre-employment screening, FFDE, forensic evaluation, ect.
∙ Exceptions to confidentiality
o Mandated of third-party referrals, e.g. pre-employment screening, FFDE, forensic evaluations, ect.
o Danger to self or others: discretionary decisions by psychologists: No duty-to-protect law in Florida (cf. Tarasoff case)
o Mandated reporting of child, elder, or disabled abused in every state: must report reasonable suspicion.
∙ Appointment and Scheduling
o Full- or part-time private practice?
o Solo or group practice?
o Handling emergencies.
o Phone contact.
∙ Practice Practicalities
o Office rent or own?
o Malpractice insurance. If you want to learn more check out What are the effects of the therapy?
o Professional dues and fees
o Work and family life
o Job vs. professional identity.
o Burnout & work-life balance.
Research in Clinical Psychology
∙ Research in the mental health fields burgeoned following the free-wheeling, “anything goes” practices of the 1970’s.
∙ Scientist-practitioner model should put psychologists in an advantageous position to evaluate the validity of a wide range of claims about theory and practice.
∙ Even if you don’t conduct research, training in the scientific method should equip you with adequate b.s. detection skills.
∙ Psychological research employs 2 main methodologies:
o 1. Case study approach: ideographic- “thick” description; multiple detailed observations on a small number of subjects: good for generating hypothesis.
o 2. Experimental approach: nomothetic- “thin” description; study limited number of variables on a large pool of subjects: good for testing hypothesis
∙ Treatment efficacy: how does this intervention compare overall to other interventions for the same condition in similar subjects?
∙ Treatment effectiveness: how well does this intervention work for this particular patient? We also discuss several other topics like What is rotational kinematics?
∙ Empirical research has in fact established the efficacy and effectiveness of many kinds of psycho therapies for mental disorders and problems in living, with success rate equaling or exceeding that of many standard medical procedures used for physical disorders. If you want to learn more check out Pluralist democracy is a theory of what?
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∙ Move in medical practice to evidence-based treatment.
∙ Move in mental health field to manualized therapy: pros and cons. ∙ Publication in clinical psychology: peer-reviewed journals vs. popular purée; case studies, empirical research, assessment and treatment guide.
Clinical Psychology: Ethical and Cultural Issues
∙ Ethics: A necessary component of any profession: medicine, mental health, law enforcement, business, etc.
∙ Aspirational vs. enforceable codes of ethics .
∙ APA Code of Ethics: 1953,1992,2002,2010.
∙ Fiduciary relationship
∙ Informed consent: assessment and treatment
∙ Third-party referrals
∙ Dual or Multiple relationships.
∙ Boundary violations: BIOTP standard.
∙ Dual Relationships
o To the degree possible, counselors should avoid entering into a dual relationship with a client
o Dual relationship: participation in more than one role with the same client.
o Counselors must make every effort to avoid dual relationships with clients that could impair professional judgement or increase the risk of harm to the client.
∙ Professional boundary violation: any interaction that is not in the best clinical interest of the patient because it:
o Compromises the psychologist’s effectiveness.
o Coerces or exploits the patient in any way .
∙ Principle is based on the idea of patient vulnerability: paternalistic? ∙ Most professional boundary violations involve sexual or financial transactions. ∙ The fiduciary relationship considered to extend for 2 years following the last clinical interaction.
∙ Professional boundaries may be fixed or flexible.
∙ Competencies in clinical psychology:
o Professional Competence: education, training, experience, learning orientation.
o Cultural Competence: skill in dealing with diverse types of people.
POWER POINT #4
Classification and Diagnoses
To be useful, a diagnosis must be:
Diagnoses may be:
∙ EX: Hypertension and depression
1952- Diagnostic and Statistical Manual of Mental Disorders (DMS): Attempt to standardize psychiatric diagnosis.
∙ 106 diagnostic categories.
∙ Reliability- validity.
∙ Largely psychodynamic orientation, with some biology.
1968- DSM- II: 182 Disorders
∙ 182 diagnostic categories.
∙ Similar theoretical orientation as DSM-I.
∙ 1974- Homosexuality removed as a mental health disorder.
1980- DSM-III: Radical revision in both theory and structure. ∙ 265 diagnostic categories.
∙ Largely biomedical orientation.
∙ Multiple substance abuse categories.
∙ Attempt to coordinate psychopathological categories with
∙ Multiaxial classification.
∙ Axis I: Is a Clinical Syndrome (Cognitive, anxiety, mood disorders [16 syndromes]) present?
∙ Axis II: Is a Personality Disorder or Mental Retardation present? ∙ Axis III: Is a General Medical Condition (diabetes, hypertension or arthritis, etc.) also present.
∙ Axis IV: Are Psychosocial or Environmental Problems (school or housing issues) also present?
∙ Axis V: What is the Global Assessment of the person’s functioning?