CHAPTER 1 • NEUROPSYCHOLOGY

CLINICAL PSYCHOLOGY:
3 MODELS OF TRAINING
DEFINITION AND TRAINING
• Scientist Practioner Model or
Boulder Model
“Clinical Psychology”
• Practioner Scholar Model or Vail
- first used in 1907 by Lightner Witmer.
Model
Witmer envisioned clinical psychology as
• Clinical Scientist Model
a discipline with similarities to a variety of
other fields, specifically medicine,
SCIENTIST-PRACTIONER MODEL
education, and sociology.
(BOULDER MODEL)
- Quick definition: essentially the branch
• Created in 1949 at a conference in
of psychology that studies, assesses, and
Boulder, Colorado of directors of
treats people with psychological
clinical psychology training programs.
problems or disorders (e.g., Myers, 2013,
VandenBos, 2007). • Emphasizes both practice and research
- Graduates should be able to
- APA Definition: integrates science,
theory, and practice to understand, competently practice (e.g., therapy,
predict, and alleviate maladjustment, assessment) and conduct research.
disability, and discomfort as well as to - A balanced approach; Balancing
Practice and Science.
promote human adaptation, adjustment,
and personal development. Clinical
Psychology focuses on the intellectual, PRACTIONER-SCHOLAR MODEL
emotional, biological, psychological, (VAIL MODEL)
social, and behavioral aspects of human • Created in 1973 in a conference in Vail,
functioning across the life span, in varying Colorado
cultures, and at all socioeconomic levels. • Also known as practitioner-scholar
(APA, 2012a) model
• Emphasizes practice over research
EDUCATION AND TRAINING IN CLINICAL • Yields the Psy.D. degree (not the
PSYCHOLOGY traditional Ph.D.)
• Commonalities among most training • Higher acceptance rates and larger
programs classes
• Doctoral degree • Proliferated in recent years
• Most enter with bachelor’s, some
with master’ s degree
CLINICAL SCIENTIST MODEL
• Required coursework
• Thesis/dissertation • Emerged in 1990s, primarily as a
• Predoctoral internship reaction against the trend toward
practice represented by Vail model
EDUCATION AND TRAINING: SPECIALTY • Richard McFall’s 1991 “Manifesto
TRACKS for a Science of Clinical Psychology”
• CHILD sparked this movement
• HEALTH • A subset of Ph. D. institutions who
• FORENSIC strongly endorse empiricism and
• FAMILY science
• Tend to train researchers rather than - Still supervised, but more
practitioners independence
- Often specialized training
EMERGING TRENDS IN TRAINING - Often required for state licensure

• Technology GETTING LICENSED

- Use of webcams for supervision.
- Computer-based assessment. • Licensure enables independent
• COMPETENCE practice and identification as a
- Skills that students must member of the profession
demonstrate. • Requires appropriate graduate
- Ex: Intervention, Assessment, coursework, postdoctoral internship,
Research, etc. and licensing exams
• Each state has its own licensing
GETTING INTO GRADUATE SCHOOL IN requirements
CLINICAL PSYCHOLOGY
• To stay licensed, most states require
continuing education units (CEUs)
• Know your professional options
• Take the appropriate undergraduate WHERE DO CLINICAL PSYCHOLOGISTS
courses WORK?
• Get to know your professors
• Get research experience • A variety of settings, but private
• Get clinically relevant experience practice is most common
• Maximize your GRE score - True since 1980s
• Select graduate programs wisely • Other common work settings include
• Write effective personal statements - Universities
• Prepare well for admissions - Psychiatric and general hospitals
interviews - Community mental health centers
• Consider your long-term goals - Other settings

INTERNSHIPS: PREDOCTORAL AND WHAT DO CLINICAL PSYCHOLOGISTS

POSTDOCTORAL DO?

• Predoctoral internship • A variety of activities, but

- It takes place at the end of doctoral psychotherapy is most common
training programs (before Ph.D. or - True since 1970s
Psy.D. is awarded) • Other common professional
- A full year of supervised clinical activities include:
experience in an applied setting - Diagnosis/assessment
- An apprenticeship of sorts, to - Teaching/supervision
transition from student to - Research/writing
professional - Other activities
• Postdoctoral internship HOW ARE CLINICAL PSYCHOLOGISTS
- Takes place after the doctoral degree DIFFERENT FROM OTHER
is awarded PROFESSIONALS?
- Typically lasts 1-2 years
• Counseling Psychologists: CHAPTER 2:
- Tend to see less seriously disturbed
THE CLINICAL INTERVIEW
clients;
- Tend to work less often in settings like • Assessment is closely linked with the
inpatient hospitals or units; identity of clinical psychologists
- Tend to endorse humanism more and - No other mental health profession
behaviorism less; incorporates assessment into their
- Tend to be more interested in work as clinical psychologists do.
vocational and career counseling.
• Clinical interviews are the most
• Psychiatrists: frequent assessment tool
- Go to medical school and are - More than any specific test
physicians - Vast majority of practicing clinical
- Have prescription privileges psychologists use interviews.
- Increasingly emphasize
biological/pharmaceutical rather Essential Qualities of Assessment
than “talk therapy” intervention. Techniques
• Social Workers
- Tend to emphasize social factors in • All assessment techniques
client’s problems (including interviews) should have
adequate:
- Earn a master’s degree rather than
- Validity—measures what it claims to
a doctorate
measure Reliability—yields
- Training emphasizes treatment and
consistent, repeatable results
fieldwork over research or formalized
Clinical utility—benefits the clinician
assessment
and ultimately the client
• School Psychologists:
- Tend to work in schools Feedback
- Tend to have a more limited
professional focus than clinical • Common to all kinds of
psychologists (student wellness and psychological assessment
learning) • Provide results of tests or interviews
- Frequently conduct school-related • May be face-to-face, a report, etc.
testing and determine LD and ADHD
The Interviewer
diagnoses
- Consult with adults in children’s • General skills
lives (e.g., teachers, staff, parents) - Quieting yourself: Minimize
• Professional Counselors: excessive internal, self-directed
- Earn a master’s degree thoughts that detract from listening
- Complete training in two years - Being self-aware: Know how you
- Little emphasis on psychological tend to affect others interpersonally,
testing or research and how others tend to relate to you.
- May specialized in career, school, - Develop positive working
college counseling relationships: Can segue into
psychotherapy & Respectful and
caring attitude is key
• Specific behaviors have been made at different points,
- Listening—the primary task of the and identify themes.
interviewer, consisting of numerous
Pragmatics of the Interview
building blocks
➢ Eye contact • Note-taking- little consensus about
➢ Body language note-taking Provide a reliable written
➢ Vocal qualities record, but can be distracting to client
➢ Verbal tracking and interviewer.
➢ Referring to clients by
• Audio- and Video-recording- also
proper name
provide a reliable record, but can be
Components of the Interview inhibiting to clients Must obtain
permission.
• Rapport • The Interview Room- professional yet
- Positive, comfortable relationship comfortable
between interviewer and client • Confidentiality- explain
- How an interviewer is with clients confidentiality and its limits to clients
• Technique (e.g., child abuse, intention to harm)
- What an interviewer does with clients
- Directive vs. nondirective styles Types of Interviews

Specific Interviewer Responses • Intake interviews- to determine

whether to “intake” the client into the
1. Open-ended questions agency or refer elsewhere.
- Allow individualized and • Diagnostic interviews- to provide
spontaneous responses from clients DSM diagnosis
- Elicit long answers that may or may - Structured interviews often used
not provide necessary info. Minimize subjectivity, enhance
2. Closed-ended questions reliability.
- Allow less elaboration and self- • Mental status exam- typically used in
expression by the client medical settings, and to quickly
- Yield quick and precise answers assess how a client is functioning at
that time.
• Clarification - question to make sure • Crisis interviews- assess problem
the interviewer accurately and provide immediate intervention.
understands the client’s comments - Clients are often considering suicide
• Confrontation - for discrepancies or or another harmful act.
inconsistencies in a client’s
comments Cultural Components
• Paraphrasing - restatement of
• Appreciating the cultural context
client’s comments to show they have
• Knowledge of the client’s culture, as
been heard
well as the interviewer’s own culture
• Reflection of feeling- echo client’s
• For behavior described or exhibited
emotions, even if not explicitly
during interview
mentioned
• Acknowledging cultural differences
• Summarizing- tie together various
topics, connect statements that may
 • Wise to discuss cultural differences - Convenience for clients
rather than ignore - Professional autonomy
• Sensitive inquiry about a client’s - Professional identification
cultural experiences can be helpful - Evolution of the profession
- Revenue for the profession
• Why psychologists should not
CHAPTER 3 prescribe:
• Training issues: which courses?
CURRENT CONTROVERSIES IN CLINICAL when? taught by whom?
PSYCHOLOGY • Threats to psychotherapy: would
medications replace talk therapy?
Current Controversies Interview
• Identity confusion: especially when
• Prescription Privileges only some prescribe Influence of
pharmaceutical industry.
• Evidence-Based / Manualized
Therapy Evidence Based Practice /
• Overexpansion of Mental Disorders Manualized Therapy
• Payment Methods: Third Part • When researchers measure therapy
• Payment vs Self Payment The outcome, they often use therapy
• Influence of Technology and manuals
Cybertherapy o To ensure uniformity across
therapists
Prescription Privileges
o To minimize variability
• Historically, prescribing has • When outcome data supports the use
distinguished psychiatrists from of a manualized therapy, the
psychologists treatment is known as “evidence
• However, in recent decades, clinical based”
psychologists have actively pursued • Treatments formerly called
prescription privileges “empirically validated” and
• Since 2002, two states have agreed “empirically supported”
to grant prescription privileges to o “Evidence-based practice”
appropriately trained psychologists includes the treatment and
– New Mexico-Louisiana factors related to people
• Other states have considered similar providing and receiving the
legislation, and may pass it soon treatment

Advantages of Evidence Based Practice

Why psychologists should prescribe: /Manualized Therapy
shortage of psychiatrists. • Scientific legitimacy
• Establishing minimal levels of
• Especially in rural areas competence
- CPs more expert than primary care • Training Improvements
docs • Decreased reliance on clinical
- Other non-physicians have privileges judgment
- Dentists, podiatrists, optometrists,
and some nurses, among others
DIsadvantages of Evidence Based Practice Risks of Overdiagnosis
/Manualized Therapy
• Threats to the psychotherapy • Unnecessary medication – harmful
relationship side effects
• Diagnostic complications • Unnecessary therapy – undermine
o “Textbook” cases vs. “real coping skills
world” cases • Negatively impact self-image and
• Restrictions on practice self-efficacy via stigma
o Mandated manuals vs. • Adversely affect health insurance
creatively customized enrollment and rates
treatments • Legal ramifications
• Debatable criteria for empirical
Overdiagnosis and the Pharmaceutical
evidence Industry

Overexpansion of Mental Disorders • More mental disorders = more

• DSM size and scope has increased potential pharmaceutical
from 1950s to present customers?
• Overdiagnosis, diagnostic • Significant numbers of psychiatrists
expansion, diagnostic inflation, involved in the creation of the DSM
diagnostic creep, medicalization of had financial ties with major
everyday problems, false positives, pharmaceutical companies
false epidemics? o 69% for DSM-5
• Minimizing the chance that people
struggling with mental illness fall Payment Methods: Third-Party Payment
through the cracks vs. overdiagnosis vs. Self-Payment
of normal life experiences
• Early in the history of clinical
• If diagnoses continue to expand, can psychology, clients paid for services
anyone be diagnosed with a mental
directly out of pocket
disorder?
• With time, health insurance
companies began covering mental
New Disorders, New Definitions
health
• Premenstrual dysphoric disorder • Today, many clients use health
o Severe versions of the insurance/managed care benefits to
symptoms of premenstrual pay for services
syndrome o Often called “third-party
• Binge eating disorder payers”
o Out-of-control overeating at Effect of Third-Party Payment on Therapy
least once per week
Definitions • Surveys of psychologists suggest that
• ADHD third-party payment can result in:
o Age by which symptoms o Negative impact on quality
appear raised from 7 to 12 o Too little control over
clinical decisions
o Ethical problems, including
confidentiality
 o Confusion about informed • Virtual reality therapeutic
consent (what to tell clients experiences
about payment method) • Computer-based self-instruction
o Greater affordability for • Therapist/client interaction via hand-
many clients held devices (e.g., iPhones, cell
phones, Blackberries)
Effect of Third-Party Payment on Diagnosis
How Well Does How Well Does
• Surveys of psychologists suggest
Cybertherapy Work?
that third party payment can result in
o Increased likelihood of • Appears to work about as well as in-
being diagnosed with a person psychotherapy
mental disorder • Specific examples include
o Certain diagnostic o CBT for anxiety disorders
categories are being used o Health psychology
more or less often • Headaches
• Pain
Effect of Third-Party Payment on
Psychologists’ Experience Technology: Suggestions for Emerging
Professional Issues
• Lower pay
• Time required for paperwork, phone • Obtain informed consent about the
calls, etc. technology
• Frustration due to denial of care • Follow relevant telehealth laws
psychologist believes to be • Follow APA ethical code
necessary • Ensure confidentiality via encryption
• In recent years, clinical psychologists • Make efforts to appreciate culture
have increasingly used technology in
• Obtain relevant training
the direct delivery of psychological
• Know client’s local emergency
services
resources
• Assessment
• Treatment Technology: Additional Potential Problems
• Cybertherapy can replace or
supplement face-to-face meetings • Confirming the identity of the client
• Benefits can include accessibility, • Confidentiality across electronic
affordability, and anonymity, and transmission
more • Making interpretations in the
absence of nonverbal cues that
Applications of Technology in Clinical would be present face-to-face
Psychology: Examples • Competence in technical as well as
clinical skills
• Videoconferencing to interview or
treat Technology: Effectiveness of Treatment
• Email or text psychotherapy
• Interactive Internet sites • Early research is beginning to
• Online psychotherapy programs demonstrate that it can work
• Success depends on many factors:
o Which cybertherapy,
disorder, device?
o What setting?
o How clients found or were
referred to cybertherapy?
o Live support available?