C1: Clinical Psychology: Definition and Training

By : The Gayz

WHAT IS CLINICAL PSYCHOLOGY? ● Dissatisfaction with the Boulder

Clinical Psychology was first used in print by scientist-practitioner model prompted the shift
Lightner Witmer in 1907 (discipline with similarities towards more practice-focused training.
to a variety of other fields, specifically medicine, ● This shift resulted in the creation of the PsyD
education, and sociology) degree, which emphasizes applied clinical skills
over research.
A clinical psychologist, therefore, was a person whose ● The number of PsyD programs has increased
work with others involved aspects of treatment, significantly since the 1970s, with a notable
education, and interpersonal issues surge in degrees awarded between 1988 and
2001.
EDUCATION AND TRAINING ● PsyD programs typically offer more
IN CLINICAL PSYCHOLOGY coursework directly related to clinical
● Clinical psychologists obtain a doctoral degree practice and fewer courses in research and
in clinical psychology, with about 3,000 awarded statistics compared to PhD programs.
annually. The PsyD (or practitioner-scholar or Vail model)
● Entry into doctoral programs typically requires a approach to training in clinical psychology has
bachelor's degree, but some may have a seen significant growth, accounting for over
master's degree, often from a terminal half of doctoral degrees awarded in the field.
master's program. ● While there are fewer PsyD programs
● Training includes at least 4 years of intensive compared to PhD programs, they tend to
coursework and a 1-year predoctoral accept and graduate larger groups of students.
internship. ● Roughly 1,500 individuals graduate annually
● Coursework covers various subjects including with both PsyD and PhD degrees in clinical
psychotherapy, assessment, statistics, psychology.
research design, and more.
● A master's thesis and doctoral dissertation are
commonly required, along with a practicum for
supervised clinical experience.
● Specialty tracks within doctoral programs offer
training in areas such as clinical child, clinical
health, forensic, family, and clinical
neuropsychology.
● Three models of training exist the
scientist-practitioner (Boulder) model, the
practitioner-scholar (Vail) model, and the
clinical scientist model.

BALANCING PRACTICE AND SCIENCE

THE SCIENCETIST-PRACTIONER (B-MODEL)
● The first conference on graduate training in
clinical psychology was held in 1949 in Boulder,
Colorado.
● The conference emphasized the joint
importance of practice and research in clinical
psychology training. LEANING TOWARD SCIENCE:
● This led to the establishment of the THE CLINICAL SCIENTIST MODEL
scientist-practitioner model, also known as Evolution of Clinical Psychology Training Models:
the Boulder model. ● Balanced Boulder model (late 1940s)
● The model required graduate students to receive ● Practice-focused Vail model (1970s)
training in both clinical methods and research ● Emergence of the clinical scientist model in the
methods. , 1990s, emphasizing empiricism and the
● The pendulum of emphasis between practice scientific method as the foundation of clinical
and research swung between extremes over psychology.
the years. Clinical Scientist Movement:
● Led by proponents advocating for a strong
LEANING TOWARD PRACTICE: emphasis on scientific method and
THE PRACTIONER-SCHOLAR (V- MODEL) evidence-based clinical practices.
● The 1973 conference in Vail, Colorado, led to ● Graduates awarded PhD degrees with a focus
the emergence of the practitioner-scholar model on scientific approach.
of training in clinical psychology. ● Initiated by Richard McFall's manifesto in 1991
and the subsequent establishment of the
Academy of Psychological Clinical Science.
C1: Clinical Psychology: Definition and Training
By : The Gayz

Contemporary Trends: ● The predoctoral internship marks the transition

● Shift in faculty theoretical orientation towards from student to professional and often offers
cognitive/cognitive behavioral approaches. specialized training.
● Increased representation of female and minority ● The application process for predoctoral
doctoral students. internships resembles applying to graduate
● Emphasis on specific competencies ensuring school, involving research, applications to
practical application of learned skills in multiple sites, interviews, and relocation.
intervention, assessment, research, ethics, and ● Postdoctoral internships, lasting 1 to 2 years,
cultural diversity. are required for licensure as a psychologist in
most states, providing further specialized
GETTING IN: WHAT DO training and supervision.
GRADUATE PROGRAMS PREFER?
● Know your professional options: Research GETTING LICENSED
various career paths within clinical psychology to Licensure is a crucial step for psychologists to practice
make informed decisions. independently and identify themselves professionally.
● Excel in undergraduate coursework: Focus ● Requirements for licensure typically include
on relevant courses like statistics, research completion of graduate coursework and
methods, psychopathology, and biopsychology. predoctoral and postdoctoral internships.
● Build relationships with professors: Strong ● Passing licensure exams, such as the
letters of recommendation are crucial; foster Examination for Professional Practice in
connections with faculty members through Psychology (EPPP) and state-specific exams
research and involvement. on laws and ethics, is necessary. (standardized
● Gain research experience: Undertake research exams)
projects with professors to enhance empirical ● State exams focus on legal issues relevant to
skills and potentially publish or present findings. psychology practice within that state, and may
● Seek clinically relevant experience: Explore be written or oral.
internships or volunteer positions in settings ● Continuing education units (CEUs) are often
related to clinical psychology to demonstrate required for license renewal in many states,
commitment and understanding. ensuring psychologists stay updated with
● Maximize GRE (Graduate Record developments in the field.
Examination) scores: Prepare thoroughly for ● CEUs can be obtained through various means
the GRE to meet program expectations and like workshops, courses, specialized training, or
improve your chances of admission. exams on professional reading material.
● Choose graduate programs wisely: Consider
factors like training model, faculty expertise, WHERE DO CLINICAL
specialization options, and personal PSYCHOLOGISTS WORK?
preferences. Clinical psychologists work in diverse settings, with
● Craft effective personal statements: Highlight private practice being the most common.
career aspirations, research interests, and ● Surveys conducted since the 1980s consistently
relevant experiences tailored to each program. show private practice as the primary
● Prepare for admissions interviews: employment site for 30% to 41% of clinical
Familiarize yourself with the program, dress psychologists.
professionally, and be ready to discuss specific ● University psychology departments rank second
interests and ask insightful questions. but have never exceeded 19%.
● Consider long-term goals: Reflect on career ● Other common settings include psychiatric
aspirations, theoretical orientation, financial hospitals, general hospitals, community mental
considerations, and program fit for a fulfilling health centers, medical schools, and Veterans
career path. Affairs medical centers, each employing
● Consult literature on admissions processes: between 2% and 9% of clinical psychologists.
Explore studies on program priorities and ● The "other" category, comprising various
differences between PhD and PsyD programs to settings like government agencies, public
better understand application expectations. schools, substance abuse centers, corporations,
and university counseling centers, has
INTERNSHIP: consistently ranked third in surveys since the
PREDOC AND POSTDOC 1980s.
● Clinical psychology doctoral programs come to a ● Overall, while private practice remains prevalent,
climax in a predoctoral internship, typically clinical psychologists are increasingly employed
lasting a year in applied settings like psychiatric in a wider array of settings.
hospitals, counseling centers, or community
mental health centers.
C1: Clinical Psychology: Definition and Training
By : The Gayz

WHAT DO THEY DO …? ● Clinical psychologists traditionally lacked

Clinical psychologists are primarily engaged in prescription privileges, though some states have
psychotherapy, which has consistently been the granted them this authority in recent years.
dominant professional activity since at least the 1970s. Approach to Treatment:
● Psychiatrists emphasize biological aspects of
● Between 1973 and the present, 76% to 87% of mental health disorders, often viewing them as
clinical psychologists have reported involvement physiological abnormalities of the brain.
in psychotherapy, spending 31% to 37% of their ● Clinical psychologists acknowledge biological
time conducting it. factors but also consider behavioral, cognitive,
● Individual therapy constitutes the largest portion and emotional aspects, focusing on
of therapy time (76%), followed by group, family, nonpharmacological interventions such as
and couples therapy (6% to 9% each). psychotherapy.
● Over half of clinical psychologists are involved to Primary Treatment Focus:
some extent in diagnosis/assessment, teaching, ● Psychiatrists often prioritize medication as the
supervision, research/writing, consultation, and primary intervention to address mental health
administration. issues.
● Diagnosis and assessment typically occupy ● Clinical psychologists may incorporate various
more time than other professional activities. therapeutic techniques, with medication being
considered as one of many possible options
HOW ARE CLINICAL PSYCHOLOGISTS rather than the first line of defense.
DIFFERENT FROM . . . View on Behavioral and Emotional Problems:
● Psychiatrists tend to approach disorders
Counseling Psychologists VS. CL.PSYCH primarily from a biomedical perspective,
Overlap and Common Ground: focusing on pharmacological solutions.
● Significant overlap exists between clinical and ● Clinical psychologists view problems as
counseling psychology. multifaceted, stemming from brain activity but
● Graduates often earn the same degree (PhD) also influenced by behavioral, cognitive, and
and obtain the same licensure. emotional factors, and thus amenable to change
● Both may work with similar clients, blurring through nonpharmacological methods.
distinctions for clients seeking services.
Client Characteristics: Social Workers VS. CL.PSYCH
● Historically, clinical psychologists worked with Focus of Work:
more seriously disturbed individuals. ● Clinical psychologists focus on individual mental
● Counseling psychologists tended to work with health issues and psychological factors
less pathological clients. contributing to them.
Settings and Populations: ● Social workers traditionally concentrate on
● Clinical psychologists often work in hospitals societal factors impacting individuals' problems,
and inpatient psychiatric units. such as poverty, abuse, and discrimination.
● Counseling psychologists often work in Approach to Client Issues:
university counseling centers. ● Clinical psychologists analyze and address
● Clinical psychologists tend to work with more psychological factors contributing to client
seriously disturbed populations. issues, often utilizing therapeutic interventions.
● Counseling psychologists tend to work with less ● Social workers tend to delve into the broader
seriously disturbed populations. social context of clients' lives and connect them
Specializations: with relevant social services and resources.
● Counseling psychologists are more interested in Client Interaction:
vocational testing and career counseling. ● Social workers frequently engage in direct
● Clinical psychologists are more interested in interactions with clients' environments by visiting
applying psychology to medical settings. their homes or workplaces and making
connections with beneficial organizations.
Psychiatrists VS. CL.PSYCH ● Clinical psychologists primarily interact with
Education and Training: clients in therapeutic settings, focusing on
● Psychiatrists attend medical school and are mental health assessment and treatment.
licensed physicians. Professional Training:
● Clinical psychologists typically have a doctoral ● Clinical psychologists typically undergo
degree in psychology, specializing in clinical or doctoral-level training, emphasizing research
counseling psychology. methods, psychological testing, and various
Prescriptive Authority: therapeutic approaches.
● Psychiatrists are authorized to prescribe ● Social workers typically earn master's degrees,
medication due to their medical training. with a focus on supervised fieldwork and an
emphasis on social and environmental factors
impacting clients.
C1: Clinical Psychology: Definition and Training
By : The Gayz

Therapeutic Focus: dealing with problems in living or mild mental

● Clinical psychologists employ various illness, rather than severe mental illness.
therapeutic modalities to address psychological ● Emphasis in Training: Their training involves
issues, often grounded in psychological theories minimal emphasis on psychological testing or
and research. research compared to clinical psychologists.
● Social workers, especially those conducting ● Practice Settings: They commonly work in
therapy, may utilize similar therapeutic community agencies and may also establish
approaches, but their interventions are typically private practices, serving a diverse range of
grounded in social and environmental theories, clients.
with less emphasis on psychological testing and ● Specializations: Professional counselors often
research methods. specialize in areas such as career counseling,
school counseling, addiction counseling,
School Psychologists VS. CL.PSYCH couple/family counseling, or college counseling.
Setting and Focus:
● Typically work in educational settings, such as Marriage and Family Therapists VS. CL.PSYCH
schools, day-care centers, or correctional ● Clinical psychologists typically hold doctoral
facilities. degrees (Ph.D. or Psy.D.), while Marriage and
● Primarily concerned with enhancing the Family Therapists (MFTs) usually earn master's
intellectual, emotional, social, and degrees.
developmental well-being of students. ● Clinical psychologists undergo extensive training
Functions and Activities: encompassing research, assessment, and
● Conduct psychological testing, especially for clinical practice, whereas MFTs' training
conditions like learning disorders and ADHD. primarily focuses on therapeutic techniques for
● Develop and implement programs tailored to couples and families.
meet educational and emotional needs. ● Clinical psychologists often emphasize research
● Provide consultation to adults involved in and assessment as integral components of their
students' lives, including teachers, training and practice.
administrators, and parents. ● The therapeutic approach of MFTs centers on
● Engage in limited direct counseling with systemic dynamics within relationships or
students. family-related issues, while clinical psychologists
Credentialing and Education: may utilize a broader range of therapeutic
● In many states, a master's degree is sufficient modalities tailored to individual needs.
for the title of school psychologist.
● A doctorate is not always required for practice in
this field.
Specialization and Scope:
● Emphasis on educational and developmental
issues within a school context.
● Focus on assessment, intervention, and
consultation within educational environments.
Professional Collaboration:
● Work closely with educators, administrators, and
parents to support students' academic and
emotional needs.

Professional Counselors VS. CL.PSYCH

● Education: Professional counselors (often
called licensed professional counselors, or
LPCs) typically hold a master's degree, as
opposed to doctoral degrees held by clinical
psychologists.
● Training Duration: Professional counselors
usually complete their training within 2 years,
which is shorter compared to the extensive
training required for clinical psychologists.
● Field of Study: They attend graduate programs
specifically in counseling or professional
counseling, distinct from doctoral programs in
counseling psychology.
● Scope of Work: Professional counselors
primarily engage in counseling individuals
C1: Clinical Psychology: Definition and Training
By : The Gayz

PRACTICE QUIZ
1.How do social workers differ from clinical ANS: Psychotherapy
psychologists?
ANS: Social workers typically lack a doctoral degree and 12.The most common work setting for clinical
training in assessment techniques. psychologists is academia (i.e., at universities).
True or False?
2.Successful completion of the postdoctoral ANS: False
internship authorizes a psychologist to practice
independently. True or False?
13.The practitioner-scholar model of training is
ANS: False
also known as the Boulder model of training.True
or False?
3.What is the primary setting in which clinical
ANS: False
psychologists work?
ANS: Private Practice
14.Sigmund Freud was the first person to use the
4.Psychiatrists ______. term “clinical psychology.” True or False?
ANS: are medical professionals ANS: False

5.Which of the following lists the necessary 15.Compared to the training of clinical
stages for independent licensure as a clinical psychologists, professional counselors typically
psychologist in order from first to last? earn a master’s degree rather than a doctoral
ANS: completion of graduate coursework, predoctoral degree. True or False?
internship, postdoctoral internship, and licensure ANS: True
exams.

6.In what way do clinical psychology PsyD

programs NOT tend to differ from PhD programs?
ANS: PsyD programs generally accept and enroll a
smaller number of students than Ph.D. programs.

7.Which of the following is NOT a way in which

clinical psychologists generally differ from
counseling psychologists?
ANS: Clinical psychologists are more interested in
vocational testing and career direction than counseling
psychologists.

8.The clinical psychology education and training

model that emphasizes roughly equal parts
science and practice is known as the ______.
ANS: Boulder model

9.When becoming licensed, a U.S. clinical

psychologist must typically pass ______.
ANS: the EPPP and a state-specific exam on laws
and ethics

10.Compared to the training of clinical

psychologists, professional counselors typically
earn a master’s degree rather than a doctoral
degree. True or False?
ANS: True

10.Which of the following is TRUE regarding

graduate training in clinical psychology?
ANS: Programs that subscribe to the clinical scientist
model of training typically award the Ph.D. degree.

11.The professional activity clinical psychologists

are most often involved in ______.
C2: Evolution of Clinical Psychology
By: The Gayz

EARLY PIONEERS ● Witmer also founded the first scholarly journal in

● These early pioneers only took initiative about the field (called The Psychological Clinic) in
mental disorders and mental health. 1907 and authored its first article titled “Clinical
Psychology”.
William Tuke (1732-1822; England) ● He created the term Clinical Psychology.
● Opened the York Retreat, a residential ● He defined clinical psychology as related to
treatment center where the mentally ill would medicine, education, and social work but stated
always be cared for with kindness, dignity, and that physicians, teachers, and social workers
decency. would not be qualified to practice clinical
● After his death, Tuke’s family members psychology.
continued to be involved in the York Retreat and
the movement to improve treatment of mentally ASSESSMENT
ill individuals. DIAGNOSTIC ISSUES
Neurosis and Psychosis (1800s) - labeling systems for
Philippe Pinel (1745-1826; France) mental illness began to take shape
● He worked successfully to move mentally ill ● Neurosis - involves psychiatric symptoms
individuals out of dungeons in Paris, where they (anxiety and depression) but has intact grasp on
were held as inmates rather than treated as reality.
patients. ● Psychosis - involves a break/detachment from
● He created new institutions where patients were reality (hallucinations, delusions, or grossly
not kept in chains or beaten but given healthy disorganized thinking)
food and benevolent treatment.
● Advocated for the staff to include in their Emil Kraeplin (1855-1926) - “Father of Descriptive
treatment of each patient a case history, ongoing Psychiatry” offered two category system of mental
treatment notes, and an illness classification of illness.
some kind—components of care ● Exogenous Disorders - mental illness caused
● “To rule [the mentally ill] with a rod of iron, as if by external factors, suggested to be the far more
to shorten the term of an existence considered treatable type.
miserable, is a system of superintendence, more ● Endogenous Disorders - mental illness caused
distinguished for its convenience than for its by internal factors.
humanity or success” ● Kraepelin coined the term, dementia praecox,
to describe one endogenous disorder similar to
Eli Todd (1769-1833; Connecticut, USA) what is now known as schizophrenia and
● A physician may 3 hospitals lang for mentally ill several other terms (paranoia, manic depressive
people there psychosis, involutional melancholia, cyclothymic
● He raised a lot of funds to build The Retreat in personality, and autistic personality)
Hartford, Connecticut in 1824. ● He set a precedent for the creation of diagnostic
● He and his staff emphasized patients’ strengths terms that eventually led to the Diagnostic and
rather than weaknesses, and allowed patients to Statistical Manual of Mental Disorders (DSM).
have significant input in their own treatment
decisions. Diagnostic and Statistical Manual of Mental
Disorders (DSM).
Dorothea Dix (1802-1887; United States) ● DSM (1952) - The original DSM was published
● She is a Sunday school teacher in a jail in by the American Psychiatric Association.
Boston who saw first hand that many of the ● DSM II (1968) - Revision of DSM but was not
inmates were there as a result of mental illness significantly different from the original.
or retardation rather than crime. ● DSM III (1980) - Revision of DSM which
● that patients could actually socialize with people signified an entirely new way of thinking about
without mental illnesses mental disorders.
● She would travel between cities to collect data - Specific diagnostic criteria—lists
and present them to local community leaders to indicating exactly what symptoms
persuade them to treat mentally ill people with constitute each disorder.
humane care. - Introduced a multiaxial system, a way
● Her efforts led to the establishment of more than of cataloguing problems of different
30 state mental institutions throughout the kinds on different axes.
United States. ● DSM-III-R (1987)
● DSM-IV (1994)
LIGHTNER WITMER AND THE CREATION OF ● DSM-IV-TR (2000)
CLINICAL PSYCHOLOGY ● DSM-5 (May, 2013)
● In 1896, Witmer founded the first psychological
clinic at the University of Pennsylvania, where
he had returned as a professor.
C2: Evolution of Clinical Psychology
By: The Gayz

ASSESSMENT OF INTELLIGENCE ● Clients were asked to tell stories to go along

● Edward Lee Thorndike - among those who with the interpersonal situations presented in the
promoted the idea that each person possesses TAT cards, their responses were thought to
separate, independent intelligences. reflect personality characteristics.
● Charles Spearman - argued for the existence of
“g,” a general intelligence thought to overlap with Draw-a-Person Test - in which psychologists infer
many particular abilities. personality characteristics from clients’ drawings of
human figures.
Alfred Binet (along with Theodore Simon) created the
first Binet-Simon scale in 1905. Incomplete Sentence Blank (Rotter & Rafferty, 1950)
● It yields a single overall score, endorsing the - In which psychologists assess personality by
concept of “g.” examining the ways clients finish sentence stems.
● First to incorporate a comparison of mental age
to chronological age as a measure of OBJECTIVE PERSONALITY TESTS
intelligence. When expressed as a division ● Offers a very different (and, in many cases,
problem, yielded the “intelligence quotient,” or more scientifically sound) method of assessing
IQ. personality.
● Lewis Terman - Terman’s revision was called ● These tests were paper-based assessments
the Stanford-Binet Intelligence Scales (1937). where clients answered multiple-choice or
● Considered as an IQ test that was a child true/false questions about themselves,
focused measure of IQ, even after Terman experiences, or preferences.
revision.
Minnesota Multiphasic Personality Inventory (MMPI)
David Wechsler - filled the need for a test of - Initially consisted of 550 true/false statements.
intelligence designed specifically for adults with the Developed by Starke Hathaway and J. C. McKinley in
publication of his Wechsler-Bellevue test (1939). 1943.
- Revisions: Wechsler Adult Intelligence ● Test takers’ patterns of responses were
Scale or WAIS (1955), WAIS-R (1981), compared with those of groups in the
WAIS-III (1997), and WAIS-IV (2008). standardization sample who represented many
● Wechsler Intelligence Scale for Children diagnostic categories.
(WISC). - released in 1949, features specific ● Utilizes validity scales to detect random or
subsets—verbal and performance scales. misleading responses
- Revisions: WISC-R (1974), WISC-III ● Minnesota Multiphasic Personality
(1991), the WISC-IV (2003), and the Inventory-2 (MMPI-2) - Released in 1989 with
WISC-V (2014). improved norms (inclusion of minorities) and
● Wechsler Preschool and Primary Scale of elimination of confusing and outdated language.
Intelligence (WPPSI) - introduced in 1967, ● Minnesota Multiphasic Personality
designed for very young children Inventory-Adolescent (MMPI-A) - Adolescent
- Revisions: WPPSI-R (1989), WPPSI-III version released in 1992.
(2002), WPPSI-IV (2012). ● All versions of the MMPI have featured
hallmarks of high-quality objective personality
ASSESSMENT OF PERSONALITY tests: easy administration and scoring,
● Mental test was first used by James McKeen
demonstrable reliability and validity, and clinical
Cattell in 1890 in an article titled “Mental Tests
utility.
and Measurements.”
NEO Personality Inventory (NEO-PI) - Developed by
PROJECTIVE PERSONALITY TESTS Costa and McCrae in 1985.
Rorschach Inkblot Method (1921) - it is a set of 10 ● It is a personality measure less geared toward
inkblots, created by Hermann Rorschach. psychopathology than is the MMPI.
● It is based on the assumption that people will ● Rather than diagnostic categories, its scales are
“project” their personalities onto ambiguous or based on universal personality characteristics
vague stimuli. common to all individuals.
● The way individuals perceive and make sense of
the blots corresponds to the way they perceive Beck Depression Inventory (BDI) and Beck Anxiety
and make sense of the world around them. Inventory (BAI) - Created by A. T. Beck and colleagues
● Measures specific states or traits such as
Thematic Apperception Test/TAT (1935) - Published depression and anxiety
by Christiana Morgan & Henry Murray.
● It used TAT cards which depicted people in PSYCHOTHERAPY
scenes or situations that could be interpreted in ● In the 1930s, most clinical psychologists worked
a wide variety of ways. in academia rather than as practitioners.
C2: Evolution of Clinical Psychology
By: The Gayz

● Psychotherapy didn't play a significant role in ● Since there are more trainings focused on
clinical psychology until the 1940s or 1950s. clinical skills, it signifies the significance of
● Psychological testing was the primary focus for psychotherapy in American health care with
early clinical psychologists. insurance companies beginning authorized
● The demand for psychotherapy increased due to payment for clinical psychologists' services.
the psychological consequences of World War II. ● In the 1980s, clinical psychologists gained
● In the mid-20th century, psychodynamic increased respect and privileges within the
therapy dominated the field. medical establishment.
● In the 1950s and 60s, behaviorism surfaced as ● Growth of the profession continued through the
a fundamentally different approach to human 1990s and 2000s, with increasing diversity in
beings and their behavioral or emotional gender and ethnicity of those joining.
problems. ● Demand for psychotherapy services led to
● The behavioral approach emphasizes an continued growth of the field.
empirical method, with problems and progress ● Today, aspiring clinical psychologists have a
measured in observable, quantifiable terms. variety of training options, including traditional
● In the 1960s, Carl Rogers's humanistic therapy PhD programs, PsyD programs, and clinical
gained popularity, offering a relationship-focused scientist model programs.
alternative to psychodynamic and behavioral ● Specializations such as forensic psychology and
approaches. health psychology are flourishing.
● Family therapy gained popularity in the 1950s, ● Recent professional developments include
viewing mental illness within the context of a empirical support for clinical techniques,
flawed system. prescription privileges, and advancements in
● Most recently, Cognitive therapy with its technology.
emphasis on logical thinking as the foundation of
psychological wellness, has become the most
popular orientation among clinical psychologists.
● The therapy marketplace now offers a wide
range of approaches, including eclectic or
integrative methods.
● Cultural competence has become increasingly
important on any and all such therapy
approaches

DEVELOPMENT OF THE PROFESSION

● Significant steps in the progression of clinical
psychology were evident from its inception.
● American Association of Clinical Psychologists
founded in 1917, later becoming the Clinical
Section of APA in 1919.
● Psychological Corporation founded in 1921,
marked the growth of psychological tests and
measures.
● Education and training in clinical psychology
became more widespread and standardized in
the 1940s.
● Boulder conference in 1949 emphasized the
importance of both practice and research in PhD
clinical psychology training.
● Therapy approaches diversified in the 1950s
with new behavioral and humanistic/ existential
approaches rivaling established psychodynamic
techniques, and increased attention on their
effectiveness.
● APA published its first ethical code in 1953,
reflecting the professional establishment for
clinical psychology.
● In the 1960s and 1970s, clinical psychology
diversified further, recruiting more females and
minorities.
● PsyD programs emerged, offering graduate
training options that emphasized applied clinical
skills over research expertise.
C2: Evolution of Clinical Psychology
By: The Gayz

PRACTICE QUIZ
C3: Current Controversies & Directions in Clinical Psychology
By: The Gayz

PRESCRIPTION PRIVILEGES ● Strong opposition from psychiatrist organizations

Prescription Privileges - the ability to prescribe due to potential loss of business.
medication has been one of the primary distinctions ● Antidepressants, the most commonly prescribed
between psychiatrists and psychologists. category of drugs in the U.S., contribute to
revenue generation for the profession.
The roots of the movement were established in the
1980s, but in the 1990s and 2000s, it rose to the level of WHY CLINICAL PSYCHOLOGISTS
a high-profile, high-stakes debate SHOULD NOT PRESCRIBE
Training Issues:
Among Individuals that also prompted the movement ● Debate over the extent and nature of
toward prescribing (Patrick H. Deleon, Morgan T. pharmacology training for clinical psychologists.
Sammons, and Robert McGrath) ● Uncertainty regarding when and how training
should occur.
New Mexico and Louisiana—became the first to grant ● Lack of expertise among faculty in many
prescription privileges to appropriately trained graduate programs.
psychologists in 2002 and 2004. Illinois followed in ● Lengthy training requirements may deter
2014, as did Iowa in 2016 and Idaho in 2017. psychologists from pursuing prescription
privileges.
WHY CLINICAL PSYCHOLOGISTS Threats to Psychotherapy:
SHOULD PRESCRIBE ● Concerns about a shift towards pharmacological
Shortage of Psychiatrists: intervention over talk therapy.
● Especially evident in rural areas with low ● Potential for psychologists to prioritize
psychiatrist-to-patient ratios. prescribing over therapy for financial reasons.
● Clinical psychologists successfully lobbied for ● Risk of losing focus on behavioral, cognitive,
prescription privileges citing low and emotional processes in favor of symptom
psychiatrist-per-capita ratios. reduction.
Expertise of Clinical Psychologists: Identity Confusion:
● Extensive and specialized training in mental ● Discrepancies in prescribing practices among
health problems compared to primary care clinical psychologists may lead to confusion for
physicians. clients. (if everyone can prescribe then the
● Better equipped to diagnose problems correctly discrepancies within the profession will be lost in
and select effective medications. translation or in other term magiging blurry yung
Precedents from Other Professions: distinction between clinical psych and
● Dentists, podiatrists, optometrists, and advanced psychiatrist)
practice nurses already have prescription Influence of the Pharmaceutical Industry:
privileges. ● Potential for drug companies to exert influence
● General practitioner physicians with limited on prescribing psychologists.
training in psychological issues also prescribe ● Calls for formal guidelines to address
psychoactive medication. interactions between psychologists and
Convenience for Clients: pharmaceutical companies.
● Streamlines treatment by allowing clinical
psychologists to provide both therapy and EVIDENCE-BASED PRACTICE
medication. MANUALIZED THERAPY
● Reduces time, money, and potential
complications from miscommunication between Evidence-based practice and manualized therapy have
professionals. become prominent in the field of mental health in recent
Professional Autonomy: decades.
● Enables clinical psychologists to independently
provide a wider range of services to clients. ● Hans Eysenck's skepticism about therapy's
● Increases ability to treat both physical and efficacy in the 1950s sparked research into its
psychological aspects of clients' difficulties. benefits, which generally proved therapy to be
Professional Identification: effective.
● Set psychologists apart from other ● Early research focused on whether therapy in
non-prescribing therapists and counselors. general worked, while later studies examined
Evolution of the Profession: specific therapies for particular disorders.
● Seen as a logical progression for the field of ● Manualized therapy involves providing detailed
clinical psychology. instructions or a manual for delivering therapy,
● Opens doors to new professional opportunities ensuring consistency across therapists and
and advancements. clients.
Revenue for the Profession: ● Research on manualized therapies for specific
● Potential for increased income offsets salary disorders has proliferated since the 1980s,
decreases reported by psychologists.
C3: Current Controversies & Directions in Clinical Psychology
By: The Gayz

leading to the development of lists of empirically Debatable criteria for empirical evidence:
supported treatments. ● Current criteria for evidence-based therapies are
● Evidence-based practice integrates the best questioned for bias towards certain therapeutic
available research with clinical expertise and orientations.
patient characteristics, culture, and preferences. ● Behavioral and cognitive therapies dominate,
● Client preferences have been shown to potentially excluding other effective but less
influence treatment outcomes, with preference quantifiable approaches.
accommodation associated with better ● Efforts have been made to identify discredited
outcomes. treatments but the debate continues.
● Integration of various data types and outlooks is
ADVANTAGES OF EBP necessary for effective practice, bridging
Scientific Legitimacy: psychology's scientific and humanistic aspects.
● Manualized therapies provide a standardized,
empirical approach to treatment, aligning clinical “We believe that manuals are mischaracterized when
psychology with scientific standards. they are described as rigid… specifying the
● Ensures consistency in treatment across components of the therapy does not have to deprive a
practitioners to medical standards. therapy of its lifeblood. At best, it can help everyone
Establishing Minimal Levels of Competence: involved come to understand what that lifeblood
● Dissemination of evidence-based treatments actually is.”
ensures therapists are educated in effective
methods. OVEREXPANSION OF MENTAL DISORDER
● Helps prevent ineffective or harmful practices, ● The Diagnostic and Statistical Manual (DSM)
improving accountability and quality of care. has significantly expanded since its inception in
Training Improvements: the 1950s, leading to an increase in diagnosed
● Incorporating evidence-based therapies into mental disorders.
graduate programs enhances education ● Half of the U.S. population is diagnosable with a
standards. mental disorder at some point in their lifetime,
● Ensures upcoming psychologists are trained in with 11% currently taking antidepressants.
treatments with empirical support. ● Various terms describe this trend, including
Decreased Reliance on Clinical Judgment: overdiagnosis, diagnostic expansion, and
● Manualized therapies reduce bias and flawed medicalization of everyday problems.
decision-making inherent in subjective clinical ● The DSM authors rigorously review proposed
judgment. disorders, seeking to capture all mental illnesses
● Enhances therapy outcomes by replacing to prevent individuals from falling through the
subjective judgment with evidence-based cracks.
techniques. ● Critics argue that many newly included disorders
in DSM-5 and changes to existing criteria may
DISADVANTAGES OF EBP pathologize normal life experiences.
Threats to the psychotherapy relationship: ● Concerns about the expanding definition of
● Manuals tend to prioritize techniques over the mental illness predate DSM-5, with instances
quality of the therapeutic relationship. like excessive shyness being redefined as social
● Emphasis on predetermined methods can anxiety disorder since 1980.
neglect the importance of a meaningful human ● A 2014 survey of over 500 therapists from eight
connection between therapist and client. countries found that over 60% identified at least
Diagnostic complications: one disorder that should be removed from the
● Manuals target specific disorders, overlooking DSM due to unclear boundaries between
comorbidity often present in real-world clients. disorders and normal behavior.
● Therapy effectiveness tested on "clean" disorder
cases may not translate well to clients with (according to ms. sa discussion niya overexpansion and
multiple diagnoses. overdiagnosis go hand in hand so isipin niyo nalang
Restrictions on practice: dahil to sa trend sa mga tiktok na “if you have this then
● The movement suggests only empirically you have that”)
supported therapies are valid, limiting therapist
autonomy. NEW DISORDERS AND NEW DEFINITION
● Emphasis on brief, inexpensive treatments can OF OLD DISORDERS
be driven by insurance companies, further The Expansion of mental disorder scope occurs through
restricting practice options. introducing new disorders and altering criteria for
● Debate exists over the extent of adherence to existing ones.
manuals, with flexibility within fidelity gaining
traction. ● Examples include premenstrual dysphoric
disorder and binge eating disorder in DSM-5.
C3: Current Controversies & Directions in Clinical Psychology
By: The Gayz

● Changes like extending ADHD symptom onset ● Psychologists report managed care affects the
age or reducing binge frequency in bulimia quality of therapy and ethical considerations like
nervosa can broaden diagnosis criteria. confidentiality.
● Overdiagnosis risks entail unnecessary ● Negative aspects for psychologists include lower
treatments with harmful side effects or therapy pay, administrative burdens, and denial of
undermining self-coping skills. necessary care.
● Diagnosis can affect self-image, stigma Disadvantage and advantage of Self-Payment:
perception, insurance eligibility, and legal ● Many individuals can't afford therapy without
judgments. insurance or managed-care benefits.
● Real-world application matters, with many ● Self-pay therapy allows for more autonomy in
clinicians diagnosing without strict adherence to decision-making between therapist and client.
DSM criteria. Effect on Diagnosis:
● Surveys indicate reliance on experience and ● Payment method influences the diagnostic
intuition over symptom checklists for diagnosis. process.
● Overdiagnosis can stem from both diagnostic ● Insurance companies typically require a
manual authors' and practicing clinicians' diagnosis for coverage, potentially affecting
decisions. treatment access. (like yung comfort kasi nung
client, kasi need muna sila ma question bago
THE INFLUENCE OF THE mabigyan ng affordable access for the therapy)
PHARMACEUTICAL INDUSTRY Diagnostic Decision Influences:
● The overexpansion of mental health diagnoses ● Psychologists are more likely to assign a
has been linked to potential influence from the diagnosis, even for mild symptoms, when clients
pharmaceutical industry. pay via managed care.
● Big drug companies benefit from broad ● Diagnostic decisions can depend on whether the
definitions of mental disorders as they expand client or insurance company pays for therapy.
their potential customer base. (CAPITALISM
THINHZ) THE INFLUENCE OF TECHNOLOGY:
● Research indicates a significant proportion of TELEPSYCHOLOGY AND MORE
DSM panel members have financial ties to Influence of Technology in Clinical Psychology:
pharmaceutical companies. ● Technological advances have significantly
● Financial ties include research funding, impacted clinical psychology to other healthcare
consultant fees, and speaking fees, suggesting fields
a conflict of interest. ● The use of technology in delivering
● The DSM-5 authors had financial links to drug psychological services, termed telepsychology
companies, albeit with some limitations imposed or telehealth, is groundbreaking yet controversial
by the DSM-5 leadership. Applications of Technology:
● Concerns arise regarding the independence and ● Videoconferencing for client interviews or
objectivity of DSM authors influenced by treatment (similar to Skype or FaceTime).
financial relationships with pharmaceutical ● Psychotherapy delivery via email, text
companies. (chat-room or one-on-one), or interactive
● Despite some limitations, financial connections Internet sites.
between DSM authors and drug companies ● Online psychotherapy programs for diagnosis
remain prevalent, raising questions about the and treatment.
integrity of the diagnostic manual. ● Virtual-reality techniques for therapeutic
experiences like exposure therapy.
SELF-PERCEPTION ● Computer-based self-instructional programs as
Payment Methods in Psychotherapy: treatment components.
● Historically, clients paid out of pocket for therapy. ● Apps and biofeedback sensors on handheld
● Over time, health insurance companies started devices for client monitoring and interaction
covering therapy, making it more accessible. Exciting Opportunities:
● Today, many clients use health ● Emerging technologies promise to serve
insurance/managed care benefits to pay for underserved populations, including those in
therapy. poverty, rural areas, or war-torn regions
Consequences of Third-Party Payment: ● Benefits include accessibility, affordability,
● Managed care and insurance benefits increase anonymity, acceptability, and adaptability.
access to therapy but also influence the
therapist-client relationship.
● Managed care companies' priorities can affect
the practices of clinical psychologists.
Impact on Therapy Quality:
● Research suggests managed care negatively
influences psychologists' day-to-day practices.
C3: Current Controversies & Directions in Clinical Psychology
By: The Gayz

PRACTICE QUIZ
C4: Diversity and Cultural Issues in Clinical Psychology
By: The Gayz

THE RISE OF MULTICULTURALISM IN CLINICAL CULTURAL AWARENESS

PSYCHOLOGY Learning about one’s own values, assumptions, and
● Clinical psychologists recognize the increasing biases that one has developed as a result of all cultural
cultural diversity among their potential clients influences.
and are working to address cultural issues ● An appreciation of the clinical psychologist’s own
sensitively and competently in therapy. unique cultural viewpoint.
“We must incorporate cultural acknowledgment into our ● A clinical psychologist attains cultural
theories and into our therapies, so that clients not of the self-awareness by understanding that their
dominant culture will not have to feel lost, displaced, or viewpoint is (like everyone’s) unique and
mystified” - McGoldrick, Giordano, & Garcia-Preto idiosyncratic.
(2005) ● By exposing ourselves to our own undesirable
● Multiculturalism is regarded as a defining issue prejudicial or discriminatory belief systems, we
in contemporary psychology, often labeled as learn to minimize them and the negative impacts
the "fourth force" alongside psychoanalysis, it might have to our clients.
behaviorism, and humanism/person-centered
psychology. KNOWLEDGE OF DIVERSE CULTURES
● Multiculturalism enhances existing psychological ● Cultural knowledge should include not only the
models rather than aiming to replace them, current lifestyle of the members of the cultural
infusing sensitivity and awareness of cultural group but also the group’s history, especially
diversity into therapeutic approaches. major social and political issues.
● Cultural diversity is a force that shapes the way ● Culturally competent clinical psychologists strive
the client understands the very problem for to learn their clients’ acculturation strategies in
which they are seeking help. an effort to understand more completely their
● Therapists are encouraged to directly assess unique ways of life.
clients' understanding of their psychological
problems through questions that explore their Acculturation - process by which individuals or groups
cultural perspectives and beliefs. adopt the cultural norms, values, and behaviors of
another culture when people find themselves in a new
Recent professional efforts in clinical psychology to cultural environment.
emphasize issues of diversity and culture include:
● Publication of Journal and Books Four separate acculturation strategies (Berry, 2003;
● The emergence of new divisions within the APA Rivera, 2008):
focusing on diversity issues. ● Assimilation - the individual adopts much of the
● The inclusion of standards and principles in APA new culture and abandons much of the original.
ethical code, requiring psychologists to work ● Separation - the individual rejects much of the
with cultural sensitivity and competence. new culture and retains much of the original.
● APA accreditation standards requiring grad ● Marginalization - the individual rejects both the
programs in psych to address cultural diversity new and the original culture.
by including diverse students & faculty and ● Integration - the individual adopts much of the
educating students on culture's role in new culture and retains much of the original.
psychology practice and science.
● The incorporation of cultural awareness in CULTURAL APPROPRIATE CLINICAL SKILLS
DSM-5 via diagnostic classification and ● Psychologists need to align assessment and
assessment, offering guidance for clinicians treatment strategies with the cultural values and
through tools like "Outline for Cultural experiences of clients.
Formulation" and a glossary of cultural concepts ● Treatment approaches should consider client
of distress (ex. taijin kyofusho, susto, maladi preferences and cultural backgrounds to ensure
moun) effectiveness.
● Revision of several prominent assessment tools ● Awareness of microaggressions is crucial as
with the specific intent of making them more they can convey prejudicial beliefs and
appropriate and serviceable to diverse clients by negatively impact therapeutic relationships.
creating instruments that minimize cultural bias ● Efforts toward culturally appropriate skills include
and increase cultural inclusion. (ex. MMPI-2) adapting treatments to diverse cultural
backgrounds with empirical evidence supporting
CULTURAL COMPETENCE their efficacy.
Multicultural counseling competence - the ● Language choice during therapy sessions is
counselor’s acquisition of awareness, knowledge, and essential, as it can affect symptom reporting and
skills needed to function effectively in a pluralistic severity, particularly for bilingual clients.
democratic society and on an organizational/societal
level, advocating effectively to develop new theories, Microaggressions - subtle comments or actions that
practices, policies, and organizational structures that are convey prejudice or stereotypes, often unknowingly, and
more responsive to all groups. can cause distress and hinder progress in therapy.
C4: Diversity and Cultural Issues in Clinical Psychology
By: The Gayz

● They may revolve around ethnicity, race, age, ● Universal Level - “all individuals are, in some
gender, socioeconomic status, religion, or sexual respects, like all other individuals” Identifies
orientation. commonalities shared by all individuals.
● Psychologists must reflect on underlying beliefs ● The model encourages psychologists to
to avoid committing microaggressions and foster appreciate clients on all three levels.
a more inclusive therapeutic environment. ● It enables recognition of unique characteristics,
cultural commonalities, and universal traits.
Cultural Adaptation of Treatments
● Adapting therapies considers how clients from
different cultures respond to standard treatments
and aims to provide customized approaches.
● Failure to culturally adapt treatments can lead to
unexpected outcomes, as seen with expressive
writing worsening symptoms for some Chinese
American women.

ARE WE ALL ALIKE? OR ALL DIFFERENT?

ETIC VERSUS EMIC PERSPECTIVE

Etic Perspective
● Emphasizes similarities among all people.
● Assumes universality and downplays cultural
differences.
● Dominant in early psychology, characterized by
male, European, middle to upper-class
WHAT CONSTITUTES A CULTURE
practitioners.
● Viewpoint considered to be normative in defining Narrow Versus Broad Definition of Culture
psychological health, identifying disorders, and Narrow Definition - Focuses primarily on ethnicity and
therapy development. race as defining characteristics of culture.
● Some argue that inclusion of other variables
Emic Perspective would detract from the significance of race and
● Recognizes and emphasizes culture-specific ethnicity.
norms.
● Considers client behaviors, thoughts, and Broad Definition - Encompasses a wide range of
feelings within their cultural context. variables beyond race and ethnicity.
● Gained prominence with multiculturalism, ● Includes socioeconomic status, gender,
allowing for understanding of clients within their geography/region, age, sexual orientation,
own cultural framework. religion/spirituality, disability/ability status,
● Stresses the importance of understanding immigrant/refugee status, and political affiliation,
individuals from different cultural groups on their among others.
own terms.
Recognition of the importance of tailoring treatment to fit
Terms "etic" and "emic" derived from linguistics, akin to the cultural context of clients, including consideration of
"phonetic" - sounds that are common to all languages subcultures (prison culture, military culture) and specific
and "phonemic." - sounds that are specific to a particular life experiences should be given importance.
language.
Interacting Cultural Variables
In psychology, "etic" emphasizes universality while ● Culture may be multifactorial, with numerous
"emic" highlights culture specificity. variables interacting to shape an individual's life
experience.
TRIPARTITE MODEL OF PERSONAL IDENTITY ● While ethnicity and race are significant, other
● Developed by D. W. Sue and Sue (2008) as a
variables also play important roles.
three-level model of personal identity.
● Culturally competent therapists consider how
● Individual Level - “all individuals are, in some
various variables (sexuality, SES) interact with
respects, like no other individuals.” each person
ethnicity to create unique cultural circumstances
is unique.
for each client. INTERSECTIONALITY BABY!!
● Group Level - “all individuals are, in some
respects, like some other individuals.”
Acknowledges similarities among individuals
within cultural groups.
C4: Diversity and Cultural Issues in Clinical Psychology
By: The Gayz

TRAINING PSYCHOLOGISTS IN ISSUES OF ● Cultural issues surrounding parent-child

DIVERSITY AND CULTURE relationships can underlie various presenting
● The growing focus on multiculturalism in clinical problems, requiring culturally sensitive
psychology necessitates training psychologists approaches in treatment, such as exploring
to be culturally sensitive and competent. parents' feelings about separation in an Italian
family versus addressing arguments differently
Educational Alternatives based on cultural background.
● Graduate programs utilize various methods for
training clinical psychologists in multicultural
issues, including dedicated courses, integration
of cultural training across all educational
experiences, and real-world experiences with
diverse cultures.
● Some programs advocate for direct interaction
with diverse cultural groups through professional
or personal experiences to enhance cultural
understanding.
● Essential components for graduate training
programs in multicultural competence include a
commitment to diversity, diverse student and
faculty recruitment, fair admissions processes,
cultural awareness, a culture-centered
curriculum, and regular evaluation of cultural
competence.
● Self-examination of cultural identity is
emphasized in training, facilitated through
various methods such as discussions,
presentations, assignments, and family
discussions, with a focus on cultivating an
attitude of respect, curiosity, and humility
towards diverse cultures, known as cultural
humility.

Measuring the Outcome of Culture-Based Training

Efforts
● Measuring the outcome of culture-based training
efforts in psychology raises methodological
questions about reliability and validity issues,
establishing baseline cultural competence
levels, and determining whose opinions to seek
when assessing cultural competence in
psychotherapy.
● Psychologists may not consistently implement
cultural competence ideals despite
understanding them, indicating a gap between
knowledge and practice.
● Studies demonstrate the effectiveness of
culturally adapted evidence-based practices,
highlighting the importance of cultural adaptation
for positive outcomes in therapy.

AN EXAMPLE OF CULTURE INFLUENCING THE

CLINICAL CONTEXT: THE PARENT–CHILD
RELATIONSHIP
● Cultural differences influence expectations
regarding parent-child relationships, with varying
norms across cultures (British - Independence,
Italian - Closeness, Chinese - Obedience,
Jewish - Openness)
● Psychologists need multicultural competence to
consider these diverse norms when treating
individuals or families, especially in culturally
diverse societies like the United States.
C4: Diversity and Cultural Issues in Clinical Psychology
By: The Gayz

PRACTICE QUIZ
C5: Ethical and Professional Issues in Clinical Psychology
By: The Gayz

AMERICAN PSYCHOLOGICAL ASSOCIATION’S ETHICAL DECISION MAKING

CODE OF ETHICS Commitment to Ethical Practice
American Psychological Association (APA) published its ● Make a personal commitment to always
first code of ethics in 1953. prioritize ethically appropriate actions
● Nine revised editions of the ethical code have Familiarization with Ethical Code
been published, including the 2002 edition. ● Thoroughly understand the American
● Two amendments added in 2010, prohibiting the Psychological Association’s (APA) ethical code.
use of ethical standards to justify human rights Consultation of Relevant Guidelines
violations. ● Refer to applicable laws and professional
● Relevant to psychologists of all specialties, guidelines related to the specific situation.
including clinical psychologists. Consideration of Perspectives
● Guidelines applicable to therapy, assessment, ● Understand the viewpoints of all involved
research, and teaching. parties.
● Discuss the situation with trusted colleagues
ASPIRATIONAL AND ENFORCEABLE while maintaining confidentiality.
APA Ethical Code (2002): Generation and Evaluation of Alternatives
General Principles: ● Brainstorm potential courses of action.
● Aspirational guidelines for ethical conduct. ● Assess the ethical implications and
● Five principles emphasizing ideal ethical consequences of each option.
behavior. Selection and Implementation
Ethical Standards: ● Choose the action that aligns most with ethical
● Enforceable rules of conduct. principles.
● Divided into 10 categories covering various ● Execute the chosen course of action with care
professional activities. and consideration.
● 89 individual standards addressing specific Monitoring and Evaluation
aspects of practice. ● Continuously assess the effectiveness of the
Clinical Psychologists Focus: chosen action.
● Emphasis on relevant standards within the ● Be vigilant for any unforeseen ethical challenges
Ethical Standards section. or consequences.
● Importance of understanding ethics as both Modification and Continual Evaluation
remedial and positive approaches. ● Adapt the ethical plan as needed based on
● Example: Ethical obligation of competence ongoing evaluation.
highlights differences in approaches. ● Stay open to feedback and new ethical
● Remedial: Bare minimum for competence. considerations.
● Positive: Striving for the highest level of General Preparation for Ethical Decision Making:
competence through additional efforts. ● Develop a strong foundation of personal ethics
and values.
● Align personal values with the ethical standards
of the psychology profession.
● Remember that ethical decision-making goes
beyond following a model; it requires ongoing
self-reflection and ethical alignment.

PSYCHOLOGIST’S ETHICAL BELIEF

Conducted by Pope, Tabachnick, & Keith-Spiegel
(1987).
● Surveyed over 450 members of Division 29
(Psychotherapy) of the American Psychological
Association.
● Rated the ethicality of 83 behaviors towards,
with, or in response to clients.
Key Findings:
Some behaviors viewed as blatantly unethical:
● Sex with clients or former clients.
● Socializing with current clients.
● Disclosing confidential information without cause
or permission.
Some behaviors viewed as unquestionably ethical:
● Shaking hands with clients.
● Addressing clients by first name.
● Breaking confidentiality if clients are suicidal or
homicidal.
C5: Ethical and Professional Issues in Clinical Psychology
By: The Gayz

● Most behaviors fell into a gray area between HIV/AIDS Cases:

ethical and unethical. ● Similar dilemma of warning potential victims.
● Highlights challenges in ethical judgment. ● Example: Dr. Reed faces a dilemma with
● Emphasizes the importance of a sound model of HIV-positive client Paul withholding status from a
ethical decision-making (Cottone, 2012). sexual partner.
Variability in Ethical Beliefs: State Variations:
Ethical beliefs may vary: ● Different states have different interpretations of
● Based on time or region of the country (Tubbs & confidentiality rules.
Pomerantz, 2001). ● Some require breaking confidentiality, others
● According to the gender or age of clients allow it but don't require it.
(Pomerantz, 2012a; Pomerantz & Pettibone, ● Definitions of warnings and triggers vary.
2005).
Influence of APA Ethical Code: WHEN THE CLIENT IS A CHILD
● While APA's ethical code guides behavior, actual OR ADOLESCENT
beliefs may be influenced by other factors. Confidentiality Challenges with Minors:
● Beliefs strongly correlate with behaviors (Pope ● Trusting relationship establishment often hinges
et al., 1987). on the psychologist's disclosure to parents.
NOTE: ● Children may withhold personal issues if
● Ethical decision-making is complex and confidentiality is breached.
influenced by various factors. ● It's effective to keep parents engaged in therapy.
● Awareness of these factors is crucial for ● Open dialogue with the child and parents can
psychologists to navigate ethical dilemmas lead to mutually agreeable confidentiality
effectively. arrangements.
CONFIDENTIALITY ● Cultural variables may influence parent-child
“Psychologists have a primary obligation and take relationships' acceptability of confidentiality
reasonable precautions to protect confidential agreements.
information” ● Example script for therapist-parent-adolescent
discussion provided by Koocher and Daniel
● Confidentiality is a cornerstone of ethical clinical (2012).
psychology (Fisher, 2012). Parental Trust and Psychologist Judgment:
● Emphasized in Principle E: Respect for People’s ● Parents trusting the psychologist's judgment is
Rights and Dignity (APA, 2002). crucial in maintaining confidentiality.
● Standard 4.01: Psychologists prioritize and ● Various behaviors (e.g., substance use,
safeguard confidential information (APA, 2002). self-harm) raise questions about informing
● Public trust requires professional services parents.
without divulging personal details. ● The age of the child may influence
● Confidentiality isn't absolute; exceptions exist, decision-making regarding confidentiality
defined by court cases like Tarasoff. breaches.
● Clinical example: Danica, 17, reveals sensitive
Tarasoff and the Duty to Warn information to Dr. Terry; parents trust Dr. Terry
but expect to be informed of potential harm.
Tarasoff Case (1969): ● Thresholds for informing parents on behaviors
● Prosenjit Poddar, a student at UC Berkeley, should be carefully assessed.
sought therapy with Dr. Lawrence Moore after Child Abuse Reporting:
expressing intent to harm Tatiana Tarasoff. ● Legal obligation for mental health professionals
● Dr. Moore broke confidentiality, but Poddar still to report known or suspected child abuse.
killed Tarasoff. ● Similar to Tarasoff ruling, immediate prevention
● The court established the duty to warn or protect of harm takes precedence.
potential victims from clients' credible threats. ● Challenges in determining the likelihood of child
Duty to Warn vs. Duty to Protect: abuse due to various factors (e.g., child's
● The Court revised the duty from warning to communication skills, truthfulness).
protection, emphasizing broader actions than ● Legal and ethical standards align with the duty
just warning. to report suspected child abuse.
● Psychologists must ensure potential victims are ● APA's ethical code emphasizes discussing limits
aware of the danger. of confidentiality with clients.
Challenges and Questions: Legal vs. Ethical Standards:
● Assessing the credibility of threats and clients' ● Legal and ethical standards often converge,
intent. particularly in duty-to-warn and child abuse
● What threats merit warnings? (e.g., reporting.
life-threatening, drunk driving, intimate partner ● State laws and APA's ethical code typically
violence) require similar behavior from clinical
● Balancing client treatment with victim protection. psychologists.
C5: Ethical and Professional Issues in Clinical Psychology
By: The Gayz

● The informed consent process includes a prohibited by ethical standards due to potential
discussion of confidentiality limits. harm and breach of the therapist-client
IFC relationship.
Informed Consent Overview: ● Psychologists may experience feelings of
● Informed consent is essential in psychological attraction towards clients, but it must be
research, assessment, and therapy, ensuring addressed through consultation or therapy,
individuals understand and agree to participate. refraining from acting on it.
Research Informed Consent: ● Nonsexual Multiple Relationships is
● Standard 8.02 (“Informed Consent to Research”) involvement between a psychologist and a
of APA's ethical code guides psychologists to client, such as friendships or financial
inform participants about study purpose, relationships, which may also pose risks to
procedures, risks, incentives, and the right to clients.
decline or withdraw. ● Psychologists should recognize the potential
● Treatment studies require disclosure of problems arising from overlapping relationships.
experimental nature, potential for control group
assignment, and alternative treatments. What Makes Multiple Relationships Unethical?
Assessment Informed Consent: ● Avoid multiple relationships if they impair
● Standard 9.03 (“Informed Consent in objectivity, competence, or effectiveness, or risk
Assessments”) outlines informing clients about exploitation or harm to the client.
the assessment nature, purpose, fees, ● Therapist-client relationship involves unequal
involvement of other parties, and limits of power, requiring vigilance to prevent exploitation
confidentiality. or harm to the client.
Therapy Informed Consent: ● Multiple relationships can be ethically complex,
● Ethical Standard 10.01 ( “the involvement of demanding caution and foresight.
third parties”) necessitates informing clients ● Seemingly harmless boundary crossings can
early about the therapy nature, fees, third-party lead to major violations over time, causing
involvement, and confidentiality limits. serious harm to clients.
● Therapy consent is an ongoing process, ● Minor boundary infractions, like offering a ride or
involving collaboration between psychologist lending items, can set a precedent for
and client. inappropriate relationships and eventual harm to
● Establishing a collaborative relationship with the the client.
client is crucial for successful psychotherapy. ● Psychologists should carefully consider actions
Collaborative Consent Process: like gift-giving, self-disclosure, or social
● Clinical psychologists should invite clients to interactions that may blur boundaries in the
actively participate in the informed consent therapeutic relationship.
process, fostering collaboration in
decision-making regarding treatment plans. COMPETENCE
● Clinical psychologists must possess sufficient
BOUNDARIES AND MULTIPLE RELATIONSHIPS capabilities, skills, experience, and expertise to
fulfill professional tasks effectively.
Defining Multiple Relationships:
Multiple Relationship - A psychologist engages in a Boundaries of Competence (Ethical Standard 2.01a)
multiple relationship when: ● Psychologists should operate within the
1. They hold a professional role with a person boundaries of their competence based on
while simultaneously being in another role with education, training, and experience.
the same person. ● Having a doctoral degree or license doesn't
2. They are in a relationship with someone closely guarantee competence for all tasks;
associated with or related to the person with psychologists must be specifically competent for
whom they have a professional relationship. each task.
3. They promise to enter into another relationship Continuing Competence (Ethical Standard 2.03)
in the future with the person or someone closely ● Psychologists must continually develop and
associated with them. maintain their competence through ongoing
efforts such as workshops and readings.
● Determining what constitutes "closely associated Cultural Competence (Ethical Standard 2.01b)
or related" can be challenging due to the ● Psychologists must be culturally competent,
interconnected nature of communities. understanding factors such as age, gender,
● Multiple relationships may include friendships, race, ethnicity, and religion, essential for
business partnerships, or romantic involvements effective practice.
with clients or individuals closely related to them. ● They acquire this competence through training,
● Most blatant and damaging are Sexual Multiple experience, and consultation, ensuring services
Relationships. Engaging in sexual intimacies are suitable for diverse clients.
with current therapy clients/patients is strictly
C5: Ethical and Professional Issues in Clinical Psychology
By: The Gayz

Addressing Personal Issues (Ethical Standard 2.06) ● Alternate Treatment: Participants receive
● Psychologists must address personal problems another treatment, the efficacy of which may be
affecting their professional duties, seeking unknown.
assistance if necessary. Ethical Considerations
Burnout Awareness and Prevention ● Ethical concerns arise regarding the treatment of
● Burnout - characterized by exhaustion from participants who do not receive the therapy
emotionally demanding work, can impair being studied.
psychologists' effectiveness. ● Participants must be informed about the
● Measures to prevent burnout include possibility of not receiving treatment before
maintaining work-life balance, seeking therapy, consenting to the study.
and engaging in self-care activities. ● Ethical challenge: Determining therapy efficacy
● Psychologists should remain vigilant for signs of without exploiting or neglecting participants.
impairment and support each other in promoting
self-care. CONTEMPORARY ETHICAL ISSUES

ETHICS IN CLINICAL ASSESSMENT Managed Care and Ethics

● Managed care may create a conflict of interest
Test Selection
for clinical psychologists between client welfare
● Psychologists must select tests appropriate for
and cost limitations.
the assessment's purpose and the client's
● Loyalty to managed care companies can impact
characteristics.
the therapeutic relationship.
● Factors include psychologist's competence,
client's culture, language, age, and test reliability ● Informed consent should include details about
and validity. managed care, including diagnostic
● Tests should not be obsolete, and psychologists requirements and information sharing.
may construct new tests with adequate reliability Technology and Ethics
and validity. ● Online psychological tests may lack validity and
Test Security reliability, raising ethical concerns.
● Psychologists must safeguard test materials to ● Online therapy raises issues of communication,
maintain security and integrity. confidentiality, and client identity.
● Preventing access to test questions prevents Ethics in Small Communities
invalid results, ensuring accurate assessment ● Clinical psychologists in small communities face
outcomes. challenges with multiple relationships due to
● Unauthorized access could lead to incorrect limited professional and personal boundaries.
placement of students, officers, or children, ● Informed consent should address the
impacting their lives negatively. inevitability and potential complications of
Test Data multiple relationships.
● Generally, psychologists are obligated to release ● Psychologists should maintain a healthy
test data to clients upon request. personal life to prevent leaning on clients and
● Test data includes client responses and notes avoid unethical behavior.
made during assessment.
● Release is contingent upon ensuring that data
won't be misused or harm the client, aligning
with the trend of patient autonomy in healthcare.

ETHICS IN CLINICAL RESEARCH

Research Obligations
● Clinical psychologists conducting research must
adhere to ethical standards to minimize harm,
avoid plagiarism, and prevent data fabrication.
Therapy Efficacy Studies
- Participants in therapy efficacy studies typically fall into
three groups:
● No Treatment (Wait-list Control Group):
Participants wait without receiving treatment.
● Placebo Treatment: Participants receive an
interaction with professionals without therapeutic
techniques.
C5: Ethical and Professional Issues in Clinical Psychology
By: The Gayz

PRACTICE QUIZ