Introduction to

Clinical Psychology
Neiley P. Satumira, MA.

What is a Clinical Psychologist?

Research
Teaching
Services
Across the Lifespan
Varying cultures
Various SES levels

Activities Engaged in by a Clinical

Psychologist
Therapy/Intervention
Diagnosis/Assessment
Clinical Supervision
Teaching
Research
Consultation
Administration

Related Health Professions

Psychiatry
Counseling Psychology
Psychiatric Social Workers
School Psychologists
Rehabilitation Psychologists
Health Psychologists
Psychiatric Nurses

Issues in both Counseling &

Clinical Ph. D. programs
APA accreditation
Licensure
Psychologist protected term
Psychological testing
Issues with Psychologists providing
medication

What is involved with a degree in

Clinical Psychology?
Statistics
Psychotherapy
Social psychology
Research
Psychometrics (test construction)
Assessment (adult or child)

What is involved with a degree in

Clinical Psychology?
Clinical Practicum
Ethical & Professional Issues
Psychopathology
Neuroscience
Family & Group Process
Cognitive Psychology

What is involved with a degree in

Clinical Psychology?
Experimental Psychopathology
Developmental
History & systems of psychology
Violence in the family
Internship
Research
The qualifying examination

Other Issues
APA approved internship programs
Psy. D. vs. Ph. D.
Ph. D. Model or Boulder model of training.

Models of training

1949 landmark conference in Boulder, Colorado

= Boulder model or the scientist-practitioner
model.
Evidence based medicine.
More applied model.
Metzoff (1984): If we train purely applied
psychologists, they will be obliged to accept on
faith what is handed down to them without being
able to evaluate it.
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The Psy. D. degree

U. of Illinois (1968).
Fear: that Psy. Ds wont find employment.

11

Professional Schools

No affiliations with universities.

Autonomous with their own financial &
organizational framework.
1987 45 professional schools.
doctorates in clinical psychology awarded by
professional schools.
Major handicap. Many are not APA accredited.

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Professional Regulation
Who is well trained & who is not?
This is an attempt to protect public
interest.
Certification guarantees that people
cannot call themselves psychologists
unless certified by a state board of
examiners.

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Licensing

Specifies nature of the title (psychologist) & training

required for licensure.
Usually defines what specific professional activities may
be offered to the public for a fee.
Usual requirements:

Education: doctoral degree from an APA-accredited Counseling

or Clinical program
Experience: 1-2 years of supervised postdoctoral clinical
experienced required.
Examinations: must pass the Examination for Professional
Practice in Psychology & whatever state examinations.

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Licensing

Requirements continued:
Administrative

Requirements

Specialties

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American Board of Professional

Psychology

ABPP
1947 established.
Certification of professional competence in the fields of
behavioral psychology, clinical psychology, clinical health
psychology, clinical neuropsychology, counseling
psychology, family psychology, forensic psychology,
group psychology, psychoanalysis, rehabilitation
psychology & school psychology.
Oral exam, observations, clinical records, 5 years post
doctoral experience.

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National Register
Self-certification.
Licensed / certified in state.

Private Practice
Managed health care.

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APA recommended changes

Health care delivery systems
Sensitivity to ethical issues
Multidisciplinary environments
Managed-care-relevant clinical skills
Expertise in applied research
Management & business skills
technology

18

Prescription Privileges
APA endorsed
Background
Benefits or Pros
Cons

19

Multicultural Issues
Pluralistic Society
APA (2003) guidelines.
Sue (1998) We must demonstrate cultural
competence: a knowledge and
appreciation of other cultural groups and
the skills to be effective with members of
these groups.

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Sue (1998)
Scientific mindedness
Dynamic sizing
Culture-specific expertise

Issues of gender

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Ethical Standards

APA (1951).
Most recent version 2002.
5 general principles:
Beneficence

& non-maleficience
Fidelity & responsibility
Integrity
Justice
Respect for peoples rights & dignity
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Competence

Represent their training accurately.

Actively present themselves correctly.
Sensitive to treatment or assessment issues that
could be influenced by a patients gender, ethnic
or racial background, age, sexual orientation,
religion, disability, or SES.
Safeguard patients against personal issues that
could affect performance.
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Privacy & Confidentiality

The role of confidentiality in the clientpsychologist relationship.
Not all information is deemed privileged.
1976 Tarasoff case.
Jaffe v. Redmond (1996).

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Human Relations
Dual relationships.
Sexual harassment & sexual intimacies
Client welfare.

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Other issues involving

psychologists.
Radio Call-in shows, TV talk shows,
Internet groupsethical?
Principle 2.64-1
2002 APA ruling.

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Clinical Psychology
Science, Practice and
Ethics
History and Recent Developments

Copyright Allyn & Bacon 2005

Ancient Roots

Hippocrates (c. 446-377)

Melancholy
Phrenitis
Mania
hysteria

Greek Philosophers

Socrates (470-399)
Plato (428-347)
Aristotle (384-323)

Ancient Roots

Yellow Emperors Book

of Internal Medicine

Medieval Europe

yin and yang

Mental tests
Malleus Malifacarum

Renaissance

De Praestigiis
Daemonum

18th and 19th Centuries:

Laying the Groundwork
Understanding Mental Disorders
Measurement of Individual Differences
Emergence of Scientific Psychiatry
Hysteria and Psychological Determinism

Understanding Mental Disorders

Psychiatry gains credibility as a branch of

medicine
Benjamin

Rush (1745-1820)
Philipe Pinel (1745-1826)
Vicenzo Chiarugi (1759-1820)
Francis Willis (1718-1807)

Understanding Mental Disorders

Moral Treatment Movement

Philipe

Pinel
William Tuke (1732-1822)

Moral Treatment comes to U.S.

Dorothea

Dix (1802-1887)

Measurement of Individual
Differences

Sir Francis Galton (1822-1911)

Hereditary

Genius (1869)
measured individual differences

James McKeen Cattell (1860-1944)

- first to use mental test
- developed standards for psychological testing

Emergence of Scientific
Psychiatry
J. Langdon Down Downs Syndrome
Ewald Hecker - hebephrenia
General paresis syphylis

Emil Kraepelin (1855-1926)

- textbook on psychiatry 1883
- dementia praecox

Emergence of Scientific
Psychiatry

Improved classification

Differentiation of mental retardation from

mental illness

Acceptance of non-biological causes of

mental disorders

Hysteria and Psychological

Determinism

Jean Martin Charcot (1825-1893)

Piere Janet (1859-1947)

Sigmund Freud (1856-1939)

Freuds impact on clinical

psychology

Psychoanalytic treatment

Unconscious determinants of behavior

impact on psychological testing

Psychological (non-biological) factors

Birth of the Discipline (1890-1910)

Rapid Growth of Psychology

Wilhelm Wundt (1832-1920) 1875
William James (1842-1910) 1875
G. Stanley Hall (1844-1924)- 1883
James McKeen Cattell - 1888
By 1900 40 psychology laboratories at US
universities

Ligthner Witmer (1867-1956)

Established first psychological clinic in 1896
First to propose a helping profession within
psychology
Established the first clinical psychology
journal The Psychological Clinic
Established first training program in clinical
psychology

Alfred Binet (1857-1911)

Norm-referenced test of intelligence
Valid items for test of intelligence
Developed the Binet-Simon Scale
forerunner of modern intelligence test
Mental age
Scientist-practitioner

Childhood: WWI through WWII

Army Alpha and Army Beta
Stanford-Binet 1916 (revised 1937)
Wechsler-Bellvue 1939
Rorschach 1921
Thematic Apperception Test 1938
MMPI - 1943

Childhood: WWI through WWII

APA Growing Pains

1917 AACP forms

1919 AACP incorporated into APA as Section f Clinical
Psychology
1921 Ph.D. + published research
1926 creates associate member status
1937 AAAP formed
1939 618 member, 1909 associates
1942 goals and membership qualifications change
1944 AAAP votes itself out of existence, joins APA

Adolescence: Post WWII

Need for clinical psychologists
Training moneys become available
Shakow Report - 1947
Boulder Conference - 1949

Scientist- Practitioner Model

Training in University Departments of
Psychology
Trained as Scientist and Practitioners
Internship 1 year of full-time practice
Trained in diagnosis, research and therapy
Original research required

Post-Boulder Training Growth

NIMH, USPHS money available for doctoral
training
VA money for internship training
1947 22 doctoral training programs in US
1949 42 doctoral training programs in US
1960 60 APA-accredited gradate training
programs (55 NIMH funded)

Adulthood
Training
Psychotherapy
Psychological Testing
Professional Practice
Specialization
Growth

Training
Miami Beach conference 1958 Psy.D.
proposed
University of Illinois 1968 first Psy.D.
program
California Professional School of Psychology
1969
Vail conference 1974 endorsement of
Psy.D. as legit

Training: Backlash

Salt Lake City, Utah 1987

- greater diversity in training
- all graduate programs must be
affiliated with regionally accredited
university (not accepted by APA)

Training: Backlash

Clinical Scientist Training proposed by

Richard McFall, 1991.

Psychotherapy

Client-Centered Therapy - Carl Rogers

Behavior Therapy Joseph Wolpe, Hans

Eysenck, B.F. Skinner

Cognitive-Behavior Therapy Albert Ellis,

Aaron Beck

Psychotherapy
Last 50 years increasingly identified with
clinical psychology
Surveys the most commonly engaged in
activity by clinical psychologists

Psychological Testing

1960 1980 backlash against testing

behavior therapy
humanists
poor psychometrics
culturally insensitive

Psychological Testing:
Consequences of Backlash
Improved standardization
Inclusive test items
Proliferation of specific tests
Revision of popular tests
Improved guidelines for test users

Professional Practice
Licensing vs. certification
All states create licensing/certification laws
1945-1980
Psychologists get third-party
reimbursement
Private practice grows
Managed care

Specialization
Division 12 Society of Clinical Psychology: Sections

II Clinical Geropsychology
III Society of a Science of Clinical Psychology
IV Clinical Psychology of Women
V. Clinical Psychology of Ethnic minorities
VI. Emergencies and Crises
VII. Association of Medical Psychology

Section 1 Clinical Child Psychology became Division

53
Section 5 Society of Pediatric Psychology became
Division 54

Growth
Training
1969 70 APA accredited programs
1979 100
1989 157
1999 over 200

Membership
- 1999 over 50% APA members identify themselves as
clinical
1990s 9 of 10 APA presidents clinical psychologists

Introduction to

Clinical Psychology:
Science, Practice and Ethics

Health Psychology: Definition

Health psychology is the aggregate of the

specific educational, scientific, and
professional contributions of the discipline of
psychology to the promotion and
maintenance of health, the prevention and
treatment of illness, the identification of
etiologic and diagnostic correlates of health,
illness, and related dysfunction, and to the
analysis and improvement of health care
system and health policy formation
(Matarazzo, 1982).

Clinical Health Psychology

Subdiscipline of health psychology and clinical
psychology
Approaches general health and illness with
methods, models and assumptions of clinical
psychology
Aim to translate research into practical
applications that can help people lead
healthier lives

Biopsychosocial model

Health and illness a product of biological,

psychological and social factors

Health Psychology: Content

Areas
1.
2.
3.
4.
5.

Health risk behaviour

Health protective and enhancing
behaviours
Health-related cognitions
Processes influencing health-care
delivery
Psychological aspects of illness

Health Risk Behaviour

Smoking

Media more impact than education (Flynn, 1992)

Gender differences: Males
nicotine
Females
situational
Cravings: 8 15 minutes

Alcohol Abuse

Tension-reduction theory
Social Learning Theory
Cognitive: Alcohol Myopia
Personality: harm avoidance
Genetic

control

Health Risk Behaviour

Obesity

Internal-External Hypothesis (Schacter,1968)

Mood regulation: more for females
Restraint Theory: dieters Oh Well
Lifestyle & Culture

STD/HIV

Health Belief Model

Who will undertake preventative action:

Susceptibility
Severity
Behaviour
Benefits
Costs

Rosenstock, 1960

Reasoned Action/ Planned

Behaviour
Attitudes

Subjective Norms

Intentions

Behaviour

Perceived
Behavioural
Control
Ajzen, 1985

Social Cognitive Theory (Bandura)

Direct Modeling
Symbolic Modeling
Self- efficacy
Outcome Expectancies

Social cognitive theory (cont.)

What does it predict?

smoking

cessation
eating nutritious food
lowering cholesterol
brushing and flossing teeth
using condoms
exercising regularly

Prevention and Health

Promotion

Stress and illness

Managing

stress

Behaviour and Health

Promoting

healthy behaviour
Decreasing negative health behaviours

Stress and Illness

Measurement:
self-report
physiological

Life Events vs Daily Hassles/Uplifts

Stress and Illness

Fight or Flight Response (Cannon)
General Adaptation Syndrome (Selye)
Cognitive Appraisal (Lazarus & Folkman)

General Adaptation Syndrome

(Selye)

Stressor
Stressor
Alarm:
Alarm:

Initial
Initialmobilization
mobilizationto
to
fend
fendoff
offthreat
threat

Resistance:
Resistance:
Continued
Continuedfight
fightagainst
against
stressor
stressor

Exhaustion:
Exhaustion:
Depletion
Depletionof
ofbodily
bodily
resources
resources

Illness
Illness&&Disease
Disease

General Adaptation Syndrome

Stress

(Selye)

Hypothalamus
Sympathetic

Endocrine

Nervous System

System

Adrenal gland
gland releases
releases
catecholamines
(epinephrine,
norepinephrine)

Increases in Heart rate,

blood pressure, &
breathing

Pituitary gland releases

adrenalcorticotropic
hormone (ACTH)

Adrenal gland releases

corticosteroids
(cortisol)

Increases in production of
energy, inhibition of
swelling

Cognitive Appraisal (Lazarus &

Folkman)
Event
Event

Primary
PrimaryAppraisal:
Appraisal:
Am
AmIIin
indanger?
danger?

Secondary
SecondaryAppraisal:
Appraisal:
What
Whatcan
canIIdo
doabout
aboutit?
it?

Stress
Stress

Negative Impact of Prolonged Stress

Response
Negative impact on body organs, mental
functioning & Immune system
Affect immune system so cannot destroy
viruses, bacteria, tumors, & irregular cells
Still not clear total impact of stress on
immunosuppression in any case it is
important influence on health and illness

Illness

Diabetes mellitus
Psychological

Increase in depression & anxiety disorders

Stress impacts blood glucose levels

Psychological

Factors:

Intervention

Blood Glucose Awareness Training (Cox, 1992)

Stress management: progressive muscle relaxation/
biofeedback

Illness

Headache: Migraine & Tension

Psychological

Hassles vs Life-events
Headache sufferers tend to evaluate stressful events
more vly
Perceive less social support
Type-A personality (Friedman & Rosenman, 1974)

Psychological

intervention

Biofeedback:

Factors: (Martin, 1998)

Migraine thermal
Tension EMG

Relaxation Training

Illness

Cancer
Psychological

Depressed mood

Psychological

Factors:

Intervention:

Treatment support: guided imagery

Palliative support

Self-Healing Personalities

Control: in facing challenge

feel power to influence
outcome
Commitment: to something
important or meaningfulwork, communities & family
Challenge: energy &
excitement for life change &
innovation

Self-Healing Personalities
Trust & Devotion:
(Rotter, 1980) people who
trust others are less likely
to be unhappy, conflicted,
or maladjusteddependable & have more
friends-healthier

Learned Optimism: Martin Seligman

(1991)

Adversity
Belief (personal control / explanatory style)
Consequence (depression, anger,

embarrassment, hurt, worry . . .)

Disputation (questioning & disputing your

demoralizing thoughts )

Energy

Training and Certification in Health Psychology

Graduate School
Pre-doctoral Internship
Post-doctoral Training
ABBP in Clinical Health Psychology