Introduction to Clinical Psychology

PREFACE iv ACKNOWLEDGEMENTS vii ABOUT THE AUTHORS viii 1 The Evolution of Clinical Psychology 1 Introduction 1 Defining the Nature and Scope of Clinical Psychology 3 Evidence-Based Practice in Psychology 7 Mental Health Professions 8 Counselling Psychology 8 School Psychology 10 Psychiatry 10 Clinical Social Work 11 Other Mental Health Professions 12 Availability of Mental Health Service Providers 13 A Brief History of Clinical Psychology 14 The Roots of Clinical Psychology 14 The History of Assessment in Clinical Psychology 15 The History of Intervention in Clinical Psychology 20 The History of Prevention in Clinical Psychology 25 The Future 25 Summary and Conclusions 25 2 Contemporary Clinical Psychology 27 Introduction 27 Activities of Clinical Psychologists 28 Assessment and Diagnosis 29 Intervention 32 Prevention 35 Consultation 35 Research 37 Teaching and Supervision 38 Administration 39 Employment Settings 39 The Two Pillars of Clinical Psychology: Science and Ethics 40 Training in Clinical Psychology 43 Models of Training in Clinical Psychology 43 Accreditation of Clinical Psychology Programs 45 Licensure in Clinical Psychology 47 Summary and Conclusions 49 3 Classification and Diagnosis 50 Introduction 50 Defining Abnormal Behaviour and Mental Disorders 52 Developmental Psychopathology 53 Diagnosis 53 Defining Disorder 54 Prevalence of Mental Disorders 55 Understanding the Development of Mental Disorders 58 The Diagnostic and Statistical Manual of Mental Disorders (DSM) System 61 The Evolution of the DSM 61 The DSM-5 63 The International Statistical Classification of Diseases and Related Health Problems (ICD) System 67 Limitations of Diagnostic Systems 68 Defining Abnormality (Revisited) 68 Diagnostic Reliability 69 Heterogeneity of Symptom Profiles 70 Diagnostic Validity 71 Comorbidity 72 Categorical versus Dimensional Classification 73 Summary and Conclusions 74 4 Research Methods in Clinical Psychology 75 Introduction 75 Generating Research Hypotheses 78 Ethics in Research 80 Research Designs 83 Case Studies 86 Single Case Designs 87 Correlational Designs 88 Quasi-Experimental Designs 90 Experimental Designs 91 Selecting Research Participants and Measures 93 Selecting the Sample 93 Selecting the Sampling Strategy 93 Setting the Sample Size 94 Measurement Options and the Importance of Psychometric Properties 95 Analyzing the Data 96 Statistical and Clinical Significance 97 Research Syntheses 98 Systematic Reviews 98 Meta-Analysis 99 Summary and Conclusions 100 5 Assessment: Overview 102 Introduction 102 Psychological Assessment 103 Evidence-Based Assessment 104 The Purposes of Psychological Assessment 105 Psychological Testing 112 Assessment versus Testing 114 Psychometric Considerations 116 Testing Practices in Clinical Psychology 120 Ethical Considerations 121 Summary and Conclusions 122 6 Assessment: Interviewing and Observation 124 Introduction 124 Ethical Issues: Limits of Confidentiality 126 Unstructured Assessment Interviews 127 Semi-Structured Diagnostic Interviews 129 General Issues in Interviewing 131 Attending Skills 131 Contextual Information 132 Culturally Sensitive Interviewing 133 Defining Problems and Goals 135 Assessing Suicide Risk 137 Interviewing Couples 138 Interviewing Families 138 Interviewing Children and Adolescents 139 Observations 141 Self-Monitoring 144 Summary and Conclusions 147 7 Assessment: Intellectual and Cognitive Measures 148 Introduction 148 Defining Intelligence 149 Theories of Intelligence 149 Assessing Intelligence: The Clinical Context 151 The Wechsler Intelligence Scales 153 Background Issues 153 Administration, Scoring, and Interpretation Issues 157 Canadian Normative Data 158 Wechsler Adult Intelligence Scale—Fourth Edition (WAIS-IV) 160 Wechsler Intelligence Scale for Children—Fifth Edition (WISC-V) 162 Wechsler Preschool and Primary Scale of Intelligence—Fourth Edition (WPPSI-IV) 163 Other Intelligence Scales 164 Selected Cognitive Assessment Scales 165 Wechsler Memory Scale—Fourth Edition (WMS-IV) 165 Wechsler Individual Achievement Test—Third Edition (WIAT-III) 167 Summary and Conclusions 168 8 Assessment: Self-Report and Projective Measures 169 Introduction 169 The Person-Situation Debate 170 Self-Presentation Biases 172 Developing Culturally Appropriate Measures 172 The Clinical Utility of Self-Report and Projective Measures 175 Self-Report Personality Measures 176 MMPI-2 and MMPI-A 177 Other Clinical Measures of Personality Functioning 182 Self-Report Checklists of Behaviours and Symptoms 184 Achenbach System of Empirically Based Assessment 184 SCL-90-R 187 Outcome Questionnaire 45 187 Beck Depression Inventory-II 188 Children’s Depression Inventory 2 189 Projective Measures of Personality 189 Rorschach Inkblot Test 190 Summary and Conclusions 192 9 Assessment: Integration and Clinical Decision-Making 194 Integrating Assessment Data 196 Case Formulation 198 Threats to the Validity of Assessments and Case Formulations 202 Patient/Client Factors 202 Clinician Factors 203 Improving the Accuracy of Clinical Judgment 205 Psychological Assessment Reports and Treatment Plans 207 Assessment Feedback 209 Summary and Conclusions 211 10 Prevention 213 Introduction 213 Approaches to Prevention 217 Promoting Evidence-Based Parenting 220 Home Visiting Programs 221 Incredible Years 221 Triple P 222 Prevention of Violence 222 Physical Abuse of Children 222 Youth Violence: Bullying and Conduct Disorder 223 Prevention of Internalizing Disorders 225 Anxiety Disorders 225 Depression 226 Prevention of Substance Abuse 226 Prevention of Problems in those Exposed to Trauma or Loss 228 Summary and Conclusions 229 11 Intervention: Overview 231 Introduction 231 The Ethics of Intervention 232 Theoretical Approaches 236 Short-Term Psychodynamic Psychotherapies 237 Interpersonal Psychotherapy for Depression 239 Process-Experiential Therapies 240 Cognitive-Behavioural Therapies 241 Seeking Psychological Treatment 244 The Duration and Impact of Psychotherapy 247 Alternative Modes of Service Delivery 249 Summary and Conclusions 254 12 Intervention: Adults and Couples 256 Introduction 256 Does Psychotherapy Work? A Controversy and Its Impact 256 Meta-Analysis and Psychotherapy Research 257 Evidence-Based Treatments: Initiatives and Controversies 261 Clinical Practice Guidelines 268 Examples of Evidence-Based Treatments 270 CBT for Depression 270 Prolonged Exposure CBT for PTSD 273 EFT for Couple Distress 274 Effectiveness Trials 274 Adoption of Evidence-Based Treatments 276 Summary and Conclusions 278 13 Intervention: Children and Adolescents 280 Introduction 280 Who Is the Client in Psychological Services for Children and Adolescents? 280 Landmarks in the Evolution of Evidence-Based Psychological Services for Children and Adolescents 283 Do Psychological Treatments for Children and Adolescents Work? 284 Which Treatments Work for Specific Disorders? 285 Clinical Practice Guidelines 288 Examples of Evidence-Based Treatments 289 Disruptive Behaviour Disorders 289 Adolescent Depression 295 Efficacy, Effectiveness, and the Dissemination of Evidence-Based Treatments 296 Summary and Conclusions 300 14 Intervention: Identifying Key Elements of Change 302 Introduction 302 Psychotherapy Process and Process-Outcome Research 303 Examining Client Factors 305 Examining Therapist Factors 307 Examining Treatment Factors 309 Some Methodological Cautions 312 Common Factors in Psychotherapy 313 Research Perspectives on Common Factors: The Therapeutic Alliance 314 Research Perspectives on Common Factors: Psychotherapy Equivalence 315 Evidence-Based Psychotherapy Relationships 318 Task Force Recommendations 319 Empirically Based Principles of Therapeutic Change 320 Summary and Conclusions 323 15 Clinical Health Psychology, Clinical Neuropsychology, and Forensic Psychology 324 Introduction 324 Clinical Health Psychology 325 Definitions of Health and Disability 326 Activities of Clinical Health Psychologists 327 Assessment and Intervention Related to Pain 330 Clinical Neuropsychology 333 Activities of Clinical Neuropsychologists 333 Assessment 335 Intervention 337 Forensic Psychology 339 Activities of Forensic Psychologists 340 Assessment 342 Intervention 343 Summary and Conclusions 344 APPENDIX 1 Major Journals Relevant to Clinical Psychology 346 APPENDIX 2 Applications to Graduate School 352 REFERENCES 361 NAME INDEX 391 SUBJECT INDEX 403