Maica S.

Pineda

CLINICAL PSYCHOLOGY

Psychology () can be:

– Pure / Basic – theories, or
– Applied – hands on application of theories

Clinical Psychology
- applied field
- diagnosis / prognosis, assessment, care, treatment Rehabilitation
Psychological Interventions
Education

Objectives of Clinical 

1. To reintegrate psychologically disturbed individuals to their everyday life and society.

2. To prevent psychological imbalances and disorders rather than cure, e.g. suicide,
depression
3. To assist in the satisfactory adjustment or readjustment of the individual to his / her
environment.
4. To work in coordination and linkages with other fields such as:

Medicine
- Neurology
- Psychiatry
- Endocrinology,
etc.

Clinical Educatio
Mental n
Psycholog
Hygiene - Counseling
y - Referral

Sociolog
Nursing y
- Psychiatric - Social Work
Nursing

Table 2
Becoming A Clinical Psychologist

CLINICAL PSYCHOLOGIST PSYCHIATRIST

Educational Background MA / MS in Clinical  Doctor of Medicine with

PhD / PsyD in Clinical  specialization in Psychiatry

Diagnosis Psychological Testing / Laboratory Techniques,

Assessment Techniques Physical Examinations

Care Physical and Psychological Physical and Psychological

Aspects Aspects

Treatment Application of Psychological Prescription of Drugs,

Principles / Theories Medical Interventions
(Psychotherapy)

Differences and Similarities Between a Clinical Psychologist and a Psychiatrist

Lecture Notes on Clinical Psychology

 Maica S. Pineda

Functions of a Clinical Psychologist

1. Research
– The improvement of any field lies on research.
– Through research there could be improvement in clinical programs that
could be planned and implemented in care and treatment.
a. Innovators – coming out with something novel out of the ordinary,
e.g. research and studies, theories, etc.
– According to Dr. Honey Carandang, a Filipino pioneer in Clinical , ‘ as
researchers and clinical psychologists, we become innovators.’
– Looking into the subjective world of the client—the causations and reactions
are case-to-case basis.
– Phenomenological approaches and techniques are needed in handling
cases.
b. Communicators – presentations and lectures of researches, theses,
dissertations and studies on conventions and other related forums,
teaching, community advocacies, etc.
2. Assessment / Diagnosis – prevention rather than curative measures are preferred.
3. Treatment – therapy
4. Teaching – facilitation in learning the field of Clinical .
5. Consultation – technical knowledge is sought.

Expert Specific field of expertise is required

Trainer Teaching of future clinicians and psychologists
Advocator Programs for human and community development
Collaborator Coordination with other related fields
Fact-finder Being a researcher
Process-specialist Assessment and treatment

6. Administration – schools, hospitals, clinics, and other related organizations.

Table 2
History of Clinical Psychology in the Philippines

YEAR EVENT
1930 Psychology Department was already established and is functioning at the University of Santo Tomas.
1932 Dr. Sinforoso Padilla, a psychologist and a Dean of the University of the Philippines, was the first to come up with a psychological
clinic, which catered academic and psychological problems of the students. The clinic lasted until World War II during the 1940’s.
1933 Jesus Perpinan established a psychological clinic at Far Eastern University.
1945 After WW II, other schools in Metro Manila also opened psychological Clinics such as the Ateneo.
1947 Dr. Zaguirre, a psychiatrist and a part-time professor of clinical  at UP put up a neuropsychological clinic at the V. Luna General
Hospital (presently the VMMC), to cater psychological needs due to the War, particularly those of the veterans. It eventually became
the present Psychological Unit of the hospital. Among the first staff were Dr. Naty Dayan and Dr. Olga Ruiz de Arana.
1948 Psychology was offered as a course and part of the curriculum at UST.
1953 Other schools followed in offering Psychology as a course such as the Philippine Women’s University.
1961 Fr. Jaime Bulatao of the Ateneo de Manila University became an exchange student to the US and was the first to receive a PhD in
Clinical  at Fordham University. Eventually, the Department of Psychology at ADMU was established.
1962 Through the pioneering efforts of Fr. Bulatao, the Psychological Association of the Philippines (PAP) was established.
1970s There was a shift from Western influence in  into indigenous influence in  which later became known as Filipino Psychology.
1980s Clinical  became a practice—assessment and diagnosis in clinics and Hospitals such as the National Mental Hospital (NMH). Works
of psychologists were given recognition separately from psychiatrists.
1990- Research and practice are constantly prevalent. New trends and studies are being developed through extensive study and
present research.

Lecture Notes on Clinical Psychology

Maica S. Pineda

DIAGNOSIS
- the classification and labeling of a patient’s problem within a set of recognized
categories of abnormal behavior
- is a process of determining abnormalities
- is a way of evaluating and assessing the strengths and weaknesses of an individual
- it is the conceptualization of the client’s problem (he is in)
- it is both a process and a method
* In the process of conceptualization, the nature of the problem is identified based from
the data collected from assessment (to reach a goal).

I. DIAGNOSIS AS A PROCESS

Aims of Diagnosis as a Process

1. Acquire knowledge of a person’s situation (Descriptive Phase)
- to collect data and pertinent information
2. Evaluation / identification of the problem (Interpretative / Inferential Phase)
3. Organize and assimilate the findings (Interpretative / Inferential Phase)

Phases / Stages of the Diagnostic Process

A. DESCRIPTIVE PHASE
B. INTERPRETATIVE / INFERENTIAL PHASE

Components of Diagnosis as a Process

1. Planning data collection
2. Collecting assessment data
- data from the methods used (observation, interview, questionnaires, tests)
3. Processing assessment data
- interpretation and evaluation of findings

4. Communication of assessed data

- psychological evaluation report

Lecture Notes on Clinical Psychology

Maica S. Pineda

II. DIAGNOSIS AS A METHOD

Method – means, ways, instruments, and techniques

Interdisciplinary Approach – being eclectic about the use of approaches

1. Medical Diagnostic Methods

A. Physical Examination – blood pressure, interview, etc.

B. Laboratory Examination – endocrinology (hormonal count), neurology,
etc.
Lumbar Puncture – extracting spinal fluid from the spinal cord by
inserting a needle.
C. Instruments – brain imaging techniques using radiation e.g., MRI, PET,
CAT, etc.

Electroencephalograph – monitors the electrical activity of the brain.

Electromyograph, Evoked Potentials, and Nerve Conduction

velocities all measure electrical activity of some sort—in muscles.

X-rays:
Positron Emission Tomography (PET) – scans and shows changes
not just structures of the brain but in its network nervous functions.

Single Photon Emission Tomography (SPECT)– similar to PET

Magnetic Resonance Imaging (MRI) ang Functional Magnetic

Resonance Imaging (fMRI) – works by tracking the activity of the atoms in
the body as they are excited by magnets in a chamber or coil placed around
the patient’s head.
Biopsies and Exploratory Surgery – these procedures involve direct
examination of the suspect brain tissue.
D. DSM – Diagnostic and Statistical Manual IV-TR

2. Psychological Diagnostic Methods

A. Clinical Interview i.e. Indigenous Techniques

B. Clinical Observation
C. Psychological Tests: psychometrics; projective tests
D. Case Study
E. Behavioral Assessments – eclectic use of techniques and other
tools.

Lecture Notes on Clinical Psychology

Maica S. Pineda

INTERVIEWING ESSENTIALS

1. Physical Arrangement – neutral arrangement

Setting - free from noise and other interferences
- privacy is very important

2. Note-taking and Recording – when recording, the client’s consent should

be asked

3. Establishment of Rapport

4. Communication
- what is the objective of the session
- duration, hours, number of sessions
- how to begin the session, use of language
- contract between the clinician and the client
- silence is important—let the client do the talking
- listening skills
- impact of the clinician
- values of the clinician
- background of the clinician
Essentials of a Communication as a Process
Verbal Style
a. Lexical Component – verbal content, choice of words and language
b. Non-lexical Component – intonation, volume, grammar, rate of speech,
duration of utterance, speech disruptions
c. Expressive Movement – mannerisms, non-verbal communication, body
language, tics

5. Use of Questions
a. open-ended
b. facilitative
c. confronting
d. clarifying
e. direct

6. Client’s Frame of Reference

7. Clinician’s Frame of Reference – relate with the frame of mind of the

client

8. Clinician’s Skills
a. attending – what details are to be given focus
a.1. psychological – putting aside personal concerns, worries,
anxieties, stress, problems

Lecture Notes on Clinical Psychology

Maica S. Pineda

a.2. physical
Sit squarely
Open posture
Lean forward
Eye contact
Relax
b. listening – perceiving the verbal and non-verbal
c. supportive presence – tissue when crying, avoid physical contact when
client is opposite sex
d. empathy – understand the situation of the client but avoid transference
e. exploration and elaboration skills – types of questions and how they
are asked
f. paraphrasing – content of what client is talking about, rephrase or repeat
question
g. reflection – talk about what the client is talking about
h. summarization - summarize the points in the session
i. clarification – clarify information or rephrase questions

CLINICAL INTERVIEW

- therapeutic purpose
- digging deeper
1. to elicit information
2. giving information
3. evaluating information – trying to look into
the cause, category (diagnostic)
4. modifying/changing/improving the client

Computer-assisted – facing the computer to

answer questions about the case.

Plante: “…it is a thoughtful, well-planned, and

deliberate conversation designed to inquire
important information and its solutions…”
Types of Interview
1. Intake – client to be acquainted with the clinician, basic info., etc.
2. Case History – entire background of the client, identify coherent or
incoherent information, lucid mind, cognitive status state, preliminary
conversation to determine whether there is something wrong with the client.
3. Mental Status
4. Crisis – critical condition. Look into the critical condition of the client,
hysterical, not communicative, suicidal, violent, etc.
5. Diagnostic

“CLINICAL EYE” – is developed through experience and keen observation

Engineering Psychology – there is psychology in time, space, and motion

because it affects behavior and activities

Lecture Notes on Clinical Psychology

Maica S. Pineda

Misunderstandings About Case Study

1. Theoretical knowledge is more valuable than practical knowledge
2. One cannot generalize from a single case, therefore, the single case study
cannot contribute to scientific development
3. The case study is most useful for generating hypotheses, whereas other
methods are more suitable for hypotheses testing and theory building.
4. The case study contains bias towards verification.
5. It is often difficult to summarize specific case studies.

Steps in Developing a Case Study

1. All data about the case should be gathered.
2. Data is organized into an approach to highlight the focus of the study.
3. Case narrative is developed.
4. The narrative may be validated or approved by other experts.
5. Case studies may be cross-compared to other case studies.

Finding Sources of Evidence for Case Study

1. Documentation
Strengths:
- it is able to be repeatedly reviewed
- are exact, confirming and have broad coverage
Weaknesses:
- irretrievability
- bias and activity
- access can be blocked because the client does not want to
disclose information
2. Archival Records

3. Interviews
Strength;
- one-on-one and insightful
Weaknesses:
- bias due to poor questions
- people tend to have incomplete recollection
- express what the interviewer wants to hear
4. Direct Observation
Strength:
- in reality, the person is observed
Weaknesses:
- time-consuming
- time costs
- causes the client to change her/his behavior
5. Participant Observation
6. Physical Artifacts
Strengths:
- cultural background
- people tend to behave differently because of different cultures
Weakness:
- selective of the biases of other people

OUTLINE OF THE PSYCHOLOGICAL REPORT

Lecture Notes on Clinical Psychology

Maica S. Pineda

I. IDENTIFYING DATA
(relevant data)

II. REASON FOR REFERRAL

III. ASSESSMENT TECHNIQUES USED

Listing: Psychological Tests, DSM Diagnosis and
Classification

IV. BACKGROUND
(information on the etiology)

V. FINDINGS AND INTERPRETATION

Multiaxial Diagnosis and Classification

VI. SUMMARY AND CONCLUSION

Inference: Information and Principles

VII. PROGNOSIS

VIII. RECOMMENDATIONS

IX. APPENDIX
Personal data form, test protocols, letters, pictures

1st case to be submitted on February 11, 2008

MIDTERM EXAMS: February 14, 2008

CLINICAL OBSERVATION

Clinical Observation
- looking into the actual experiences / anecdotes of the client as far as the
problem is concerned.
- what would be the nonverbal communication she/he is trying to project /
manifest along with the language content.
- the attitudes are important in the evaluation of the client’s consistency.
- emotions and thoughts can be read through observation.
- “fill in the gaps” of some questions about the client.

Unguarded Moments – unconscious reactions, speeches

Lecture Notes on Clinical Psychology

Maica S. Pineda

PSYCHOLOGICAL TESTS

Psychological Tests – are tools that measure samples of behavior

Battery of Tests
– a number of tests
– the choice of tests for a holistic profile of the individual’s personality /
behavior
IQ tests (verbal and nonverbal)
Personality Tests
a. objective – e.g., 16PF
b. subjective – projective tests, e.g., TAT, RIT, DHTPT, DAP,
Sach’s, BMVGT, RISB
Inventories – e.g., surveys

In the choice of tests, consider the following :

1. Relevance to the problem (case)
2. Appropriateness to the client
3. Familiarity to the clinician
4. Adaptability to the time available (ideally, 2 sessions)
5. Reliability 0.5 t o 0.9
6. Validity
7. Clinical usefulness of test norms
8. Advisability of a routine
9. Testing Battery
Ma’am Galura’s tests: PNLT – 20-25 minutes time limit
EPI (Emotional Profile Index)
BMVGT
DHTPT no time
limit
Sach’s – 60 items
Luscher Color Test – usually 10-15
minutes

PLANNING OF THE TREATMENT

Treatment Plan – gives the statement of goals, site of treatment, persons and
professionals who will be responsible, and description of the preferred treatment
modality. It is the design of the treatment.

I. Data of the Patient

II. Treatment Goals

1. Immediate – when a client is referred, there is a pressing need or purpose
to be done, emergency.
2. Short-term – involve certain conditions that will sometimes modify or alter
the pre-planned goals (those that were planned as immediate goals).
Needs that have to be addressed: 2 days, 3 days, or inpatient.
3. Long-term – some other plans, follow-ups, outpatient

Lecture Notes on Clinical Psychology

Maica S. Pineda

III. Site of Treatment

1. Hospital
2. Outpatient ( Office, Center, Rehabilitation Center)
3. Home
4. Schedule: time, days, duration ( ex. 1hour, 3x a week, 6 months, etc.)

IV. Professionals Involved

1. Psychologists
2. Psychiatrists and other Specialists
3. Counselors – for educational interventions
4. Lawyers
5. Social Workers

V. Treatment Modality (Type of Treatment Technique)

1. Individual Therapy
2. Family Therapy
3. Support/ Group Therapy
4. Milieu Therapy

IMPLEMENTING THE TREATMENT PLAN

Implementing the Treatment Plan – gives emphasis on the “clinician and

client relationship.” The interaction between clinician and client will depend on:
1. Quality of the Relationship
- Impersonal – “walang personalan, trabaho lang.” This is to avoid
subjectivity and protect the integrity of the clinician and client.
2. Clinician’s interests, concerns, and respect for the client
3. Clinician’s administration of treatment to the client.

Clinician’s Role
1. Skills to “scan” – “clinical eye,” cues to watch out (nonverbal
communication/mannerisms).
2. The way the client responds – be watchful on the physical and
psychological responses/reactions of the client, as well as the consistency
of the client’s responses.
3. Clinician’s reactions – we have to be conscious of our reactions and
mannerisms because the client might give a wrong impression which
might affect his responses.

Client’s Role
1. Describe and identify the nature of her/his disorder (symptoms, family
members, past disorders).
2. Describe her/his reactions as treatment progresses (are there
improvements or additional information?).
3. Initiate and follow through whatever changes are going to be made
(cooperative).

Lecture Notes on Clinical Psychology