Chapter 1 - Definition & Training of Clinical Psychology
APA Division 12 Definition of Clinical Psychology
The field of Clinical Psychology integrates science, theory, and
practice to understand, predict, and alleviate maladjustment,
disability, and discomfort as well as to promote human
adaptation, adjustment, and personal development. Clinical
Psychology focuses on the intellectual, emotional, biological,
psychological, social, and behavioral aspects of human
functioning across the life span, in varying cultures, and at all
socioeconomic levels. (APA, 2012)
Education and training in clinical psychology
o Commonalities among most training programs
o Doctoral degree
o Most enter with bachelor's, some with master's degree
o Required coursework
o Thesis/dissertation
o Predoctoral internship (more information in later
slides
Education and training: Specialty Tracks
In recent decades, specialty tracks have emerged, including:
o Child
o Health
o Forensic
o Family
o Neuropsychology
Three models of training
1. Scientist-practitioner model (or Boulder model)
2. Practitioner-scholar model (or Vail model)
3. Clinical scientist model
Science-Practitioner Model (Boulder Model):
Balancing Practice and Science
▫ Created in 1949 at a conference in Boulder, Colorado
of directors of clinical psychology training programs
▫ Emphasizes both practice and research
▫ Graduates should be able to competently practice (e.g.,
therapy, assessment) and conduct research
▫ A balanced approach
Practitioner-Scholar Model (Mail Model):
Emphasizing Practice
▫ Created in 1973 in a conference in Vail, Colorado
▫ Also known as practitioner-scholar model
▫ Emphasize practice over research
▫ Yields the Psy.D (not Ph.D)
Clinical Scientist Model: Emphasizing Research
▫ Emerged in 1990s, primarily as a reaction against the
trend toward practice represented by Vail model
▫ Richard McFall's 1991 "Manifesto for a Science of
Clinical Psychology" sparked this movement
▫ A subset of Ph. D. institutions who strongly endorse
empiricism and science
▫ Tend to train researchers rather than practitioners
Emerging Trends in Training
o Technology
o Use of webcams for supervision
o Computer-based assessment
o Competencies
o Skills that a student must demonstrate
Ex. Intervention, assessment, research, etc.
Sample Grad Program Website Self-Description
o Boulder model example: University of Alabama
" .. graduates function in a variety of settings as teachers,
researchers, and providers of clinical services... The program
emphasizes the integration of scientific knowledge and the
professional skills and attitudes needed to function as a clinical
psychologist in academic, research, or applied settings."
o Vail model example: Chicago School of Professional
Psychology
"As a professional school, our focus is not strictly on research
and theory, but on preparing students to become outstanding
practitioners, providing direct service to help individuals and
organizations thrive."
o Clinical scientist model example: Indiaha University
"Indiana University's Clinical Training Program is designed
with a special mission in mind: To train first-rate clinical
scientists... applicants with primary interests in pursuing careers
as service providers are not likely to thrive here."
Getting in to Graduate School in Clinical Psychology
▫ Know your professional options
▫ Take the appropriate undergraduate courses
▫ Get to know your professors
▫ Get research experience
▫ Get clinically relevant experience
▫ Maximize your GRE score
▫ Select graduate programs wisely
▫ Write effective personal statements
▫ Prepare well for admissions interviews
▫ Consider your long-term goals
Internships: Predoc and Postdoc
Predoctoral internship
▫ Takes place at the end of doctoral training programs
(before Ph.D. or Psy.D. is awarded)
▫ A full year of supervised clinical experience in an
applied setting
▫ An apprenticeship of sorts, to transition from student
to professional
Postdoctoral internship
▫ Takes place after the doctoral degree is awarded
▫ Typically lasts 1-2 years
▫ Still supervised, but more independence
▫ Often specialized training
▫ Often required for state licensure
Getting Licensed
▫ Licensure enables independent practice and
identification as a member of the profession
▫ Requires appropriate graduate coursework,
postdoctoral internship, and licensing exams
▫ Each state has its own licensing requirements
▫ To stay licensed, most states require continuing
education units (CEUs)
Where Do Clinical Psychologists Work?
▫ A variety of settings, but private practice is most
common
▫ True since 1980s
Other common work settings includes:
▫ Universities
▫ Psychiatric and general hospitals
▫ Community mental health centers
▫ Other settings
What do Clinical Psychologist, Do?
A variety of activities, but psychotherapy is most common
▫ True since 1970s
Other common professional activities include:
▫ Diagnosis/assessment
▫ Teaching/supervision
▫ Research/writing
▫ Other activities
How Are Clinical Psychologists Different From Other
Professionals?
▫ Counseling Psychologists:
▫ Tend to see less seriously disturbed clients
▫ Tend to work less often in settings like inpatient
hospitals or units
▫ Tend to endorse humanism more and behaviorism less
▫ Tend to be more interested in vocational and career
counseling
▫
How Are Clinical Psychologists Different From Other
Professionals?
Psychiatrists:
▫ Go to medical school and are physicians
▫ Have prescription privileges (this is changing for
clinical psychologists--see Chapter 3)
▫ Increasingly emphasize biological/pharmaceutical
rather than "talk therapy" intervention
Social Workers:
▫ Tend to emphasize social factors in client's problems
▫ Earn a master's degree rather than a doctorate
▫ Training emphasizes treatment and fieldwork over
research or formalized assessment
School Psychologists:
▫ Tend to work in schools
▫ Tend to have a more limited professional focus than
clinical psychologists (student wellness and learning)
▫ Frequently conduct school-related testing and
determine LD and ADHD diagnoses
▫ Consult with adults in children's lives (e.B., teachers,
staff, parents)
Professional Counselors:
▫ Earn a master's degree
▫ Complete training in two years
▫ Little emphasis on psychological testing or research
▫ May specialized in career, school, college counseling
Chapter 2 – ETHICS
APA Code of Ethics - is a set of guidelines and principles that
outlines. the ethical standards and conduct expected of
psychologists in their professional work. It is designed to help
psychologists make ethical decisions and ensure that they
prioritize the well-being and rights of individuals they serve.
Who is the APA code of ethics for?
The American Psychological Association (APA) Code of Ethics
is designed for all psychologists, regardless of their
specialization or field of practice. It provides guidelines and
standards for ethical behavior that psychologists are expected
to follow in their professional activities.
▫ clinical psychology, counseling psychology,
educational psychology research, industrial-
organizational psychology, and more
ASPIRATIONAL vs ENFORCEABLE
Aspirational: The 5 General Principles
▫ describe an idea of ethical functioning or how
psychologists should thrive to conduct themselves
▫ does not imply ethical violations
▫ broad description of exemplary ethical behavior
Enforceable: The 10 Ethical Standards
▫ If any of these violated, it can result in professional
and legal ramification
▫ Ethical Violations – A standard has been violated
Two Approaches to Ethics: Remedial and Positive
Knapp and VandeCreek (2006) describe two approaches to
ethics: Remedial and Positive
Remedial Approach
An approach to ethics which involve doing just
enough to avoid any trouble that might come from a violation
of ethical standards
Positive Approach
An approach to ethics which involve doing just
enough to avoid any trouble that might come from a violation
of ethical standards.
Ex. Doing the Bare Minimum (Taking Courses, Getting
Supervision)
Ethical Decision Making
Cella Fisher's Model for Ethical Decision Making
▫ Prior to any ethical dilemma arising, make' a
commitment to doing right
▫ Become familiar with the APA Ethic's Code
▫ Consult any law or professional guidelines relevant to
the situation at hand.
▫ Try to understand the perspective of various parts
affected by the actions you may take.
▫ Consult with your colleagues (always protecting
confidentiality) for additional input and discussion.
▫ Generate and evaluate your alternatives
▫ Select and implement the course of action that seems
most ethical appropriate.
▫ Monitor and evaluate the effectiveness of your course
of action.
▫ Modify and continuo to evaluate ethical plan
necessary.
5 ETHICAL PRINCIPLES
Beneficence and Nonmaleficence
▫ This concept emphasizes the importance of doing
good (beneficence) and avoiding damage
(nonmaleficence). Psychologists are encouraged to
work toward the betterment of those they serve while
avoiding damage.
Fidelity and Responsibility
▫ Psychologists must respect professional norms, be
trustworthy, and accept responsibility for their actions.
Integrity
▫ In their work, psychologists should strive to encourage
honesty and candor. They must avoid dishonest
techniques and be open and honest about their
objectives and activities.
Justice
▫ All people should be treated fairly and equally.
Psychologists are responsible for ensuring that the
rewards and costs of their job are divided fairly.
Respect for People's Rights and Dignity
▫ Psychologists must respect all persons' autonomy and
dignity, as well as their right to privacy,
confidentiality, and self-determination.
10 ETHICAL STANDARDS
These ethical guidelines guide psychologists in respecting the
ethics of the psychology profession, maintaining professional
conduct, and protecting the welfare of those they serve.
1. Resolving ethical issues
1.07 Improper complaints
▫ Psychologists do not file or encourage the filing of
ethics complaints that are made with reckless
disregard or willful ignorance of facts that would
disprove the allegation.
2. Competence
2.06 Personal problems and conflicts
▫ When psychologists become aware bf personal
problems that may interfere with their performing
work-related duties adequately, they take appropriate
measures, such as obtaining professional consultation
or assistance
3. Human Relations
3.01 Unfair discrimination
▫ Psychologists do not engage in unfair discrimination
based on age, gender, gender identity, race, ethnicity
culture, national origin religion, sexual orientation
disability, socioeconomic status, or any basis
proscribed by law.
Privacy and Confidentiality
o Take reasonable precautions to protect confidential
information obtained through or stored in any medium
o Asking for consent
o Psychologists include in written and oral reports and
consultations, only information germane to the
purpose for which the communication is made.
o Psychologists do not disclose in their writings,
lectures, or other public media, confidential,
personally identifiable information concerning their
clients.
4. Advertising and other public statement
5.05 Testimonials
▫ Psychologists do not solicit testimonials from current
therapy clients/patients or other persons who because
of their particular circumstances агe vulnerable to
undue influence.
5. Record Keeping and Fees
6.03 Withholding Records for nonpayment
▫ Section 6.03 stipulates that psychologists cannot
withhold client records in an emergency for the sole
reason that payment hasn't yet been received.
▫ A psychologist must provide the client's records so
emergency staff can proceed with appropriate
treatment.
6. Education and training
7.03 Accuracy in Teaching
▫ Section 7.03 requires that psychologists in teaching
position provide their students with an accurate
course syllabus and bases for evaluation.
 ▫ When engaged in teaching or training, psychologists
present psychological information accurately.
7. Research and Publication
8.07 Deception in Research
▫ Psychologists do not deceive prospective participants
about research that is reasonably expected to cause
physical pain or severe emotional distress.
▫ There is an exception..unless the use of deceptive
techniques is justified by the study's scientific and
educational value.
8. Assessment
9.02 use of Assessments
▫ When an assessment is used that is not valid or
reliable, it is the psychologist's duty to explain the
strengths and weaknesses of the test results as well as
the interpretation of those test results.
Assessment
▫ When psychologists conduct a record review or
provide consultation or supervision and an individual
examination is not warranted or necessary for the
opinion, psychologists explain this and the sources of
information on which they based their conclusions and
recommendations.
▫ Psychologists use assessment instruments whose
validity and reliability have been established for use
with members of the population tested.
▫ Psychologists who develop tests other assessment
techniques use appropriate psychometric procedures
and current scientific or professional knowledge for.
test design, standardization, validation, reduction or
elimination of bias, and recommendations for use.
▫ Psychologists take into account the purpose of the
assessment as well as the various test factors, test-
taking abilities, and other characteristics of the person
being assessed.
▫ Psychologists do not base their assessment or
recommendations on data or test results that are
outdated for the current purpose
9. Therapy
10.10 Terminating Therapy
▫ Psychologists terminate therapy when becomes
reasonably clear that the client/patient no longer needs
the service, is not likely to benefit, or is being harmed
by continued service.
▫ Psychologists may terminate therapy when threatened
otherwise endangered by the client/patient another
person with whom the client/patient has a relationship.
Minimizing intrusions on privacy
Psychologists include in written and oral reports and
consultations, only information germane to the purpose for
which the communication is made.
Informed consent for recording voices and images in
research
"Informed consent for recording voices and images in research"
involves obtaining explicit permission from participants before
capturing their audio or visual data during a research study
Informed consent for therapy
"Informed consent to therapy" is the process through which a
mental health or healthcare professional informs a patient or
client about the details of therapy, including its goals, methods,
potential risks and benefits, and any alternatives.
BOUNDARIES & MULTIPLE RELATIONSHIPS
Boundaries
▫ Boundaries in the therapeutic relationship specify the
proper limitations of the therapist client interaction.
These boundaries exist to protect the client's
vulnerability as well as the therapeutic intervention's
integrity.
Multiple Relationships
▫ A multiple relationship happens when a professional
performs one professional role with a person while
also performing another professional role with the
same person or having a relationship with a closely
linked person or business.
Potential Issues with Multiple Relationships:
1. Impaired Judgement - Personal relationships can obscure a
therapist's professional judgment, resulting in biased
conclusions or recommendations.
2. Risk of Exploitation - Given the power relationships in a
therapist-client relationship, the client may be exploited.
3. Loss of Objectivity - Emotional or financial involvements
might lead to a loss of fairness, jeopardizing the efficacy of
therapy.
4. Privacy Concerns - Multiple relationships can raise
concerns about confidentiality, especially in close-knit groups.
Ethical guidelines on multiple relationships
1. AVOIDANCE WHEN POSSIBLE
The American Psychological Association (APA) advises
against it. If many ties are likely to damage objectivity or hurt
the client, they should be avoided.
2. PROFESSIONAL ASSESSMENT
Therapists are encouraged to assess potential multiple
relationships. their impact on their professional responsibilities
and on the client.
3. TRANSPARENCY AND INFORMED CONSENT
Multiple relationships should be avoided if possible. If
necessary, frank discussion and informed consent should be
acquired.
Contemporary ethical issues
Manage care exerts a strong influence on the current practice of
clinical psychology.
o Divided Loyalty
▫ "strive to benefit" "safeguard the welfare"
▫ tug of war between the managed care companies
profits vs their client's psychological welfare the
therapeutic relationship may suffer
How to avoid this?
1. Inform the client
▫ Inform the client about managed-care companies-and
much more about manage care during the Informed
consent process.
Ethical dilemma client is struggling with a problem that does
not meet the criteria of DSM.
▫ The psychologist may falsely assign a diagnosis to
ensure that managed-care companies will pay the bill.
▫ The psychologist may be tempted to "upcode" or
assign more serious diagnosis than the client's
symptoms actually merit; to increase more sessions of
therapy or the amount of money the managed-care
company will devote to treatment.

Motivation
▫ Even if the psychologist's motivation is the client's
welfare, such actions are unethical and can constitute
the illegal act of Insurance fraud as well.

Technology and Ethics

Technological advances have led to changes in the practice of
clinical psychology in recent years, and new ethical challengos
have also risen.

Psychological Tests
▫ The internet has a wide array of so-called
psychological tests of one kind or another, claiming to
measure intelligence, personality, and other variables.
Many of these tests have questionable validity and
reliability, and the feedback they provide may be
inaccurate and distressing to clients.
▫ Any clinical psychologist who creates or uses
unscientifically sound tests of this type may be
engaging in unethical practices.

Online therapy concerns

▫ As the client is taking a test, are the test conditions
standardized?
▫ Will the client keep the test materials secure?
▫ Is the client distracted by other tasks? Is the client
actually the one completing the test?
▫ Are there important behavioral observations the
psychologist might be missing because of remote
nature of assessment?