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Clinical Psychology

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Clinical Psychology­ (PSY401)
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LESSON 02
THE SKILLS & ACTIVITIES OF A CLINICAL PSYCHOLOGIST
WHO IS A CLINICAL PSYCHOLOGIST?
A clinical psychologist is a professional who applies principles and procedures to understand, predict
and alleviate intellectual, emotional, psychological and behavioral problems"
(American Psychological Association).
PROFESSIONAL SKILLS / ACTIVITIES OF A CLINICAL PSYCHOLOGIST
The fundamental skill areas that are essential for competent functioning as a clinical psychologist within
the areas of mental health include the following:
1.
Assessment & Diagnosis
2.
Intervention & Therapy
3.
Teaching
4.
Clinical Supervision
5.
Research
6.
Consultation
7.
Program Development
8.
Administration
1. ASSESSMENT & DIAGNOSIS
ASSESSMENT
Assessment has long been a critical part of the clinical psychologist's role. Clinical psychologists most
commonly administer psychological tests for the purposes of assessing a person's mental health.
Assessment, whether through observation, testing or interviewing, is a way of gathering information so
that an important question can be solved. Assessment of an individual's development, behavior,
intellect, interests, personality, cognitive processes, emotional functioning, and social functioning are
performed by clinical psychologists, as are assessment activities directed toward couples, families, and
groups.
Interpretation of assessment results, and integration of these results with other information available, in
a way that is sensitive to the client, and particularly clients of special populations, is an essential skill of
clinical psychologists. The process of assessment is very important as it leads to the diagnosis of the
client's problem(s).
All practicing clinicians engage in assessment of one form or another. Take, for example, the following
cases:
A child who is failing the fourth grade is administered an intelligence test to check if there is an
intellectual deficit; a student with an undesirable behavior in class is administered a personality test to
check the presence of anti-social personality traits.
Clinical psychologists also conduct detailed interviews with patients, asking questions intended to
reveal signs of a psychological problem. At times, it is difficult to determine whether someone should
be identified as having a psychological disorder. According to the American Psychiatric Association, a
pattern of behavior or thinking is considered a psychological disorder only if
(1) The person is experiencing significant distress or impairment,
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Clinical Psychology­ (PSY401)
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(2) The source of the problem resides within the person and is not a normal response to negative life
events, and
(3) The problem is not a deliberate reaction to conditions such as poverty, prejudice, or conflicts with
society.
DIAGNOSIS
To formulate an effective method of treatment, clinical psychologists must not only determine that there
is a problem but also must make a specific diagnosis. That is, they must identify the specific disorder or
problem affecting the patient. Clinical psychologists are trained to assess, and make functional
diagnoses regarding intellectual level, cognitive, emotional, social, and behavioral functioning, as well
as mental and psychological disorders. For this purpose, the most widely used diagnostic scheme in the
United States is the Diagnostic and Statistical Manual of Mental Disorders, a reference book published
by the American Psychiatric Association. This manual contains a complete list of psychological
disorders classified into 16 broad categories.
For example, panic disorder, post-traumatic stress disorder, obsessive-compulsive disorder, and phobias
are grouped under the category of anxiety disorders. The manual describes the main symptoms for each
disorder in concrete behavioral terms. It also gives the prevalence rates for men and women in the
population; a list of predisposing factors; the normal age of onset; and the prognosis, or expected
outcome.
In clinical settings, diagnoses may be made formally, using widely accepted criteria, such as the DSM
IV, or informally, such as diagnosis of family dynamics using a particular theoretical model.
2. INTERVENTION & THERAPY
A major activity of clinical psychologists is intervention or treatment. Many clinical psychologists work
directly with people who have a mental illness or psychological disorder. By choosing an appropriate
treatment, clinical psychologists can help such people overcome their problem or, at minimum, manage
their symptoms. All psychological intervention rests on the ability to develop and maintain functional
therapeutic relationships with clients.
Intervention is an important skill, as clients seen by clinical psychologists are often highly distressed
and sensitive. The major purpose of intervention is to empower individuals to make adaptive choices
and to gain healthy control of their own lives.
All interventions require skill in the following tasks: conceptualization of the problem; formulation of a
treatment plan; implementation of the treatment plan; and evaluation of the accuracy and completeness
of the above mentioned tasks, as well as outcome of the intervention.
Psychotherapy is the activity that most frequently engages the typical clinician's efforts and to which
the most time is devoted. The lay person often has an image of the therapy situation as one in which the
client lies on a couch while the therapist, bearded and mysterious, sits behind with notepad and
furrowed brow. Actually, therapy comes in many different sizes and shapes. A few therapists still use a
couch, but more often the client sits in a chair adjacent to the therapist's desk.
Most often therapy involves a one- to- one relationship, but today couple's therapy, family therapy and
group therapy are also very common. The therapist and client meet regularly, typically (but not
necessarily) in weekly sessions, to work out the solution of the client's problems until both agree that the
client has substantially improved and does not need further treatment. Although clinical psychologists
cannot prescribe medication, they often combine psychotherapy with drug treatment by working in
collaboration with the client's physician.
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Clinical Psychology­ (PSY401)
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There are many different approaches to the practice of psychotherapy. Each is based on different ideas
about the sources of personal problems. Most therapies can be classified as:
Psychodynamic
Humanistic
Behavioral,
Cognitive, or
Eclectic
This manual contains a complete list of psychological disorders classified into 16 broad categories.
For example, panic disorder, post-traumatic stress disorder, obsessive-compulsive disorder, and phobias
are grouped under the category of anxiety disorders. The manual describes the main symptoms for each
disorder in concrete behavioral terms. It also gives the prevalence rates for men and women in the
population; a list of predisposing factors; the normal age of onset; and the prognosis, or expected
outcome.
3. TEACHING
Clinical psychologists who have full or part- time academic appointments obviously devote a
considerable amount of time to teaching. Those, whose responsibilities are primarily in the area of
graduate education, teach courses in advanced psychopathology, psychological testing, interviewing,
intervention, personality theory and so on. Some also teach abnormal psychology, introduction to
clinical psychology. Much of this teaching is of the familiar class- room lecture type. But a considerable
amount of teaching is also done on a one- to- one, supervisory basis.
Clinical psychologists in clinical setting may also teach informal classes or do orientation works with
other mental health personnel, such as nurses, aides, social worker, occupational therapist and so on. In
some cases the clinician may go out into the community and lead workshops on various topics for police
officers, volunteers, ministers, probation officers and others.
4. CLINICAL SUPERVISION
This activity is another form of teaching. However, it typically involves more one- to- one teaching,
small group approaches, and other less formal, non class room varieties of instruction. Clinical
psychologists often spend significant portions of their time supervising students, interns and others.
Becoming skilled in the therapy and assessment techniques requires more than just reading textbooks. It
also involves seeing clients and then discussing their cases with a more experienced supervisor.
During supervision, clinical psychologists discuss the trainee's clinical cases in depth while providing
therapeutic guidance as they learn psychotherapy or psychological testing skills. In short one learns by
doing but under the controlled and secure conditions of a trainee- supervisor relationship.
5. RESEARCH
Clinical psychology has grown out of an academic research tradition. As a result, when clinical training
programs were first established after World War II, the scientist- practitioner model was adopted. This
meant that in contrast to other mental health workers such as psychiatrist or social worker, all clinicians
were to be trained both as scientist and as practitioner. Although this research emphasis may not be as
prominent in some training programs as it once was, the fact remains that clinical psychologists are in a
unique position both to evaluate research conducted by others and to conduct their own research.
Clinical psychology research can be both basic and applied. Among the health care professions, clinical
psychology is one of the few to provide extensive research training. Thus, clinical psychologists are
well suited to design, implement, and evaluate research and conduct program evaluation/quality
assurance programs as part of their activities.
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Research is an integral activity of clinical psychologists working in academic and clinical settings. The
range of research projects carried out by clinicians is enormous. Clinical studies include search for the
causes of mental disorders, development and validation of assessment devices, evaluation of therapy
techniques and so on. By virtue of their training in research, clinical psychologists have the ability both
to consume and produce new knowledge.
6. CONSULTATION
Consultation, regardless of the setting in which it occurs, or the particular purpose it has, is a significant
activity of many clinical psychologists. A growing number of clinical psychologists serve as
consultants. In consultation, the goal is to increase the effectiveness of those to whom one's efforts are
directed by imparting to them some degree of expertise. Consultation might involve an informal
discussion, a brief report, or a more ongoing and formal consultation arrangement. It takes innumerable
forms, in many different settings.
For example, companies might consult with a clinical psychologist to help reduce co-worker conflicts or
provide stress management strategies for high stress employees such as business executives, fire
fighters, police officers, or prison guards. Consultation might involve helping a physician to better
manage patient non-compliance with unpleasant medical procedures. Consultation might also include
assessment, teaching, research, and brief psychotherapy activities.
Consultation can run the gamut from clinical cases to matter of business, personnel and profit. It can
deal with individuals or entire organizations. Sometimes it is remedial, other times it is oriented toward
prevention.
7. PROGRAM DEVELOPMENT
Clinical psychologists are often asked to contribute to the development of treatment/evaluation
programs, and should obtain appropriate supervised experience in such activities during their training.
They typically work with other professionals, either directly or indirectly, who are also providing
professional services to the client.
As such, clinical psychologists must be skilled in interacting with other professionals in a respectful and
helpful manner to develop successful programs.
8. ADMINISTRATION
Nearly every clinical psychologist spends time on administrative tasks. For example, client records must
be maintained, the clients' clinical reports must be maintained, the policies and procedures for clinical or
research operations are to be developed, etc.
Some clinicians become full- time administrators. It would be difficult to list all the sorts of
administrative posts held by clinical psychologists. However, here are a few examples:
Head of a university psychology department, director of a veterans administration clinic, vice president
of a consulting firm, director of the clinical training program, chief psychologist in the hospital etc.
To Summarize,
We can say that, CLINICAL PSYCHOLOGY is one of the largest and most popular fields in
psychology. Clinical psychologists assess and treat a wide range of psychological problems. These
problems range from short-term emotional crises, such as those due to family conflicts, to severe and
chronic mental illnesses, such as schizophrenia.
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Clinical Psychology­ (PSY401)
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Some clinical psychologists specialize in treating specific problems, such as phobias or depression.
Others specialize in treating specific populations, such as children, the elderly, or members of ethnic
minority groups.
Clinical psychologists usually seek to treat emotional and behavioral problems with psychotherapy, a
form of intervention that relies primarily on verbal communication between therapist and client. In
addition, many clinical psychologists study the normal human personality and the ways in which
individuals differ from one another in their patterns of thinking, feeling, behaving, and relating to
others.
Still other clinical psychologists administer and interpret various kinds of psychological tests. These
include personality tests, intelligence tests, and aptitude tests. These tests are routinely given in schools
and businesses to assess an individual's skills, interests, and emotional functioning.
Clinical psychologists also use psychological tests to diagnose possible mental disorders. By identifying
early signs of distress or mental disturbance, clinical
psychologists work to promote mental health and to prevent mental disorders.
EDUCATION AND TRAINING OF A CLINICAL PSYCHOLOGIST
The road to becoming a clinical psychologist is a long one divided by a number of distinct stages and
phases that include college, graduate school, clinical internship, post doctoral fellowship, licensure and
finally employment, continuing education and advanced certification.
EDUCATION
GRADUATE WORK
The typical clinical psychology student in the United States completes a bachelor's degree and then five
years of graduate work. It typically includes training in assessment, research, diagnosis and therapeutic
skills, along with an internship.
MASTERS DEGREE PROGRAM
There are also clinical psychology programs that award the master's degree. Because of contemporary
licensing laws that dictate who may practice independently as a psychologist, fewer individuals
graduating from master's programs can achieve in the way of professional independence. Past evidence
suggests that sub doctoral-level clinicians, are paid less, and are not perceived fully licensed to practice
independently. The American Psychological Association also accepts the doctoral degree alone as the
key to work as an independent professional.
PHD / PSY.D PROGRAM
A student interested in obtaining a doctorate degree in clinical psychology can choose between two
types of degrees; the traditional PhD (Doctorate of Philosophy) or Psy.D (Doctorate of Psychology).
Although the American Psychological Association recommends a core curriculum of courses and
activities (APA 1987b), each program maintain its own unique orientation based on the faculty and the
traditions of the programs.
In researching graduate programs, one will find that each program has its own unique balance on
emphasizing the roles of biological, psychological and social factors in human behavior.
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POST DOCTORATE
It requires 1-2 years of post doctoral training and supervision before one is eligible to take the national
licensing examination. It includes clinical work as well as research, teaching and other professional
activities.
Overall students interested in becoming clinical psychologists and gaining admission into quality
graduate programs must take their college experience very seriously. Completing courses in psychology,
research design and statistics as well as having excellent grades, GRE scores and clinical experience
during the college years are very important.
CLINICAL PSYCHOLOGY EDUCATION IN PAKISTAN
To be a clinical psychologist, students have to complete Masters in Psychology (M.Sc. Psychology)
from an HEC recognized university. After that they must take a specialization course in clinical
practice.
It is not necessary to take a GRE test to get admission to any of the specialized clinical training
programs offered within the country. An excellent GPA and a good score in entry test and interview,
however, is a must.
The following specializations are being offered in Pakistan:
Advanced Diploma in Clinical Psychology (ADCP) duration: 18 months.
Masters in Clinical Psychology (M.S. Clinical) duration: 2 years.
Doctorate in Clinical Psychology (D. Clinical) duration: 2 years (after M.S. Clinical) or 3 years (after
ADCP).
TRAINING OF A CLINICAL PSYCHOLOGIST
The process of training of a clinical psychologist is very long and intensive. There are disagreements
among clinicians as to how to train the psychologists and in what direction the field should move.
However it is useful to remember that clinical psychology is but a specialized application of the more
basic core of psychology.
Within the United States, two different models of training have developed, one leading to the doctor of
Philosophy (PhD). The other is the doctor of Psychology
(Psy.D) degree. The basic difference between the two lies in their relative emphasis on the importance
of psychological research in the training of doctoral level clinical psychologists. The predominant
training philosophy in clinical psychology today is the scientist-practitioner model (leading to PhD).
COURSEWORK
Clinical students normally must take a series of basic courses such as statistics and research design,
biological foundations of behavior, social psychology,
developmental psychology, and cognitive psychology.
The exact number and content of these courses will vary somewhat from program to program. The
intent is to give the student an understanding of the basics that underlie human behavior or that permit
us to investigate that behavior.
These courses provide a strong scientific foundation for the student's clinical training and give life to
the scientist-practitioner model in clinical psychology. Clinical students also enroll in several courses
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Clinical Psychology­ (PSY401)
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that teach the fundamentals of clinical practice or deal with clinical topics at an advanced level. For
example, there are often courses in psychopathology, theory and research in therapy, or principles of
cognitive-behavioral interventions, or seminars in such topics as schizophrenia, methods of family and
group therapy, community psychology, or neuropsychological assessment.
PRACTICUM WORK
Books and coursework are fine, but ultimately one must learn by doing. As a result, all programs seek to
build the student's clinical skills through exposure to clinical practice.
The dictionary defines a practicum as "work done by an advanced student that involves the practical
application of previously studies theory". Whatever the specific form or content of the practicum
experience, it is a major vehicle for the acquisition of specific clinical skills.
The student's practicum work is supervised by clinical faculty member or by clinicians in the
community who have special skills. Most psychology departments that have clinical training programs
also operate a psychological clinic.
RESEARCH
The implementation of the scientist-practitioner model requires that the student develop research
competency. This is accomplished through courses in statistics, computer methods, and research
methodology and also by active participation in research projects. There are differences among schools
as to the extent of their commitment to the scientist-practitioner approach to training. Programs that
emphasize the research commitment usually see to it that research experience is not confined to the
thesis and dissertation. In one department, for example, each clinical student joins the research "team"
of a faculty member.
THE INTERNSHIP
The internship is a vital part of any training program. It is the capstone of the student's previous
experience in clinical courses and practice and provides the experience that begins to consolidate the
scientist-practitioner role. It allows the student to work full-time in a professional setting, and also in
acquiring new skills.
An internship of one sort or another is required of all students in clinical programs accredited by the
APA. The internship most often seems to come at the end of graduate training.
To Summarize,
Clinical psychologist's training is an essential factor to warrant professional competence. Such training
is the starting point of psychologist's professional activity and has to be permanently updated. Training
has to be theoretical as well as practical and must use appropriate methodology according to specific
targets to be reached.
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Table of Contents:
  1. MENTAL HEALTH TODAY: A QUICK LOOK OF THE PICTURE:PARA-PROFESSIONALS
  2. THE SKILLS & ACTIVITIES OF A CLINICAL PSYCHOLOGIST:THE INTERNSHIP
  3. HOW A CLINICAL PSYCHOLOGIST THINKS:Brianís Case; an example, PREDICTION
  4. HISTORICAL OVERVIEW OF CLINICAL PSYCHOLOGY:THE GREEK PERIOD
  5. HISTORY OF CLINICAL PSYCHOLOGY:Research, Assessment, CONCLUSION
  6. HOW CLINICAL PSYCHOLOGISTS BECAME INVOLVED IN TREATMENT
  7. MODELS OF TRAINING IN CLINICAL PSYCHOLOGY:PROFESSIONAL SCHOOLS
  8. CURRENT ISSUES IN CLINICAL PSYCHOLOGY:CERTIFICATION, LICENSING
  9. ETHICAL STANDARDS FOR CLINICAL PSYCHOLOGISTS:PREAMBLE
  10. THE ROLE OF RESEARCH IN CLINICAL PSYCHOLOGY:LIMITATION
  11. THE RESEARCH PROCESS:GENERATING HYPOTHESES, RESEARCH METHODS
  12. THE CONCEPT OF ABNORMAL BEHAVIOR & MENTAL ILLNESS
  13. CAUSES OF MENTAL ILLNESOVERVIEW OF ETIOLOGY:PANDAS
  14. THE PROCESS OF DIAGNOSIS:ADVANTAGES OF DIAGNOSIS, DESCRIPTION
  15. THE CONCEPT OF PSYCHOLOGICAL ASSESSMENT IN CLINICAL PSYCHOLOGY
  16. THE CLINICAL INTERVIEW:The intake / admission interview, Structured interview
  17. THE ASSESSMENT OF INTELLIGENCE:RELIABILTY AND VALIDITY, CATTELLíS THEORY
  18. INTELLIGENCE TESTS:PURPOSE, COMMON PROCEDURES, PURPOSE
  19. THE USE AND ABUSE OF PSYCHOLOGICAL TESTING:PERSONALITY
  20. THE PROJECTIVE PERSONALITY TESTS:THE RORSCHACH
  21. THE OBSERVATIONAL ASSESSMENT AND ITS TYPES:Home Observation
  22. THE BEHAVIORAL ASSESSMENT THROUGH INTERVIEWS, INVENTORIES AND CHECK LISTS
  23. THE PROCESS AND ACCURACY OF CLINICAL JUDGEMENT:Comparison Studies
  24. METHODS OF IMPROVING INTERPRETATION AND JUDGMENT
  25. PSYCHOLOGICAL INTERVENTIONS AND THEIR GOALS:THE EXPERT ROLE
  26. IMPORTANCE OF PSYCHOTHERAPY:ETHICAL CONSIDERATIONS
  27. COURSE OF NEW CLINICAL INTERVENTIONS:IMPLEMENTING TREATMENT
  28. NATURE OF SPECIFIC THERAPEUTIC VARIABLES:CLIENTíS MOTIVATION
  29. THE BEGINNING OF PSYCHOANALYSIS:THE CASE OF ANNA, THE INSTINCTS
  30. PSYCHOANALYTIC ALTERNATIVES:EGO ANALYSIS, CURATIVE FACTORS
  31. CLIENT CENTERED THERAPY:PURPOSE, BACKGROUND, PROCESS
  32. GESTALT THERAPY METHODS AND PROCEDURES:SELF-DIALOGUE
  33. ORIGINS AND TRADITIONAL TECHNIQUES OF BEHAVIOR THERAPY
  34. COGNITIVE BEHAVIORAL THERAPY:MODELING, RATIONAL RESTRUCTURING
  35. GROUP THERAPY: METHODS AND PROCEDURES:CURATIVE FACTORS
  36. FAMILY AND COUPLES THERAPY:POSSIBLE RISKS
  37. INTRODUCTION AND HISTORY OF COMMUNITY PSYCHOLOGY:THE ENVIRONMENT
  38. METHODS OF INTERVENTION AND CHANGE IN COMMUNITY PSYCHOLOGY
  39. INTRODUCTION AND HISTORY OF HEALTH PSYCHOLOGY
  40. APPLICATIONS OF HEALTH PSYCHOLOGY:OBESITY, HEALTH CARE TRENDS
  41. NEUROPSYCHOLOGY PERSPECTIVES AND HISTORY:STRUCTURE AND FUNCTION
  42. METHODS OF NEUROLOGICAL ASSESSMENT:Level Of Performance, Pattern Analysis
  43. FORENSIC PSYCHOLOGY:Qualification, Testifying, Cross Examination, Criminal Cases
  44. PEDIATRIC AND CHILD PSYCHOLOGY: HISTORY AND PERSPECTIVE
  45. INTERVENTIONS & TRAINING IN PEDIATRIC AND CLINICAL CHILD PSYCHOLOGY