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HOW A CLINICAL PSYCHOLOGIST THINKS:Brian’s Case; an example, PREDICTION

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Clinical Psychology­ (PSY401)
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Lesson 03
HOW A CLINICAL PSYCHOLOGIST THINKS
Although the science and the practice of clinical psychology may sound different, they are linked by a
common way of thinking about people and the problems they experience. A series of four tasks are
central to how clinical psychologists think about people and problems, whether in generating research
and knowledge for the field as a whole or for gaining a better understanding of a given individual.
These tasks are:
1. Description,
2. Explanation,
3. Prediction, and
4. Change of human functioning.
1. Description
Accurate understanding of any individual or any psychological problem begins with a careful
description of the person and the contexts in which she or he lives. In individual cases this description
includes attention to the nature of the person's current functioning as well as a careful documentation of
his / her prior development.
In the broader field of clinical psychology, this description includes the development of systems for
classification or categorization (taxonomies) of problems that are considered the subject matter of the
field, the development of sound tools for the measurement of these problems, and documentation of the
prevalence of these problems.
Brian's Case; an example
Imagine that you are working as a clinical psychologist, and an adolescent is referred to you for help.
Brian is 16 years old. Approximately one year ago his parents went through a very difficult divorce.
Following his parents' divorce, Brian, his mother, and younger sister moved to a new town in order for
his mother to begin a new job and for the family to try to "start over". Because Brian's father did not
provide regular financial support, the family was faced with significant economic difficulties as they
tried to get by on his mother's salary. Brian did not adjust well either to his parents' divorce or to the
move to a new school and town. He had difficulty making new friends at school and became
progressively more withdrawn and lonely. Three months before coming to see you, Brian became
severely depressed and made a serious, but uncompleted, suicide attempt.
You are faced with a number of important questions in your initial meetings with him. Is there a specific
pattern of behaviors, thoughts, or feelings that characterize the difficulties that Brian is experiencing?
Are these problems unique to him, or are they similar to difficulties experienced by other people?
After some initial information has been obtained about a person, clinical psychologists must formulate a
series of questions to systematically gain more information. These questions should be guided by a
sound theory of human behavior and by research findings regarding the problems of the individual
client.
The questions may include the following:
What are Brian's strengths and competencies?
In what areas of life has he been successful?
What aspects of life are satisfying to him?
What are his future plans (regarding his suicidal tendency)?
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Answers to these questions are part of the task of developing a careful, detailed description of the scope
and nature of Brian's problems, his strengths and capabilities, and the environment or context in which
he lives.
Clinical science is concerned with identification of patterns of problematic behaviors, emotions, and
thoughts that can be carefully and reliably documented in more than one point in time. Accurate
description is dependent on tools for reliably measuring the behaviors, thoughts, and feelings of
individuals. The most important observations and descriptions are those that focus on consistent patterns
of problematic behaviors across individuals and within the same individual over time. For example, is
Brian representative of a large group of individuals who display a similar pattern of behaviors? If it is
the case, such description places Brian's problems into a broader context of the nature of depression
during adolescence.
2. Explanation
Description of an individual or a psychological problem is not adequate for complete understanding of
that person or problem. It is imperative that clinical psychologists develop careful models to explain
how or why the problem developed, either in an individual or in people in general.
This task includes the development and testing of models of etiology or cause, including but not limited
to the use of experimental methods to test causality. The explanation enterprise of psychological science
and of psychological practice involves the generation of hypotheses about an individual or a problem,
hypotheses that can then be carefully and rigorously tested.
Why did Brian attempt to take his life? Why has he sunk into a behavioral pattern in which he is
overwhelmed by daily responsibilities and feels that he has lost control over his own life? These
questions lead to an answer: "because of his parents' divorce". But this answer again leads to more
general questions such as "what are the psychological consequences of the parental divorce and the
losses and stresses that are associated with divorce?" and "what is the relationship between such a loss
and later depression, suicidal ideation, or suicide attempts?"
The answers to these questions lie beyond information that you can obtain by examining a single case
such as Brian's. Here you must turn to the broader science of psychology for an explanation of the
problems that Brian is experiencing. From here, the process of research begins, that attempts to focus on
all possible dimensions of the problem. For example, what are the consequences of parental separation
and divorce on the psychological functioning of the children and adolescents? Are the effects of divorce
long term or short term? Are there other factors (biological, environmental, etc.) associated with this
problem? And so on.
The clinical psychologists develop explanations of problematic behavior using these questions as
guidelines for research. They may explain psychological problems emphasizing the role of biological
factors, cognitive schemas and networking, conditioning and learning processes, interpersonal
relationships, and an integration of one or more of these factors.
3. PREDICTION
The most stringent and necessary test of any explanation is to see if it leads to predictions that are
supported by empirical research. The importance of prediction, like description and explanation, is
evident in the work of psychologists helping individuals as well as in the work of clinical researchers
trying to understand a problem in the general population. Prediction is possible only through repeated
observations in which conditions are either controlled or well understood.
As you treat Brian's depression, you must try to predict the course of his symptoms in the initial weeks
and months of his treatment. He has made an attempt to take his own life, and you must make a
judgment about the likelihood that he will make another suicide attempt. What factors would be useful
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in trying to predict subsequent suicidal thinking or attempts? Even if he does not make another attempt
on his life, you must make a prediction about the likely course of his current problems. Are these
problems likely to continue? Will they remit on their own, or is psychological treatment or medication
necessary? Are there certain psychological treatments that are likely to be effective in treating his
depression?
In research, prediction is tested in two ways: (a) longitudinal studies of the course of problems as they
occur in real life; and (b) experimental studies testing specific predictions or hypotheses under
controlled circumstances. In both methods, the goal of clinical psychologist is to try to identify cause-
and-effect relationships regarding important clinical problems.
4. CHANGE
Because clinical psychology involves the application of psychological knowledge to alleviate human
problems, it is not enough for clinical psychologists to describe, explain, or predict human functioning.
Clinical psychologists must also be concerned with producing change in people's lives. Specifically,
clinical psychologists develop and carry out planned and controlled interventions for the treatment and
prevention of psychopathology, for coping with and prevention of some forms of physical illness, and
for the promotion of psychological and physiological health. Facilitating change is a goal of researchers
and practicing clinicians alike.
Efforts to change people's lives must be based on research evidence that allows the clinician to make
reasonable predictions about the effects of specific interventions. For example, what should you expect
if you encourage Brian to discuss his feelings, including both his sense of sadness and his feelings of
anger, about his parents' divorce? Is this discussion likely to lead to meaningful and lasting changes in
his behavior, thoughts, and emotions? Alternatively, what is likely to happen if you systematically
encourage and reward Brian for increasing his involvement in pleasant and constructive activities
involving school, sports and friends? Will making changes in his behavior be sufficient to alleviate his
deep feelings of loss related to his parents' divorce? And from a different perspective, it may be
important to change how Brian thinks about his parents, about himself, and about the reasons for his
parents' divorce. If Brian learns to think about his parents' divorce in a different way, will this new way
of thinking lead to meaningful changes in his emotions and behaviors?
Clinical psychologists are concerned with developing much more than a set of techniques for helping
people change. They are committed to developing a broad set of principles to understand how and why
people change. Clinical psychologists are more than technicians who can follow a set of procedures
designed to help a person deal with a problem or change some aspect of his or her behavior.
Clinical psychologists need to understand whether certain techniques work with some people or some
problems and not others, and they need to understand the reasons that these techniques work. Without
this type of comprehensive understanding of the mechanisms of how people change, psychologists
cannot continue to systematically improve the ways that they can help people, and they may be unaware
of ways to generalize their current methods to different people or problems.
CLINICAL PSYCHOLOGY EMPLOYMENT SETTINGS
Clinical psychologists are found in a number of service settings, including the following:
General Hospitals and Medical Clinics;
Mental Health Clinics and Psychiatric Hospitals; Rehabilitation Hospitals and Clinics;
Community Service Agencies;
Private Practice;
Universities and Colleges;
Industry;
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The Military;
Prisons and Correctional Facilities;
Private and Government Research Agencies; and
Schools.
Research on the employment settings of clinical psychologists reveals that the most frequent
employment setting for clinical psychologists is private practice, while the university settings are the
second most common employment sites.
The following table shows the different employment sites for clinical psychologists in the United
States during year 1997.
Employment Site
Percentage in Year: 1997
Psychiatric hospital
05 %
General hospital
04 %
Outpatient clinic
04 %
Community mental health center
04 %
Medical school
09 %
Private practice
40 %
University settings
19 %
Other settings
11 %
PRIVATE PRACTICE
About 40% of clinical psychologists work in solo or group private practices. As a private practitioner,
the clinical psychologist offers certain services to the public, as much as a dentist or general medical
doctor does.
Office hours are established and patients (i.e. clients) are seen for assessment, diagnosis and
psychotherapy. Fees are charged for services rendered.
Many psychologists are drawn to independently providing direct clinical, consultation and other
professional services to their clients and enjoy being their own boss and setting their own hours and
policies. Research supports that, private practitioners report more job satisfaction (Norcross&
Prochaska, 1983; Norcross, Karg & Prochaska 1997a) and less job stress than other psychologists.
COLLEGES AND UNIVERSITIES
About 20% of clinical psychologists are employed in academic environments (American Psychological
Association, 1993a). Most of these psychologists work as Professors. They generally teach psychology
courses, supervise the clinical and or research work of psychology students and conduct both
independent and collaborative research.
They also typically serve on various college or university committees, providing leadership and
assistance with the academic community. Some clinical psychologists work in academic clinical
settings, such as student counseling centers, providing direct clinical services to students.
HOSPITALS
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Many clinical psychologists work in hospital settings. They may conduct psychological testing, provide
individual, family or group psychotherapy act as a consultant to other mental health or medical
professionals on psychiatric or general medical hospital units, and may serve in administrative roles
such as unit chief on a psychiatric ward.
Many states now allow psychologists to become full members of the medical staff of hospitals. In
California, for example, psychologists are allowed to have full admitting, discharge and treatment
privileges which allow them to treat their patients when they are hospitalized and to participate in
hospital committees.
MEDICAL SCHOOLS
Clinical psychologists serve on the faculties of many medical schools. They typically act as "clinical
faculty", which generally involves several hours (i.e., two to four) per week of pro bono time
contributed to the training of medical center trainees. These trainees might include psychiatry residents,
other medical residents (e.g., pediatric residents), medical students, nursing students or non-medical
hospital trainees such as psychology interns or postdoctoral fellows, social work interns, nursing
students etc.
These psychologists might conduct seminars & workshops or provide individual case supervision and
consultation. Psychologists may also serve as academic or research faculty at medical schools.
OUTPATIENT CLINICS
Many psychologists work in various outpatient clinics such as community mental health centers. These
psychologists often provide a range of clinical services to other professionals and organizations.
For example, these psychologists might provide psychotherapy for children who have been abused or
group therapy for adult substance abusers. They might also provide parent education classes. While
psychologists in these settings may conduct research, direct clinical service is often the primary activity
and priority of these settings.
BUISNESS AND INDUSTRY
Many clinical psychologists working in business and industry settings offer consultation services to
management, assessment and brief psychotherapy to employees, and conduct research on various
psychosocial issues important to company functioning and performance.
For example, these psychologists might consult with the human resource department, provide stress
management workshops, or conduct interpersonal skills building workshops. Psychologists might help
managers learn to improve their ability to motivate and supervise their employees. They may assist in
developing strategies for interviewing and hiring job applicants.
MILITARY
Many clinical psychologists are employed by one of the branches of the military such as the Navy, Air
Force, or Army. They often provide direct clinical services. Some conduct research while others act as
administrators in military hospitals and clinics. Psychologists also act as civilians working in military
hospitals. Typically psychologists working in the military hold an officer rank such as captain.
FORENSIC PSYCHOLOGIST (PRISON AND PROBATION SERVICES)
Forensic psychology is concerned with the behavior of individuals within the judicial and penal
systems, such as offenders, victims, witnesses, judges, juries, prisoners and prison staff. Much of the
work of a clinical forensic psychologist focuses on therapy in correctional settings where specific
activities include:
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a) Carrying out one-to-one assessments - often to assess the risk of re-offending) or to assess the risk of
suicide or self-injury;
b) Developing and evaluating the contribution of assessment techniques such as psychometrics;
c) Undertaking research projects to evaluate the contribution of specific service elements, policy
initiatives or group program developments, e.g. exploring probation 'drop-out' rates or evaluating a
group program;
d) Participating in the delivery of, or acting as coordinating 'Treatment Manager' for, nationally
recognized cognitive-behavioral group programs, e.g. Enhanced Thinking Skills or Sex Offender
Treatment Program;
e) Overseeing the training of prison/probation service staff.
f) Dedicating time to the preparation of court reports.
OTHER LOCATIONS
This category includes
·
Professional schools
·
Correctional facilities
·
Managed care organizations
·
Nursing homes
·
Child and family services
·
Rehabilitation centers
·
School systems
·
Health maintenance organizations and so on.
PROS AND CONS OF A CAREER IN CLINICAL PSYCHOLOGY
Some key points to consider in support of Clinical psychology:
Personal Fulfillment Working with and helping clients can bring a great deal of personal satisfaction.
Making a Difference Unique feelings come when you see a client make changes in their lives because
you have helped them.
Being Your Own Boss In private practice, clinical and counseling psychologists are often their own
bosses and set their own hours.
Changing Environment Each client provides different and interesting information about himself or
herself; therefore, the psychologist is rarely bored from doing routine work.
Learning Experience  Clients' diagnoses and therapeutic plans tend to be at least somewhat unique,
providing ongoing learning opportunities.
Some cautions
The education and training is very demanding and prolonged.
There are cases when treatment may produce little or no improvement in the client's condition.
Paperwork associated with each client requires enormous care. Health insurance companies alone
require a lot of detailed documentation about clients.
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CONCLUSION
Clinical psychologists are unique from other mental health professionals in their provided services,
service settings, populations seen, and knowledge base.
Populations Seen
Clinical psychologists work with a broad range of populations, including the following: individuals
(infants, children, adolescents, adults, and the elderly); couples (regardless of gender composition);
families (traditional, multi- generational, and blended families); groups; organizations; and systems.
Service Settings
Clinical psychologists are found in a number of service settings, including the following: General
Hospitals and Medical Clinics; Mental Health Clinics and Psychiatric Hospitals; Rehabilitation
Hospitals and Clinics; Community Service Agencies; Private Practice; Universities and Colleges;
Industry; the Military; Prisons and Correctional Facilities; Private and Government Research Agencies;
and Schools.
Services Provided
The typical services provided by clinical psychologists include: assessment and measurement;
diagnosis; treatment; consultation: teaching and supervision; policy planning; research; program
evaluation; and, administration.
Knowledge Base
The knowledge base within clinical psychology is so broad that no individual clinical psychologist can
become competent in all areas of clinical psychology. Therefore, clinical psychologists must function
within the specific limits of their competence (i.e., knowledge and expertise), and are expected to
clearly acknowledge the limitations of their scope of practice. Clinical psychologists are responsible for
referring to others (either within or outside the area of clinical psychology) when they are faced with a
task outside of the limits of their knowledge and skill.
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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:Brian’s 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, CATTELL’S 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:CLIENT’S 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