Roles of A Clinician

1. Assessment
 Clinicians assess patients using a variety of method
to collect information about people.
 For diagnosis
 Guide a client towards an optimal vocation
 Selection of job candidates
 Describe a client’s personality
 Guide legal decisions to institutions
 Establish pre-treatment baseline levels

2. Treatment
 Designing interventions such as psychotherapy,
behavior modification, psychological counselling,
depending on the theoretical orientation of the
clinician.

3. Conducting Research
 Development and standardization of clinical tools
 A branch in psychology that studies, assesses, and
for diagnostic assessment tests and examination of
treats people with psychological problems or
their reliability, and validity;
disorders.
 Adapting and testing the efficacy of both
psychological and biological interventions
The field of Clinical Psychology integrates science,
theory, and practice to understand, predict, and
4. Teaching
alleviate maladjustment, disability, and discomfort as
 teach Psychology subjects to undergraduate and
well as to promote human adaptation, adjustment, and
graduate students;
personal development.
development. It focuses on the intellectual,
 in the field, clinicians guide student-interns in their
emotional, biological, psychological, social, and
on-the-job trainings.
behavioral aspects of human functioning across the
lifespan, in varying cultures at the socioeconomic levels.
levels.
5. Consultation
 Provide advice to organizations about a variety of
Clinical psychology is the psychological specialty that
problems and activities in the aspects of research,
provides continuing and comprehensive mental and
teaching.
assessment, treatment, and teaching.
behavioral health care for individuals and families;
consultation to agencies and communities; training,
Mental Health Practitioners
education and supervision; and research-based practice.
Psychometrician, Pyschologits and Psychometrician
It is a specialty in breadth — one that is broadly
inclusive of severe psychopathology — and marked by
Educational Requirements
comprehensiveness and integration of knowledge and
skill from a broad array of disciplines within and outside
Psychometrician Psychologist Psychiatrist
of psychology proper. The scope of clinical psychology
encompasses all ages, multiple diversities and varied
Bachelor’s Masters degree Medical degree
systems.
degree in in psychology (Doctor of
Psychology PhD or PsyD Medicine)
Clinical Psychology is the scientific study of mental
doctoral degree Residency in
health, personality and everyday adjustment. It is the
Psychiatry
branch of psychology engaged in the diagnosis,
treatment and prevention of psychological problems,
i.e., mental, emotional and or behavioral problems. It is
a specialty that involves the application of psychology
for the purpose of understanding, preventing, and
addressing psychologically-based distress or
dysfunction.

Psychometrician (RPm)
 Test construction, validation, and standardization

LEC 2: Historical Events in Clinical
 Administering and scoring objective and structured Psychology
personality test.

 Interpreting the result of these tests and preparing William Tuke (1796)
written reports.  Founder of the York
 Conducting intake interviews before psychiatric Retreat in England
consultations and psychological interventions  “The Retreat”
Retreat” or “York
Retreat”
Retreat” – mental health
Psychologist (RPsy) facility which led the
world in the humane
 Provide psychological treatments treatment of the mentally
ill.
 Conduct counseling using different therapies
 Conduct psychological assessments, such as IQ test,
personality tests, & projective techniques.

Psychiatrist (M.D.) The York Retreat –

mental health facility
 Identifying a particular disorder (diagnosis)
 Prescribes medicine
 Conduct psychotherapy

Painting of the York Retreat by George Isaac

Sidebottom, a patient in the 1890s-early 1900s

Philippe Pinel (1801)

 Published a book about
the humane treatment
of mentally ill
 “Medico-Philosophical
Treatise on Mental
Alienation on Mania” –
collection of his case
studies in which he
analyzes each of his
patients and discussed a
treatment in a
psychologically-oriented
approach
Eli Todd (1824)
 founder of Harford 1880: U.S Census Bureau listed 7 categories
Retreat in Connecticut, of mental disorders
and represented a
generation of  DEMENTIA
transition in mental  DIPSOMANIA
health.  EPILEPSY
 believed that it is best  MANIA
to treat insanity, both  MELANCHOLIA
in moral and physical  MONOMANIA
ways.  PARESIS

James McKeen Cattell (1890)

Hartford Retreat  American
 Used a moral psychologist who
curative approach in oriented US
dealing with patients psychology towards
with mental illness. the use of “mental
 Tranquil, kind test”
test”.
environment to  Dynamometer
pacify patients and pressure, rate of
allowed respite from hand movement,
the society. reaction time for
sound are some of
John S. Butler the mental tests he
 Superintendent at the Hartford Retreat after Dr. Eli created.
Todd; made a way to cater the increasing number
of patients Sir Francis Galton (1891)
 researched on individual
differences; which led him
to devise measures:
“Keenness of Sight and
Hearing, Color Sense,
Judgment of Eye,
Breathing Power,
Dorothea Dix (1841) Reaction time, and so on.
 educator and social  Introduced fingerprinting
reformer; her devotion for identification
to the welfare of
mentally ill.
 encountered horrific American Psychological Association was
conditions in Boston founded in July 1892
prison, prompting
 A small group of men interested in “the new
extensive efforts for
psychology”
psychology” founded APA at the University of
better treatment.
Pennsylvania. Initially, they gathered 31 individuals,
 toured the country
including themselves, to be members of the group.
documenting the
 G. Stanley Hall became APA’s first president
conditions and treatment of patients, campaigning
asylums for the mentally ill.
 Her efforts directly affected the building of 32
Emil Kraepelin (1893)
(1893)
institutions in the US
 German psychiatrist who
worked on understanding
mental illnesses based on
natural scientific concepts.
 proposed the early
diagnostic category,
 “dementia praecox”
praecox” Psychological Corporation was established in
 identified that pathogenesis and manifestation of New York City in 1921.
psychiatric disorders
 pioneered in the field of psychopharmacological •Founded by James McKeen Cattell, along with Robert
research Woodworth and Edward Lee Thorndike; they market
psychological tests and related materials to educational,
Lightner Witmer (1896) corporate, and government clients.
 Opened the first •Known to be PsyCorp until now, but it is under
psychological clinic at Pearson Assessment (Source:www.pearsonclinical.co.uk)
the University of
Pennsylvania Rorschach Inkblot technique was published in 1921.
 coined the term,  developed by Hermann Rorschach to measure
“Clinical Psychology”
Psychology” thought disorder to identify mental illness.

Binet-Simon Intelligence Test (1905

 series of tests designed
to assess mental
abilities (focused on
attention and memory)
by Alfred Binet and
Theodore Simon. Thematic Apperception Test was published in 1935.
Sample item:  First developed by Henry Murray and Christiana
Execute simple command Morgan.
and imitate simple gesture  Subjects tend to interpret or describe ambiguous
situations based on their own past experiences and
motivations in the form of stories.
Stanford-Binet
Intelligence Test (1916)
 test translated by
Lewis Terman, a
psychologist at
Stanford University,
and was published in
the United States as a
means of gauging
intelligence.
 Had heavy reliance on
vocabulary/language Wechsler-Bellevue Intellifence test was published in
skills tested on gifted children 1939.
 David Wechsler designed a general intelligence test
American Association of Clinical that consisted 11 subtests, divided into two parts:
Psychologists was founded in December 28, verbal and performance, for adults.
1917.

•A group of eight psychologists at Carneige Institute oF

Technology founded the group, focusing on clinical
psychology, only.
•J. E Wallace Wallin was elected as the chairperson.
•The group lasted only for 2 years, because the
objective was almost similar with the APA’s.
Minnesota Multiphasic Personality Inventory was APA published first ethical code.
published in 1943.
 outlines aspirational
 Developed by principles as well as
Starke Hathaway enforceable standards
and J.C. McKinley, that psychologists should
both are faculty use when making
members at the decisions
University of
Minnesota.
 psychological test
that assesses
personality traits Vail conference was held, and yielded PsyD (doctor of
and psychopathology. Psychology) and practitioner-scholar training model in
1973.
Boulder Conference (1949)
1970s – onwards: updates and revisions of
psychological tests, researches, and psychotherapies.

 First national training conference on clinical

psychology held in Boulder, Colorado.
 Conference gave equal weight to science and
practice; the role of psychologist being seen as
science-practitioner.

DSM was published in 1952.

 Diagnostic and Statistical Manual of Mental
Disorder - a manual that sets classification
and diagnosis standards used by clinicians,
researchers, regulation agencies and health
insurers worldwide.
  Perform series of therapeutic tasks and prescribe
tasks for patients to complete at home.
 Include exposure to stimuli and aversion practices,
such as:
 Initiating punishments every time one exhibit
problematic behaviors
 Giving rewards after exhibiting good behaviors

Behavioral Theorists

 Ivan Pavlov – discovery of Classical Conditioning

 B.F. Skinner-
Skinner- learning is a process of 'conditioning'
 Oldest clinical in an environment of stimulus, reward and
psychology theory punishment.
 Bears the strongest  Edward Thorndike- Stimulus Response Theory;
similarity to the believed that learning boils down to two things:
preconception of stimulus, and response.
clinical psychology  John Watson- Theory of Behaviorism- focused not
 Founded by Sigmund on the internal emotional and psychological
Freud in the 1800s conditions of people, but rather on their external
 Originally termed as and outward behaviors.
“psychoanalysis”  Edward Tolman- combines the objective study of
behavior while also considering the purpose or
 Analysis of how one’
one’s past experiences influence goal of behavior. Tolman thought that learning
one’
one’s current behaviors and emotions developed from knowledge about the environment
 Psychoanalysts of the past and psychodynamic and how the organism relates to its environment
therapists of today agree that one cannot fully heal
and function with unprocessed underlying traumas. COGNITIVE
 Typically long-term, frequent, and grounded  Involves homework and
mostly in verbal communication focuses on the present, as
well as the future.
Psychodynamic Theories  Founded by Aaron Beck in
 Sigmund Freud-Structural
Freud-Structural Model of Personality the 1950s
 Carl Jung-Collective unconscious-believed that  Focuses on how thoughts
human beings are connected to each other and guide actions
their ancestors through a shared set of  Believe that changing
experiences. one’
one’s problematic
 Melanie Klein-Objects Relations Theory thought patterns result in
 Alfred Adler-Inferiority
Adler-Inferiority and Birth Order the remedy of difficult
 Anna Freud-Child
Freud-Child Psychoanalysis emotions and troubling
 Erik Erikson-Theory
Erikson-Theory of Psychosocial Development behaviors.
 Most common tactics include thought journals and
BEHAVIORAL reward and punishment systems similar to those in
 The most distinct from psychodynamic theory behavioral therapy.
 This branch of psychology began in the early 1900s  Many modern psychologists combine cognitive and
out of Pavlov, Watson, and Skinner’
Skinner’s work with behavioral theories into one clinical psychology
animal behaviors. approach.
 With Pavlov’
Pavlov’s experiment with dogs, behavioral
psychologists believe that humans learn to exhibit Cognitive Theorists
certain behaviors as a result of mental associations  Jean Piaget – theories of cognitive development
 Little concerned with patients’ pasts  David Elkind-expanded
Elkind-expanded on the concept of Piaget’
Piaget’s
 Spend little time on talk therapy adolescent egocentricity. Elkind theorized that the
physiological changes that occur during
adolescence result in adolescents being primarily
concerned with themselves.
 Lawrence Kohlberg – Moral development
 Carol Gilligan – Morality of care/ystem of beliefs LEC 4: Diagnostic Appraisal
about human responsibilities, care, and
consideration for others, proposed three moral Topics to be discussed:
positions that represent different extents or  Behavioral observation
breadth of ethical care.  Clinical assessment and interview

BIOLOGICAL Behavioral Observation

 The structure and chemistry of the brain plays  a functional approach that focuses clearly on the
important roles in human thought, emotion, and observable ways in which the client interacts with
behavior. his or her environment.
 may be used informally as part of an interview or
in a testing session.

 Identify the problematic behavior that needs to be

HUMANISTIC addressed.
 Focuses on the things that make people distinctly
human
Narrative Recording
 Empowerment through free will
 Involves taking note of any behaviors of interest.
 Through talk therapy, written and spoken narrative,
 Flexible in terms of how descriptive or inferential
humanistic clinicians work with patients to take
the recording is, and little quantification is used.
control of their emotional and behavioral
responses to human experiences.
Ratings Recording
 Relies heavily on validation and empathy
 Evaluator provides a
rating of a particular
Humanistic Theorists
behavior, in terms of
 Abraham Maslow – Hierarchy of Needs-actions are
frequency or quality, after
motivated by physiological needs
a defined period of
 Carl Rogers – Person-centered; all people possess
observation.
an inherent need to grow and achieve their
 it can be applied to a
potential
wide variety of behaviors,
 James F.T. Bugental – Existential Humanistic –
it can be statistically
Search for Authenticity
analyzed, it is time-
 Rollo May – Existentialist Theory - human beings
efficient, and the ratings
fear death because we cannot comprehend our
can be made for
own lack of existence. However, May believed that
individuals or groups.
facing these feelings of anxiety and fear was a
necessary experience if personal growth and
meaning were to be achieved in life.
 The Interviewer
 Most pivotal element of a clinical interview
 Skilled interviewer is a master of not only of the
technical and practical aspects of the interview,
but also demonstrates broad-based wisdom about
the human interaction it entails.

Clinical Assessment and Interview

 An array of methods and instruments used by
mental health practitioners – chiefly psychologist –
to evaluate an individual’
individual’s functioning in multiple
areas and to inform and facilitate decisions or
recommendations intended to improve functioning
in one or more areas.

Clinical Assessment

Quieting Yourself
 Learn to set aside your internal and self-directed
thinking pattern
 The voice in the interviewers own mid should not
interrupt or drown out the voice of the client
 A certain amount of Self-reflection and
thoughtfulness

Clinical Interview Being Self-Aware

 a directed conversation in which the clinician  Self-awareness should not be confused with the
(interviewer) intends to elicit specific information excessive self-conciousness
from the client (interviewee) for purposes of  Emphasize the ability to know how he or she tends
diagnosis and treatment. to affect others interpersonally and how others
 can be conducted through face-to-face, by tend to relate to him or her
telephone, or online interviews.  Be cognizant of unique traits, including cultural
 questions during the interview may be assumptions as well as more superficial
standardized (e.g. set questions or open ended), characteristics, consider the effect on the interview
but the interviewer essentially determines which process
questions to ask based on the responses given by
the patient to previous ones. Develop Positive Working Relationships
 Listening attentively, appropriate empathy,
Diagnostic Interview genuine respect, and cultural sensitivity play
 an interview in which a health or mental health significant roles
professional explores a patient’
patient’s presenting
problem, current situation, and background, with
the aim of formulating a diagnosis and prognosis as
well as developing a treatment program.
  strong sense of rapport may let the client feel that
they are connected, and that the interviewer
empathizes with their issues.
 tend to disclose more information and invest
themselves further throughout the
session/interview.

Things that may help in establishing rapport:

Eye Contact
 Not only facilitates listening but it also Technique
communicates listening  What an interviewer does with clients
 Continuous and ppropriate eye contact may let the  Questions, Responses, and specific actions of the
client feel heard interviewer
 Culture plays a role in the meaning of eye contact;  May choose to be directive in order to achieve the
too long eye contact = threat seduction, or other objective of the session; but some uses
messages that an interviewer would be wise to nondirective style to allow the client to control the
avoid course of interview.
 Little or inconsistent eye contact = inattentive or  May respond to clients by clarification,
insulting paraphrasing, reflection of feeling, or summarizing.
 Clarification – making sure of the accuracy in
Body Language terms of understanding the client’
client’s comments.
 General rules for the interviewer; Face the client,  Paraphrasing – ensure clients that they are
appear attentive, minimize restlessness, display actually heard by restating the contents of clients’
clients’
appropriate facial expressions comments.
 Body languge can be misinterpreted by an  Reflection of Feeling – echoes the client’s
interviewer whose knowledge of the clients emotions through the tone of the voice and body
cultural background is deficient language; you may clarify about their emotions
based on nonverbal cues.
Vocal Qualities  Summarizing – tying together various topics that
 Be mindful of voice’
voice’s pitch, tone, volume, and may have been discussed, connecting statements
fluctation during interview that may have been made at different points, and
 Attend closely to the vocal qualities of the clients, identifying themes that have recurred during the
as well. interview.

Verbal Tracking Conclusions

 Effective interviewers are able to repeat key words  Can take a number of different forms, depending
and phrases back to their clients to ensure the upon the type of interview, client’s problem,
clients that they had been accurately heard. setting, or other factors.
 Monitor the train of thought implied by clients  May provide initial conceptualization of the client’
client’s
pattern of statements, and are thus able to shift problems and recommendations.
topics smoothly rather than abruptly.

Components of the Interview

Rapport
 How an interviewer is with clients
 positive, comfortable relationship between the
clinician and client