Introduction to Clinical and Counseling Psychology

1. Introduction to Clinical and Counseling Psychology PSY 340 Lauren J. Roscoe, M. A.

2. Course Goals Introduce main concepts of clinical/ counseling Understand differences and similarities of fields How clinical and counseling psychology contribute Get you interested in clinical and counseling!!!

3. Course Structure: 4 sections Section 1: Professional context and historical roots Section 2: Psychotherapy Fundamentals and Theories Section 3: Career Counseling, Assessment and Diagnosis Section 4: Research, Integration, Becoming a Psychologist

4. Section 1: Professional Context and Historical Roots Goals for this section: Understand the context of helping professions Know where psychologists work, what they do, and necessary training History/ development of clinical/ counseling Ethical Considerations Current/Future Professional Issues

5. Mental Health Professions in Context There are several mental health professions (MHP) All with similar goals but various specialties Differ in training, education, licensing, pay and prestige levels Ideally need to work together Understand the complex social matrix See clinical and counseling�s contribution

6. Clinical and Counseling: What sets us a part! We are professional: Extensive post-graduate education at recognized universities Educated in research, evaluation, and implementation of helping skills Licensed or certified by states Guided by American Psychological Association (APA) Ethics Code �Psychologist�: term only used for individuals with a doctorate

7. What are the differences? Clinical More emphasis on medical model Clientele issues may be more serious, beyond the developmental focus May include focus on children Counseling Developmental, focus assets/ strengths Prevention and wellness vs. medical model Vocational Roots Relatively non-disturbed clientele, adjustment issues Works primarily with adults

8. Are the differences that meaningful? Course work and requirements similar Example of SIU program Each person chooses specialty areas Need to be experts in the areas Clinical or counseling doesn�t matter� sought and acquired knowledge and expertise does!!! Differences emphasized/ enlarged as each field attempts to keep its �special place� and define itself in the complex matrix of MHP�s

9. In relation to other MHP�s Other types of Psychology Educational Psychology School Psychology Clinical Neuropsychology Rehabilitation Psychology Community Psychology Forensic Psychology Industrial/ Organizational (IO) psychology Psychiatry Social Work Marriage, Family, Child Counseling (MFCCs)

10. So what do C/C�s Do? Psychotherapy and counseling Assessment Teaching Research and Publishing Consulting Administration

11. Where do C/C�s work? Psychotherapy and counseling: Counseling and clinical centers Community Mental Health Private/ Group Practice Hospitals, VA�s Employee Assistance Programs (EPAs) Prisons, Government agencies, Military Assessment: All of the above

12. Where do C/C�s work? (cont) Teaching Colleges & Universities Professional Schools Community Colleges (can with M.A.) Research Colleges & Universities Professional Schools Hospitals Professional organizations (APA)

13. Where do C/C�s work? (cont) Consulting Business/ Industry Larger Consulting firms (e.g.,RHR) Private Practice/ Executive coaching Administration Hospitals, VA�s Community Mental Health Schools and Universities Professional organizations Non-profits, Government

14. How are C/C�s trained? Two training models Boulder Model (1949, APA) Scientist-Practitioner Model Research/academic + applied skills Vail Model (1973, APA) Professional Model Emphasizes practice, much less research focus Development of free-standing professional schools

15. Degrees in Clinical and Counseling Master of Arts (M.A.) or Master of Science (M.S.) 2 years, with completion a of Thesis Often obtained in route to Ph.D. Can teach at community college, see clients under a supervisor

16. Degrees in Clinical and Counseling Ph.D., Doctor of Philosophy Scientist-practitioner (Boulder Model) 3 years related course work 1year Dissertation 1year Internship (APA approved) Totaling a minimum 5 years postgraduate APA accredited programs in universities Typically in Psychology Department or School of Education

17. Degrees in Clinical and Counseling Psy.D (sigh-dee), Doctor of Psychology Professional Model (Vail Model) 4 to 6 years Applied focus Not researched driven, some will do dissertation Completion of year internship Typically at professional schools

18. Licensure and Certification Motivating forces: Protect public from untrained/ incompetent Need to establish independent professional identity License- demonstrated competence Certification- verify completed education Registration- inform state that practicing

19. Professional Organizations American Psychological Association (APA) Formed 1892 by G. Stanley Hall Over 50 specialty Divisions Division 17: Counseling Psychology (1952) Division 12: Clinical Psychology (1944) Journals, Conferences, Professional Standards, Ethics Code American Psychological Society (APS) Dissatisfied scientists broke off from APA in 1988 Advancement of scientific psychology

20. History of Clinical and Counseling Modern academic psychology developed in Western Europe and American Psychology born 1879 in Leipzig, Germany Wilhelm Wundt William James- 1st American Psychologist Laboratory at Harvard in 1875 Shift from structuralism, to functionalism, and to behaviorism Person-centered/ Humanism: 3rd force Multi-culturism: 4th force

21. History: Explanation of Deviant Members Supernatural forces Demonology Invasion of spirits, Gods, or demons Priests were appropriate treatment Medical Model Define and discover solutions Helped to remove stigma Note symptoms, reveal disease process, treatment and prevention Psychological Model: Freud

22. History: Treatment of Deviant Members Dark and Middle Ages Often involved cruelty, tortured until confessed, execution Monasteries were refuges 19th Century Treatment shifted to asylums Often chained, poorly fed, various treatments

23. History: Reform Advocates of mentally ill Phillip Pinel- release from restraints and treat with kindness Benjamin Rush- Advocated humane treatment in U.S. Dorothea Dix- (1841- 1881 campaign) improved conditions in U.S. and Europe 32 new mental hospitals Clifford Beers- 1908 published book about experience in asylum: �A mind that found itself�

24. Bridging Academic and Applied Early 1900s, Emil Kraeplin developed 1st diagnostic system for mental disorders Mental illnesses separate and distinct disorder Course and outcome predetermined Historical events shaping psychology World War I Army Alpha IQ test to screen recruits Army Beta- non-verbal test for illiterates Norms, standards, reliability, validity established for tests Discipline of Clinical Psychology recognized

25. Historical Summary: Take Homes! Shift in focus of cause and treatment of deviant members Supernatural Medical Psychological Development and merge of academic and applied psychology Facilitated by World Wars Need for testing and psychological services Development of assessments Struggle still seen in models (Boulder vs. Vail) Clinical and counseling psychology had similar and different routes Remnants are seen today

26. Ethical Terminology Confidentiality- Ethical responsibility to not reveal information 3 circumstances when must break confidentiality Tarasoff Liability (1971) � Duty to warn, protect Privilege- Legal right of consumers to control information Protected relationship (husband-wife; lawyer-client) Laws vary by state, no partial waiving

27. Ethical Terminology (cont) Assumptions: Success treatment requires full disclosure Clients will not disclose unless assured privacy Informed Consent Fully informed about the treatment ($,timing, Xments, therapist qualifications,etc.) Limits of confidentiality

28. APA Ethics Code Rationale Protect public and psychologists Agreed upon professional standards Framework for decisions and grievances Revisions First code published 1953 Four extensive revisions since 1953 Currently use 1992 code, but new revision draft out by APA Format Introduction and preamble 6 General Principles Standards

29. General Principles Principle A: Competence Knowledgeable and practice within expertise Principle B: Integrity Honest and fair, aware how beliefs affect work, clarify roles Principle C: Professional and Scientific Responsibility Uphold professional standards of conduct, collaborate when necessary, recognize the effect personal actions have on view of psychology

30. General Principles (cont) Principle D: Respect for People�s Rights and Dignity Value worth/dignity of all people, aware of differences (i.e., age, gender, race,religion, sexual orientation, etc), eliminate biases/ prejudices Principle E: Concern for Other�s Welfare Respect integrity, protect welfare, aware of power differences, do not exploit or mislead Principle F: Social Responsibility Work to benefit society (i.e., share knowledge, pro-bono), work to alleviate suffering, avoid misuse of work

31. Higher Order Ethical Principles Autonomy Responsibility/ freedom for own behavior, not at the expense of others and must be competent Beneficence �do good�, contribute to health and welfare Non-maleficence Above all �do no harm�, Justice Fairness and equality, equal treatment of all people Fidelity Truthfulness, loyalty and trust

32. Ethical Dilemma Ethical Dilemma: a situation where no course of action is satisfactory, reasons for both sides Prima Facia- follow principles unless conflicted with a higher principle (Kitchener, 1984) Prevalent ethical issues (Pope & Vetter, 1992): Confidentiality Dual relationships

33. Ethical Misconduct Psychologist personal vs. professional roles Consider public view of psychology APA Ethics Review Board Report to state licensing board Malpractice Professional relationship existed Negligent Act Client harmed Negligent act caused harm

34. The Changing Environment Diversity and changing population Increased diversity, fewer diverse counselors Population is aging The era of Managed Care, HMOs Efficacy, Accountability, and Cost-effectiveness Defining roles & Competition with other MHPs Medical Model vs. Wellness/ Prevention

35. Era of Managed Care Changes in health care system Driven by increasing costs Increased accountability Health care controlled by corporations Conflict of interest: profit vs. care Competition ($ focus, accountability) Accountability Demonstrate services accomplish what they claim Peer review- judgment of services by peers OQ45.2- outcome tracking instrument

36. Era of Managed Care (cont) Cost-effectiveness Treatments that work and cost less Role of prevention???? Cost cutting strategies Reimburse low cost Dr.�s Contract for specific services Prospective Payment System (PPS) Diagnose Related Groups Limit payment to certain �proven� treatments

37. Era of Managed Care (cont) Efficacy vs. Effectiveness Empirically supported treatments (ESTs) ESTs and treatment manuals Treatment planning based on diagnosis Movement towards medical model Manuals to treat symptoms Impact on training, education, research

38. Defining Roles in the New Era Who will provide services? Cost-effectiveness Treatment manuals Master level services PhD�s Supervise Create Manuals Administration

39. Defining Roles (cont) HMOs determine what services and who gets them! Permission for services, �gatekeeper� Who you see Provider Panels Provider Profiling How much $$ How many sessions Managed Care and ethical considerations

40. Defining Roles (cont) Specialties fighting for niche Facilitates definition of clinical and counseling Relationship with physicians Prescription Privileges??? Medical Model vs. Prevention/ Wellness How does it fit into managed care??

41. Prescription Privileges (Gutierrez & Silk, 1998) Arguments For Integrated care Cost-effective Help underserved Not enough Psychiatrists Different levels of training, licenses, insurances Control of MEDS Precedent of other fields Arguments Against Against developmental framework Improve collaboration Split the profession Increase in premiums Specialists better Changes in training

42. Medical Model vs. Wellness Medical Model Sick-well dichotomy Labels, diagnosis Remedial, not preventative Negative focus Wellness Developmental Prevention Focus on holism Synergistic Continuum Positive focus

43. Wellness and Counseling Psychology Definition and Dimensions of Wellness Wellness as a paradigm for counseling psychology Prevention Psychology should work to put itself �out of business� Cost-effective in era of cost containment

44. Wellness Definition & Dimensions �Wellness in not just absence of illness� WHO (1967) Dimensions: Social, Physical, Emotional,Intellectual, Spiritual, Environmental/ Occupational Integrative, Synergistic parts �sum is greater than whole� Wellness as a continuum Movement towards higher levels

45. Wellness: Paradigm for Counseling Psychology Myers (1991) Wellness as the paradigm for counseling psychology Label what we already do Aligns with developmental focus and emphasis on positive psychology and prevention

46. Section 1 Wrap-Up!! Understand the context of helping professions Know where psychologists work, what they do, and necessary training Basic history/ development Ethical Considerations Current/Future Professional Issues HMOs, ESTs, Prevention, Medical vs. Wellness