Clinical Psychology Science, Practice, and Culture

Clinical Psychology Science, Practice, and Culture Andrew M. Pomerantz Southern Illinois University Edwardsviile SAGE Publications Los Angeles London New Delhi Singapore

DETAILED CONTENTS Preface Acknowledgments xxi xxv Part I. Introducing Clinical Psychology Chapter 1. Defining Clinical Psychology 3 What Is Clinical Psychology? 3 Original Definition 3 More Recent Definitions 4 Education and Training in Clinical Psychology 5 Balancing Practice and Science: The Boulder Model 5 Leaning Toward Practice: The Vail Model 6 Box 1.1. Comparing PHD Programs With PsyD Programs 6 Leaning Toward Science: The Clinical Scientist Model 7 Getting In: What Do Graduate Programs Prefer? 8 Professional Activities and Employment Settings 15 Where Do Clinical Psychologists Work? 15 What Do Clinical Psychologists Do? 16 How Are Clinical Psychologists Different From... 17 Counseling Psychologists 17 Psychiatrists 18 Social Workers 19 School Psychologists 19 Chapter Summary 20 Key Terms and Names 20 Critical Thinking Questions 21 Chapter 2. Evolution of Clinical Psychology 23 Origins of the Field 23 Early Pioneers 24 William Tuke (1732-1822) 24 Philippe Pinel (1745-1826) 25 Eli Todd (1762-1832) 25 Dorothea Dix (1802-1887) 26

Lightner Witmer and the Creation of Clinical Psychology 26 Assessment 28 Diagnostic Issues 28 Box 2.1. Is It a DSM Disorder? Decisions to Include or Exclude Potential Disorders 30 Assessment of Intelligence 31 Assessment of Personality 32 Psychotherapy 34 Box 2.2. The Influence of War on Clinical Psychology 35 Development of the Profession 36 Box 2.3. Timeline of Key Historical Events in Clinical Psychology 38 Chapter Summary 42 Key Terms and Names 42 Critical Thinking Questions 43 Chapter 3. Current Controversies in Clinical Psychology 45 Prescription Privileges 46 Why Clinical Psychologists Should Prescribe 46 Why Clinical Psychologists Should Not Prescribe 48 Box 3.1. Prescription Privileges: What If You Were the Client? 50 Evidence-Based Treatments/Manualized Therapy 50 Box 3.2. Metaphorically Speaking: Evidence-Based Treatment Manuals and Teaching Manuals 52 Advantages of Evidence-Based Manualized Therapy 53 Disadvantages of Evidence-Based Manualized Therapy 55 Box 3.3. Evidence-Based/Manualized Therapies: What If You Were the Client? 56 Payment Methods 56 Effect on Therapy 57 ; Effect on Diagnosis 58 The Influence of Technology 58 Applications of Technology in Clinical Psychology 59 Emerging Professional Issues 60 Chapter Summary 61 Key Terms and Names 62 Critical Thinking Questions 62

Chapter 4. Cultural Issues in Clinical Psychology 63 The Rise of Multiculturalism in Clinical Psychology 63 The Diversification of the U.S. Population 63 Multiculturalism as the "Fourth Force " 65 Recent Professional Efforts to Emphasize Issues of Culture 65 Cultural Competence 69 What Is Cultural Competence? 69 Cultural Self-Awareness 69 Knowledge of Diverse Cultures 70 Box 4.1. Metaphorically Speaking: If You've Seen Yao Ming, You Understand Heterogeneity Within a Culture 71 Culturally Appropriate Clinical Skills 72 Are We All Alike? Or All Different? 73 Etic Versus Emic Perspective 73 Tripartite Model of Personal Identity 73 What Constitutes a Culture? 74 Narrow Versus Broad Definitions 74 Interacting Cultural Variables 76 Training Psychologists in Cultural Issues 77 Educational Alternatives 77 Measuring the Outcome of Culture-Based Training Efforts 78 An Example of Culture Influencing the Clinical Context: The Parent-Child Relationship 79 Chapter Summary 81 Key Terms 81 Critical Thinking Questions 82 Chapter 5. Ethical Issues in Clinical Psychology 83 American Psychological Association Code of Ethics 84 Aspirational and Enforceable 84 Ethical Decision Making 86 Psychologists' Ethical Beliefs 86 Confidentiality 87 Tarasoff and the Duty to Warn 88 When the Client Is a Child or Adolescent 89 Box 5.1. Considering Culture: Confidentiality, Ethnicity, and Family 91 Informed Consent 93 Multiple Relationships 95 Defining Multiple Relationships 95 What Makes Multiple Relationships Unethical? 96

Competence 97 Ethics in Clinical Assessment 100 Ethics in Clinical Research 101 Contemporary Ethical Issues 101 Managed Care and Ethics 101 Technology and Ethics 102 Ethics in Small Communities 103 Box 5.2. Metaphorically Speaking: If You've Played the "Six Degrees of Kevin Bacon" Game, You Understand Multiple Relationships in Small Communities 104 Chapter Summary 105 Key Terms and Names 106 Critical Thinking Questions 106 Chapter 6. Conducting Research in Clinical Psychology 107 Why Do Clinical Psychologists Do Research? 108 Treatment Outcome 108 Box 6.1. Measuring Therapy Outcome: Essential Questions. 108 Box 6.2. Considering Culture: Treatments That Work, But for Whom? 111 Assessment Methods 111 Diagnostic Issues 113 Professional Issues 113 Teaching and Training Issues 115 How Do Clinical Psychologists Do Research? 116 The Experimental Method 116 Quasi-experiments 116 Between-Group Versus Within-Group Designs 117 Analogue Designs 117 Correlational Methods 118 Case Studies 119 Meta-analysis 120, Cross-Sectional Versus Longitudinal Designs 120 Box 6.3. Metaphorically Speaking: If You Read Movie Reviews, You Understand Meta-analysis 121 Ethical Issues in Research in Clinical Psychology 122 Box 6.4. Key American Psychological Association Ethical Standards Related to Research in Clinical Psychology 122

Chapter Summary 123 Key Terms 123 Critical Thinking Questions 124 Part II. Assessment Chapter 7. Diagnosis and Classification Issues 127 Defining Normality and Abnormality 127 What Defines Abnormality? 128 Who Defines Abnormality? 128 Why Is the Definition of Abnormality Important? 130 Diagnosis and Classification of Mental Disorders: A Brief History 132 Before the DSM 132 DSM Earlier Editions 134 DSM Recent Editions 135 Criticisms of the Current DSM 138 Box 7.1. Considering Culture: Are Eating Disorders Culture-Bound Syndromes? 139 Box 7.2. Premenstrual Dysphoric Disorder 141 Alternative Directions in Diagnosis and Classification 144 Box 7.3. Metaphorically Speaking: If You've Eaten Chocolate Chip Cookies, You Understand the Dimensional Model of Psychopathology Chapter Summary Key Terms and Names Critical Thinking Questions 145 146 147 147 Chapter 8. The Clinical Interview The Interviewer General Skills Specific Behaviors Components of the Interview Rapport Technique Box 8.1. Considering Culture: Communication Across Cultures Box 8.2. Metaphorically Speaking: If You've Taken Multiple Choice, True/False, and Essay Exams, You Understand Open- and Closed-Ended Interview Questions 149 150 150 152 153 153 154 155 158

Conclusions 160 Pragmatics of the Interview 160 Note Taking 160 Audio and Video Recordings 161 The Interview Room 161 Confidentiality 163 Types of Interviews 163 Intake Interviews 163 Diagnostic Interviews 164 Mental Status Exam 166 Crisis Interviews 168 Cultural Components 169 Appreciating the Cultural Context 169 Acknowledging Cultural Differences 170 Chapter Summary 171 Key Terms 171 Critical Thinking Questions 172 Chapter 9. Intellectual and Neuropsychological Assessment 173 Intelligence Testing ' 174 Classic Theories of Intelligence 11A More Contemporary Theories of Intelligence 175 Box 9.1. Metaphorically Speaking: If You've Watched Michael Jordan, Then You Understand the Challenges of Defining and Assessing Intelligence 176 Wechsler Intelligence Tests 177 Stanford-Binet Intelligence Scales Fifth Edition (SB5) 182 Additional Tests of Intelligence: Addressing Cultural Fairness 183 Achievement Testing 185 Achievement Versus Intelligence 185 Box 9.2. Considering Culture: Defining Intelligence Around the World 186 Wechsler Individual Achievement Test Second Edition (WIAT-II) 190 Neuropsychological Testing 191 Halstead-Reitan Neuropsychological Battery 192 Bender Visual-Motor Gestalt Test Second Edition (Bender-Gestalt-II) 193

Chapter Summary 194 Key Terms and Names 195 Critical Thinking Questions 196 Chapter 10. Personality Assessment and Behavioral Assessment 197 Multimethod Assessment 198 Culturally Competent Assessment 198 Box 10.1. Considering Culture: Culture-Specific Norms for Personality Tests 200 Objective Personality Tests 201 Minnesota Multiphasic Personality Inventory-2 (MMPI-2) 201 Box 10.2. Simulated MMPI-2 Items 202 Box 10.3. Metaphorically Speaking: If You've Shopped on Amazon.com, You Understand Empirical Criterion Keying 203 Millon Clinical Multiaxial Inventory-Ill (MCMI-III) 208 NEO Personality Inventory Revised (NEO-PI-R) 209 California Personality Inventory-III (CPI-III) 210 Beck Depression Inventory-II (BDI-II) 211 Projective Personality Tests 211 Rorschach Inkblot Method 212 Thematic Apperception Test (TAT) 214 Box 10.4. TAT Card 12F With Simulated Responses 215 Sentence Completion Tests 217 Behavioral Assessment 218 Techniques in Behavioral Assessment 219 Technology in Behavioral Assessment 220 Chapter Summary 220 Key Terms and Names 221 Critical Thinking Questions 222 Part III. Psychotherapy Chapter 11. General Issues in Psychotherapy 225 Does Psychotherapy Work? 226 Whoi When, and How Should Researchers Ask? 226 Box 11.1. Considering Culture: Culture-Specific Expectations About Psychotherapy 227 Efficacy Versus Effectiveness of Psychotherapy 229 Results of Efficacy Studies 229 Results of Effectiveness Studies 230

Which Type of Psychotherapy Is Best? 231 The "Dodo Bird" Verdict and Common Factors 231 Therapeutic Relationship/Alliance 232 Other Common Factors 233 Box 11.2. Metaphorically Speaking: If You Use Toothpaste, Then You Understand Common Factors in Psychotherapy 234 Reconsidering the Dodo Bird Verdict Specific Treatments for Specific Disorders 235 Box 11.3. Considering Culture: Are Evidence-Based Treatments Appropriate for Diverse Clients? 236 What Types of Psychotherapy Do Clinical Psychologists Practice? 237 The Past and Present 237 The Future 239 Eclectic and Integrative Approaches 239 Denise: A Fictional Client to Consider From Multiple Perspectives 240 Box 11.4. Metaphorically Speaking: If You Know the Difference Between Fruit Salad and a Smoothie, You Understand the Difference Between Eclectic and Integrative Psychotherapists 241 Box 11.5. Denise: A Fictional Client to Consider From Multiple Perspectives 242 Chapter Summary 243 Key Terms and Names 243 Critical Thinking Questions 244 Chapter 12. Psychodynamic Psychotherapy 245 Defining Psychodynamic Psychotherapy 246 Goal of Psychodynamic Psychotherapy 246 Accessing the Unconscious 247 Box 12.1. Metaphorically Speaking: If You've Been to a Movie Theater, You Understand Projection 253 Box 12.2. Considering Culture: Culture-Specific Responses to the "Blank Screen" Therapist 257, Psychosexual Stages: Clinical Implications 258 Oral Stage 259 Anal Stage 260 Phallic Stage 260 More Contemporary Forms of Psychodynamic Psychotherapy 261 Interpersonal Therapy 262 Time-Limited Dynamic Psychotherapy 263

Outcome Issues. 264 Box 12.3. Metaphorically Speaking: If You've Watched the Olympics, You Understand Allegiance Effects 265 Box 12.4. Denise in Psychodynamic Psychotherapy 266 Chapter Summary 267 Key Terms and Names 268 Critical Thinking Questions 269 Chapter 13. Humanistic Psychotherapy 271 Humanistic Concepts: Clinical Implications 272 Goal of Humanistic Psychotherapy 273 Elements of Humanistic Psychotherapy 276 Empathy 276 Unconditional Positive Regard 276 Box 13.1. Considering Culture: Empathy Across Cultures 277 Genuineness 278 Necessary and Sufficient? 279 Therapist Attitudes, Not Behaviors 280 Reflection: An Important Therapist Response 280 Alternatives to Humanism 281 Historical Alternatives 281 Box 13.2. Metaphorically Speaking: If You've Looked in a Magnifying Mirror, Then You Understand Reflection 282 Contemporary Alternatives 283 Outcome Issues 285 Box 13.3. Denise in Humanistic Psychotherapy 286 Chapter Summary 287 Key Terms and Names 288 Critical Thinking Questions 289 Chapter 14. Behavioral Psychotherapy 291 Origins of Behavioral Psychotherapy 292 Goal of Behavioral Psychotherapy 294 Emphasis on Empiricism 294 Defining Problems Behaviorally 294 Measuring Change Observably 296 Two Types of Conditioning 298 Classical Conditioning 298 Operant Conditioning 299

Techniques Based on Classical Conditioning 300 Exposure Therapy 300 Systematic Desensitization 302 Assertiveness Training 303 Box 14.1. Considering Culture: Assertiveness Training and Collectivist Values 304 Techniques Based on Operant Conditioning 305 Contingency Management 305 Extinction 306 Box 14.2. Metaphorically Speaking: If You've Lost Money in a Soda Machine, You Understand Extinction and the Extinction Burst 308 Token Economies 308 Shaping 309 Observational Learning (Modeling) 311 Alternatives to Behavior Therapy 311 Behavioral Consultation 311 Parent Training 313 Teacher Training 314 Outcome Issues 314 Box 14.3. Denise in Behavioral Psychotherapy 315 Chapter Summary 316 Key Terms and Names 317 Critical Thinking Questions 318 Chapter 15. Cognitive Psychotherapy 319 Goal of Cognitive Therapy 321 The Importance of Cognition 321 Revising Cognitions 322 Teaching as a Therapy Tool 324 Homework 324 Box 15.1. Considering Culture: Cognitive Therapy With Lesbian, Gay, and Bisexual Clients 325 A Brief, Structured, Focused Approach 326, Two Approaches to Cognitive Therapy 326 Albert Ellis 'ill Aaron Beck 330 Box 15.2. Metaphorically Speaking: If You've Seen Attorneys Argue in Court, Then You Understand How Cognitive Therapists Dispute Thought Distortions 333

Recent Applications of Cognitive Therapy 334 Cognitive Therapy for Medical Problems 335 Cognitive Therapy for Personality Disorders 336 Quality of Life Therapy 337 Outcome Issues 338 Box 15.3. Denise in Cognitive Psychotherapy 338 Chapter Summary 340 Key Terms and Names 340 Critical Thinking Questions 341 Chapter 16. Group and Family Therapy 343 Group Therapy 343 An Interpersonal Emphasis 343 Practical Issues in Group Therapy 349 Ethical Issues in Group Therapy 351 Outcome Issues 352 Box 16.1. Denise in Group Therapy 352 Family Therapy 354 The System as the Problem 354 Box 16.2. Considering Culture: Gender, Abuse, and Family Therapy 356 Assessment of Families 357 Box 16.3. Metaphorically Speaking: If You've Been to a Car Repair Shop, You Understand Systems Theory 358 Family Therapy: Essential Concepts 361 Ethical Issues in Family Therapy 365 Outcome Issues 367 Chapter Summary 367 Key Terms and Names 368 Critical Thinking Questions 369 Part IV. Special Topics Chapter 17. Clinical Child and Adolescent Psychology 373 Psychological Issues of Childhood 374 Disorders of Childhood 374 Resilience and Vulnerability 375 Assessment of Children and Adolescents 376 The Developmental Perspective 376 Box 17.1. Factors Fostering Resilience in Children 377

Box 17.2. Considering Culture Parent-Child Relationships Across Cultures 378 A Comprehensive Assessment 379 Assessment Methods 381 The Use of Specific Assessment Techniques 386 Psychotherapy With Children and Adolescents 386 Self-Instructional Training 387 Box 17.3. Metaphorically Speaking: If You've Had Dancing Lessons, You Understand Self-Instructional Training 390 Parent Training 391 Play Therapy Psychodynamic 392 Play Therapy Humanistic 394 Outcome Issues in Psychotherapy for Children and Adolescents 395 Chapter Summary 396 Key Terms and Names 397 Critical Thinking Questions 397 Chapter 18. Health Psychology 399 Laura A. Pawlow and Andrew M. Pomerantz Definitions: Health Psychology Versus Behavioral Medicine 400 Stress 400 Stress and Physical Illness 401 Stress and Coping 403 Box 18.1. Considering Culture: Physical and Psychological Expressions of Depression Across Cultures 404 Social Support 406 Clinical Applications 407 Weight Management 407 Smoking 409 Alcohol Abuse and Dependence 411 Pain Management and Biofeedback 412 Box 18.2. Metaphorically Speaking: If You've Used Exercise Equipment With a Heart Rate Monitor, You Understand Biofeedback 414 Box 18.3. Sample of an Abbreviated Progressive Relaxation Training Script 415 Compliance With Medical Regimens 416 Coping With Medical Procedures 416

Cultural Factors in Health Psychology 418 Chapter Summary 420 Key Terms and Names 421 Critical Thinking Questions 421 Chapter 19. Forensic Psychology 423 Bryce F. Sullivan and Andrew M. Pomerantz Definition and History 423 Forensic Activities of Clinical Psychologists 425 Assessment Activities 425 Box 19.1. Metaphorically Speaking: If You've Bought Car Insurance, You Understand Clinical and Statistical Methods of Predicting Dangerousness 429 Treatment and Other Forensic Activities 437 Box 19.2. Considering Culture: Cultural Competence in Forensic Clinical Psychology 439 Chapter Summary 444 Key Terms and Names 444 Critical Thinking Questions 445 Glossary 447 References 485 Photo Credits 513 Index 517 About the Author 533