Introduction to Clinical Psychology

CATHERINE M. LEE earned a Ph.D. from the University of Western Ontario in 1988. She is a full professor of psychology at the University of Ottawa. Dr. Lee teaches graduate courses in evidence-based services for children and families and an undergraduate course on Clinical Psychology, as well as supervises practicum students and interns at the Centre for Psychological Services and Research. Her research interests focus on the provision of evidence-based services to promote positive parenting. She has authored over 75 articles, chapters, and books on this and related topics. Dr. Lee is a Fellow of the Canadian Psychological Association (CPA) and the CPA Clinical Psychology Section. She is an ad hoc reviewer for many granting agencies and scholarly journals, and she serves on the editorial boards of Clinical Child and Family Psychology Review and Cognitive and Behavioral Practice. She is the former chair of the Clinical Psychology Section of the CPA and was President of the CPA in 2008–2009. She is a site visitor for the Canadian Psychological Association Accreditation Panel. She is an accredited trainer for Triple P International.JOHN HUNSLEY received a Ph.D. from the University of Waterloo in 1985. He is a full professor in the clinical psychology program at the University of Ottawa and is the director of the program. Dr. Hunsley teaches graduate courses in clinical research methods and psychological assessment. Dr. Hunsley's research interests focus on evidence-based psychological practice, the delivery of psychological services, and the scientific basis of psychological assessment. He has authored over 130 articles, chapters, and books on these topics. Dr. Hunsley is a Fellow of the Association of State and Provincial Psychology Boards, the Canadian Psychological Association (CPA), and the CPA Clinical Psychology Section. He has received the CPA Award for Distinguished Contributions to Education and Training in Psychology. From 2007 to 2011, he served as the editor of Canadian Psychology. He has also served on the editorial board of Assessment, Canadian Psychology, Journal of Personality Assessment, Professional Psychology: Research and Practice, and Scientific Review of Mental Health Practice.

• PREFACE ivACKNOWLEDGEMENTS viiABOUT THE AUTHORS viii1 The Evolution of Clinical Psychology 1Introduction 1Defining the Nature and Scope of Clinical Psychology 3Evidence-Based Practice in Psychology 7Mental Health Professions 8Counselling Psychology 8School Psychology 10Psychiatry 10Clinical Social Work 11Other Mental Health Professions 12Availability of Mental Health Service Providers 13A Brief History of Clinical Psychology 14The Roots of Clinical Psychology 14The History of Assessment in Clinical Psychology 15The History of Intervention in Clinical Psychology 20The History of Prevention in Clinical Psychology 25The Future 25Summary and Conclusions 252 Contemporary Clinical Psychology 27Introduction 27Activities of Clinical Psychologists 28Assessment and Diagnosis 29Intervention 32Prevention 35Consultation 35Research 37Teaching and Supervision 38Administration 39Employment Settings 39The Two Pillars of Clinical Psychology: Science and Ethics 40Training in Clinical Psychology 43Models of Training in Clinical Psychology 43Accreditation of Clinical Psychology Programs 45Licensure in Clinical Psychology 47Summary and Conclusions 493 Classification and Diagnosis 50Introduction 50Defining Abnormal Behaviour and Mental Disorders 52Developmental Psychopathology 53Diagnosis 53Defining Disorder 54Prevalence of Mental Disorders 55Understanding the Development of Mental Disorders 58The Diagnostic and Statistical Manual of Mental Disorders (DSM) System 61The Evolution of the DSM 61The DSM-5 63The International Statistical Classification of Diseases and Related Health Problems (ICD) System 67Limitations of Diagnostic Systems 68Defining Abnormality (Revisited) 68Diagnostic Reliability 69Heterogeneity of Symptom Profiles 70Diagnostic Validity 71Comorbidity 72Categorical versus Dimensional Classification 73Summary and Conclusions 744 Research Methods in Clinical Psychology 75Introduction 75Generating Research Hypotheses 78Ethics in Research 80Research Designs 83Case Studies 86Single Case Designs 87Correlational Designs 88Quasi-Experimental Designs 90Experimental Designs 91Selecting Research Participants and Measures 93Selecting the Sample 93Selecting the Sampling Strategy 93Setting the Sample Size 94Measurement Options and the Importance of Psychometric Properties 95Analyzing the Data 96Statistical and Clinical Significance 97Research Syntheses 98Systematic Reviews 98Meta-Analysis 99Summary and Conclusions 1005 Assessment: Overview 102Introduction 102Psychological Assessment 103Evidence-Based Assessment 104The Purposes of Psychological Assessment 105Psychological Testing 112Assessment versus Testing 114Psychometric Considerations 116Testing Practices in Clinical Psychology 120Ethical Considerations 121Summary and Conclusions 1226 Assessment: Interviewing and Observation 124Introduction 124Ethical Issues: Limits of Confidentiality 126Unstructured Assessment Interviews 127Semi-Structured Diagnostic Interviews 129General Issues in Interviewing 131Attending Skills 131Contextual Information 132Culturally Sensitive Interviewing 133Defining Problems and Goals 135Assessing Suicide Risk 137Interviewing Couples 138Interviewing Families 138Interviewing Children and Adolescents 139Observations 141Self-Monitoring 144Summary and Conclusions 1477 Assessment: Intellectual and Cognitive Measures 148Introduction 148Defining Intelligence 149Theories of Intelligence 149Assessing Intelligence: The Clinical Context 151The Wechsler Intelligence Scales 153Background Issues 153Administration, Scoring, and Interpretation Issues 157Canadian Normative Data 158Wechsler Adult Intelligence Scale—Fourth Edition (WAIS-IV) 160Wechsler Intelligence Scale for Children—Fifth Edition (WISC-V) 162Wechsler Preschool and Primary Scale of Intelligence—Fourth Edition (WPPSI-IV) 163ther Intelligence Scales 164Selected Cognitive Assessment Scales 165Wechsler Memory Scale—Fourth Edition (WMS-IV) 165Wechsler Individual Achievement Test—Third Edition (WIAT-III) 167Summary and Conclusions 1688 Assessment: Self-Report and Projective Measures 169Introduction 169The Person-Situation Debate 170Self-Presentation Biases 172Developing Culturally Appropriate Measures 172The Clinical Utility of Self-Report and Projective Measures 175Self-Report Personality Measures 176MMPI-2 and MMPI-A 177Other Clinical Measures of Personality Functioning 182Self-Report Checklists of Behaviours and Symptoms 184Achenbach System of Empirically Based Assessment 184SCL-90-R 187Outcome Questionnaire 45 187Beck Depression Inventory-II 188Children's Depression Inventory 2 189Projective Measures of Personality 189Rorschach Inkblot Test 190Summary and Conclusions 1929 Assessment: Integration and Clinical Decision-Making 194Integrating Assessment Data 196Case Formulation 198Threats to the Validity of Assessments and Case Formulations 202Patient/Client Factors 202Clinician Factors 203Improving the Accuracy of Clinical Judgment 205Psychological Assessment Reports and Treatment Plans 207Assessment Feedback 209Summary and Conclusions 21110 Prevention 213Introduction 213Approaches to Prevention 217Promoting Evidence-Based Parenting 220Home Visiting Programs 221Incredible Years 221Triple P 222Prevention of Violence 222Physical Abuse of Children 222Youth Violence: Bullying and Conduct Disorder 223Prevention of Internalizing Disorders 225Anxiety Disorders 225Depression 226Prevention of Substance Abuse 226Prevention of Problems in those Exposed to Trauma or Loss 228Summary and Conclusions 22911 Intervention: Overview 231Introduction 231The Ethics of Intervention 232Theoretical Approaches 236Short-Term Psychodynamic Psychotherapies 237Interpersonal Psychotherapy for Depression 239Process-Experiential Therapies 240Cognitive-Behavioural Therapies 241Seeking Psychological Treatment 244The Duration and Impact of Psychotherapy 247Alternative Modes of Service Delivery 249Summary and Conclusions 25412 Intervention: Adults and Couples 256Introduction 256Does Psychotherapy Work? A Controversy and Its Impact 256Meta-Analysis and Psychotherapy Research 257Evidence-Based Treatments: Initiatives and Controversies 261Clinical Practice Guidelines 268Examples of Evidence-Based Treatments 270CBT for Depression 270Prolonged Exposure CBT for PTSD 273EFT for Couple Distress 274Effectiveness Trials 274Adoption of Evidence-Based Treatments 276Summary and Conclusions 27813 Intervention: Children and Adolescents 280Introduction 280Who Is the Client in Psychological Services for Children and Adolescents? 280Landmarks in the Evolution of Evidence-Based Psychological Services for Children and Adolescents 283Do Psychological Treatments for Children and Adolescents Work? 284Which Treatments Work for Specific Disorders? 285Clinical Practice Guidelines 288Examples of Evidence-Based Treatments 289Disruptive Behaviour Disorders 289Adolescent Depression 295Efficacy, Effectiveness, and the Dissemination of Evidence-Based Treatments 296Summary and Conclusions 30014 Intervention: Identifying Key Elements of Change 302Introduction 302Psychotherapy Process and Process-Outcome Research 303Examining Client Factors 305Examining Therapist Factors 307Examining Treatment Factors 309Some Methodological Cautions 312Common Factors in Psychotherapy 313Research Perspectives on Common Factors: The Therapeutic Alliance 314Research Perspectives on Common Factors: Psychotherapy Equivalence 315Evidence-Based Psychotherapy Relationships 318Task Force Recommendations 319Empirically Based Principles of Therapeutic Change 320Summary and Conclusions 32315 Clinical Health Psychology, Clinical Neuropsychology, and Forensic Psychology 324Introduction 324Clinical Health Psychology 325Definitions of Health and Disability 326Activities of Clinical Health Psychologists 327Assessment and Intervention Related to Pain 330Clinical Neuropsychology 333Activities of Clinical Neuropsychologists 333Assessment 335Intervention 337Forensic Psychology 339Activities of Forensic Psychologists 340Assessment 342Intervention 343Summary and Conclusions 344APPENDIX 1 Major Journals Relevant to Clinical Psychology 346APPENDIX 2 Applications to Graduate School 352REFERENCES 361NAME INDEX 391SUBJECT INDEX 403