The evolution of clinical psychology- lecture 1

What is mental health?

Mental health is a state of well-being in which every individual realizes his or her own potential, can
cope with the normal stresses of life, can work productively and fruitfully, and is able to contribute to
his or her community.

Defining the Nature and Scope of Clinical Psychology

• Clinical psychology is the branch of psychology that focuses on developing assessment strategies
and interventions to deal with painful experiences that touch everyone’s life.
• The practice of clinical psychology uses scientifically based methods to reliably and validly assess
both normal and abnormal human functioning.
• Clinical psychology involves gathering evidence about optimal strategies for delivering health
care services.
• Over the decades, the nature and definition of clinical psychology has shifted, expanded, and
evolved.
• Clinical psychology includes both scientific research, focusing on the search for general
principles, and clinical service, focusing on the study and care of clients, and information
gathered from each of these activities influences practice and research.

Evidence-Based Practice (EBP) in Psychology

• The EBP model

1. requires the clinician to synthesize information drawn from research and systematically
collected data on the patient in question, the clinician’s professional experience, and the
patient’s preferences when considering healthcare options and
2. emphasizes the importance of informing patients, based on the best available research
evidence, about viable options for assessment, prevention, or intervention services.

in order to practice in an evidence-based manner, a healthcare professional must be familiar with the
current scientific literature and must use both the research evidence and scientifically informed
decision-making skills to determine how research evidence can inform service planning for a patient.

Mental health professions

1. Counselling psychology- Counselling psychology primarily deals with providing support and
interventions for individuals facing normal life challenges and transitions, while clinical
psychology focuses more on diagnosing and treating severe mental health conditions. The
distinction between the two fields is becoming less significant, with practitioners from both areas
often working in similar settings and employing evidence-based interventions.
2. School psychology- School psychologists are professionals with training in both psychology and
education, primarily focused on addressing the learning, social, emotional, and mental health
needs of children and adolescents. While historically centered on learning-related issues, their
role has expanded to encompass broader mental health concerns and the development of
preventive programs within school settings. Despite overlaps with child clinical psychology,
school psychology is likely to remain a distinct discipline due to its unique focus on educational
contexts and interventions.
3. Psychiatry- Primary care physicians are often the first point of contact for mental health issues,
while psychiatrists specialize in diagnosing and treating mental illnesses. Psychiatrists undergo
extensive medical training with a focus on biological aspects of mental health. They historically
 leaned towards psychoanalytic therapies but now emphasize evidence-based treatments,
including medication and psychotherapy. Recruitment of psychiatrists faces challenges globally.
4. Clinical social work- Social workers focus on improving the health and well-being of individuals,
families, and communities through various activities such as counseling, advocacy, case
management, and program planning. They work in diverse settings including hospitals, schools,
and social service agencies. The title "social worker" is protected by legislation, and while
registration requirements vary, many social workers play crucial roles in mental health teams,
especially as case managers for individuals with severe mental disorders. Training programs
emphasize the social determinants of mental health, and like other mental health professions,
social work is increasingly focused on evidence-based practices.

History: the roots of clinical psychology

• Hippocrates emphasized what is now known as a biopsychological approach to understanding

both physical and psychological disorders.
• Plato and Aristotle promoted some of Hippocrates' ideas. Plato emphasized the role of societal
forces and psychological needs in the development and alleviation of mental disorders, whereas
Aristotle emphasized the biological determinants of mental disorders.
• In the late 1500s, st. Vincent de Paul proposed that mental and physical illnesses were caused by
natural forces and that the extreme manifestation of mental disorders was not caused by
witchcraft or satanic possessions. In Europe and North America, the historical treatment of
mental illness was often inhumane, with sufferers being isolated in grim asylums. Conditions
were dire, with chaining of patients and barbaric treatments like bleeding with knives or
immersion in cold water.
• During 1700 approaches to mental illness changed. A shift towards scientific thinking influenced
the treatment of mental illness. Reformers like Philippe Pinel in France, William Tuke in England,
and Benjamin Rush in the United States advocated for humane treatment of the mentally ill,
emphasizing compassion over physical punishment. Additionally, the growth of neurology as a
medical specialty led to the recognition of psychological factors in conditions like hysteria. Jean-
Martin Charcot's work in France, particularly with hypnosis, influenced subsequent
developments in psychology by figures like Pierre Janet and Sigmund Freud.

The history of assessment in clinical psychology

• The early history of clinical psychology is largely the history of clinical assessment, as clinical
psychology developed from psychology’s focus on measuring, describing, and understanding
human behavior.
• individuals who influenced the early work on assessment in clinical psychology are the German
psychiatrist Emil Kraepelin and the French psychologist Alfred Binet.
• Building on Binet’s pioneering work and Terman’s adaptation of the Binet-Simon test, the field of
psychological assessment grew rapidly.
• The 1930s also witnessed the emergence of projective tests to evaluate personality and
psychological functioning. Whereas intelligence tests measure performance on a task, and paper-
and-pencil personality tests are based on self-description, projective tests are predicated on the
notion that an individual’s interpretation of a situation is determined by his or her personality
characteristics.
• Around the same time, American psychologists Henry Murray and Christina Morgan, working at
the Harvard Psychological Clinic, published the Thematic Apperception Test (TAT), which
comprised 20 pictures.
• The assessment milestone of the 1940s was unquestionably the publication of the Minnesota
Multiphasic Personality Inventory (MMPI) by psychologist Starke Hathaway in 1943.
• Initial behavioral approaches to assessment involved the identification of specific behaviors
deemed to be central to the person’s distress, by virtue of being either a key symptom that
should be changed in therapy or a central factor responsible for causing and/or maintaining the
person’s distress.
• In the 1980s, the publication of the third edition of the American Psychiatric Association’s
Diagnostic and Statistical Manual of Mental Disorders (DSM) led to increased attention to the
value of structured interview approaches to gathering diagnostic information.
• The DSM-III was an explicit attempt to improve the reliability of psychiatric diagnoses by
providing as clear guidance as possible on specific criteria that must be met to render a
diagnosis.
• it is generally accepted that assessment data should be obtained from (a) multiple methods, such
as interviews, observations, and self-reports; and, increasingly, (b) multiple informants (i.e., not
just from the client).

The history of intervention in clinical psychology

• The modern history of psychotherapy is typically seen as beginning with the work of
Sigmund Freud and the development of psychoanalysis.
• In subsequent years, psychiatrists such as Carl Jung and Alfred Adler joined Freud to develop
and promote a psychoanalytic approach to the understanding and treatment of mental
disorders.
• Lightner Witmer, an American student of Wundt’s credited with being the first to use the
term clinical psychology, established a clinic offering psychological services in 1896 and
university training in clinical psychology in 1904. Witmer was a university professor whose
interests lay primarily in the application of research to learning and memory processes.
• John Watson demonstrated that it was possible to use conditioning principles to explain the
development of phobias. The next step that had important implications for treatment
purposes was when Mary Cover Jones showed that the principles of conditioning could be
used to extinguish a phobic reaction in a child.
• he publication in 1942 of Carl Rogers’ book Counseling and Psychotherapy. In contrast to the
then- dominant psychoanalytic approach, Rogers’ approach was rooted in an assumption
that people were inherently capable of developing in a positive, healthy manner.
• Hans Eysenck’s (1952) critique of the effectiveness of psychotherapy was a turning point for
psychotherapy research and training. Eysenck argued that the rates of improvement among
clients receiving either psychodynamic or eclectic (i.e., an unspecified mix of theories and
techniques) therapy were comparable to rates of remission of symptoms among clients
receiving no therapy at all
• The publication in the late 1970s of two influential books laid the foundation for what is now
known as cognitive-behavioral
therapy.
• Another milestone was reached in 1980 when Smith, Glass, and Miller used a statistical
technique called meta-analysis to review 475 controlled studies of psychotherapy.

The history of prevention in clinical psychology

Unfortunately, until recently, clinical psychologists have focused their services almost exclusively
on those who already have problems. Due to growing awareness that psychological principles
can be applied to pro- mote healthy lifestyles, clinical psychologists now frequently play an
important role in public health initiatives to change lifestyle-related illnesses.
 Topic 2-Contemporary clinical psychology
A clinical psychologist can:
1. Provide psychological services – work with individuals or couples, families, and groups;
2. Conduct research and provide clinical training
3. Consult with other professionals and agencies – work with organizations
4. all of the above

Assessment and diagnosis- involves evaluating the psychological functioning of an individual or a

relationship
• The precise nature of the assessment depends on the purpose of the assessment.
• The assessment plays an important role in the planning, monitoring, and evaluation of the
intervention.
• assessment tools to assess a host of psychological phenomena
• Interviews and observational systems;
• Intellectual and cognitive measures
• Self-report measures and projective measures

What is the purpose of assessment?- all clinical assessments share a primary goal of aiding the
understanding of the person’s current level of psychosocial functioning.
Assessment in clinical psychology involves diagnosing mental health conditions, creating personalized
treatment plans, monitoring progress, evaluating outcomes, and managing risks for individuals
seeking mental health support.

Dominant approaches
1. Psychodynamic
1. Cognitive-behavioral
2. Experiential
3. Interpersonal
4. eclectic

Intervention- Most commonly psychologists use techniques to identify or challenge thoughts, relate
thoughts to feelings, focus on the affect by validating or labeling emotions, gather information, and
guide or direct the client.
• Evidence suggests that psychological treatments can be effective in treating a wide range of
health problems.
• The majority of people who receive psychotherapy attend fewer than 10 sessions. Approximately
a third of clients attend only one or two sessions, and fewer than 1 in 10 clients attend more than
20 sessions of therapy.

Prevention-prevention activities tend to focus on either reducing risk factors or enhancing

protective factors.
• Prevention activities are relatively new.
• Risk factors - increase the likelihood of the development of a disorder.
• Protective factors – decrease the likelihood of eventually developing a disease or disorder.
• Factors that maintain disorder
Prevention efforts are usually based in community settings, as opposed to institutional settings such
as hospitals or private clinical psychology practices. Prevention programs can be offered to large
groups of people at a time, such as educating children about ways to resist pressures to abuse
alcohol or educating parents about issues around bullying in the school- yard. Alternatively,
prevention programs may be offered in a one-on-one format, as is often done in teaching life skills to
individuals already diagnosed with severe mental illness. Most commonly, the role of the clinical
psychologist is to develop, implement, and evaluate the prevention programs. The prevention
program is often delivered by mental health professionals such as nurses, counsellors, or social
workers.

Consultation-Providing information, advice, and recommendations about how best to assess,

understand, or treat a client
• Clinical psychologists often act in the role of consultant.
• The focus of the consultation is related to developing a prevention or intervention program.
• Organizational consultation – Organizational consultation, or "community consultation,"
involves developing prevention or intervention programs, evaluating an organization's
healthcare services, and offering opinions on healthcare policies set by the organization.
• Consultation with agencies fall into one of several categories:
• Need assessment- to determine the extent of an unmet health care need in an
identified population (To figure out how much healthcare is lacking for a specific
group of people.)
• Program developing- psychologist develop a program to educate the target
population about the available services.
• Program evaluation- Program evaluation checks if the program was done as planned
and if it achieved its goals.
• Policy consultation- It involves checking if an agency's policy aligns with its mission,
professional standards, or scientific evidence. For instance, a clinical psychologist
might assess if a healthcare company's policy on reimbursing psychotherapy services
matches appropriate standards.

Why is research important in clinical psychology?

Research is fundamental to clinical psychology as it underpins evidence-based practice, ensuring that
interventions and treatments are effective. It contributes to expanding knowledge and skills,
improving service quality, and informing policies. Additionally, research fosters professional
development and enhances mental health outcomes for individuals and communities.

Teaching and supervision

• Clinical supervision is a central part of the training of clinical psychologist - Graduate
students gain practical skills in psychological services through supervised practicums in
diverse settings like university clinics, medical hospitals, and psychiatric facilities, guided by
licensed psychologists. This hands-on training prepares them for a year-long internship in
real-world contexts, ensuring their readiness for various professional roles.

• Research supervision- The research supervisor, often an external psychologist, guides

students throughout their program. They help students understand relevant research
literature, plan ethical research, and provide input on study design, analysis, and
presentation

Science and ethics

• Ethical codes of conduct require that clinical psychologists maintain their knowledge of the
scientific foundation of their professional activities.
• Ethical principles that guide the way that psychologists work include:
 Respect for the people-ensure that individuals understand and consent to their
participation in research or treatment.
 The responsible provision of services-Ethical guidelines requires clinicians to provide
services that are effective, safe, and beneficial for clients.
  The maintenance of integrity in professional relationships-Ethical standards
promote honesty, transparency, and confidentiality in interactions between
psychologists and their clients.
 Professional responsibilities to society- Ethical codes emphasize psychologists'
obligations to contribute positively to society, promote social justice, and adhere to
legal and ethical norms in their work.

Training in clinical psychology

Three models guide the training of clinical psychologists:
1. The scientist-practitioner model- a training model that emphasizes competencies in both
research and provision of psychological services. Ufro vrclad:refers to a training approach
where graduate students in clinical psychology programs develop competencies in both
research and providing psychological services. This involves conducting original research for
their dissertation and demonstrating clinical skills through practicum training and a full-time
internship under licensed psychologists' supervision.
2. The clinical scientist model-focuses on training students to conduct research and contribute
to understanding in the field, emphasizing the integration of empirical (information,
knowledge, or evidence that is based on observation or experience rather than theory or
speculation) evidence into clinical practice.
3. The practitioner-scholar model (Psy. D.) __shifts the focus of doctoral training from heavy
research emphasis to prioritizing clinical skills and practice. It was developed because many
felt the scientist-practitioner model wasn't focusing enough on practical training for
graduates who primarily worked in clinical settings. Programs following this model often
award a Psy.D. degree, which includes some research training but is mainly geared toward
producing clinicians informed by research.

Topic 3 Classification and Diagnosis 65-97

Defining Abnormal Behavior and Mental Disorders The DSM Approach to Diagnosis Other
Classification Systems

Classification system

A classification system allows scientist to organize, describe, and

relate the subject matter of their discipline.
We can classify things based on a categorical approach or a
dimensional approach.
Categorical approach 🡪 an entity is a member of category or not a
member of category.
Dimensional approach 🡪 all entities can be arranged on a continuum
to indicate the degree of membership in category.

1. ICD: It's like a big list that helps classify all kinds of health issues. It's made by the World Health
Organization and is available in many languages. It gets updated online for free.

2. Different Uses: Different countries use this list in different ways. Some use it to understand what
health problems are common in their population, while others change it to fit their own healthcare
systems. In the US, they have a modified version for billing and reporting.
3. Relation to DSM-5: There's another book called DSM-5 that talks about mental health issues. The
ICD and DSM-5 are kind of similar, but they have some differences in how they describe and
categorize disorders.

4. ICD-11: There's a newer version of the ICD coming out soon. It's going to be a bit more like DSM-5
but will still have its own unique features.

5. ICF: Besides just talking about diseases, there's another system called ICF that looks at how well
people can function in their daily lives and what might affect that, like disabilities or the
environment. This is especially helpful for psychologists who work with rehabilitation or pain
management.

Validity and utility

Validity: Think of validity as making sure your research actually measures what it's supposed to. It's
like checking if a thermometer gives the right temperature.
psychology, it's about making sure the methods used in a study really capture what's going on and
that the conclusions drawn from the study are solid.

Utility: Utility is about whether the results of your research are actually helpful in the real world. It's
like asking if the information from your study can be used by psychologists to understand and help
people better. So, even if your study is accurate, it's only really useful if it can be applied to solve
real-life problems or advance our understanding of psychology.

In short, validity ensures accuracy within the study, while utility ensures usefulness beyond it. Both
are important to make sure research is both accurate and helpful.

Internalizing problems and externalizing

problems

Thomas Achenbach conducted research and yielded two broad

dimensions of problems.

Es mokled: Externalizing problems are acting out behaviors such as yelling,

destroying things, stealing, and showing aggression.

Internalizing problems are feelings of sadness, worry, and

Withdrawal.
internalizing problems and externalizing problems are two broad dimensions of difficulties
experienced by children, as identified by researcher Thomas Achenbach.

1. Externalizing Problems: These are characterized by outwardly-directed behaviors that are often
disruptive or aggressive. Examples include yelling, destroying things, stealing, and showing
aggression. Children with externalizing problems may have difficulty controlling their impulses and
may exhibit behaviors that disrupt their environment or harm others.

2. Internalizing Problems: In contrast, internalizing problems involve inwardly-directed emotions

and behaviors. This includes feelings of sadness, worry, and withdrawn behavior. Children with
internalizing problems may tend to internalize their distress, leading to symptoms such as
depression, anxiety, or social withdrawal.

Achenbach's work suggests that these two dimensions, externalizing and internalizing problems,
represent distinct but interrelated aspects of psychopathology in children. By using a dimensional
approach, psychologists can assess a child's functioning based on the intensity of both externalizing
and internalizing problems, providing a comprehensive understanding of their psychological well-
being.

A diagnostic system is a classification based on rules used to organize and understand diseases and
disorders.- We have two classification systems: DSM-V and ICD-10.
Modern attempts to classify and diagnose abnormal human behavior
began with Emil Kraeplin.
In the modern era, we also use elements of the prototype model.

What is abnormal behavior?

Abnormal behavior is behavior that deviates from what is considered typical or expected within a
given context.
1. Subjectivity of Normalcy: What is considered abnormal depends on societal norms and
expectations. People often seek psychological assistance to determine whether their experiences or
behaviors fall within the range of normalcy.

2. Contextual Considerations: Understanding the context in which behavior occurs is crucial in

determining its abnormality. For example, behaviors like temper tantrums in a 2-year-old may be
developmentally appropriate but would be concerning in an adult.

3. Age-Appropriateness: Behavior is interpreted differently based on age. What is considered

normal for a preschool-age child may be indicative of psychopathology in older children or adults.

4. Cultural Influences: Cultural norms play a significant role in determining the acceptability of
behavior. Grieving rituals, for example, vary widely across cultures, impacting how sadness is
expressed.

5. Developmental Appropriateness: Diagnostic criteria for disorders often specify that symptoms
must be developmentally inappropriate. Thus, understanding the typical range of behavior for a
particular developmental stage is essential in identifying abnormal behavior.

American Psychiatric Association defines mental disorder in the following manner:

A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s

cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological,
or
developmental processes underlying mental functioning. Mental disorders are usually associated
with
significant distress or disability in social, occupational, or other important activities. An expectable or
culturally approved response to a common stressor or loss, such as the death of a loved one, is not a
mental
disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily
between the individual and society are not mental disorders unless the deviance or conflict results
from a
dysfunction in the individual, as described above.

Etiology of mental disorders

The etiology of mental disorders is understood through a biopsychosocial model, which
acknowledges the contribution of biological, psychological, and social factors to the development of
mental disorders.
1. Biological Factors: Some theories emphasize genetic elements as significant contributors to the
development of mental disorders. Genetic factors may influence vulnerability to certain disorders,
although the precise contribution varies across disorders.

2. Psychological Factors: Psychological theories often emphasize cognitive processes, developmental

factors, and interpersonal relationships in the development of mental disorders. For example,
stressors such as life events or trauma can increase the risk of developing anxiety or depressive
disorders.

3. Social Factors: Social factors, such as socioeconomic status, family dynamics, and environmental
stressors, also play a role in the development of mental disorders. For instance, exposure to natural
disasters or other traumatic events can increase the likelihood of experiencing mental health issues.

4. Interaction of Factors: The etiology of mental disorders is complex and involves the interaction of
biological, psychological, and social factors. These factors may vary in their relative importance
across different disorders and individuals.

5. Developmental Trajectories: Longitudinal studies provide insights into how mental health
symptoms change over the lifespan. For example, research shows that depressive symptoms may
peak in young adulthood, decrease during middle adulthood, and then increase again in older
adulthood.

6. Risk and Protective Factors: Researchers study individual differences in the emergence of
psychological disorders to identify both risk and protective factors. Understanding these factors can
help predict who is at greater risk for developing a disorder and inform prevention and intervention
efforts.

7. Recurrence and Recovery: Longitudinal studies also track the recurrence of mental health
episodes following initial episodes. Factors influencing recurrence versus recovery are of particular
interest to researchers, as they can inform treatment strategies and prognosis.

The diagnostic and statistical manual of

mental disorders (DSM) system ravi es agar mivamate araferi wignidan mgoni araa sachiro
The evolution of the DSM:

DSM – 1952.
DSM II – 1968
DSM III – 1980
DSM III-R – 1994
DSM IV – 2000
DSM V – uses the categorical approach to classification. Also uses
concepts of internalizing and externalizing problems.
DSM V
Each diagnosis has information about:

 Diagnostic features
 Associated features and disorders
 Prevalence Course
 Familial pattern
 Differential diagnosis
 Specific culture , age, gender features.

ICD system
ICD System:

The ICD is a statistical classification developed by the World Health Organization (WHO) covering all
health conditions, including mental and behavioral disorders. It's currently in its 10th edition (ICD-
10) and is available in multiple languages. The ICD is periodically updated to reflect changes in
scientific evidence. Its primary use varies among countries, from providing population-level data on
illnesses to informing individual patient service provision in healthcare systems.

Compatibility with DSM-5:

ICD-10-CM (Clinical Modification) is generally compatible with DSM-5, providing numerical codes for
disorders described in DSM-5. However, differences exist in diagnostic classes, specific diagnoses,
and conceptualizations of certain disorders between the two systems. For example, the definition of
acute stress reaction differs between ICD-10 and DSM-5.

Evolution to ICD-11:

ICD-11, planned for release in 2018, follows the organizational structure of diagnostic classes used in
DSM-5 but may still have differences in diagnostic criteria. Notably, ICD-11 aims for greater clinical
utility, with research informing the description and organization of mental disorders. It will include a
diagnostic manual for clinical purposes and a separate one for research purposes.

Companion Classification System:

The WHO has also developed the International Classification of Functioning, Disability and Health
(ICF), which provides a framework for describing health-related conditions beyond disease
classification. It focuses on overall functioning and disability, including environmental factors
affecting health functioning.

Limitations of Diagnostic Systems:

The passage discusses several limitations of diagnostic systems, including:

1. Defining Abnormality: Concerns about overdiagnosis and the medicalization of ordinary life.
2. Diagnostic Reliability: Issues with inter-rater reliability, especially regarding rare conditions
and reliance on categorical rather than dimensional approaches.
 3. Inter-rater Reliability: Challenges in accurately identifying uncommon conditions and
evaluating reliability accurately due to the process of diagnosing based on recorded
interviews.
4. Test-Retest Approach: The importance of a test-retest approach for reliability, with evidence
suggesting potential overestimation of reliability in previous DSM versions due to the use of
different research designs.

comorbidity

Comorbidity means having more than one mental health problem at the same time. For example,
someone might have both anxiety and depression. It's pretty common, especially among adults and
young people.

When people have more than one mental health issue, it can make things harder for them. They
might have more trouble with daily tasks, have been dealing with these issues for a long time, have
more physical health problems, and need to see the doctor more often.

For researchers and doctors, it's important to know about comorbidity because it helps them
understand how different mental health issues are connected and how to give the best treatment.
They're realizing that mental health problems might not fit neatly into separate categories, and
instead, they might be better understood as part of a bigger picture, like different pieces of a puzzle
that all fit together.

Research methods in clinical psychology- chapter 4

Generating research hypotheses

• Sources of research ideas: personal experience, professional experience, and knowledge of
the scientific literature.
• Our thinking is always influenced by the type of theory we hold about human behavior.
• The deductive process of forming hypotheses  using formal theory to generate a
hypothesis.
• The inductive process of forming hypotheses  this process is not explicitly guided by
theory. It is influenced by the researcher’s informal theories and general view.
• Developing a general research idea;
1. Conduct a systematic search of the published research;
2. If there is no research, the researcher begins to formalize ideas so they can be tested in a
scientific manner.
3. Considering the extent to which the research idea may be based on cultural assumptions
that may limit the applicability or relevance of the planned research.
4. Considering ethical issues.
5. Scetch out the study procedure.

Research design
• Research designs are case studies, correlational design, quasi-experimental design, and
experimental design.
• Often research designs have problems with validity.
• Internal validity – the extent to which the interpretations drawn from the results of a study
can be justified and alternative interpretations can be reasonably ruled out.
• External validity – the extent to which the interpretations drawn from the results of a study
can be generalized beyond the narrow boundaries of the specific study.
Case studies
• A typical case study involves a detailed presentation of an individual patient, couple, or
family illustrating some new or rare observation or treatment innovation.
• It has the potential to generate hypotheses;
• It doesn’t allow to test hypotheses.
• A-B single case study design – A period represents symptoms prior to the intervention
(baseline), and B period represents symptoms after the intervention.
• A-B-A single case design – A period is a baseline, B period represents intervention and this
intervention is followed by a period of no intervention (A).
Correlational design
• The most commonly used design in clinical psychology.
• Associations between variables.
• Can never determine causality.
• We can create groups and compare them, but still, it is not an experimental design.
• Correlational design can be used for factor analysis.
• Factor analysis – a statistical procedure used to determine the conceptual dimensions or
factors that underlie a set of variables, test items, or tests.
• The moderator variable influences the strength of the relationship between variables.
• The mediator variable explains the mechanism by which the predictor variable influences
criterion variable.
Quasi-experimental and experimental designs
• In quasi-experimental design, a researcher manipulates some variables, but there is no
random assignment to experimental conditions.
• In experimental design, there is a random assignment to conditions and experimental
manipulation.
• Randomized controlled trial – an experiment in which research participants are randomly
assigned to one of two or more treatment conditions.
Sample
• Decisions about the strategies used to recruit participants can affect the validity and
generalizability of a study.
• Probability sampling focuses on the use of numerous strategies to ensure that the research
sample is representative of the population.
• Non-probability sampling strategies, hese sampling strategies may include advertising for
research participants in a newspaper, on a website, or in a mental health treatment setting.
Measurement options
• Self-Report Measures: The research participant completes a ques- tionnaire describing some
aspect of himself or herself. This may range from global self-ratings, such as overall
happiness or psycho- logical adjustment, to very specific self-ratings, such as anxiety while
completing a research task.

• Informant-Report Measures: Information about a target research participant is gathered

from other individuals. In clinical psychol- ogy research, this is typically someone who is well-
acquainted with the participant, such as a partner, a parent, or a teacher. Data may also be
obtained for individuals with only limited experience with the participants. In studies of
social interaction, for example, informant-report measures may be gathered from all the
partici- pants who interacted with a given participant.
• Rater Evaluations: Data may be obtained from someone knowl- edgeable about a
participant’s involvement in a study, such as a rater who viewed videotapes of the
 participant performing a task or a therapist who provided treatment to the participant. Such
ratings can range from evaluations of very specific to very global features.
• Performance Measures: Participants may be asked to complete tasks in a study, such as a
visuomotor task, a response time task, an identification task, or a task related to specific
intellectual or social skills. The quality of the participant’s performance on the task is used as
data in the study.
• Projective Measures: A technique, such as a storytelling task, may be used to assess the
underlying needs or motives of a research participant. The assumption in using such
measures is that they provide data that are different from those obtained through self-
report.
• Observation of Behaviour: Coding systems or general ratings may be used to summarize
elements of a participant’s actual behaviour. This may occur either in naturalistic settings
such as the family home or in laboratory settings.
• Psychophysiological/Biological Measures: A range of measure- ment options is available to
evaluate a participant’s biological characteristics. These include measures of autonomic
arousal, car- diovascular activity, and neurological functioning.
• Archival Data: Research data are often obtained from informa- tion sources that exist apart
from the actual research study. This may include such sources as police records, health care
utilization records, and academic records.

Psychometric properties of measures

• Reliability
• Internal consistency- The degree to which elements of the meas- ure (such as items on a
test) are homogeneous.
• Test-retest reliability- The stability over time of scores on a measure.
• Inter-rater reliability- The consistency of scores on a measure across different raters or
observers.
• Validity
• Content validity- he extent to which the measure fully and accurately represents all
elements of the domain of the construct being assessed.
• Face validity- The extent to which the measure overtly appears to be measuring the
construct of interest.
• Criterion validity- The association of a measure with some crite- rion of central relevance to
the construct, such as differentiating between groups of research participants.
• Concurrent validity- The association of a measure with other rel- evant data measured at
the same point in time.
• Predictive validity- he association of a measure with other rel- evant data measured at some
future point in time.
• Convergent validity- The association between a measure and other measures of either the
same construct or conceptually related constructs.
• Discriminant validity- The association between measures that, conceptually, should not be
related.
• Incremental validity- The extent to which a measure adds to the prediction of a criterion
beyond what can be predicted with other measurement data.

Research syntheses
 • Systematic reviews- the use of a systematic and explicit set of methods to identify, select,
and critically appraise research studies.
• Meta-analysis- a set of statistical procedures for quantitatively summarizing the results of a
research domain.

Psychological assessment, interviewing, and observation- chapter 5,6

Psychological assessment is a decision-making process in which data are systematically collected on

the person, the person’s history, and the person’s physical, social, and cultural environment.
Assessment goals determine questions and tools used during assessment.
Purpose:
1. Assessment-Focused Services: These are services aimed at understanding how a person is
doing psychologically. They focus on gathering information about the individual's mental and
emotional well-being.
2. Intervention-Focused Assessment Services: These assessments are done as a first step in
providing help or treatment. They help determine what kind of intervention is needed to
address the individual's issues.
3. Screening: Screening involves checking people for potential problems or risks. It's like a quick
check-up to see if someone might need further assessment or support for mental health
concerns.
4. Diagnosis/Case Formulation: This involves identifying and understanding mental health
disorders or issues a person may be experiencing. It helps psychologists understand the
unique aspects of an individual's situation.
5. Prognosis/Prediction: This aspect looks at predicting how things might go in the future
based on the current situation. It helps in understanding what might happen if certain
interventions or treatments are provided.
6. Treatment Planning: This covers figuring out what needs to be addressed, setting goals for
treatment, and deciding on strategies to achieve those goals. It's like creating a roadmap for
therapy or other interventions.
7. Treatment Monitoring: Once treatment starts, this involves keeping an eye on how things
are going. It helps ensure that the chosen interventions are working and allows for
adjustments if needed.
8. Treatment Evaluation: This is about looking back and assessing how well the treatment
worked. It helps determine if the treatment goals were met and if any changes or
improvements are needed for future intervention.

Evidence Based Research is an approach to psychological evaluation that uses research and theory to
guide the variables assessed, the methods and measures, and the manner in which the assessment
process unfolds.

1. Identifying Reliable Psychological Tools: The first step in the development of Evidence-Based
Assessment (EBA) involves finding psychological tools like interviews, surveys, and
observation methods that have been proven to be reliable and valid. These tools are used for
various assessment purposes like diagnosing mental health issues, monitoring treatment
progress, or evaluating treatment effectiveness.
2. Rating System for Assessment Instruments: Hunsley and Mash created a system for rating
these tools based on how well they perform for specific assessment purposes and
conditions. This system looks at factors like reliability (how consistent the results are), validity
(how accurately the tool measures what it's supposed to), and whether there are established
norms for interpreting the results.
 3. Integrating Assessment Data: Once reliable tools are identified and rated, the next step is to
use statistical methods to combine the data collected from these tools for individual clients.
The goal is to create procedures that help clinicians make important decisions about their
clients' treatment based on solid scientific evidence.
4. Developing Decision-Making Tools: Researchers like De Los Reyes, Thomas, Goodman, and
Kundey, as well as Youngstrom and colleagues, have developed equations and frameworks to
assist psychologists in making diagnoses and predicting treatment outcomes for their clients.
This involves creating a dataset of common diagnoses and problems, researching factors that
influence these issues and treatment outcomes, and compiling a library of psychological
tools to aid in diagnosis and risk assessment.
5. Using Data to Inform Treatment: With this information and tools at hand, psychologists can
use data collected from their clients, along with insights from research, to make informed
decisions about the best psychological services for their clients. This approach aims to tailor
treatments to individual needs based on solid evidence and assessment data.

Testing a psychometric consideration

1. Standardization: This involves creating a consistent procedure for administering and scoring
a psychological test. It ensures that the test is delivered in the same way across different
settings and by different administrators. Standardization includes specifying details such as
the format of test items, instructions for administration, time limits, and rules for scoring.
Without standardization, the reliability and validity of the test results may be compromised,
as variations in administration and scoring procedures could lead to inconsistent outcomes.
2. Reliability: Reliability is the extent to which a test produces consistent and stable results over
time and across different conditions. It is essential for ensuring that the scores obtained from
a test are dependable and free from measurement error. Several aspects of reliability are
typically assessed:
 Internal Consistency: This assesses the extent to which all items within a test
measure the same underlying construct. It is evaluated using statistical techniques
such as Cronbach's alpha, which measures the degree of correlation between
different items on the test.
 Test-Retest Reliability: This measures the consistency of test scores when the same
test is administered to the same individuals on two separate occasions. It assesses
whether the scores remain stable over time in the absence of any real change in the
construct being measured.
 Inter-Rater Reliability: This measures the degree of agreement between different
raters or scorers when administering and scoring the test. It ensures that different
administrators or observers obtain similar results when evaluating the same
responses or behaviors.
3. Validity: Validity refers to the extent to which a test accurately measures the psychological
construct it is intended to assess. It is a multifaceted concept, and various types of validity
evidence are typically considered:
 Content Validity: This assesses whether the test items adequately represent the
content domain or construct being measured. It involves expert judgment to ensure
that the test items cover all relevant aspects of the construct.
 Criterion-Related Validity: This evaluates the extent to which test scores are
predictive of or correlated with external criteria or outcomes that are theoretically
related to the construct being measured. It includes concurrent validity (correlation
with a criterion measured at the same time) and predictive validity (correlation with
a criterion measured at a future point in time).
  Construct Validity: This examines whether the test accurately measures the
underlying psychological construct it purports to assess. It involves testing
hypotheses about relationships between the test scores and other variables to
provide evidence for the construct being measured.
 Incremental Validity: This assesses the extent to which a test adds unique predictive
value beyond what is already predicted by existing measures or information. It
demonstrates the usefulness of the test in providing additional information for
decision-making beyond what is already known.
4. Norms: Norms provide a frame of reference for interpreting test scores by comparing an
individual's performance to that of a relevant group. Normative data typically include
information about the distribution of scores within the reference group, such as means,
standard deviations, percentiles, or percentile ranks. Norms can be based on various
populations, such as the general population, specific age groups, genders, or clinical
populations. They help clinicians and researchers understand the significance of an
individual's score by placing it in context relative to others.
Additional:
5. types of Reliability: While you mentioned internal consistency, test-retest reliability, and
inter-rater reliability, you could also briefly mention other types such as alternate forms
reliability (consistency between different versions of the same test) and split-half reliability
(consistency between two halves of the test).
6. Types of Validity: In addition to content validity, criterion-related validity, and construct
validity, you could mention face validity (whether a test appears to measure what it is
supposed to measure) and convergent validity (the degree to which test scores correlate
with scores on other measures of the same construct).
7. Challenges in Test Development: You could discuss some common challenges faced in test
construction, such as ensuring cultural and linguistic appropriateness, minimizing response
bias, and addressing issues of test fairness and accessibility for diverse populations.
8. Ethical Considerations: It's important to touch on ethical considerations in test construction
and validation, including issues related to informed consent, confidentiality, and potential
biases in test content or administration.

Clinical Interview
1. Structured Interviews:
 Structured interviews are highly standardized and typically follow a predetermined
set of questions and response options.
 They are commonly used in population surveys or other situations where
consistency and comparability of responses across different individuals are essential.
 The questions are carefully designed to cover specific topics of interest, and the
interviewer follows a strict protocol in asking questions and recording responses.
 Structured interviews minimize interviewer bias and ensure that all participants are
asked the same questions in the same manner, allowing for easy comparison of
responses.
2. Semi-Structured Interviews:
 Semi-structured interviews offer a middle ground between structured and
unstructured formats.
 While they provide a general structure and sequence of questions, they also allow
for some flexibility in how the interviewer explores topics and interacts with the
interviewee.
 The interviewer may have a predetermined list of questions to cover but can also
deviate from the script to delve deeper into specific areas of interest or follow up on
the interviewee's responses.
  Semi-structured interviews are often used in clinical settings, where the interviewer
needs some guidance but also the flexibility to adapt the conversation to the client's
unique circumstances and concerns.
3. Unstructured Interviews:
 Unstructured interviews lack a predetermined set of questions or a specific
sequence of topics to be covered.
 They offer the highest degree of flexibility, allowing the interviewer to guide the
conversation based on the interviewee's responses and interests.
 Unstructured interviews are common in qualitative research and clinical
assessments, where the goal is to explore complex issues in-depth and gain a rich
understanding of the interviewee's experiences, perspectives, and emotions.
 While unstructured interviews can yield valuable insights and uncover unexpected
information, they may also be more susceptible to interviewer bias and variability in
the depth and coverage of topics discussed.

General issues in interviewing

• Attending skills
• Contextual information
• Culturally sensitive interviewing
• Defining problems and goals
• Assessing suicide risk
• Interviewing couples
• Interviewing families
• Interviewing children and adolescent

Observations and Self-monitoring

Observations: During assessment interviews, psychologists keenly observe clients, noting behaviors,
speech patterns, and physical movements. This observation provides valuable data beyond verbal
responses. Observations can occur in various settings, like homes or schools, to gather additional
insights into clients' behaviors and interactions. Advantages:
 Provides additional data beyond verbal responses.
 Offers insights into behaviors that clients may not describe in interviews.
 Allows assessment of behaviors in natural settings. Disadvantages:
 Observations may not fully represent typical behavior.
 Require permission and cooperation from clients and other involved parties.
 May be influenced by observer biases.

Self-Monitoring: Self-monitoring involves clients tracking their own behaviors, emotions, or

thoughts. It provides valuable information for treatment planning and evaluation. Self-
monitoring can take various forms, including recording events, thoughts, or symptoms.
Technology, like smartphones or bio-sensors, can aid in self-monitoring. Advantages:
 Provides detailed, real-time data.
 Helps establish baseline conditions and track progress.
 Allows clients to actively participate in their treatment. Disadvantages:
 Data may be inaccurate due to client errors or reactivity.
 Requires clear instructions and understanding from clients.
 May not capture all relevant behaviors or thoughts.