Evoluon of Clinical Psychology

Early Pioneers
• William Tuke (1732-1822)
– Was appalled by how paents
were treated in asylums
– Opened the York Retreat
• Paents received good food,
frequent exercise, and friendly
interacons with sta,
• Became an example of humane
treatment that many in Europe
and the US followed
• Began a movement to improve
the treatment of mentally ill
paents
 Early Pioneers
• Philippe Pinel (1745-1826)
– Like Tuke, was a liberator of
the mentally ill
– Moved the mentally ill out of
dungeons in Paris where they
were held as inmates rather
than treated as paents
– Convinced others that
• The mentally ill were not
possessed by devils
• Deserved compassion and hope
rather than maltreatment and
scorn
 Early Pioneers
• Philippe Pinel (1745-
1826)
– Trease on Insanity
(1806)
• “To rule [the mentally ill]
with a rod of iron, as if to
shorten the term of an
existence considered
miserable, is a system of
superintendence, more
disnguished for its
convenience than for its
humanity or success.”
 Early Pioneers
• Eli Todd (1762-1832)
– Learned of Pinel’s e,orts in
France and helped to spread
the word in the US
– Opened The Retreat in
Har?ord, Conneccut in 1824
• Ensured that paents were
always treated in a humane and
digni@ed way
• He and sta, emphasized
paents’ strengths rather than
weaknesses
• Allowed paents input in their
own treatment decisions
 Early Pioneers
• Dorothea Dix (1802-1887)
– Worked in a jail in Boston
• Saw that many inmates were
there as a result of mental
illness or retardaon than crime
– Collected data in many cies
demonstrang this
• This resulted in the
establishment of more than 30
state instuons for the
mentally ill throughout the US
– E,orts provided decent and
compassionate treatment for
the mentally ill
The Creaon of Clinical Psychology
• In the late 1800’s, psychologists didn’t pracce
psychology, they studied it
– Psychology had liEle of the applied funcons that
it has today
The Creaon of Clinical Psychology
• Lightner Witmer (1867-1956)
– Founded the @rst psychology
clinic at the University of
Pennsylvania in (1896)
• This was the @rst me that
psychology was applied to
people’s problems
– By 1914 there were 20 clinics
in the US
– By 1935 there were 150 in the
US
The Creaon of Clinical Psychology
• Lightner Witmer (1867-1956)
– Founded The Psychological Clinic
• The @rst scholarly journal in the
@eld of clinical psychology
• Witmer authored the @rst arcle,
tle “Clinical Psychology”
– The @rst known use of the term
– “During the last ten years the
laboratory of psychology at the
University of Pennsylvania has
conducted, under my direcon,
what I have called a ‘psychological
clinic’
 Assessment
• Labeling systems for mental illnesses in the late
1800s were rudimentary
– Mental illnesses were oHen placed in one of two very
broad categories: neurosis and psychosis
– Neuroc individuals
• Thought to su,er from some psychiatric symptoms, but
maintain an intact grasp on reality (e.g. anxiety and depression)
– Psychoc individuals
• Demonstrate a break from reality in the form of hallucinaons,
delusions, or grossly disorganized thinking (e.g. schizophrenia)
 Assessment
• Emile Kraeplin (1855-1926)
– Considered the father of
descripve psychiatry
– Di,erent two-category
system of mental illness
• Exogenous Disorders
– Caused by external factors
• Endogenous Disorders
– Caused by internal factors
• Suggested that exogenous
disorders were the far more
treatable type
 Assessment
• Emile Kraeplin (1855-1926)
– Assigned names to speci@c
disorders
• Demena praecox
– An endogenous disorder similar to
what we now call Schizophrenia
• Also coined
– Paranoia, manic depressive psychosis,
involuonal melancholia, cyclothymic
personality and ausc personality
– Many of his terms have been
replaced
• He sll set a precedent for the creaon
of diagnosc terms
– This eventually led to the DSM
 The Diagnosc and Stascal Manual of
Mental Disorders (DSM)
• Before the DSM
– Original reason for categorizing mental disorders was
to collect stascs on the populaon
• In 1840, the US Census Bureau included a single category
for this purpose
– “Idiocy/Insanity”
• In 1880, there were seven categories
 The Diagnosc and Stascal Manual of
Mental Disorders (DSM)
• DSM-I and DSM-II
– The DSM was published by the American Psychiatric Associaon in 1952
– DSM-II followed in 1968
• Was not considered to be signi@cantly di,erent from DSM-I
– Both gave vague descripons of each disorder
• DSM-III was released in 1980 and was an enrely new way of
thinking
– Provided speci@c diagnosc criteria
• Lists indicang exactly what symptoms constute each disorder
– Introduced a mulaxial system
• A way of cataloguing problems of di,erent kinds on di,erent axes
• This was retained unl DSM-5 (May, 2013)
 Assessment of Intelligence
• Assessing intelligence
– This was even more characterisc of clinical psychology
than therapy was
• Dispute among psychology’s pioneers about the
nature of intelligence
– Edward Lee Thorndike
• Promoted the idea that each person possesses separate,
independent intelligences
– Charles Spearman
• Argued for the existence of “g,” a general intelligence thought to
overlap with many parcular abilies
 Assessment of Intelligence
• Alfred Binet (1857-1911)
– Created the @rst Binet-Simon
scale in 1905
• Test yielded a single overall score
– Endorsing the concept of “g”
• Was the @rst to compare mental
age to chronological age
– Yielding an “intelligence quoent”
– Was revised by Lewis Terman in
1937
– Now called the Stanford-Binet
Intelligence Scale
– Mostly a child-focused measure
of IQ
 Assessment of Intelligence
• David Wechsler (1896-1981)
– Published the Wechsler-
Bellevue test in 1939
– Wechsler Adult Intelligence
Scale (WAIS)
• Currently in its fourth revision
– Wechsler Intelligence Scale
for Children (WISC)
• Currently in its @Hh revision
– Wechsler Preschool and
Primary Scale of Intelligence
(WPPSI)
• Currently in its fourth revision
 Assessment of Personality
• Projecve Personality Tests
– Based on the assumpon that people will “project”
their personalies onto ambiguous or vague smuli
• The way people perceive and make sense of the smuli
corresponds to the way they perceive and make sense of
the world around them
– What’s your favorite movie?
– What’s your favorite song?
– Why?
 Assessment of Personality
• Hermann Rorschach (1884-1922)
– In 1921 released his set of 10
inkblots
• The Rorschach Test
Assessment of Personality
 Assessment of Personality
• Themac Appercepon
Test (TAT)
– Projecve test using
cards depicng people in
scenes or situaons
– Paents are asked to tell
stories to go along with
the interpersonal
situaons presented in
the IAT cards
 Assessment of Personality
• Other projecve tests
– Draw-a-Person test
• The psychologist infers personality characteriscs from
clients’ drawings of human @gures
– Incomplete sentence Blank
• The psychologist assesses personality by examining the
ways clients @nish sentence stems
• The popularity of projecve tests had decreased
over me in light of quesons about their
reliability and validity
 Assessment of Personality
• Objecve Personality Tests
– Typically pencil-and-paper instruments of
mulple-choice or true/false quesons
– Content is on the client, their experiences, and/or
their preferences
 Assessment of Personality
• The Minnesota Mulphasic Personality Inventory
(MMPI)
– Published in 1943 by Starke Hathaway and J.C. McKinley
– Consisted of 550 true/false statements
– Responses were compared with those of groups in the
standardizaon sample who represented many diagnosc
categories
– Included over 200 separate scales consisng of combinaon
of MMPI items
– Included validity scales to detect random responding or
intenonally misleading responses
 Assessment of Personality
• The NEO Personality Inventory (NEO-PI)
– Scales are based on universal personality characteriscs
common to all individuals
– Based on three of the “Big Five” personality traits
• Neurocism, extraversion, and openness
 Psychotherapy
• Psychotherapy was not always the primary acvity of
clinical psychologists
– In 1930, almost every clinical psychologist worked in academia
• The demand created by the psychological consequences of
World War II on US soldiers likely played a role in making
therapy more prominent
Current Controversies in Clinical
Psychology
 Prescripon Privileges
• Historically been one of the primary disncons between psychiatrists and
psychologists
– Within the general public, it is a dening dierence
• Recent years have seen some clinical psychologists acvely pursue prescripon
privileges
– Roots of the movement were established in the 1980s
– The 1990s and 2000s saw high-prole, high stakes debates
• The APA has published numerous arcles
– Endorsing prescripon privileges
– Oering suggesons for training of psychologists to become procient in prescribing
safely and eecvely
• Several prominent psychologists have promoted the movement towards
prescribing
– Patrick H. DeLeon
– Morgan T. Sammons
– Robert McGrath
 Prescripon Privileges
• Three states have granted prescripon
privileges to trained psychologists
– New Mexico in 2002
– Louisiana in 2004
– Illinois in 2014
– Others have given serious consideraon
• Several psychopharmacology training programs
are available for psychologists in the US military
Why Clinical Psychologists Should Prescribe

• Shortage of psychiatrists
• Clinical psychologists are more expert than primary care
physicians
• Other nonphysician professionals already have
prescripon privileges
• Convenience for clients
• Professional autonomy
• Professional idencaon
• Evoluon of the profession
• Revenue for the profession
Why Clinical Psychologists Should Prescribe

• Shortage of Psychiatrists
– Low rao of those who can prescribe medicaons
and those who need them
– Underserved segments of society would benet
from a higher rao of prescribers to paents
• The lobbying for privileges in New Mexico and
Louisiana
– The low number of psychiatrists per capita was a
cornerstone of the (successful) argument
Why Clinical Psychologists Should Prescribe

• Clinical Psychologists are More Expert Than Primary

Care Physicians
– Psychiatrists have specialized training in mental health
issues
• However, they aren’t the only ones prescribing psychoacve
medicaons
– More than 80% of prescripons come from primary care
physicians
• Clinical psychologists’ training is more extensive and specialized
than a physicians’
– Thus, clinical psychologists could be be;er able to diagnose problems
correctly and select eecve medicaons
Why Clinical Psychologists Should Prescribe

• Other Nonphysician Professionals Already Have

Prescripon Privileges
– These include densts, podiatrists, optometrists, and
advanced pracce nurses
– This sets a precedent for specially trained clinical
psychologists to do the same
Why Clinical Psychologists Should Prescribe

• Convenience for Clients

– Many paents could benet from both nonpharmacological
intervenons (i.e. psychotherapy) and prescripon medicaons
• A psychotherapist
– Can provide psychotherapy
– Can’t provide the medicaon
• A primary care physician or psychiatrist
– Can provide medicaon
– Can’t provide psychotherapy
– Inconvenient for both the paent and provider
• Increases the me and money that paents spend on appointments
• Requires two busy treatment providers to be in communicaon
Why Clinical Psychologists Should Prescribe

• Professional Autonomy
– Clinicians may feel restricted in what they can do
– With prescripon privileges, clinicians provide a
wider range of services to clients
Why Clinical Psychologists Should Prescribe

• Professional Idencaon
– It might be di=cult for the general public to disnguish
between psychologists and other non-prescribing
therapists or counselors
– The ability to prescribe would set psychologists apart
(and above) other professions
Why Clinical Psychologists Should Prescribe

• Evoluon of the Profession

– Clinical psychologist has undergone many changes in its brief
history
• Many were inially unfamiliar
• These changes have allowed the profession to thrive
– Many see prescripon privileges as the next step in the
evoluon of the profession
• They argue that to stop this would impede growth
– Prescripon privileges could open mulple doors
• Direct pharmaceucal treatment of clients
• Consultaon with physicians about psychoacve medicaons for
paents
Why Clinical Psychologists Should Prescribe

• Revenue for the Profession

– Financial benet for the profession and its members
• Salaries have decreased as a result of managed care
• Prescripon privileges could oset this
– Some psychiatrist organizaons strongly oppose
prescripon privileges of clinical psychologists
• Members stand to lose business if psychologists can prescribe
– Could be huge
» In the 1990s, the percentage of those on andepressants doubled
from 37% to 74%
» Andepressants were the most commonly prescribed category of
drug in the US in 2011
 Why Clinical Psychologists Should Not
Prescribe
• Training issues
• Threats to psychotherapy
• Identy confusion
• The potenal inAuence of the pharmaceucal
industry
 Why Clinical Psychologists Should Not
Prescribe
• Training Issues
– Good quesons
• What kind of educaon should clinical psychologists receive before they are licensed to
prescribe?
• What should it cover?
• Who should teach them?
• When should it take place?
– Early in graduate school?
– During the predoctoral internship?
– As specialized training aCer the doctoral degree?
– Some argue for a comprehensive understanding of everything involved in a
prescripon decision
• The only way to appreciate the impact of the drug on
– Mulple systems of the body
– The interacons with other medicaons
– All other medical factors
– Others argue for just a basic competence in psychopharmacology
– Most fall in the middle…
 Why Clinical Psychologists Should Not
Prescribe
• Threats to Psychotherapy
– If clinical psychologists can prescribe, what will become of
psychotherapy?
• Some worry that it will driC from “talk therapy” to pharmacological
intervenon
• Clients may come to expect medicaon from clinical psychologists
• Clinical psychologist might discover that prescribing is more protable
– Cummings (2007)
• “Undoubtedly, the acquision of prescripon authority… would
signicantly expand the economic base of the psychological pracce.
When that day comes, it remains to be seen, however, whether they
abandon the hard work of psychotherapy for the expediency of the
prescripon pad.”
 Why Clinical Psychologists Should Not
Prescribe
• Identy Confusion
– Unl/Unless all psychologists prescribed, an
identy crisis could emerge
• Some clinical psychologists will prescribe, some won’t
• Training
– Some will have trained during graduate school
– Others will have specialized training long aCer earning their
doctoral degrees
– The public could become genuinely confused
about the role that a clinical psychologist plays
 Why Clinical Psychologists Should Not
Prescribe
• The Potenal InAuence of the Pharmaceucal Industry
– Drug companies a;empt to increase prots by oering
giCs, funding research, controlling the publicaon of
research results, etc.
– Some have concerns that psychologists might be targeted in
these ways
• This could result in biasing a clinician to make decisions that are
not solely based on the client’s welfare
– In response, some psychologists have called for formal
guidelines on how psychologists should interact with drug
companies
Evidence-Based Pracce/Manualized Therapy

• The movement in favor of evidence-based and

manualized therapy has intensied in recent
decades
• First, we have to pose a queson…
– Does psychotherapy work?!?
• How do we know?
• If it does, what makes it work?
• If it doesn’t, is it ethical to charge?
• What if it works only as a placebo?
– Is it ethical to charge for a placebo?
Evidence-Based Pracce/Manualized Therapy
• Hans Eysenck (1952)
– Stated that psychotherapy had no proof of posive outcomes
– Sparked a huge debate within the eld
• Early wave of research proved Eysenck to be wrong
– Psychotherapy was found to be quite e=cacious
• Smith and Glass (1977)
• Smith, Glass, and Miller (1980)
– Much of this work was on the eecveness
• Of any type of psychotherapy
• On any diagnosis
• Recent waves of research have targeted
– Specic psychotherapeuc intervenons
– Specic diagnoses
• Waves went from
– “Does therapy work?” to
– “Which forms of therapy work best for which disorders?”
Evidence-Based Pracce/Manualized Therapy

• Two research designs

– Does therapy work?
• Therapists can be assigned clients and instructed to provide therapy for them
– No further instrucons are given
– Therapy can dier widely
» Between therapists
» Between paents
• Lack of uniformity isn’t a problem for this research design
– Which forms of therapy work best for which disorders?
• Here, you need to make absolutely sure that therapy is the same
– Across therapists
– Across paents
• In order to do this, you need a therapy manual
– The purpose of the manual is to keep variability among therapists to a minimum
– If the technique is eecve, it can then be shared with others in exact, unambiguous
terms
Evidence-Based Pracce/Manualized Therapy

• There have been many, many research studies on manualized

treatments, for example…
– Exposure and response prevenon
• A specic form of behavior therapy for the treatment of OCD
– Dialeccal Behavior Therapy (DBT)
• For the treatment of Borderline Personality Disorder
– Cognive Behavioral Therapy (CBT)
• For the treatment of depression and anxiety
• Each of these treatments
– Have shown to be eecve in the treatment of the specic disorder
– Have had their results published in professional journals
• This is extremely important because this is how we know that
treatments work
– Without these studies, would treatment be ethical?
Evidence-Based Pracce/Manualized Therapy

• Division 12 (Clinical Psychology) of the American

Psychological Associaon
– Created a task force to compile a list as a reference for
therapists who sought the most proven therapies for
parcular disorders
• Was originally called “empirically validated” and then “empirically
supported”
• Now called “evidence-based pracce”
– This term incorporates
» The treatment itself
» Factors related to the people providing and receiving it
– “The integraon of the best available research with clinical experse in the
context of paent characteriscs, culture, and preferences”
» “APA Presidenal Task Force on Evidence-Based Pracce, 2006, p. 273
Evidence-Based Pracce/Manualized Therapy

• Reviews the latest

research on
pharmacological and
psychosocial treatments
that work for the full range
of psychological disorders
– 26 of the 28 chapters
review the evidence base
for 17 major syndromes
– This most recent version
was released in 2015
Evidence-Based Pracce/Manualized Therapy

• Advantages of Evidence-Based Pracce/Manualized Therapy

– Scienc legimacy
– Establishing minimal levels of competence
– Training improvements
– Decreased reliance on clinical judgement
• Disadvantages of Evidence-Based Pracce/Manualized
Therapy
– Threats to the psychotherapy relaonship
– Diagnosc complicaons
– Restricons on pracce
– Debatable criteria for empirical evidence
 Advantages of Evidence-Based
Pracce/Manualized Therapy
• Scienc Legimacy
– Before manualized therapies, a cric could describe clinical
psychology as a “co;age industry” of sorts
• A depressed paent who saw Dr. A might get one form of therapy
• Another depressed paent who saw Dr. B might get another
– A scienc approach to treatment requires a benecial
treatment that all members of the discipline uniformly
pracce
• We expect such standards from medical doctors treang a
physical disease
• If clinical psychology subscribes to the medical model of diagnosis
and treatment, the same expectaon should apply to them
 Advantages of Evidence-Based
Pracce/Manualized Therapy
• If clinical psychologists were allowed to pracce their own
unique brand of therapy…
– A few of them would be ineecve or even harmful
• As evidence-based treatments are disseminated and used…
– Ensures that potenally incompetent or detrimental therapists
will be educated in eecve treatments
– As treatments evolve into professional standards, psychologists
will be obligated to follow them
– The public will receive a more consistent, proven brand of
treatment for each disorder
– Psychologists can be held to a greater standard of accountability
 Advantages of Evidence-Based
Pracce/Manualized Therapy
• Training Improvements
– These manualized treatments can be incorporated
into graduate programs
– The APA considers criteria related to training in
evidence-based treatments when making
accreditaon decisions
– Upcoming generaons of psychologists will have
been educated in evidence-based therapy
 Advantages of Evidence-Based
Pracce/Manualized Therapy
• Decreased Reliance on Clinical Judgement
– Clinical judgements are suscepble to bias and are quite Aawed
• This can compromise therapy decisions and clinical outcome
– Surveys suggest that clinicians rely more on their on clinical
judgement than mechanical or actuarial judgements based on
empirical evidence
• This is a problem
 Disadvantages of Evidence-Based
Pracce/Manualized Therapy
• Threats to the Psychotherapy Relaonship
– What aspects of therapy are eecve?
• Some of “what works” in therapy is a;ributable to specic techniques
• A greater proporon is due to the therapeuc alliance
– The relaonship between the therapist and paent
– Therapy manuals typically don’t emphasize the therapeuc
alliance
• Overlook “how” therapists relate to their clients
• Favor “what” therapists do with (or to) their clients
– A therapist operang as a technician carrying out an algorithm
could be a disservice to those seeking a meaningful human
connecon
• Some psychologists argue that it should be the relaonship, not the
technique, that is manualized
 Disadvantages of Evidence-Based
Pracce/Manualized Therapy
• Diagnosc Complicaons
– Evidence based treatments target specic disorders
• When tested in clinical trials, the clients are of that target
disorder – typically without any other diagnosis
– This isn’t generalizable to clinical seOngs in which
comorbidity is the norm
• It’s possible that the therapy could be useful for “clean” (i.e.
uncomplicated) disorders but not useful in more “messy”
diagnosc features commonly seen in real world seOngs.
– Some work focuses specically on this issue
 Disadvantages of Evidence-Based
Pracce/Manualized Therapy
• Restricons on Pracce
– Some suggest that empirically supported
treatments are the only therapies worth praccing
– Some psychologists have used the term
malprac ce in reference to using a therapy that
lacks empirical support
– Managed-care and Health Insurance Companies
• May use empirical support to argue that psychologists
should pracce certain treatments exclusively
– This could further limit the psychologists autonomy
 Disadvantages of Evidence-Based
Pracce/Manualized Therapy
• Restricons on Pracce (cont.)
– Proponents of manualized therapy oCen think it gets a bad rap:
• “We believe that manuals are mischaracterized when they are described
as rigid… specifying the components of the therapy does not have to
deprive a therapy of its lifeblood. At best, it can help everyone involved
come to understand what that lifeblood actually is (Spokas, Rodebaugh, &
Heimburg, 2008, p. 322).
 Disadvantages of Evidence-Based
Pracce/Manualized Therapy
• Restricons on Pracce (cont.)
– Does strict adherence to manualized therapy
produce be;er outcomes?
 Disadvantages of Evidence-Based
Pracce/Manualized Therapy
• Restricons on Pracce (cont.)
– Does strict adherence to manualized therapy produce be;er
outcomes?
• Therapists who demonstrate Aexibility while using manuals are more
successful in comparison to therapists who follow manuals rigidly
– Chu & Kendall, 2009
• The opon of Aexibility, as opposed to the requirement of rigid
adherence, helps clinicians accept manualized treatments as a form of
pracce
– Forehand, Dorsey, Jones, Long, & McMahon, 2010
– Curry (2009)
• Sees manuals as training in musical instruments…
– It requires the learning of standard techniques, but also allows for (or even
encourages) improvisaon
 Disadvantages of Evidence-Based
Pracce/Manualized Therapy
• Debatable Criteria for Empirical Evidence
– What should it take for a manualized therapy to
make the “empirically supported” or “evidence-
based” list?
• Some argue that the current criteria are quesonable,
or do not account for failed trials of a treatment
• Others argue that the criteria are biased
– Favor the more empirically oriented therapies
» e.g., behavioral and cognive
– Shut out therapies that produce less easily quanable results
» e.g., psychodynamic or humanisc
Overexpansion of Mental Disorders
• Size and scope of the DSM has
vastly increased over me
– The number of people with mental
disorders has climbed with it…
• 50% of the U.S. populaon is diagnosable
at some point in their lifeme
• 11% of the U.S. populaon is currently
taking andepressant medicaon
– Many dierent names for the increase
rates of mental disorders
• Overdiagnosis, diagnosc expansion,
diagnosc inAaon, diagnosc creep,
medicalizaon of everyday problems,
false posives, false epidemics, etc.
Overexpansion of Mental Disorders
• Some criques of DSM-5 overdiagnosis
– “There has been no real epidemic of mental illness, just a much looser
denion of sickness, making it harder for people to be considered well.
The people remain the same; the diagnosc labels have changed and are
too elasc. Problems that used to be an expected and tolerated part of
life are now diagnosed and treated as mental disorder.”
• Frances, 2013, p. 82
– “The danger of DSM-5 ideology is that it extends the scope of mental
disorder to a point where almost anyone can be diagnosed with one.”
• Paris, 2013, p. 41
– “The more that psychiatric diagnoses appear to encroach on the
boundaries of normal behavior, the more psychiatry opens itself to
cricisms that there is no validity to the concept of mental disorders
(e.g., there’s no such thing as mental illness – it’s a ‘myth’).”
• Pierre, 2013, p. 109
Cultural Issues in Clinical
Psychology
 What is Mulcultural Psychology?
• Psychology – the systemac study of behavior,
cognion, and aect
• Mulcultural psychology – the systemac study of
behavior, cognion, and aect in many cultures
– Culture as an external factor
• In!uencing the events that occur around us and our interacons
with other people
– Culture as an internal factor
• In!uencing internal processes such as how we interpret the things
going on around us
 What is Culture?
• Matsumoto et al., 1997
– Asked university undergraduates to de)ne culture
– Received a wide variety of responses coded in 18
categories
– 3 categories most o-en used:
• Expressions, History, and Beliefs
– Other categories included:
• Race, Religion, Family, and Hobbies
 What is Culture?
• Berry et al., 1992; Kroeber and Kluckholn,
1952
– 6 Uses of “culture” in everyday language
• Descripve – the speci)c behaviors and acvies
associated with a culture
• Historical – a groups heritage and tradions
• Normave – the rules that govern the behavior of a
group
• Psychological – behavioral processes such as learning
and problem solving
• Structural – the organizaonal elements of a culture
• Genec – the origins of that culture
 What is Culture?
• Atkinson (2004)
– Culture “consists of values and behaviors that are learned
and transmiEed within an iden)able community… and
also includes the symbols, arfacts, and products of that
community”.
– Culture usually refers to a parcular group of people and
includes their values, or guiding beliefs and principles, and
behaviors, or typical acvies.
• Culture
– The values, beliefs, and pracces of a group of people,
shared through symbols and passed down from generaon
to generaon
 Narrow and Broad De)nions of Culture

• Narrow de)nion
– Limited to race, ethnicity, and/or naonality
• Broad de)nion
– Any and all potenally salient ethnographic, demographic,
status, or aJliaon idenes
– Sue, Ivey, and Pedersen (1996)
• Any group that shares a theme or issue(s)
• Therefore, language, gender, ethnicity/race, spirituality, sexual
preference, age, physical issues socioeconomic status, and survival
a-er trauma all de)ne “cultures”.
– Some argue that broad de)nions are not parcularly
helpful
 Culture and Worldview
• Worldview
– Sue (1977)
• The way in which people perceive their relaonship to nature,
instuons, other people, and things.
• Worldview constutes our psychological orientaon in life and can
determine how we think, behave, make decisions, and de)ne
events
– Dierent cultural groups perceive, de)ne, and interact
with their environment in dierent ways on the basis of
their past learning experiences
– People from dierent cultures may see or experience the
same thing but interpret it in drascally dierent ways
 What is Race?
• Biological concept
– Zuckerman (1990)
• “To the biologist, a race, or subspecies, is an inbreeding,
geographically isolated populaon that diers in disnguishable
physical traits from other members of the species.”
– Casas (1984)
• Race is a group of people who share a speci)c combinaon of
physical, genecally inherited characteriscs that disnguish them
from other groups
– Negroid, Caucasoid, and Mongoloid
• These groups are disnguished from one another by phenotype,
or noceable physical features
– Skin color, texture of hair, shape and color of eyes, thickness of nose
and lips
 What is Race?
• Biological concept cont.
– Dierences between racial groups are strictly
phenotypic, represented in super)cial physical
manifestaons.*
– It is generally accepted that human beings came
from the same beginnings in Africa and that
genec dierences among groups can be
explained by migraon paEerns
What is Race?
 What is Race?
• Sociocultural concept
– The perspecve that characteriscs, values, and behaviors
that have been associated with groups of dierent physical
characteriscs serve the social purpose of providing a way
for outsiders to view another group and for members of a
group to perceive themselves
– Concept resulted from the geographic isolaon of groups
sharing similar physical characteriscs
• Once these groups migrated to dierent parts of the globe, they
also developed their own unique set of values, beliefs, and
pracces.
 What is Race?
• Sociocultural concept
– Atkinson (2004)
• The sociocultural use of the term “race” connues
because it provides people a way of organizing the
world and reducing complexity
• Also provides a vehicle for identy and empowerment.
 Ethnicity
• Atkinson (2004)
– Ethnicity – the combinaon of race and culture
• Ethnicity is determined by both physical and cultural
characteriscs.
 Mulcultural Psychology vs. Cross-cultural
Psychology

• Mulcultural psychology
– The systemac study of all aspects of human
behavior as it occurs in seOngs where people of
dierent backgrounds encounter one another
• I know, this is slightly dierent than before…
– Bochner (1999)
• Concerned with the psychological reacons of
individuals and groups caught up in culturally
heterogeneous seOngs
• These include the behaviors, percepons, feelings,
beliefs, and aOtudes resulng from living in these
condions
 Mulcultural Psychology vs. Cross-
cultural Psychology
• Cross-cultural psychology
– The study of comparisons across cultures or countries, as
opposed to comparisons of groups within one society.
 Mulculturism as the “Fourth Force”
• Three movements have
broadly been recognized as
dominant paradigms in their
respecve eras
– First force: Psychoanalysis
– Second force: Behaviorism
– Third force: Humanism/Person-
Centered Psychology
• Pederson (1990, 1999, 2008)
put forth the idea that
mulculturalism represents
the “fourth force”
 Mulculturism as the “Fourth Force”
• Suggests that mulculturalism is a major in!uence of the
me
– A bit dierent than the previous forces, though…
• Each of the earlier forces was a response/challenge to the
previous one
– Behaviorism was a response to psychoanalysis
– Humanism/Person-Centered was a response to behaviorism
• Mulculturalism doesn’t challenge any of the previous forces
– It enhances and strengthens the exisng forces
– Describes how mulculturalism can be applied to individuals of
various cultural backgrounds
 Mulculturism as the “Fourth Force”
• Comas-Diaz (2011)
– Encourages that clinicians ask the following
culturally relevant quesons
• What do you call your problem (or illness or
distress)?
• What do you think your problem does to you?
• What do you think the natural cause of your
problem is?
• Why do you think this problem has occurred?
• How do you think this problem should be treated?
• How do you want me to help you?
• Who else (e.g. family, friends, religious leaders) do
you turn to for help?
• Who (e.g. family, friends, religious leaders) should
be involved in decision making about this problem?
 Books and Journals
• Wide variety of books oer educaon on working with
culturally diverse populaons
– Working With Asian Americans (Lee, 1997)
– Psychotherapy With Women (Mirkin, Suyemoto, & Okun, 2005)
– Counseling Muslims (Ahmed & Amer, 2012)
 Emergence of American Psychological
Associaon Divisions
• New American Psychological Associaon Divisions
– Typically arise when a subset of members recognizes a
need to study or examine a speci)c topic in depth
– Some recently created, culturally focused divisions
• Division 35 – Society for the Psychology of Women
• Division 36 – Psychology of Religion
• Division 44 – Society for the Psychological Study of Lesbian,
Gay, and Bisexual Issues
• Division 45 – Society for the Study of Ethnic Minority Issues
• Division 51 – Society for the Psychological Study of Men and
Masculinity
 American Psychological Associaon Ethical
Code
• American Psychological
Associaon Ethical Code
(2002)
– Compels psychologists to
work with cultural
sensivity and
competence
– Awareness of diversity
issues
• A requirement
• Not merely an aspiraon
 American Psychological Associaon
Accreditaon Standards
• American Psychological Associaon (2005)
– Standards of Accreditaon
• “Cultural and Individual Dierences and Diversity”
– One of eight domains that an educaonal program must address adequately
to be accredited
– Applies to
» Doctoral programs
» Predoctoral internships
» Postdoctoral internships seeking accreditaon
– Accreditaon standards for doctoral programs list criteria such
as…
• Including people of diverse backgrounds among students and faculty
• Educang students about the role of culture in the science and
pracce of professional psychology
 DSM Eorts Toward Mulculturalism
• Introducon to DSM-5 states:
– “…key aspects of culture relevant to diagnosc classi)caon and
assessment have been considered in the development of DSM-5”
• American Psychiatric Associaon, 2013, p. 14
• Informaon on cultural variaon is embedded in the descripon of
speci)c disorders
• Provides general guidance of clinicals to help with overall cultural
competence
– Outline for Cultural Formulaon
• Instructs clinicians on cultural aspects of assessment
– e.g. cultural identy, cultural conceptualizaon of distress, cultural features of the relaonship
with the therapist
– Cultural Formulaon Interview
• A series of 16 quesons that can guide a clinical towards a culturally informed
view
 DSM Eorts Toward Mulculturalism
• Cultural Concepts of Distress
– Includes nine terms that represent psychological problems
observed in groups from various parts of the world
• Taijin Kyofusho (found in Japanese and some other cultures)
– When a person anxiously avoids interpersonal situaons because they
believe their appearance, acons, or odor will oend other people
• Sutso (found in some Lano/Lana/Hispanic cultures)
– When a frightening event is thought to cause the soul to leave the body,
resulng in depressive symptoms
• Maladi Moun (found in some Haian communies; similar to the
“evil eye” are more common in other parts of the world)
– When a person can “send” psychological problems like depression and
psychosis to another
– Usually the result of envy or hatred toward the other person’s success
 Cultural Competence
• What is Cultural Competence?
– “Mulcultural counseling competence is de)ned as the
counselor’s acquision of awareness, knowledge, and skills
needed to funcon eecvely in a pluralisc democrac
society… and on an organizaonal/societal level, advocang
eecvely to develop new theories, pracces, policies, and
organizaonal structures that are more responsive to all groups”
• Sue and Sue, 2008, p. 46
– Three primary components:
• Awareness
• Knowledge
• Skills
 Cultural Self-Awareness
• Cultural competence begins with cultural self-
awareness (J. E. Harris, 2012)
• Cultural awareness – the understanding that our
viewpoint (like everyone’s) is unique and idiosyncrac
– Basic facts such as where one’s parents or ancestors came
from
– The values, assumpons, and biases that one has
developed as a result of all cultural in!uences
– Cultural awareness leads to several conclusions
• e.g. dierences between people are not necessarily de)ciencies
– Especially if the dierences are valued in a cultural group
 Knowledge of Diverse Cultures
• Not enough to know your own culture…
– The therapist must also know of the client’s culture
• Eorts to know the client’s culture should be
connual
– Through reading, direct experiences, relaonships with
people in various cultures, and other means
 Knowledge of Diverse Cultures
• Cultural knowledge should include history
– Parcularly with regard to social and polical issues
• e.g. African Americans
– Slavery, cruelty, exploitaon, and overt and covert racism
• These can have an eect on therapeuc alliance
– A clinical psychologist who fails to recognize this
history
• May form expectaons or make interpretaons that are
culturally insensive
• Jeopardize the therapeuc relaonship
 Knowledge of Diverse Cultures
• Heterogeneity
– The psychologist should not assume that every
individual is typical of his or her cultural group
• To assume that a member of a cultural group will
exhibit all the characteriscs common to that group is
to prejudge
– The psychologist should appreciate the cultural
group norms, but also appreciate the
heterogeneity inherent in every culture
• This is might be what’s so frustrang to me…
 Knowledge of Diverse Cultures
• Acculturaon
– When people )nd themselves in a new cultural environment,
they may respond in a variety of ways
• Retaining elements of their original culture
• Adopng elements of the new culture (acculturaon)
– Four separate acculturaon strategies (Berry, 2003; Rivera, 2008)
• Assimilaon – the individual adopts much of the new culture and
abandons much of the original
• Separaon – the individual rejects much of the new culture and retains
much of the original
• Marginalizaon – the individual rejects both the new and the original
culture
• Integraon – the individual adopts much of the new culture and retains
much of the original
Culturally Appropriate Clinical Skills
• Microaggressions
– Comments or acons made in a cross-cultural context that
convey prejudicial, negave, or stereotypical beliefs and may
suggest dominance or superiority of one group over another
• Foaud & Arredondo, 2007; Sue, 2010, Sue et al., 2007
– O-en “liEle things” said without any intenon of hoslity or
any awareness that the comments might be insulng or
invaliding – but, in fact, they are
– The best way for psychologists to avoid microaggressions
• Examine the thoughts and beliefs that underlie them
• This will result in greater humility and self-awareness for the
psychologist
• I hate this idea for so many reasons…
Microaggressions
 Emic vs. Ec Perspecve
(Dana, 1993)
• Ec Perspecve
– Emphasizes the similaries between all people
• Assumes universality among all people
• Generally does not aEach much importance to dierences among cultural groups
– Common in the early days of psychology
• When most psychologists were male, of European descent, and of middle-class or higher
socioeconomic standing
• Emic Perspecve
– Recognizes and emphasizes culture-speci)c norms
– Considers a client’s behaviors, thoughts, and feelings within the context of the
client’s own culture
• This is opposed to imposing norms of another culture on the client
– Stresses that individuals from various cultural groups “must be understood on their
own terms” (Dana, 1993, p. 21)
• The terms were derived from the )eld of linguiscs
– Phone!cs – sounds common to all languages
– Phonemics – sounds that are speci)c to a parcular language
 Triparte Model of Personality Identy
(Sue & Sue, 2008)
• Three-level model in which all levels hold some degree of
importance
– Individual level
• “All individuals are, in some respects, like no other individuals”
– Group level
• “All individuals are, in some respects, like some other individuals”
– Universal level
• “All individuals are, in some respects like all other individuals”
• Argue that a psychologist should appreciate a client on all three
levels
– Some characteriscs are enrely unique to the client
– Others are common within the client’s cultural group
– Sll others are common to everyone
Triparte Model of Personality Identy
(Sue & Sue, 2008)
Comparing Incidence and Prevalence Rates

• Prevalence vs. Incidence

– Prevalence – the current rate of a parcular
disorder at a given point in me
– Incidence – the number of new cases of a disorder
diagnosed in a given period of me
• Literature is mixed
– Some studies show lower rates of mental
disorders in minority populaons; others show
higher rates
 The Epidemiologic Catchment Area Project
(ECA)
• The )rst and largest mental health study ever conducted in
the U.S. (Robins & Regier, 1991)
• Data
– Collected between 1980 and 1983
– 20,000 individuals
– Five communies
• Balmore, Maryland; St. Louis, Missouri; Durham, North Carolina; Los
Angeles, California; New Haven Conneccut
• Parcipants
– Those in community, mental hospitals, jails, residenal drug and
alcohol treatment centers, and nursing homes
– Interview using the Diagnosc Interview Schedule (DIS)
– European Americans (N = 12,944)
– African Americans (N = 4,638)
– Lanos/as (N = 1,600)
 The Epidemiologic Catchment Area Project
(ECA)
• Results
– 20% of the U.S. populaon were currently
experiencing a mental disorder, or had within the
last 6 months
– Most common lifeme disorders (Robins & Regier,
1991)
• Phobia 14.3%
• Alcohol abuse/dependence 13.8%
• Generalized Anxiety Disorder 8.5%
• Major Depressive Episode 6.3%
• Dysthymia 3.2%
 The Epidemiologic Catchment Area
Project (ECA)
• Rates of Psychiatric Disorders for Blacks, Whites, and
Hispanics
The Epidemiologic Catchment Area Project
(ECA)
 Naonal Comorbidity Survey (Kessler et al.,
1994)

• Intended to improve upon the methodology

used in the ECA
– Naonally representave sample of more than
8,000 people living in the community
– Composite Internaonal Diagnosc Interview
(UM-CIDI)
• Based o the DIS and also gives diagnoses based on
DMS criteria
 Naonal Comorbidity Survey (Kessler et al.,
1994)
• Sample
– European Americans (N = 4,498)
– African Americans (N = 666)
– Lano/na Americans (N = 719)
• Included English speaking Lano/na Americans
• Showed a higher prevalence rate for psychiatric disorders than the
ECA
– Nearly ½ met criteria for at least one DSM diagnosis
• Most common diagnoses
– Alcohol use/abuse – 23.5%
– Major Depression – 17.1%
– Social Phobia – 13.3%
– Drug use/dependence – 11.9%
– Simple Phobia – 11.3%
 Naonal Comorbidity Survey (NCS)

• Kessler et al., 1994

 Problems with Epidemiologic Studies
• Chang (2002)
– Small sample sizes of some groups
• Few comparisons were made for Asians
• No comparisons were made for American Indians and Arab
Americans
– Within group heterogeneity
• Aggregate data combine all members of an ethnic group, ignoring
the variaon that exists within groups
– Diagnosc Accuracy
• DSM is based on western diagnosc concepts
 Conclusions from Exisng Data
• The Surgeon General’s Report on Mental
Health: Culture, Race, and Ethnicity (U.S.
Department of Health and Human Services,
2001)
– Concludes that the prevalence rates for mental
disorders in the various ethnic groups are virtually
equal
– Also notes that the current research is limited and
much more research needs to be done
 Conclusions From Exisng Data
• Prevalence across the globe
– Certain disorders appear with relave consistency
• Schizophrenia – 1%
• Bipolar Disorder – 0.3-1.5%
• Panic Disorder – 0.4-2.9%
– Combined with results of family and genec
studies, this suggests a strong genec component
and weak cultural eects
 Conclusions From Exisng Data
• Prevalence across the globe
– Dierenal rates suggest culture plays more of a
role
• Depression rates range from 2% to 19% across
countries
– Weissman et al., 1996
• Suggests that cultural factors such as poverty and
violence may play a greater role than genecs*
– Naonal Instute of Mental Health, 1998
 Gender Dierences*
• NCS data
– No overall dierences in rates of mental disorder between
men and women
– Dierences in the parcular types of disorders
experienced
• Women have higher rates of depression and anxiety
• Men have higher rates of substance abuse and ansocial disorders
– Iwamasa & Bangi, 2003; Kessler et al., 1993, 1994)
• Women – higher rates of “internalizing” disorders
• Men – higher rates of “externalizing” disorders
Denion and Training
 What is Clinical Psychology?
Original Denion
• Lightner Witmer
– First to operate a psychological
clinic
– First to use the term “clinical
psychology”
– Saw clinical psychology as a
discipline with similaries to
medicine, educaon, and
sociology
– A clinical psychologist was a
person whose work with others
involved aspects of treatment,
educaon, and interpersonal
issues.
 What is Clinical Psychology?
More Recent Denions
• Contemporary clinical psychologists do many
things with many di*erent goals for many di*erent
people
– Myers, 2013; VandenBos, 2007
• Clinical psychology is essenally the branch of psychology that
studies, assesses, and treats people with psychological
problems or disorders
– This denion doesn’t portray all that clinical
psychologists do, how they do it, and who they do it for
• An accurate, comprehensive, contemporary denion would
need to be more inclusive and descripve
 What is Clinical Psychology?
More Recent Denions
• The Division of Clinical Psychology (Division 12) of the
American Psychological Associaon (APA) denion:
– “The eld of Clinical Psychology integrates science, theory,
and pracce to understand, predict, and alleviate
maladjustment, disability, and discomfort as well as to
promote human adaptaon, adjustment, and personal
development.
– Clinical Psychology focuses on the intellectual, emoonal,
biological, psychological, social, and behavioral aspects of
human funconing across the life span, in varying cultures,
and at all socioeconomic levels (APA, 2012a).”
 What is Clinical Psychology?
More Recent Denions
• “Perhaps the safest observaon about clinical
psychology is that both the eld and its
praconers connue to outgrow the classic
denions” (Norcross & Saye;e, 2016)
• Here, we dene Clinical Psychology:
– Clinical psychology involves rigorous study and applied
pracce directed toward understanding and improving
the psychological facets of the human experience,
including but not limited to issues or problems of
behavior, emoons, or intellect.
Educaon and Training in Clinical Psychology
Educaon and Training in Clinical Psychology

• Must obtain a doctoral degree in clinical psychology (about

3,000 awarded each year)
– Most students enter with a bachelor’s degree, some with a master’s
degree
– At least 4 years of intensive, full-me coursework
• This includes courses on psychotherapy, assessment, stascs, research
design and methodology, biological bases of behavior, cognive-a*ecve
bases of behavior, social bases of behavior, individual di*erences, and other
subjects
– A master’s thesis, comprehensive examinaon and doctoral
dissertaon
– One or more praccum assignments of supervised clinical work
– 1 year predoctoral internship
• 75% match rate
Educaon and Training in Clinical Psychology

• More than half of APA-accredited doctoral programs in

clinical psychology o*er (but not require) training within
a specialty track
– Most common specialty areas in clinical psychology: clinical
child, clinical health, forensic, family, and clinical
neuropsychology
• There are three disnct models of training used in
graduate programs
– Scienst-praconer (Boulder) model
– Praconer-scholar (Vail) model
– Clinical Scienst model
Balancing Pracce and Science: The Scienst-
Praconer (Boulder) Model
• First conference in training in clinical psychology
was held in Boulder, Colorado in 1949
– Agreed that training should emphasize both pracce
and research
• Graduate students need to be trained and competent in
– The applicaon of clinical methods
» Assessment, psychotherapy, etc.
– The research methods necessary to evaluate the eld sciencally
• Coursework should reHect this dual emphasis
– Classes on stascs, research methods, psychotherapy,
assessment, etc.
Balancing Pracce and Science: The Scienst-
Praconer (Boulder) Model
• Term scienst-
praconer model was
used to label this two-
pronged approach
– This was the dominant
model and sll is the
most widely used
• More programs subscribe
to the Boulder model
than any other
 Leaning Toward Pracce: The Praconer-
Scholar (Vail) Model
• Another conference in training in clinical psychology
was held in Vail, Colorado in 1973
– Was discontent regarding the Boulder model
• “Why do I need such extensive training as a scienst when my
goal is simply to pracce?”
– Only a minority of clinical psychologists enter academia and primarily
conduct research
– Clinical pracce was the more popular career choice
– Many sought a doctoral level degree with
• Less extensive training in research
• More extensive training in the development of applied clinical
skills
 Leaning Toward Pracce: The Praconer-
Scholar (Vail) Model
• This discontent brought forth
– The praconer-scholar model of training
– A new type of doctoral degree, the PsyD
• Since the 1970’s, programs o*ering a PsyD have
proliferated
– The number of PsyD degrees awarded increased by
more than 160% between 1988 to 2001
– These programs typically o*er
• More coursework related to pracce
• Less coursework related to research and stascs
 Leaning Toward Pracce: The Praconer-
Scholar (Vail) Model
• Before the PsyD, the PhD was the only doctoral
degree for clinical psychology
– Now, more than half the doctoral degrees being awarded
in the eld are PsyD degrees
• There are fewer PsyD programs than PhD programs
– About 80 PsyD programs and 250 PhD programs
• The typical PsyD program accepts and graduates
many more students than the typical PhD program
– For this reason, the number of people graduang with
each degree is about the same (1,500 each)
PsyD and PhD Programs
Comparing PsyD and PhD Programs
• In general, compared with PhD programs, PsyD programs
tend to
– Place less emphasis on research and more emphasis on clinically
relevant aspects of training
– Accept and enroll a much larger percentage and number of
applicants
– Be housed in freestanding, independent (or university aKliated)
“professional schools,” as opposed to a departments in universies
– Accept students with lower GRE scores and GPAs
– O*er signicantly less funding (i.e. graduate assistantships,
fellowships, tuion, remission, etc.)
– Accept and enroll more students with a master’s degree
Comparing PsyD and PhD Programs
• In general, compared with PhD programs, PsyD
programs tend to
– Have lower rates of success placing students in APA-
accredited predoctoral internships
– Produce graduates who score lower on the naonal licensing
exam (EPPP)
– Graduate students sooner (about 1.5 years on average)
– Graduate students who pursue pracce-related careers
rather than academic or research-related careers
– Have a slightly higher percentage of faculty who are
psychodynamic as opposed to cognive-behavioral
Leaning Toward Science: The Clinical Scienst
Model
• Began with a 1990s movement toward
increased empiricism
– Leaders agreed that science should be the bedrock
of clinical psychology
– Created the clinical scienst model
• Stressed the scienc side of clinical psychology more
strongly than the Boulder model
– Graduates of these programs are sll awarded a PhD
• However, the PhD implies a very strong emphasis on the
scienc method and evidence-based clinical methods
Leaning Toward Science: The Clinical Scienst
Model
• “Manifesto for a Science of
Clinical Psychology” – Richard
McFall, 1991
– Argued that “the scienc
clinical psychology is the only
legimate and acceptable form
of clinical psychology… aNer all,
what is the alternave?... Does
anyone seriously believe that a
reliance on intuion and other
unscienc methods is going to
hasten advances in knowledge?”
Leaning Toward Science: The Clinical Scienst
Model
• Academy of Psychological Clinical Science
– Founded by McFall, who served as president for
several years
– Programs in this academy sll represent a minority
of all clinical psychology programs
– Among the members are many prominent and
inHuenal programs and individuals
 GeOng In: What do graduate programs
prefer?
• If you plan on applying to a
clinical psychology program,
you should get this book!!
• GeOng into a clinical
psychology program is
diKcult
– Admission rates are
compeve
– Applicaon process is
demanding
– On average PhD programs
receive 270 applicaons and
admit only 6% of them
 Common Suggesons
• Know your professional opons
– There are many roads to becoming a clinical
psychologist
– There are many professions with overlapping
professional acvies
– This knowledge will
• Allow for more informed decisions
• Create a be;er match between yourself and the
programs you apply to
 Common Suggesons
• Take, and earn high grades in, the appropriate
undergraduate courses
– Graduate programs want students whose undergraduate
training maximizes their chances of success in graduate
school
– Commonly required or recommended courses
• Stascs, research/experimental methods, psychopathology,
biopsychology, and personality
– Choose elecves carefully
• Classes with direct clinically relevance are seen favorably
– e.g. eld studies or internships
 Common Suggesons
• Get to know your professors
– Le;ers of recommendaon are among the most
important factors in admission decisions
– Professors can be ideal recommenders – assuming the
professor knows the student
• The be;er you know the professor the be;er the le;er can
be
– A professor can write a brief and vague le;er for student he/she
doesn’t know who got an A in their class
– A professor can write a more compelling le;er for a student with a
strong working relaonship through research, advising, or other
professional acvies
 Common Suggesons
• Get research experience
– This will prove (to you and who you apply to work
with) that you know what you’re geOng in to
– Your experience in a research methods course is
valuable, but won’t set you apart
– Will give you experience with
• The general empirical process
• A specialized subject area
– May lead to a publicaon or conference presentaon
 Common Suggesons
• Get clinically relevant experience
– Opons are, understandably, limited for
undergraduates and those with bachelor’s degrees
– Some potenal seOngs
• Community mental health centers, inpaent psychiatric
centers, crisis hotlines, alternave schools, camps for
children with behavioral or emoonal issues, etc.
– This can demonstrate to the admissions
commi;ee that you are serious and well informed
about clinical psychology
 Common Suggesons
• Maximize your GRE score
– GRE scores (and undergraduate GPA) are key
determinants of admission
– Appropriate preparaon includes
• Learning what scores your preferred programs seek
• Knowing whether your preferred program seeks the
subject test
• Studying informally or through a review course
• Taking pracce exams
• Retaking it as necessary
 Common Suggesons
• Select graduate programs wisely
– Finding the right advisor is like nding a spouse. You’re
both more likely to match if you’re looking for each other
– Best to learn as much as possible about potenal programs
• What is the model of training (Boulder, Vail, or clinical scienst)?
• To what clinical orientaons do the faculty subscribe?
• What areas of specializaon do the faculty members represent?
• What clinical opportunies are available?
– Finances, geography, and family deserve consideraon
• Be careful, though…
 Common Suggesons
• Write e#ecve personal statements
– The best statements are wri;en in concert with other
applicaon materials and the program
– Opportunity to discuss career aspiraons, research interests,
and clinical interests
• Must all be orchestrated well
– Chance to explain info that may appear only brieHy on a resume
or vitae
• e.g. research or clinical experiences with a professor
– Note
• Be sure that your wring is strong
• Want to make an impression without being too revealing or overly
personal
 Common Suggesons
• Prepare well for admissions interviews
– High-ranking applicaons are invited for an in-
person interview
– Arrive with a strong understanding of
• The faculty you are interested in working with
• The program as a whole
– The more specic, the be;er
– Develop a list of your own quesons
 Common Suggesons
• Consider your long-term goals
– Do you see yourself as a clinician or researcher?
– Have you determined your theorecal orientaon
or do you want a program to expose you to new
ones?
– What specic areas of clinical or scienc work
are most interesng to you?
 Predoctoral Internship
• Consists of a full year of supervised clinical
experience in an applied seOng
– e.g. a psychiatric hospital, a Veteran’s A*airs medical
center, a university counseling center, a community
mental health center, a medical school, etc.
• Must be completed before the PhD is awarded
• Many internship sites are accredited by the APA
– Those that are not may be looked on less favorably
by state licensing boards
 Predoctoral Internship
• Works on a match system
– Applicants and placements rank their preferences and an
algorithm computes the results
• Feels much like applying to graduate school again
– Apply to many schools, travel for interviews, rank preferences,
await feedback, relocate to a new geographical area, etc.
• Suggested to apply to between 10 and 15 sites
• There are more students than there are sites 
– This leaves hundreds of students each year without a match
– Likely due to the increase in PsyD programs
 Postdoctoral Training
• The PhD or PsyD usually doesn’t qualify one for clinical
or research work
– If clinical (i.e. psychotherapy), 2,000 postdoctoral,
supervised, unpaid hours must be gained (for licensure)
– If research, you likely lack the number of publicaons to get
an academic job
• Postdocs are a me to gain these experiences
– ONen involve the same process as applying to graduate
school and the predoctoral internship
• e.g. interviews, travel, geographical relocaon
– Posions typically last 1 to 2 years
 GeOng Licensed
• Licensure
– Once all the training requirements are met – graduate
school, predoctoral internship, postdoc – one can
prepare for licensure
– Becoming licensed
• Gives professionals the right to idenfy as members of the
profession
– You can’t call yourself a “psychologist” unless you are licensed
• Authorizes the psychologist to pracce independently
– You are not yet qualied for a license upon compleng
your training requirements
 GeOng Licensed
• Licensure Examinaons
– Examinaon for Professional Pracce in Psychology (EPPP)
• Standardized mulple-choice exam on a broad range of psychological
topics
– Industrial organizaonal, personality, development, clinical, cognive, neuro,
social, etc.
– State-specic exam on law and ethics
• May be wri;en or oral
• Connuing Educaon
– Once licensed, clinical psychologists must accumulate connuing
educaon units (CEUs) to renew the license from year to year
• The purpose is to ensure that clinical psychologists stay up to date on
developments in the eld
– This allows for the maintenance and improvement of the standard of care they
provide to clients
Self-Views of Clinical Psychologists
 How Are Clinical Psychologists Di*erent
From…
• Counseling Psychologists
– Historically di*ered in terms of client characteriscs
• Clinical psychologists saw more seriously disturbed
individuals
• Counseling psychologists work with (“counsel”) less
pathological clients
– Today there are more similaries
• See similar types of clients (though see next slide…)
• Students earn the same degree (the PhD) and obtain the
same licensure status
 How Are Clinical Psychologists Di*erent
From…
• Counseling Psychologists (cont.)
– Clinical psychologists
• Sll work with more disturbed paents
• More likely to work in hospital or inpaent psychiatric
units
– Counseling psychologists
• Work with less seriously disturbed populaons
• More likely to work in university counseling seOngs
 How Are Clinical Psychologists Di*erent
From…
• Counseling Psychologists (cont.)
– Di*erences in theorecal orientaon
• Clinical psychologists more likely to
– Endorse behaviorism
– Be interested in applicaons of psychology to medical seOngs
• Counseling psychologists more likely to
– Endorse humanisc/client-centered approaches
– Be interested in vocaonal tesng and career counseling
 How Are Clinical Psychologists Di*erent
From…
• Psychiatrists
– Go to medical school and are licensed physicians
• Training in psychiatry doesn’t begin unl much later in
training
– First several years of training are idencal to other physicians
– Are allowed to prescribe medicine
• Clinical psychologists are rallying against this, though
 How Are Clinical Psychologists Di*erent
From…
• Psychiatrists (cont.)
– Fundamental di*erences in the understanding and
approach to behavioral or emoonal problems
• Psychiatrists
– Training emphasizes biology
» Disorders are viewed rst and foremost as physiological
abnormalies of the brain
» Favor medicaon over other therapeuc intervenons
• Clinical Psychologists
– Biological aspects of client’s problems may not be the dening
characterisc
– Pharmacology is not the rst line of defense
 How Are Clinical Psychologists Di*erent
From…
• Social Workers
– Tradionally focused on the interacon between
• The individual
• The components of society that may contribute or alleviate the
individual’s problems
– Tradionally saw clients’ problems as products of social ills
(e.g. racism, oppressive gender roles, poverty, abuse, etc.)
– Training
• Social worker
– Typically earn master’s degrees
– Strong emphasis on supervised eldwork
– Li;le emphasis on research methods, psychological tesng, or physiological
psychology
 How Are Clinical Psychologists Di*erent
From…
• School Psychologists
– Typically work in schools
– Primary funcons
• Enhance intellectual, emoonal, social, and
developmental lives of students
• Frequently conduct psychological tesng
– Especially intelligence and achievement tests
• Consult with adults involved in students’ lives
– e.g. teachers, school administrators, school sta*, parents, etc.
 How Are Clinical Psychologists Di*erent
From…
• Professional Counselors
– ONen called Licensed Professional Counselors (LPCs)
– Training
• A;end graduate programs in counseling or professional
counseling
– Not to be confused with doctoral programs in counseling psychology
• Earn a master’s degree within 2 years
• Programs typically have rather high acceptance rates
compared with programs in similar professions
– ONen specialize in careers such as school, addicon,
couple/family, or college counseling