Introduction to Clinical Psychology Science, Practice, and Ethics Jeffrey E. Hecker University of Maine Geoffrey L. Thorpe University of Maine J.E.H.: To Lee and Olivia G.L.T.: To Beth and Tim First published 2005 by Pearson Education, Inc. Published 2016 by Routledge 2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN 711 Third Avenue, New York, NY 10017, USA Routledge is an imprint of the Taylor & Francis Group, an informa business 2005 Copyright © Taylo r & Francis. All rights reserved. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Credits and acknowledgments borrowed from other sources and reproduced,with permission, in this textbook appear on appropriate page within text. ISBN : 9780205277742 (hbk) Library of Congress Cataloging-in-Publication Data Hecker, Jeffrey E., 1959– Introduction to clinical psychology : science, practice, and ethics / Jeffrey E. Hecker, Geoffrey L. Thorpe p. cm. Includes bibliographical references and index. ISBN 0-205-27774-8 1. Clinical psychology. I. Thorpe, Geoffrey L. II. Title. RC467.H388 2004 616.89–dc22 2003063232 Please visit the companion website at www.routledge.com/9780205277742 C O N T E N T S Preface xiii P A R T O N E Introduction and Foundations 1 1 Definition and Training 3 Definition 3 Characteristics of Clinical Psychology 4 Emphasis on Science 4 Emphasis on Maladjustment 5 Emphasis on the Individual 5 Emphasis on Helping 6 Activities and Work Settings of Clinical Psychologists 6 Research 6 Teaching 7 Psychotherapy 10 Assessment 11 Consultation 12 Administration 13 Distinguishing Clinical Psychology from Related Professions 16 Psychiatry 17 Counseling Psychology 19 School Psychology 19 Social Work 20 Other Related Professions 20 Training in Clinical Psychology 21 Undergraduate Preparation 25 Graduate Training 27 Post-Doctoral Training 29 Continuing Professional Education in Psychology 31 Ethics and the Development of a Clinical Psychologist 34 iii iv CONTENTS 2 History and Recent Developments 37 Ancient Roots 37 Eighteenth and Nineteenth Centuries: Laying the Groundwork for Clinical Psychology 39 Understanding of Mental Disorders 40 Measurement of Individual Differences 42 Emergence of Scientific Psychiatry 43 Hysteria and the Ascendance of Psychological Determinism 44 The Birth of a Discipline: 1890–1910 45 Childhood: World War I through World War II 48 Assessment 49 Theory 51 Professional Developments 53 Adolescence: Post WWII and the Development of an Identity 55 Adulthood: Milestones and Growing Pains 58 Training 58 Psychotherapy 59 Psychological Testing 62 Professional Practice 64 Specialization 67 Growth 68 Concluding Remarks 71 3 Psychological Models in Clinical Psychology 73 The Role of Theoretical Models 73 How Models Help 73 Dangers of Models 73 Psychoanalysis 74 Development 75 Key Assumptions 77 Influences on Clinical Psychology 82 Current Status 83 Interpersonal Models 84 Development 84 Key Assumptions 86 Influences on Clinical Psychology 87 Current Status 87 CONTENTS v Humanism 87 Development 87 Key Assumptions 90 Influences on Clinical Psychology 92 Current Status 93 The Behavioral Model 94 Development 95 Key Assumptions 97 Influences on Clinical Psychology 99 Current Status 100 The Cognitive Model 101 Development 102 Key Assumptions 102 Influences on Clinical Psychology 103 Current Status 104 4 Biological Models in Clinical Psychology 106 Development 107 Electricity and the Nervous System 107 Phrenology 108 The Case of Phineas Gage 108 Key Assumptions 109 The Brain and the Nervous System 109 Brain Structure and Function 112 Behavioral Genetics 116 Family, Twin, and Adoption Studies 118 Influences on Clinical Psychology 120 Medical Imaging Techniques 120 Current Status 121 Integrating Biological and Psychological Models 121 Biological and Behavioral Processes 122 P A R T T W O Psychological Assessment 125 5 General Issues in Psychological Assessment 127 Stage I: Planning the Assessment 127 Classification 128 vi CONTENTS Description 133 Prediction 134 Stage II: Data Collection 142 Stage III: Processing Assessment Data 143 Clinical Judgment 145 Computer-Assisted Assessment 149 Stage IV: Communicating Assessment Findings 151 Goals 151 Writing Style 152 Organization of the Report 153 Concluding Comment: Testing versus Assessment 155 6 Clinical Interviewing 159 Types of Clinical Interviews 160 Intake 160 Case History 162 Diagnostic 165 Mental Status Exam 165 Crisis 167 The Importance of Rapport 168 Communication Strategies 169 Verbal Strategies 169 Nonverbal Strategies 170 Listening Skills 171 Diagnostic Interviewing 172 Structured Interviews 176 Research on Diagnostic Interviewing 177 Interviewing with Children 180 Developmental Considerations 183 Interview Techniques 184 Issues of Cultural Diversity in Clinical Interviewing 187 7 Intellectual and Educational Assessment 192 Intelligence 192 Definition 192 Theories of Intelligence 194 Measurement 199 CONTENTS vii Interpretation of Individually Administered Tests of Intelligence 207 Screening Measures 209 Issues and Controversies 210 Correlates of IQ 211 Heritability of IQ 211 Malleability of IQ 215 Intellience over the Life Span 217 Educational Assessment 218 Tests of Aptitude and Test of Achievement 218 Tests of Aptitude 220 Tests of Achievement 220 Learning Disabilities 221 8 Personality Assessment 226 Projective Methods 227 Rorschach 228 Thematic Apperception Test 235 Projective Drawings 239 Objective Methods 242 MMPI/MMPI-2/MMPI-A 243 The Millon Scales 251 NEO-Personality Inventory 256 The Place of Personality Assessment in Contemporary Clinical Psychology 258 9 Behavioral Assessment 262 Conceptual Basis 262 Typical Procedures 263 Traditional Approaches to Assessment 264 Syndrome-Based Diagnosis 264 Empirically Based (Dimensional) Classification 266 Traditional Psychodynamic Approaches 267 Defining Features of Behavioral Assessment 267 Development of Behavioral Assessment 268 Current Views 269 viii CONTENTS Functional Analysis 270 Problem Description 271 Identifying Controlling Variables 272 Adaptive Significance of the Problem Behavior 272 Selection of Treatment 273 Evaluation of Treatment Progress and Outcome 273 Behavioral Assessment Methods 274 Behavioral Interviews 274 Structured Interviews 275 Questionnaires 276 Behavior Rating Scales 276 Analogue Techniques 277 Self-Monitoring 277 Direct Observation 278 Psychophysiological Recording Methods 279 Assessment of Dysfunctional Cognitions 279 Self-Statements 279 Automatic Thoughts and Cognitive Schemas 280 Irrational Beliefs 281 P A R T T H R E E Intervention 285 10 Psychotherapy: Research Issues and Efficacy 287 What Is Psychotherapy? 287 The Psychotherapy Client 288 The Psychotherapist 289 The Psychotherapy Relationship 290 Research Issues 291 Goals of Psychotherapy Research 293 Psychotherapy Research Studies 294 Psychotherapy Research Designs 295 Analogue Research 304 Validity of Psychotherapy Research 305 Does Psychotherapy Work? 309 Eysenck’s Challenge and Meta-Analysis 309 Empirically Supported Treatments 313 Efficacy versus Effective Research 318 Are All Psychotherapies the Same? 319 Concluding Comments 323 CONTENTS ix 11 Psychodynamic Psychotherapy 326 Psychoanalysis 326 Background and Basic Principles 326 The Technique of Freudian Analysis 331 The Course of a Therapeutic Analysis 332 Psychoanalytic Theory since Freud 335 Carl Jung’s Analytical Psychotherapy 336 Alfred Adler’s Individual Psychology 340 The Neo-Freudians 343 The Ego Psychologists 344 The Object Relations Theorists 344 Brief Psychodynamic Theory 346 Interpersonal Psychotherapy 349 The Place of Psychodynamic Psychotherapy in Contemporary Clinical Psychology 350 12 Humanistic, Experiential, and Family Therapies 356 Humanistic Psychotherapy 356 Existential Psychotherapies 356 Gestalt Therapy 357 Client-Centered Therapy 359 Eclectic Treatment Combinations 363 A Three-Stage Model of Helping 363 Process-Experiential Therapy 364 Family Therapy 367 Systems Perspective 368 Development of Family Therapy 369 Schools of Family Therapy 370 Criticisms 373 Group Therapy 373 Group Analytic Psychotherapy 374 Behavior Therapy in Groups 375 Humanistic Group Therapy 375 Common Features of Group Therapy 376 13 Cognitive-Behavioral Interventions 379 Behavior Therapy Techniques 379