Thursday, September 23, 2010

The Practice of Clinical Psychology (PSY480)

The Practice of Clinical Psychology Worksheet
Using the text for this course, the University Library, the Internet, and/or other resources answer the following questions. Your response to each question should be at least 150 words in length.
1. What are at least two legal issues associated with clinical psychology? What impact do these issues have on the field of clinical psychology?
Confidentiality is one of those issues that intersect the jurisdictions of both legal and ethical consideration in the realm of psychotherapy. Confidentiality issues are in conflict when the legal requirements of a court contradict the Ethics Code of the APA (Plante, 2005). Exceptions to the confidentiality agreement between clinician and patient include: immediate danger—such as suicide or homicide, and emotional, sexual, or physical abuse. In cases where the Ethics Code of the APA and the law intersect the Ethics Code should always be upheld and the discrepancy should be explained to the court (Hogan, 2007). However, there are also exceptions to the rule of confidentiality: a client might opt out of confidentiality in specific circumstance, such as when the patient wants to involve a spouse, child, parent, or friend in the clinical situation (Plante, 2005). Because of confidentiality concerns, clinical psychologists must be careful to document any exceptions in writing, in order to maintain professional integrity.
Another area where legal issues affect psychologists is forensic activities (Plante, 2005). In essence it is important that when psychologists are giving expert testimony in criminal and civil trials they must make sure that the assessment tool they choose to use was developed specifically for the purposes that the psychologist is using it. This is not so much a legal issue, but rather an ethical issue that has legal implications.
2. What are at least two ethical issues associated with clinical psychology? What impact do these issues have on the field of clinical psychology?
Competence is a major point of concern in any discussion about ethics in psychology. Psychologists must make sure that they are up to date on the appropriate training and instruction concerning changes in their specialized fields (Plante, 2005). Plante documents a surprising statistic that 50% of the material learned during a psychologist’s graduate work is obsolete 10-12 years after graduation. This basically means that clinical psychologists must relearn 50% of their field every decade or so. It is also important that psychologists practice in the area of psychology that they were trained for.
In the areas of advertising and other public statements it is important that clinical psychologists are not misleading or deceptive (Plante, 2005). They should make sure that they do not overstate their qualifications or points of view. They must also go further and act preemptively to correct misleading statements made by others on their behalf. On a practical level this affects the field of clinical psychology by causing psychologists to be clear about their points and to not overstate their qualifications during public statements.
3. What are professional boundaries, boundary crossings, and boundary violations? What impact do these things have the field of clinical psychology?
At the heart of most professional boundary violations in America is the concept of dual relationships (Plante, 2005). A dual relationship exists when a clinician and a patient develop a relationship other than their professional relationship. This can be as mild as the clinician going to a dinner party to meet a client and as extreme as a sexual relationship between the clinician and patient. Psychologists are encouraged—and disciplined when violations occurred—to avoid conflicts of interest and dual relationships with patients. Boundary violations and boundary crossings occur when a clinician engages in an extra-psychotherapeutic relationship with a patient. The counterargument though is that sometimes psychotherapy must occur in a patient’s natural environment—such as in the case of severe disability. However, to maintain a professional relationship and professional boundaries the relationship should be kept in professional settings and in professional situations. In all, there are some situations where dual relationship are unavoidable, such as a small town practice where the clinician knows everyone in town.
4. What are at least two cultural limitations associated with assessment and treatment?
There are some behavioral problems that are culturally specific and therefore require culturally specific treatment approaches (Plante, 2005). For instance, conversion disorder was very prominent in the Victorian Era—presumably because of sexual repression—but is not so common today. Another culturally specific psychological symptom is koro, the belief that, “..genitals are retracting into the stomach region and primarily occurs among Asian men” (Plante, 2005, p. 435). So in this case it is the assessment and treatment that is limited by cultural limitations.
It is telling that most psychological studies conducted in the past half century have been on Caucasian people from the middle and upper economic classes (Plante, 2005). This means that the generalization of the results of these tests to ethnic and racial minorities is questionable to say the least. Psychologists are now looking to culturally specific treatment options as legitimate alternatives to the traditional 50-minute hour of individual insight oriented psychotherapy. For instance, the use of sweat lodges and talking circles has been advised for Native Americans, and the “loss of face” dynamic is being considered in Asian American clients.
5. How does clinical work change based on environment (e.g., hospitals, community, prisons)? Be sure to provide at least two examples in your response.
The child clinical psychologist works with child patients in hospital settings and deals primarily with family coping, pain management, and assisting children undergoing a medical procedure (Plante, 2005). However, in prison settings—where someone is involuntarily committed—most states require that the patient have a diagnosable mental illness and to have an inability to care for themselves. The difference is that the hospital setting is usually voluntary and the prison setting is largely involuntary, and in the hospital setting a psychologist is concerned more with helping patients deal with hospital activities and in prison situations a psychologist is concerned with diagnosing mental illness properly.
Community mental health clinics are primarily concerned with, “…physical and/or sexual abuse, attention deficit hyperactivity disorder, conduct disorders, autism, enuresis…encopresis, and school phobia” (Plante, 2005, p. 359). The community mental health clinical is a local alternative to the corporate environment of a hospital. This setting offers more personal diagnosis and treatment.
References
Hogan, T.P. (2007). Psychological testing: A practical introduction (2nd ed.). Hoboken, NJ: Wiley.
Plante, T. G. (2005). Contemporary clinical psychology (2nd ed.). Hoboken, NJ: Wiley

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