PREFACE iv

ACKNOWLEDGEMENTS vii

ABOUT THE AUTHORS viii

1 The Evolution of Clinical Psychology 1

Introduction 1

Defining the Nature and Scope of Clinical Psychology 3

Evidence-Based Practice in Psychology 7

Mental Health Professions 8

Counselling Psychology 8

School Psychology 10

Psychiatry 10

Clinical Social Work 11

Other Mental Health Professions 12

Availability of Mental Health Service Providers 13

A Brief History of Clinical Psychology 14

The Roots of Clinical Psychology 14

The History of Assessment in Clinical Psychology 15

The History of Intervention in Clinical Psychology 20

The History of Prevention in Clinical Psychology 25

The Future 25

Summary and Conclusions 25

2 Contemporary Clinical Psychology 27

Introduction 27

Activities of Clinical Psychologists 28

Assessment and Diagnosis 29

Intervention 32

Prevention 35

Consultation 35

Research 37

Teaching and Supervision 38

Administration 39

Employment Settings 39

The Two Pillars of Clinical Psychology: Science and Ethics 40

Training in Clinical Psychology 43

Models of Training in Clinical Psychology 43

Accreditation of Clinical Psychology Programs 45

Licensure in Clinical Psychology 47

Summary and Conclusions 49

3 Classification and Diagnosis 50

Introduction 50

Defining Abnormal Behaviour and Mental Disorders 52

Developmental Psychopathology 53

Diagnosis 53

Defining Disorder 54

Prevalence of Mental Disorders 55

Understanding the Development of Mental Disorders 58

The Diagnostic and Statistical Manual of Mental Disorders (DSM) System 61

The Evolution of the DSM 61

The DSM-5 63

The International Statistical Classification of Diseases and Related Health Problems (ICD) System 67

Limitations of Diagnostic Systems 68

Defining Abnormality (Revisited) 68

Diagnostic Reliability 69

Heterogeneity of Symptom Profiles 70

Diagnostic Validity 71

Comorbidity 72

Categorical versus Dimensional Classification 73

Summary and Conclusions 74

4 Research Methods in Clinical Psychology 75

Introduction 75

Generating Research Hypotheses 78

Ethics in Research 80

Research Designs 83

Case Studies 86

Single Case Designs 87

Correlational Designs 88

Quasi-Experimental Designs 90

Experimental Designs 91

Selecting Research Participants and Measures 93

Selecting the Sample 93

Selecting the Sampling Strategy 93

Setting the Sample Size 94

Measurement Options and the Importance of Psychometric Properties 95

Analyzing the Data 96

Statistical and Clinical Significance 97

Research Syntheses 98

Systematic Reviews 98

Meta-Analysis 99

Summary and Conclusions 100

5 Assessment: Overview 102

Introduction 102

Psychological Assessment 103

Evidence-Based Assessment 104

The Purposes of Psychological Assessment 105

Psychological Testing 112

Assessment versus Testing 114

Psychometric Considerations 116

Testing Practices in Clinical Psychology 120

Ethical Considerations 121

Summary and Conclusions 122

6 Assessment: Interviewing and Observation 124

Introduction 124

Ethical Issues: Limits of Confidentiality 126

Unstructured Assessment Interviews 127

Semi-Structured Diagnostic Interviews 129

General Issues in Interviewing 131

Attending Skills 131

Contextual Information 132

Culturally Sensitive Interviewing 133

Defining Problems and Goals 135

Assessing Suicide Risk 137

Interviewing Couples 138

Interviewing Families 138

Interviewing Children and Adolescents 139

Observations 141

Self-Monitoring 144

Summary and Conclusions 147

7 Assessment: Intellectual and Cognitive Measures 148

Introduction 148

Defining Intelligence 149

Theories of Intelligence 149

Assessing Intelligence: The Clinical Context 151

The Wechsler Intelligence Scales 153

Background Issues 153

Administration, Scoring, and Interpretation Issues 157

Canadian Normative Data 158

Wechsler Adult Intelligence Scale—Fourth Edition (WAIS-IV) 160

Wechsler Intelligence Scale for Children—Fifth Edition (WISC-V) 162

Wechsler Preschool and Primary Scale of Intelligence—Fourth Edition (WPPSI-IV) 163

Other Intelligence Scales 164

Selected Cognitive Assessment Scales 165

Wechsler Memory Scale—Fourth Edition (WMS-IV) 165

Wechsler Individual Achievement Test—Third Edition (WIAT-III) 167

Summary and Conclusions 168

8 Assessment: Self-Report and Projective Measures 169

Introduction 169

The Person-Situation Debate 170

Self-Presentation Biases 172

Developing Culturally Appropriate Measures 172

The Clinical Utility of Self-Report and Projective Measures 175

Self-Report Personality Measures 176

MMPI-2 and MMPI-A 177

Other Clinical Measures of Personality Functioning 182

Self-Report Checklists of Behaviours and Symptoms 184

Achenbach System of Empirically Based Assessment 184

SCL-90-R 187

Outcome Questionnaire 45 187

Beck Depression Inventory-II 188

Children’s Depression Inventory 2 189

Projective Measures of Personality 189

Rorschach Inkblot Test 190

Summary and Conclusions 192

9 Assessment: Integration and Clinical Decision-Making 194

Integrating Assessment Data 196

Case Formulation 198

Threats to the Validity of Assessments and Case Formulations 202

Patient/Client Factors 202

Clinician Factors 203

Improving the Accuracy of Clinical Judgment 205

Psychological Assessment Reports and Treatment Plans 207

Assessment Feedback 209

Summary and Conclusions 211

10 Prevention 213

Introduction 213

Approaches to Prevention 217

Promoting Evidence-Based Parenting 220

Home Visiting Programs 221

Incredible Years 221

Triple P 222

Prevention of Violence 222

Physical Abuse of Children 222

Youth Violence: Bullying and Conduct Disorder 223

Prevention of Internalizing Disorders 225

Anxiety Disorders 225

Depression 226

Prevention of Substance Abuse 226

Prevention of Problems in those Exposed to Trauma or Loss 228

Summary and Conclusions 229

11 Intervention: Overview 231

Introduction 231

The Ethics of Intervention 232

Theoretical Approaches 236

Short-Term Psychodynamic Psychotherapies 237

Interpersonal Psychotherapy for Depression 239

Process-Experiential Therapies 240

Cognitive-Behavioural Therapies 241

Seeking Psychological Treatment 244

The Duration and Impact of Psychotherapy 247

Alternative Modes of Service Delivery 249

Summary and Conclusions 254

12 Intervention: Adults and Couples 256

Introduction 256

Does Psychotherapy Work? A Controversy and Its Impact 256

Meta-Analysis and Psychotherapy Research 257

Evidence-Based Treatments: Initiatives and Controversies 261

Clinical Practice Guidelines 268

Examples of Evidence-Based Treatments 270

CBT for Depression 270

Prolonged Exposure CBT for PTSD 273

EFT for Couple Distress 274

Effectiveness Trials 274

Adoption of Evidence-Based Treatments 276

Summary and Conclusions 278

13 Intervention: Children and Adolescents 280

Introduction 280

Who Is the Client in Psychological Services for Children and Adolescents? 280

Landmarks in the Evolution of Evidence-Based Psychological Services for Children and Adolescents 283

Do Psychological Treatments for Children and Adolescents Work? 284

Which Treatments Work for Specific Disorders? 285

Clinical Practice Guidelines 288

Examples of Evidence-Based Treatments 289

Disruptive Behaviour Disorders 289

Adolescent Depression 295

Efficacy, Effectiveness, and the Dissemination of Evidence-Based Treatments 296

Summary and Conclusions 300

14 Intervention: Identifying Key Elements of Change 302

Introduction 302

Psychotherapy Process and Process-Outcome Research 303

Examining Client Factors 305

Examining Therapist Factors 307

Examining Treatment Factors 309

Some Methodological Cautions 312

Common Factors in Psychotherapy 313

Research Perspectives on Common Factors: The Therapeutic Alliance 314

Research Perspectives on Common Factors: Psychotherapy Equivalence 315

Evidence-Based Psychotherapy Relationships 318

Task Force Recommendations 319

Empirically Based Principles of Therapeutic Change 320

Summary and Conclusions 323

15 Clinical Health Psychology, Clinical Neuropsychology, and Forensic Psychology 324

Introduction 324

Clinical Health Psychology 325

Definitions of Health and Disability 326

Activities of Clinical Health Psychologists 327

Assessment and Intervention Related to Pain 330

Clinical Neuropsychology 333

Activities of Clinical Neuropsychologists 333

Assessment 335

Intervention 337

Forensic Psychology 339

Activities of Forensic Psychologists 340

Assessment 342

Intervention 343

Summary and Conclusions 344

APPENDIX 1 Major Journals Relevant to Clinical Psychology 346

APPENDIX 2 Applications to Graduate School 352

REFERENCES 361

NAME INDEX 391

SUBJECT INDEX 403

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