Clinical Psychology

A Global Perspective

Stefan G. Hofmann, Stefan G. Hofmann

• Publisher: Wiley-Blackwell
• Year: 2017
• ISBN:
  9781118960011
• Edition: 1
• Topic: Psicologia
• Subtopic: Psicologia clinica

The first book to offer a truly global perspective on the theory and practice of clinical psychology

While clinical psychology is practiced the world over, up to now there has been no text devoted to examining it within a global context. The first book of its kind, Clinical Psychology: A Global Perspective brings together contributions from clinicians and scholars around the world to share their insights and observations on the theory and practice of clinical psychology.

Due partly to language barriers and entrenched cultural biases, there is little cultural cross-pollination within the field of clinical psychology. In fact, most of the popular texts were written for English-speaking European and Anglo-American audiences and translated for other countries. As a result, most psychologists are unaware of how their profession is conceptualized and practiced in different regions, or how their own practices can be enriched by knowledge of the theories and modalities predominant among colleagues in other parts of the world. This book represents an important first step toward rectifying that state of affairs.

• Explores key differences and similarities in how clinical psychology is conceptualized and practiced with children, adolescents and adults across different countries and cultures
• Addresses essential research methods, clinical interviews, psychometric testing, neuropsychological assessments, and dominant treatment modalities
• Follows a consistent format with each chapter focusing on a specific area of the practice of clinical psychology while integrating cultural issues within the discussion
• Includes coverage of how to adapt one's practice to the differing cultures of individual clients, and how to work in multidisciplinary teams within a global context

Clinical Psychology: A Global Perspective is a valuable resource for students, trainees, and practicing psychologists, especially those who work with ethnic minority groups or with interpreters. It is also a must-read for practitioners who are considering working internationally.

1
Research Methods

Julian A. Rubel and Wolfgang Lutz

Introduction

In most areas of psychology, chapters on research methods are predominantly concerned with the description of well‐controlled conditions of laboratory studies and their proper analysis. However, the scope of clinical psychology is much broader than that of basic psychological science and laboratory studies. The variety of topics ranges from foundational issues to applied contexts. As clinical psychology is a far‐reaching field of applied psychology, much research is concerned with phenomena that could not easily be studied in the lab or under controlled conditions. As a consequence, research methods within clinical psychology need to include designs and evaluation strategies ranging from laboratory studies to clinical interventions as they are delivered in the field. However, instead of making considerations about research methodology less important, this broader focus increases the importance of a knowledge of methodological issues to allow the appropriate analysis and interpretation of study results (Kazdin, 2013). Increased sophistication of applied research methods helped clinical psychology to establish itself as a profession. Regardless of their future occupation, a firm understanding of research methods is pivotal to every scholar in clinical psychology. Clinical scientists must not only be acquainted with research design considerations and statistical concepts, they also need to have expertise in this area to be able to provide a treatment that is based on scientific evidence.

The present chapter provides a nontechnical overview of the most important concepts of research methods in clinical psychology. In the first section of this chapter, central concepts pertaining to the study of the frequency, development and prevention of psychological problems are described briefly. Since most research in clinical psychology is on interventions, the second part of this chapter deals with the evaluation of these treatments. In this section, we present methods that are concerned with the following three overarching questions: (a) Does the intervention work? (b) Is the intervention effective for a specific patient? (c) How, for whom, and under which conditions does the intervention work?

Research on the Frequency, Cause, and Prevention of Psychological Problems, and Disorders

Epidemiology

Much research within clinical psychology attempts to answer questions such as: Who has a psychological problem or disorder? How is a disorder distributed in a specific population? Which factors lead to or increase the risk of psychological disorders? How does an untreated disorder develop? Who is seeking treatment and who needs it? The field of epidemiology deals with these questions (e.g., Rockett, 1999). Descriptive epidemiology deals with the distribution (occurrence, spatial, temporal) of these phenomena, and analytic epidemiology deals with the determinants (causes) of psychological disorders. Important concepts in epidemiological research are described below.

Prevalence

Prevalence indicates the frequency of a psychological disorder, generally or in a specific population. The prevalence rate is the proportion of people with a specific disorder in relation to the population of interest. Prevalence must be specified with regard to a particular time period and the examined population: For example, 12‐month prevalence refers to the rate of occurrence within a period of 12 months. In comparison, lifetime prevalence refers to the entire lifespan. Instead of a time period, prevalence can also refer to a specific time point (point prevalence). An additional important figure is treatment prevalence, which is not concerned with the frequency of occurrence of a disorder but the frequency with which persons seek treatment for a specific disorder.

Incidence

Incidence refers to the number of persons in a given time period and population that newly develop a disorder. Thus, the incidence rate is the proportion of persons in a given population that have a disorder but did not have that disorder in the past. In accordance with this definition, two measurement points would be necessary for a valid incidence estimate: The first time point provides the base‐rate of people in a population who do not suffer from the disorder. The second time point determines the number of patients who were not ill at the first time point but are ill now. Like prevalence, incidence depends on the investigated period, and the population. If, for example, the second measurement point is one year after the first measurement point, the incidence rate is specific for this 1‐year period.

Risk Measures

Generally, two types of risk measures can be differentiated: unconditional risks and conditional risks. Unconditional risks address the likelihood of developing a specific disorder in a given period. These risks can be calculated with the respective prevalence and incidence estimates described above. Conditional risks address whether certain variables increase (risk factor) or decrease (protective factor) the probability of developing a disorder. As such, whether the prevalence and/or incidence rates differ is investigated depends on the variable in question (e.g., sex). Many psychological disorders occur more frequently in women than in men. Consequently, being female is a risk factor for the development of these disorders.

Etiology and Analytical Epidemiology

When investigating the causes of psychological disorders, multidimensional models are usually assumed. That is to say, psychopathology is too complex to be explained by a single cause. Rather, many different influence factors from multiple dimensions are thought to interact, and eventually result in a psychological disorder. Etiology and analytical epidemiology address the questions of who develops a disorder and under which circumstances, taking into account behavioral, biological, emotional, social, and developmental influences. To observe the relative influence of each of the different factors, similar methods are applied, as described below (also see the section on the control‐group experiment). The basic idea is to investigate groups that differ with regard to certain influence factors and are identical with regard to others. The examination of the effects of genes, for example, is often done within so called “twin studies.” Twins are identical with regard to their genetic code but might be exposed to other very different influence factors, especially if they were raised apart from each other. Those characteristics, which are shared by twins after many years within different environmental conditions, are highly likely to have strong genetic influences.

For the design of examinations that seek to establish causal influence factors, it is important to show that the potential influence factor was present before the disorder. Therefore, the repeated assessment of the same individuals over time is needed (longitudinal designs). Cross‐sectional designs, in which data is collected from different age groups at the same time, can also hint at causal associations. However, this design assumes that the age groups are comparable with regard to other, not measured characteristics. If there are systematic differences between the different age groups (cohort effects) these can hamper the interpretation of cross‐sectional studies.

Prevention

Besides the treatment of psychological disorders, the prevention of their onset is crucial for clinical psychology. Prevention research within clinical psychology investigates interventions or programs that help to reduce the risk of developing a psychological disorder. While primary prevention programs aim at risk reduction on a global level (e.g., for all inhabitants of a country), secondary prevention focuses on individuals who already show an increased risk of developing a disorder or already report subclinical problems. As such, prevention research is based on etiology and epidemiology, as knowledge on the potential causes of psychological disorders is needed to create effective programs. The evaluation of these programs uses the same methods as those presented below for the evaluation of other clinical interventions.

Evaluating Clinical Interventions and Treatments

Central to clinical psychology is the question of the effectiveness of specific clinical interventions as well as complete psychological treatments (e.g., cognitive behavioral treatments, psychodynamic treatments). The first step in the process of evaluating psychological interventions and treatments is an appropriate definition of the program or intervention, and the identification of criteria that differentiate success from failure. In psychotherapy research, for example, it is agreed that assessments of outcomes should not be limited to a single dimension (e.g., depressive symptoms), even if the focus of the study is a specific disorder (e.g., depression). While symptoms should be one of the primary outcomes, most stu...