Thomas G. Plante
Santa Clara University and
Stanford University
About the Author xxix
PART ONE
Foundations and Fundamentals 1
Chapter 1
What Is Contemporary Clinical Psychology? 3
Highlight of a Contemporary Clinical Psychologist:
Patrick H. DeLeon, PhD, ABPP 3
CASE STUDY: Carlos 5
Definition and Inherent Intrigue 6
Perspective and Philosophy 7
Education and Training 9
Activities 11
Research 11
Assessment 12
Treatment 12
Teaching 15
Consultation 15
Administration 16
Employment Settings 16
Private or Group Practices 16
Colleges and Universities 17
Hospitals 17
Medical Schools 17
Outpatient Clinics 18
Business and Industry 18
Military 18
Other Locations 18
Subspecialties 18
Child Clinical Psychology 19
Clinical Health Psychology 20
Clinical Neuropsychology 20
Forensic Psychology 21
Geropsychology 21
Organizations 21
American Psychological Association 21
American Psychological Society 22
State and County Psychological Associations 22
American Board of Professional Psychology 22
Other Organizations 23
How Does Clinical Psychology Differ from Related Fields? 23
Counseling Psychologists (PhD) 23
School Psychologists (MA or PhD) 24
Psychiatry (MD) 25
Social Work (MSW) 26
Psychiatric Nursing (RN) 27
Marriage and Family Therapists (MFT) 27
Other Counselors 27
Other Psychologists 28
The Big Picture 28
Key Points 29
Key Terms 30
For Reflection 30
Real Students, Real Questions 30
Web Resources 31
Chapter 2
Foundations and Early History of Clinical Psychology 33
Highlight of a Contemporary Clinical Psychologist:
Rev. Gerdenio “Sonny” Manuel, SJ, PhD 33
Early Conceptions of Mental Illness: Mind and Body Paradigms 36
The Greeks 36
The Middle Ages 38
The Renaissance 39
The Nineteenth Century 39
The Birth of Psychology 41
The Founding of Clinical Psychology 42
The Influence of Binet’s Intelligence Test 43
The Influence of the Mental Health and Child Guidance Movement 43
The Influence of Sigmund Freud in America 44
The American Psychological Association and Early Clinical Psychology 44
The Influence of World War I 45
Clinical Psychology between World Wars I and II 46
Psychological Testing 46
Psychotherapy 46
Training 47
Organizational Split and New Publications 47
The Big Picture 47
Key Points 48
Key Terms 49
For Reflection 49
Real Students, Real Questions 50
Web Resources 50
Chapter 3
Recent History of Clinical Psychology 51
Highlight of a Contemporary Clinical Psychologist:
Amy Bassell Crowe, PhD 51
The Influence of World War II 53
Clinical Psychology Immediately after World War II 53
Training 56
The Boulder Conference 56
Post-Boulder Conference Events 60
The Rise of Alternatives to the Psychodynamic Approach 60
The Behavioral Approach 61
The Cognitive-Behavioral Approach 62
The Humanistic Approach 62
The Family Systems Approaches 63
Psychotropic Medication 65
Community Mental Health Movement 66
The Integrative Approaches 66
The Biopsychosocial Approach 68
A New Training Model Emerges 69
The Vail Conference 69
Salt Lake City Conference 70
Additional Conferences 70
Michigan Conference on Postdoctoral Training 70
Present Status 70
The Big Picture 72
Key Points 72
Key Terms 73
For Reflection 73
Real Students, Real Questions 74
Web Resources 74
Chapter 4
Research: Design and Outcome 75
Highlight of a Contemporary Clinical Psychologist:
Alan E. Kazdin, PhD, ABPP 75
Research Methods and Designs 77
Experiments 79
Identifying Independent and Dependent Variables 79
Minimizing Experimental Error 79
Maximizing Internal and External Validity 80
Experimental Designs 82
True Experimental Designs 82
Quasi-Experimental Designs 83
Between Group Designs 84
Within Group Designs 84
Mixed Group Designs 85
Analogue Designs 86
Case Studies 86
Single Subject Designs 87
Multiple Baseline Designs 88
Correlational Methods 90
Epidemiological Methods 92
Cross-Sectional and Longitudinal Designs 92
Treatment Outcome Research 93
Treatment Package Strategy 94
Dismantling Treatment Strategies 95
Constructive Treatment Strategies 95
Parametric Treatment Strategy 95
Comparative Treatment Strategy 96
Client-Therapist Variation Strategy 96
Process Research Strategy 96
Questions and Challenges in Conducting Treatment Outcome Research 96
Is a Research Program’s Treatment Similar to the Treatment in
Actual Practice? 96
Are the Patients and Therapists Used in a Research Study Typical of
Those in Actual Practice? 97
What Are Some of the Ethical Problems with Treatment
Outcome Research? 97
How and When Is Treatment Outcome Measured? 98
Statistical versus Clinical Significance 99
How Can Treatment Outcome Decisions Be Made When Studies
Reach Different Conclusions? 100
What Is a Program of Research and How Is It Conducted? 101
Contemporary Issues in Clinical Psychology Treatment Outcome Research 101
Biopsychosocial Approaches to Psychopathology Research 102
Meta-Analysis 103
Empirically Supported Treatments 103
Comprehensive and Collaborative Multisite Clinical Trial Research Projects 106
Community-Wide Interventions 106
Cross Cultural Research 107
How and Where Is Research Conducted in Clinical Psychology and
How Is It Funded? 107
How Are Research Results Communicated and Incorporated
into Practice? 108
The Big Picture 109
Key Points 110
Key Terms 112
For Reflection 112
Real Students, Real Questions 113
Web Resources 113
Chapter 5
The Major Theoretical Models: Paving the Way toward Integration 115
Highlight of a Contemporary Clinical Psychologist: Marcia J. Wood, PhD 115
The Four Major Theoretical Models in Clinical Psychology 117
The Psychodynamic Approach 117
CASE STUDY: Mary 118
Freud’s Psychoanalytic Perspective 118
The Revisionist or Neo-Freudian Perspective 121
The Object Relations Perspective 121
The Behavioral and Cognitive-Behavioral Approaches 122
The Classical Conditioning Perspective 124
The Operant Perspective 125
The Social Learning Perspective 125
The Cognitive Perspective: Beliefs, Appraisals, and Attributions 126
The Humanistic Approach 128
The Client-Centered Perspective 129
Maslow’s Humanistic Perspective 129
The Gestalt Perspective 130
The Family Systems Approach 130
The Communication Approach 131
The Structural Approach 132
The Milan Approach 132
The Strategic Approach 134
The Narrative Approach 134
Understanding Mary from Different Theoretical Orientations 135
Psychodynamic Formulation and Plan 135
Cognitive-Behavioral Formulation and Plan 135
Humanistic Formulation and Plan 136
Family Systems Formulation and Plan 136
Conclusion 136
The Big Picture 137
Key Points 137
Key Terms 138
For Reflection 139
Real Students, Real Questions 139
Web Resources 139
Chapter 6
Integrative and Biopsychosocial Approaches in Contemporary
Clinical Psychology 141
Highlight of a Contemporary Clinical Psychologist: Paul L. Wachtel, PhD 141
The Call to Integration 143
Commonalities among Approaches 144
Efforts toward Integration 145
Eclectism 146
Beyond Psychological Models 147
Biopsychosocial Integration 148
Biological Factors 148
Social Factors 153
CASE STUDY: Mary—Integrating Biological Factors 153
Synthesizing Biological, Psychological, and Social Factors in
Contemporary Integration 155
The Diathesis-Stress Perspective 155
CASE STUDY: Mary—Integrating Social Factors 157
The Reciprocal-Gene-Environment Perspective 157
Psychosocial Influences on Biology 158
Development of the Biopsychosocial Perspective 158
Application of the Biopsychosocial Perspective to Contemporary Clinical
Psychology Problems 159
Obsessive-Compulsive Disorder 159
Panic Disorder and Anxiety 161
CASE STUDY: Hector Experiences Obsessive-Compulsive
Disorder (Biopsychosocial) 162
CASE STUDY: Nicole Experiences School Phobia (Biopsychosocial) 165
Cardiovascular Disease 166
CASE STUDY: Taylor Experiences Cardiovascular Disease, Job and
Family Stress, and Type A Personality (Biopsychosocial) 167
Cancer 168
CASE STUDY: Marilyn—Biopsychosocial with Cancer 169
CASE STUDY: Mary—Biopsychosocial Synthesis 171
Conclusion 172
The Big Picture 172
Key Points 172
Key Terms 173
For Reflection 173
Real Students, Real Questions 173
Web Resources 174
PART TWO
Roles and Responsibilities 175
Chapter 7
Contemporary Psychological Assessment I: Interviewing and
Observing Behavior 177
Highlight of a Contemporary Clinical Psychologist: Stanley Sue, PhD 177
Goals, Purposes, and Types of Assessment 179
Reliability and Validity 180
Interviewing 182
Rapport 183
Effective Listening Skills 184
Effective Communication 185
Observation of Behavior 186
Asking the Right Questions 186
Types of Interviews 186
Initial Intake or Admissions Interview 186
CASE STUDY: Joe Experiences Depression 187
Mental Status Interview 188
Crisis Interview 190
Diagnostic Interview 190
Structured Interviews 193
Computer-Assisted Interviews 195
Exit or Termination Interview 195
Potential Threats to Effective Interviewing 197
Bias 197
Reliability and Validity 197
Behavioral Observations 199
Naturalistic Observation 199
Self-Monitoring 201
Controlled Observations 202
Checklists and Inventories 203
Beck Inventories 203
Child Behavior Checklist (CBCL) 205
The Symptom Checklist 90-Revised (SCL-90-R) 205
CASE STUDY: Jose and the BDI, CBCL, and SCL-90-R 206
Other Checklists and Inventories 207
Physiological Testing 208
The Big Picture 209
Key Points 209
Key Terms 210
For Reflection 210
Real Students, Real Questions 211
Web Resources 211
Contemporary Psychological Assessment II: Cognitive and
Personality Assessment 213
Highlight of a Contemporary Clinical Psychologist:
Lori Goldfarb Plante, PhD 213
Cognitive Testing 214
Intelligence Testing 214
What Is Intelligence? 215
How Do Clinical Psychologists Measure Intelligence? 217
Wechsler Scales 218
CASE STUDY: Gabriel—WAIS-III (Intellectual Assessment) 221
Stanford-Binet Scales 222
Other Tests of Intellectual Ability 222
CASE STUDY: Donald—WISC-IV (Intellectual Assessment) 224
Other Tests of Cognitive Ability 226
Neuropsychological Testing 229
Questions and Controversies Concerning IQ and Cognitive Testing 231
Case Study: Robert Experiences a Head Injury and Resulting
Antisocial Behaviors (Neuropsychological) 232
Conclusion 233
Personality Testing 234
What Are Personality and Psychological Functioning? 234
Is Personality Really Enduring? 236
How Do Clinical Psychologists Measure Personality and
Psychological Functioning? 236
Objective Testing 237
Projective Testing 242
Case Study: Martha Experiences Severe Depression and Borderline
Personality (Rorschach) 243
CASE STUDY: Xavier Experiences Bipolar Disorder (Rorschach) 244
Questions and Controversies Concerning Personality and
Psychological Testing 248
CASE STUDY: Debbie Experiences Alcoholism, Depression, and
Phobic Anxiety (TAT) 248
CASE STUDY: Xavier (Sentence Completion) 249
Case Study: Elias Experiences Anxiety and Depression
(Sentence Completion) 249
Santa Clara University and
Stanford University
About the Author xxix
PART ONE
Foundations and Fundamentals 1
Chapter 1
What Is Contemporary Clinical Psychology? 3
Highlight of a Contemporary Clinical Psychologist:
Patrick H. DeLeon, PhD, ABPP 3
CASE STUDY: Carlos 5
Definition and Inherent Intrigue 6
Perspective and Philosophy 7
Education and Training 9
Activities 11
Research 11
Assessment 12
Treatment 12
Teaching 15
Consultation 15
Administration 16
Employment Settings 16
Private or Group Practices 16
Colleges and Universities 17
Hospitals 17
Medical Schools 17
Outpatient Clinics 18
Business and Industry 18
Military 18
Other Locations 18
Subspecialties 18
Child Clinical Psychology 19
Clinical Health Psychology 20
Clinical Neuropsychology 20
Forensic Psychology 21
Geropsychology 21
Organizations 21
American Psychological Association 21
American Psychological Society 22
State and County Psychological Associations 22
American Board of Professional Psychology 22
Other Organizations 23
How Does Clinical Psychology Differ from Related Fields? 23
Counseling Psychologists (PhD) 23
School Psychologists (MA or PhD) 24
Psychiatry (MD) 25
Social Work (MSW) 26
Psychiatric Nursing (RN) 27
Marriage and Family Therapists (MFT) 27
Other Counselors 27
Other Psychologists 28
The Big Picture 28
Key Points 29
Key Terms 30
For Reflection 30
Real Students, Real Questions 30
Web Resources 31
Chapter 2
Foundations and Early History of Clinical Psychology 33
Highlight of a Contemporary Clinical Psychologist:
Rev. Gerdenio “Sonny” Manuel, SJ, PhD 33
Early Conceptions of Mental Illness: Mind and Body Paradigms 36
The Greeks 36
The Middle Ages 38
The Renaissance 39
The Nineteenth Century 39
The Birth of Psychology 41
The Founding of Clinical Psychology 42
The Influence of Binet’s Intelligence Test 43
The Influence of the Mental Health and Child Guidance Movement 43
The Influence of Sigmund Freud in America 44
The American Psychological Association and Early Clinical Psychology 44
The Influence of World War I 45
Clinical Psychology between World Wars I and II 46
Psychological Testing 46
Psychotherapy 46
Training 47
Organizational Split and New Publications 47
The Big Picture 47
Key Points 48
Key Terms 49
For Reflection 49
Real Students, Real Questions 50
Web Resources 50
Chapter 3
Recent History of Clinical Psychology 51
Highlight of a Contemporary Clinical Psychologist:
Amy Bassell Crowe, PhD 51
The Influence of World War II 53
Clinical Psychology Immediately after World War II 53
Training 56
The Boulder Conference 56
Post-Boulder Conference Events 60
The Rise of Alternatives to the Psychodynamic Approach 60
The Behavioral Approach 61
The Cognitive-Behavioral Approach 62
The Humanistic Approach 62
The Family Systems Approaches 63
Psychotropic Medication 65
Community Mental Health Movement 66
The Integrative Approaches 66
The Biopsychosocial Approach 68
A New Training Model Emerges 69
The Vail Conference 69
Salt Lake City Conference 70
Additional Conferences 70
Michigan Conference on Postdoctoral Training 70
Present Status 70
The Big Picture 72
Key Points 72
Key Terms 73
For Reflection 73
Real Students, Real Questions 74
Web Resources 74
Chapter 4
Research: Design and Outcome 75
Highlight of a Contemporary Clinical Psychologist:
Alan E. Kazdin, PhD, ABPP 75
Research Methods and Designs 77
Experiments 79
Identifying Independent and Dependent Variables 79
Minimizing Experimental Error 79
Maximizing Internal and External Validity 80
Experimental Designs 82
True Experimental Designs 82
Quasi-Experimental Designs 83
Between Group Designs 84
Within Group Designs 84
Mixed Group Designs 85
Analogue Designs 86
Case Studies 86
Single Subject Designs 87
Multiple Baseline Designs 88
Correlational Methods 90
Epidemiological Methods 92
Cross-Sectional and Longitudinal Designs 92
Treatment Outcome Research 93
Treatment Package Strategy 94
Dismantling Treatment Strategies 95
Constructive Treatment Strategies 95
Parametric Treatment Strategy 95
Comparative Treatment Strategy 96
Client-Therapist Variation Strategy 96
Process Research Strategy 96
Questions and Challenges in Conducting Treatment Outcome Research 96
Is a Research Program’s Treatment Similar to the Treatment in
Actual Practice? 96
Are the Patients and Therapists Used in a Research Study Typical of
Those in Actual Practice? 97
What Are Some of the Ethical Problems with Treatment
Outcome Research? 97
How and When Is Treatment Outcome Measured? 98
Statistical versus Clinical Significance 99
How Can Treatment Outcome Decisions Be Made When Studies
Reach Different Conclusions? 100
What Is a Program of Research and How Is It Conducted? 101
Contemporary Issues in Clinical Psychology Treatment Outcome Research 101
Biopsychosocial Approaches to Psychopathology Research 102
Meta-Analysis 103
Empirically Supported Treatments 103
Comprehensive and Collaborative Multisite Clinical Trial Research Projects 106
Community-Wide Interventions 106
Cross Cultural Research 107
How and Where Is Research Conducted in Clinical Psychology and
How Is It Funded? 107
How Are Research Results Communicated and Incorporated
into Practice? 108
The Big Picture 109
Key Points 110
Key Terms 112
For Reflection 112
Real Students, Real Questions 113
Web Resources 113
Chapter 5
The Major Theoretical Models: Paving the Way toward Integration 115
Highlight of a Contemporary Clinical Psychologist: Marcia J. Wood, PhD 115
The Four Major Theoretical Models in Clinical Psychology 117
The Psychodynamic Approach 117
CASE STUDY: Mary 118
Freud’s Psychoanalytic Perspective 118
The Revisionist or Neo-Freudian Perspective 121
The Object Relations Perspective 121
The Behavioral and Cognitive-Behavioral Approaches 122
The Classical Conditioning Perspective 124
The Operant Perspective 125
The Social Learning Perspective 125
The Cognitive Perspective: Beliefs, Appraisals, and Attributions 126
The Humanistic Approach 128
The Client-Centered Perspective 129
Maslow’s Humanistic Perspective 129
The Gestalt Perspective 130
The Family Systems Approach 130
The Communication Approach 131
The Structural Approach 132
The Milan Approach 132
The Strategic Approach 134
The Narrative Approach 134
Understanding Mary from Different Theoretical Orientations 135
Psychodynamic Formulation and Plan 135
Cognitive-Behavioral Formulation and Plan 135
Humanistic Formulation and Plan 136
Family Systems Formulation and Plan 136
Conclusion 136
The Big Picture 137
Key Points 137
Key Terms 138
For Reflection 139
Real Students, Real Questions 139
Web Resources 139
Chapter 6
Integrative and Biopsychosocial Approaches in Contemporary
Clinical Psychology 141
Highlight of a Contemporary Clinical Psychologist: Paul L. Wachtel, PhD 141
The Call to Integration 143
Commonalities among Approaches 144
Efforts toward Integration 145
Eclectism 146
Beyond Psychological Models 147
Biopsychosocial Integration 148
Biological Factors 148
Social Factors 153
CASE STUDY: Mary—Integrating Biological Factors 153
Synthesizing Biological, Psychological, and Social Factors in
Contemporary Integration 155
The Diathesis-Stress Perspective 155
CASE STUDY: Mary—Integrating Social Factors 157
The Reciprocal-Gene-Environment Perspective 157
Psychosocial Influences on Biology 158
Development of the Biopsychosocial Perspective 158
Application of the Biopsychosocial Perspective to Contemporary Clinical
Psychology Problems 159
Obsessive-Compulsive Disorder 159
Panic Disorder and Anxiety 161
CASE STUDY: Hector Experiences Obsessive-Compulsive
Disorder (Biopsychosocial) 162
CASE STUDY: Nicole Experiences School Phobia (Biopsychosocial) 165
Cardiovascular Disease 166
CASE STUDY: Taylor Experiences Cardiovascular Disease, Job and
Family Stress, and Type A Personality (Biopsychosocial) 167
Cancer 168
CASE STUDY: Marilyn—Biopsychosocial with Cancer 169
CASE STUDY: Mary—Biopsychosocial Synthesis 171
Conclusion 172
The Big Picture 172
Key Points 172
Key Terms 173
For Reflection 173
Real Students, Real Questions 173
Web Resources 174
PART TWO
Roles and Responsibilities 175
Chapter 7
Contemporary Psychological Assessment I: Interviewing and
Observing Behavior 177
Highlight of a Contemporary Clinical Psychologist: Stanley Sue, PhD 177
Goals, Purposes, and Types of Assessment 179
Reliability and Validity 180
Interviewing 182
Rapport 183
Effective Listening Skills 184
Effective Communication 185
Observation of Behavior 186
Asking the Right Questions 186
Types of Interviews 186
Initial Intake or Admissions Interview 186
CASE STUDY: Joe Experiences Depression 187
Mental Status Interview 188
Crisis Interview 190
Diagnostic Interview 190
Structured Interviews 193
Computer-Assisted Interviews 195
Exit or Termination Interview 195
Potential Threats to Effective Interviewing 197
Bias 197
Reliability and Validity 197
Behavioral Observations 199
Naturalistic Observation 199
Self-Monitoring 201
Controlled Observations 202
Checklists and Inventories 203
Beck Inventories 203
Child Behavior Checklist (CBCL) 205
The Symptom Checklist 90-Revised (SCL-90-R) 205
CASE STUDY: Jose and the BDI, CBCL, and SCL-90-R 206
Other Checklists and Inventories 207
Physiological Testing 208
The Big Picture 209
Key Points 209
Key Terms 210
For Reflection 210
Real Students, Real Questions 211
Web Resources 211
Contemporary Psychological Assessment II: Cognitive and
Personality Assessment 213
Highlight of a Contemporary Clinical Psychologist:
Lori Goldfarb Plante, PhD 213
Cognitive Testing 214
Intelligence Testing 214
What Is Intelligence? 215
How Do Clinical Psychologists Measure Intelligence? 217
Wechsler Scales 218
CASE STUDY: Gabriel—WAIS-III (Intellectual Assessment) 221
Stanford-Binet Scales 222
Other Tests of Intellectual Ability 222
CASE STUDY: Donald—WISC-IV (Intellectual Assessment) 224
Other Tests of Cognitive Ability 226
Neuropsychological Testing 229
Questions and Controversies Concerning IQ and Cognitive Testing 231
Case Study: Robert Experiences a Head Injury and Resulting
Antisocial Behaviors (Neuropsychological) 232
Conclusion 233
Personality Testing 234
What Are Personality and Psychological Functioning? 234
Is Personality Really Enduring? 236
How Do Clinical Psychologists Measure Personality and
Psychological Functioning? 236
Objective Testing 237
Projective Testing 242
Case Study: Martha Experiences Severe Depression and Borderline
Personality (Rorschach) 243
CASE STUDY: Xavier Experiences Bipolar Disorder (Rorschach) 244
Questions and Controversies Concerning Personality and
Psychological Testing 248
CASE STUDY: Debbie Experiences Alcoholism, Depression, and
Phobic Anxiety (TAT) 248
CASE STUDY: Xavier (Sentence Completion) 249
Case Study: Elias Experiences Anxiety and Depression
(Sentence Completion) 249