The key components of a clinical psychology formulation: A consensus study.

OBJECTIVE: Psychological formulation is a key competency for clinical psychologists. However, there is a lack of consensus regarding the key components and processes of formulation that are hypothesized to contribute to poor reliability of formulations. The aim of this study was to develop consensus on the essential components of a formulation to inform training for clinical psychologists and best practice guidelines. METHODS: A Delphi methodology was used. Items were generated from the literature and discussed and refined with a panel of experts (n = 10). In round one, 110 clinical psychologists in the United Kingdom rated the importance of components of formulation via an online questionnaire. Criteria for consensus were applied and statements were rerated in round two if consensus was not achieved. RESULTS: Consensus was achieved on 30 items, with 18 statements regarding components of a formulation and 12 statements regarding formulation process. Items that clinicians agreed upon emphasized the importance of integrating sociocultural, biological, strengths and personal meaning alongside well-established theoretical frameworks. Consensus was not reached on 20 items, including whether a formulation should be parsimonious or adhere to a model. CONCLUSION: Our findings provide mixed evidence regarding consensus on the key components of formulation. There was an agreement that formulation should be client-led and incorporate strengths and sociocultural factors. Further research should explore client perspectives on the key components of formulation and how these compare to the clinicians' perspectives.

Accounting for Confounding in Observational Studies.

The goal of this review is to enable clinical psychology researchers to more rigorously test competing hypotheses when studying risk factors in observational studies. We argue that there is a critical need for researchers to leverage recent advances in epidemiology/biostatistics related to causal inference and to use innovative approaches to address a key limitation of observational research: the need to account for confounding. We first review theoretical issues related to the study of causation, how causal diagrams can facilitate the identification and testing of competing hypotheses, and the current limitations of observational research in the field. We then describe two broad approaches that help account for confounding: analytic approaches that account for measured traits and designs that account for unmeasured factors. We provide descriptions of several such approaches and highlight their strengths and limitations, particularly as they relate to the etiology and treatment of behavioral health problems.

Consensus-based good practice guidelines for clinical psychologists to support care staff in enabling sexual expression in people with intellectual disabilities-A Delphi study.

BACKGROUND: Care staff supporting people with intellectual disabilities (PWID) report accepting views on PWID's sexual expression, but people with intellectual disabilities report their sexual expression is restricted by care staff. METHODS: We recruited a panel of 17 UK clinical psychologists experienced in helping care staff support PWID's sexual expression. We used the Delphi Method to develop consensus-based practice guidelines for UK clinical psychologists supporting care staff in this way. RESULTS: Having proposed three guidelines each in Round One, panel members reached consensus (≥90% agreement) that 12 were important, falling under four themes: "Addressing staff attitudes," "Addressing uncertainty about rights and responsibilities of people with intellectual disabilities," "Locating the problem, being part of the solution," and "Supporting care staff to understand and reflect upon their role." CONCLUSIONS: Clinical psychologists help care staff support PWID's sexual expression by normalizing care staff concerns, encouraging reflection, clarifying PWID's rights, and prompting those at managerial and service level to support care staff.

Psychology's Replication Crisis and Clinical Psychological Science.

Despite psychological scientists' increasing interest in replicability, open science, research transparency, and the improvement of methods and practices, the clinical psychology community has been slow to engage. This has been shifting more recently, and with this review, we hope to facilitate this emerging dialogue. We begin by examining some potential areas of weakness in clinical psychology in terms of methods, practices, and evidentiary base. We then discuss a select overview of solutions, tools, and current concerns of the reform movement from a clinical psychological science perspective. We examine areas of clinical science expertise (e.g., implementation science) that should be leveraged to inform open science and reform efforts. Finally, we reiterate the call to clinical psychologists to increase their efforts toward reform that can further improve the credibility of clinical psychological science.

The Utility of Event-Related Potentials in Clinical Psychology.

Event-related potentials (ERPs) are direct measures of brain activity that can be leveraged for clinically meaningful research. They can relate robustly both to continuous measures of individual difference and to categorical diagnoses in ways that clarify similarities and distinctions between apparently related disorders and traits. ERPs can be linked to genetic risk, can act as moderators of developmental trajectories and responses to stress, and can be leveraged to identify those at greater risk for psychopathology, especially when used in combination with other neural and self-report measures. ERPs can inform models of the development of, and risk for, psychopathology. Finally, ERPs can be used as targets for existing and novel interventions and prevention efforts. We provide concrete examples for each of these possibilities by focusing on programmatic research on the error-related negativity and anxiety, and thus show that ERPs are poised to make greater contributions toward the identification, prediction, treatment, and prevention of mental disorders.

American Psychological Association practice guidelines for psychopharmacology: Ethical practice considerations for psychologists involving psychotropic use with children and adolescents.

OBJECTIVES: This study discusses the implications of the American Psychological Association's 2011 Practice Guidelines for Pharmacology as they apply to psychologists working with juvenile clients. Special considerations apply due to concerns about the developmental side effects that occur when psychotropic medications are prescribed to children and adolescents. METHODS OR DESIGN: This study provides recommendations for implementing each of the Practice Guidelines. Constructive criticism of the Practice Guidelines is also discussed with the aim of improving service delivery. RESULTS: This study provides specific recommendations for psychologists regarding obtaining adequate knowledge about psychopharmacology to inform clients or consult with physicians. Suggestions are made for continuing education requirements for psychologists who work with juveniles. CONCLUSIONS: Recommendations are made for psychologists working with juveniles to increase their knowledge of psychotropic medications for a more ethical and informed voice regarding the prescribing of such medications.

A methodological review of meta-analyses of the effectiveness of clinical psychology treatments.

This article presents a methodological review of 54 meta-analyses of the effectiveness of clinical psychological treatments, using standardized mean differences as the effect size index. We statistically analyzed the distribution of the number of studies of the meta-analyses, the distribution of the sample sizes in the studies of each meta-analysis, the distribution of the effect sizes in each of the meta-analyses, the distribution of the between-studies variance values, and the Pearson correlations between effect size and sample size in each meta-analysis. The results are presented as a function of the type of standardized mean difference: posttest standardized mean difference, standardized mean change from pretest to posttest, and standardized mean change difference between groups. These findings will help researchers design future Monte Carlo and theoretical studies on the performance of meta-analytic procedures, based on the manipulation of realistic model assumptions and parameters of the meta-analyses. Furthermore, the analysis of the distribution of the mean effect sizes through the meta-analyses provides a specific guide for the interpretation of the clinical significance of the different types of standardized mean differences within the field of the evaluation of clinical psychological interventions.

Evaluating clinicians' representations of schizoaffective disorder.

BACKGROUND: Schizoaffective disorder (SAD) has routinely exhibited poor diagnostic accuracy and reliability. In addition to phenomenological problems with the definition of SAD, the way in which clinicians represent the symptoms of the disorder could contribute to its poor diagnostic outcomes. PURPOSE: The present study sought to examine clinicians' representations of SAD compared to schizophrenia (SCZ), bipolar disorder with psychotic features (BiPD-PSY), and major depressive disorder with psychotic features (MDD-PSY). METHOD: Participants (N=113) were clinicians recruited via email as part of a larger study. They were randomly assigned to either select symptoms from a predetermined criteria list or freely list features of the disorders based on their own mental representations. RESULTS: Participants' conceptualizations of SAD were not entirely congruent with DSM-5 criteria; they conceptualized it as less psychotic than SCZ and less affective than the two mood disorder tasks. SAD was conceptualized as significantly more depressive than manic. CONCLUSIONS: This study's findings support the notion that clinicians' conceptualizations of SAD are not entirely congruent with its DSM-5 criteria, which could contribute to diagnostic difficulties.

Clinical Psychology Training: Accreditation and Beyond.

Beginning with efforts in the late 1940s to ensure that clinical psychologists were adequately trained to meet the mental health needs of the veterans of World War II, the accreditation of clinical psychologists has largely been the province of the Commission on Accreditation of the American Psychological Association. However, in 2008 the Psychological Clinical Science Accreditation System began accrediting doctoral programs that adhere to the clinical science training model. This review discusses the goals of accreditation and the history of the accreditation of graduate programs in clinical psychology, and provides an overview of the evaluation procedures used by these two systems. Accreditation is viewed against the backdrop of the slow rate of progress in reducing the burden of mental illness and the changes in clinical psychology training that might help improve this situation. The review concludes with a set of five recommendations for improving accreditation.

Evidence-Based Psychological Assessment.

In recent years there has been increasing emphasis on evidence-based practice in psychology (EBPP), and as is true in most health care professions, the primary focus of EBPP has been on treatment. Comparatively little attention has been devoted to applying the principles of EBPP to psychological assessment, despite the fact that assessment plays a central role in myriad domains of empirical and applied psychology (e.g., research, forensics, behavioral health, risk management, diagnosis and classification in mental health settings, documentation of neuropsychological impairment and recovery, personnel selection and placement in organizational contexts). This article outlines the central elements of evidence-based psychological assessment (EBPA), using the American Psychological Association's tripartite definition of EBPP as integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences. After discussing strategies for conceptualizing and operationalizing evidence-based testing and evidence-based assessment, 6 core skills and 3 meta-skills that underlie proficiency in psychological assessment are described. The integration of patient characteristics, culture, and preferences is discussed in terms of the complex interaction of patient and assessor identities and values throughout the assessment process. A preliminary framework for implementing EBPA is offered, and avenues for continued refinement and growth are described.

Measures Assessing the Quality of Case Conceptualization: A Systematic Review.

CONTEXT: The quality of case conceptualization differs across clinicians. It is unclear which case conceptualization quality assessment measure researchers, clinicians, and trainers might use for their specific purpose. OBJECTIVE: We evaluated measures that purport to assess the quality of case conceptualizations. METHOD: We searched EMBASE, PubMed, Medline, and PsycINFO databases with the terms case formulation* OR case conceptuali*ation*. Further specific terms were then used to narrow the search. RESULTS: Of all the articles reviewed, 8 measures of case conceptualization met inclusion criteria. There is no single measure that has been validated across a range of different settings. However, the Case Conceptualisation Coding Rating Scale, Case Formulation Content Coding Method, and Case Formulation Quality Checklist have been most robustly tested. CONCLUSION: Further research is required to test the psychometric properties of measures so that robust quality measures can be used across different settings/client groups.

Development and Validation of a Short Version of the Supervisory Relationship Questionnaire.

UNLABELLED: The Supervisory Relationship Questionnaire (SRQ) is one of the few theoretically sound and psychometrically valid questionnaires for measuring the SR within clinical supervision. However, its length can make it difficult to use in clinical practice and research. This study aimed to produce a shorter version of the SRQ (the Short Supervisory Relationship Questionnaire: S-SRQ) that retained its reliability and psychometric validity. The SRQ's 67 items were initially reduced using the criteria of external, internal and face validity. Two hundred and three UK trainee clinical psychologists then completed a series of online questionnaires including the S-SRQ and other clinical supervision measures. A Principal Component Analysis identified three components of the S-SRQ: 'safe base', 'reflective education' and 'structure', and an 18-item version was produced. Analyses revealed that the S-SRQ has high internal reliability, adequate test-retest reliability and good convergent, divergent and predictive validity. Participants also rated the S-SRQ as easy to use and potentially helpful for providing feedback on the SR in supervision. The S-SRQ (three subscales, 18 items) is a valid and reliable measure of the SR from the supervisee perspective. The current findings also support aspects of existing models of the SR. The S-SRQ is a promising measure for use in clinical, training and research settings. Copyright © 2014 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: The Short Supervisory Relationship Questionnaire (S-SRQ) is a psychometrically reliable and valid 18-item measure of the supervisory relationship based on the SRQ. Clinically, the measure represents a quick and accessible means for supervisees to assess the quality of their supervisory relationship and discuss this with their supervisors. It can also be used in conjunction with the supervisor-completed Supervisory Relationship Measure to support a dyadic discussion about clinical supervision and the supervisory relationship.

Comparing Methods to Denote Treatment Outcome in Clinical Research and Benchmarking Mental Health Care.

Approaches based on continuous indicators (the size of the pre-to-post-test change; effect size or ΔT) and on categorical indicators (Percentage Improvement and the Jacobson-Truax approach to Clinical Significance) are evaluated to determine which has the best methodological and statistical characteristics, and optimal performance, in comparing outcomes of treatment providers. Performance is compared in two datasets from providers using the Brief Symptom Inventory or the Outcome Questionnaire. Concordance of methods and their suitability to rank providers is assessed. Outcome indicators tend to converge and lead to a similar ranking of institutes within each dataset. Statistically and conceptually, continuous outcome indicators are superior to categorical outcomes as change scores have more statistical power and allow for a ranking of providers at first glance. However, the Jacobson-Truax approach can complement the change score approach as it presents outcome information in a clinically meaningful manner. Copyright © 2015 John Wiley & Sons, Ltd. KEY PRACTITIONERS MESSAGES: When comparing various indicators or treatment outcome, statistical considerations designate continuous outcomes, such as the effect size of the pre-post change (effect size or ΔT) as the optimal choice. Expressing outcome in proportions of recovered, changed, unchanged or deteriorated patients has supplementary value, as it is more easily interpreted and appreciated by clinicians, managerial staff and, last but not the least, by patients. If categorical outcomes are used with small datasets, true differences in institutional performance may get obscured due to diminished power to detect differences. With sufficient data, outcome according to continuous and categorical indicators converge and lead to similar rankings of institutes' performance.

Expanding our Reach: Telehealth and Licensure Implications for Psychologists.

This article discusses the background and history of the Association of State and Provincial Psychology Board's (ASPPB) Principles and Standards for Telepsychology. The Principles/Standards are described with comments on each one as they apply to the practice of telepsychology, and with a guide on how they coordinate with the American Psychological Association's Guidelines for the Practice of Telepsychology. Further, barriers to the interjurisdictional practice of telepsychology are reviewed and a proposed solution to them is presented. The ASPPB psychology interjurisdictional compact, known as the PSYPACT is in process of being introduced as an effective vehicle for addressing these barriers.

The Complexity of Primary Care Psychology: Theoretical Foundations.

How does primary care psychology deal with organized complexity? Has it escaped Newtonian science? Has it, as Weaver (1991) suggests, found a way to 'manage problems with many interrelated factors that cannot be dealt by statistical techniques'? Computer simulations and mathematical models in psychology are ongoing positive developments in the study of complex systems. However, the theoretical development of complex systems in psychology lags behind these advances. In this article we use complexity science to develop a theory on experienced complexity in the daily practice of primary care psychologists. We briefly answer the ontological question of what we see (from the perspective of primary care psychology) as reality, the epistemological question of what we can know, the methodological question of how to act, and the ethical question of what is good care. Following our empirical study, we conclude that complexity science can describe the experienced complexity of the psychologist and offer room for personalized client-centered care. Complexity science is slowly filling the gap between the dominant reductionist theory and complex daily practice.

Are the "memory wars" over? A scientist-practitioner gap in beliefs about repressed memory.

The "memory wars" of the 1990s refers to the controversy between some clinicians and memory scientists about the reliability of repressed memories. To investigate whether such disagreement persists, we compared various groups' beliefs about memory and compared their current beliefs with beliefs expressed in past studies. In Study 1, we found high rates of belief in repressed memory among undergraduates. We also found that greater critical-thinking ability was associated with more skepticism about repressed memories. In Study 2, we found less belief in repressed memory among mainstream clinicians today compared with the 1990s. Groups that contained research-oriented psychologists and memory experts expressed more skepticism about the validity of repressed memories relative to other groups. Thus, a substantial gap between the memory beliefs of clinical-psychology researchers and those of practitioners persists today. These results hold implications for the potential resolution of the science-practice gap and for the dissemination of memory research in the training of mental-health professionals.

Globalization of psychology: Implications for the development of psychology in Ethiopia.

The present article reports on the variation of mental health resources across the globe and considers the merits or otherwise of the process of globalization in low- and middle-income countries (LMIC), with a specific emphasis on Ethiopia. Although globalization has gained momentum in recent years, there is a concern that the globalization of Western mental health frameworks is problematic, as these concepts have been developed in a different context and do not accommodate the current diversity in understanding in LMIC countries. The importance of understanding the mental health frameworks of LMIC like Ethiopia, prior to considering if and how aspects of high-income countries (HIC) conceptualizations may be appropriately imported, is therefore reflected upon. Traditional approaches in managing mental health difficulties and possible reasons for the limited engagement with clinical psychology in Ethiopia are considered. Current developments within the fields of mental health and clinical psychology in Ethiopia are discussed, and the need to develop more local research in order to increase understanding and evaluate treatment interventions is recognized. Further consideration and debate by Ethiopian mental health professionals as well as those from HIC are recommended, to promote both reciprocal learning and new local discourses about mental health.

Reflections on the development of psychology in Ethiopia and future directions.

The introduction and development of psychology in Ethiopia has been mainly limited to Addis Ababa University in the capital city, and also to educational and school psychology which was highly influenced by the field of education at this pioneering university. Similarly, mental health services have been principally developed at the Amanuel Mental Hospital in Addis Ababa that has existed since the 1950s. However, the expansion of higher learning institutions on one hand, and the apparent growing prevalence of mental illness on the other, seem to have contributed to the development of both mental health training and services in other regional cities and towns. Although the influence of the education-oriented psychological training of the Addis Ababa University is still present, clinical psychology education and services are now being started in other universities. One of these is the master's programme in clinical psychology opened for the first time in the University of Gondar. This article sheds light on the development of psychology in Ethiopia and addresses some of the issues raised about the factors that have influenced its development such as traditional beliefs, poverty and comparisons between mental health in lower middle-income countries and higher middle-income countries ( Uppal et al., 2014 ). The paper also proposes future directions for the education, research, infrastructure and services of clinical psychology and mental health in Ethiopia.

Current status of psychology and clinical psychology in India - an appraisal.

This paper provides an overview of the social and cultural context for the emergence and development of psychology in India and also more specifically of the development of clinical psychology. It details the range of universities offering psychology programmes and the various bodies involved in supporting the development of the psychology. The paper also describes the development of clinical psychology in India and the variety of roles undertaken by clinical psychologists. Finally, it raises a number of issues facing the development of Indian psychology into the future.

A review of systems for psychology and psychiatry: adaptive systems, personality psychopathology five (PSY-5), and the DSM-5.

We outline a crisis in clinical description, in which atheoretical categorical descriptors, as in the Diagnostic and Statistical Manual of Mental Disorders (DSM), has turned focus away from the obvious: evolved major adaptive systems. Adaptive systems, at the core of a medical review of systems (ROS), allow models of pathology to be layered over an understanding of systems as they normally function. We argue that clinical psychology and psychiatry would develop more programmatically by incorporating 5 systems evolved for adaptation to the external environment: reality modeling for action, short-term danger detection, long-term cost-benefit projection, resource acquisition, and agenda protection. These systems, although not exhaustive, coincide with great historical issues in psychology, psychopathology, and individual differences. Readers of this journal should be interested in this approach because personality is seen as a relatively stable property of these systems. Thus, an essential starting point in ROS-based clinical description involves personality assessment. But this approach also places demands on scientist-practitioners to integrate across sciences. An ROS promotes theories that are (a) compositional, answering the question: What elements comprise the system?; (b) dynamic, answering: How do the elements and other systems interact?; and (c) developmental: How do systems change over time? The proposed ROS corresponds well with the National Institute of Mental Health's recent research domain criteria (RDoC) approach. We urge that in the RDoC approach, measurement variables should be treated as falsifiable and theory-laden markers, not unfalsifiable criteria. We argue that our proposed ROS promotes integration across sciences, rather than fostering the isolation of sciences allowed by atheoretical observation terms, as in the DSM.