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TIMOTHY J. TRULL University of Missouri–Columbia

MITCHELL J. PRINSTEIN University of North Carolina at Chapel Hill

CLINICAL PSYCHOLOGY

E IGHTH ED I T ION

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Clinical Psychology, Eighth Edition Timothy J. Trull and Mitchell J. Prinstein

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About the Authors

Dr. Timothy Trull is the Curator’s Professor of Psychological Sciences and Byler Distinguished Professor at the University of Missouri–Columbia. He enjoys both teaching a variety of courses in clin- ical psychology, particularly abnormal psychology and clinical psychology, and supervising clinical psychology graduate students in their research, assessment, and clinical work. Tim earned his M.A. and Ph.D. in clinical psychology at the University of Kentucky. He is a co-author of the Structured Inter- view for the Five-Factor Model of Personality (SIFFM), which assesses both adaptive and maladaptive per- sonality features. Tim publishes much of his research in the Journal of Abnormal Psychology, Psychological

Assessment, and the Journal of Personality Disorders. Sponsored through grants from the National Institute of Health, the National Institute on Alcohol Abuse and Alcoholism, and the Borderline Personality Disorder Research Foundation, his research projects include evaluating etiological models of borderline personality disorder, exploring the relations between personality disorders and substance use disorders, assessing genetic and environmental influ- ences on personality and psychopathology, and using of ambulatory assessment in clinical psychology. In addition to his work at the university, Tim is a mem- ber of the scientific faculty at the Midwest Alcoholism Research Center (MARC) and is a practicing clinical psychologist. He has won a number of awards that include Outstanding Alumnus, University of Kentucky; the Graduate Faulty Mentoring Award, University of Missouri; the Robert S. Daniels Junior Faculty Teaching Award; and the Psi Chi Professor of the Year. Tim is a Fellow of the American Psychological Association and the Association for Psychological Science. Case Conference Study Paper

iii

Dr. Mitchell J. Prinstein is a Bowman and Gordon Gray Distinguished Term Professor and the Director of Clinical Psychology at the University of North Carolina at Chapel Hill. He received his Ph.D. in clinical psychology from the University of Miami and completed his internship and postdoctoral fellow- ship at the Brown University Clinical Psychology Training Consortium. Mitch’s research examines interpersonal models of internalizing symptoms and health risk behaviors among adolescents, with a spe- cific focus on the unique role of peer relationships in the developmental psychopathology of depression and self-injury. He is the PI on several past and active grants from the National Institute of Mental Health,

the National Institute of Child and Human Development, and several private foundations. He serves as the Editor for the Journal of Clinical Child and Adolescent Psychology, and an editorial board member for several developmental psychopa- thology journals. Mitch has received several national and university-based awards recognizing his contributions to research (American Psychological Association Society of Clinical Psychology Theodore Blau Early Career Award, Columbia University/Brickell Award for research on suicidality, APA Fellow of the Society of Clinical Child and Adolescent Psychology and the Society of Clinical Psychology), teaching (UNC Chapel Hill Tanner Award for Undergraduate Teaching; Psi Chi Professor of the Year), professional development of graduate students (American Psychological Association of Graduate Students Raymond D. Fowler Award), and undergraduate students (Psychology Club Department Research Mentor Award). Case Conference Study Paper

iv ABOUT THE AUTHORS

This edition is dedicated to the memory of my father-in-law Armin Klein, an inspiring clinical psychologist whose life, compassion, wit, and

intellect touched many of us. (TJT)

Dedicated to my amazing wife, to my happy baby daughter, and to future students of clinical psychology who are looking for inspiration. (MJP)

Brief Contents

P A R T I Foundations of Clinical Psychology 1 1 Clinical Psychology: An Introduction 3 2 Historical Overview of Clinical Psychology 32 3 Current Issues in Clinical Psychology 59 4 Research Methods in Clinical Psychology 93 5 Diagnosis and Classification of Psychological Problems 128

P A R T II Clinical Assessment 159 6 The Assessment Interview 161 7 The Assessment of Intelligence 191 8 Personality Assessment 218 9 Behavioral Assessment 255

10 Clinical Judgment 283

P A R T III Clinical Interventions 309 11 Psychological Interventions 311 12 Psychotherapy: The Psychodynamic Perspective 343 13 Psychotherapy: Phenomenological and Humanistic-Existential

Perspectives 370 14 Psychotherapy: Behavioral and Cognitive-Behavioral

Perspectives 397 15 Group Therapy, Family Therapy, and Couples Therapy 431

P A R T IV Specialties in Clinical Psychology 457 16 Community Psychology 459 17 Health Psychology and Behavioral Medicine 485 18 Neuropsychology 513 19 Forensic Psychology 539

vi

Contents

PREFACE xxi i i

P A R T I Foundations of Clinical Psychology 1

1 Clinical Psychology: An Introduction 3 What Is Clinical Psychology? 4 Closely Related Mental Health Professions 5

Psychiatrists 5 BOX 1.1 Professional Issues: But Is It the Right Prescription for

Clinical Psychology? 6

Counseling Psychologists 7 Other Mental Health Professionals 8

Professions and Titles Not Regulated by the Government 12 The Clinical Psychologist 12

Activities of Clinical Psychologists 12 Employment Sites 17 A Week in the Life of Dr. Karen C 17 Some Demographic Notes 20 Research and the Scientific Tradition 21

Training: Toward a Clinical Identity 21 An Overview 22 Clinical Psychology Training Programs 22

A Profession in Movement 25 Women in Clinical Psychology 25

BOX 1.2 A Graduate Student Perspective: Julia Martinez 26

vii

Training Models 27 Clinical Practice 28

A Tolerance for Ambiguity and a Thirst for New Knowledge 28 CHAPTER SUMMARY 29 KEY TERMS 29 WEB SITES OF INTEREST 31

2 Historical Overview of Clinical Psychology 32 Historical Roots 33 Diagnosis and Assessment 34

The Beginnings (1850–1899) 34 The Advent of the Modern Era (1900–1919) 35 Between the Wars (1920–1939) 35 World War II and Beyond (1940–Present) 36

Interventions 39 The Beginnings (1850–1899) 39 The Advent of the Modern Era (1900–1919) 40 Between the Wars (1920–1939) 41 World War II and Beyond (1940–Present) 42

Research 45 The Beginnings (1850–1899) 45 The Advent of the Modern Era (1900–1919) 46 Between the Wars (1920–1939) 46 World War II and Beyond (1940–Present) 46

The Profession 49 The Beginnings (1850–1899) 49 The Advent of the Modern Era (1900–1919) 50 Between the Wars (1920–1939) 51 World War II and Beyond (1940–1969) 52 The Growth of a Profession (1970–Present) 53 The 1988 Schism 54

CHAPTER SUMMARY 56 KEY TERMS 56 WEB SITES OF INTEREST 58

3 Current Issues in Clinical Psychology 59 Models of Training in Clinical Psychology 60

The Scientist-Practitioner Model 60 The Doctor of Psychology (Psy.D.) Degree 61 Professional Schools 62 Clinical Scientist Model 63

viii CONTENTS

BOX 3.1 Clinical Psychologist Perspective:

Richard M. McFall, Ph.D. 64

Combined Professional-Scientific Training Programs 66 Graduate Programs: Past and Future 66

Professional Regulation 67 BOX 3.2 Graduate Student Perspective: Christine Maldonado 68

Private Practice 71 The Costs of Health Care 72 Prescription Privileges 75

BOX 3.3 Clinical Psychologist Perspective:

Patrick H. DeLeon, Ph.D., J.D. 76

BOX 3.4 Clinical Psychologist Perspective:

Elaine M. Heiby, Ph.D. 79

Technological Innovations 81 Telehealth 81 Ambulatory Assessment 81 Computer-Assisted Therapy 82

Culturally Sensitive Mental Health Services 83 Ethical Standards 86

Competence 86 BOX 3.5 Focus on Professional Issues Clinicians Who Participate in

Radio Call-In Shows, TV Talk Shows, or Internet Groups: Are They

Ethical? 87

Privacy and Confidentiality 87 Human Relations 88

CHAPTER SUMMARY 89 KEY TERMS 90 WEB SITES OF INTEREST 91

4 Research Methods in Clinical Psychology 93 Introduction to Research 94 Methods 95

Observation 95 BOX 4.1 Clinical Applications: What Case Studies Can Tell Us About

Phobias and Early Trauma 98

BOX 4.2 Clinical Applications: Generating Hypotheses from

Therapy 99

Epidemiological Methods 100 Correlational Methods 101 Cross-Sectional Versus Longitudinal Approaches 105 The Experimental Method 106

CONTENTS ix

BOX 4.3 Clinical Psychologist Perspective: Scott O.

Lilienfeld, Ph.D. 108

Single-Case Designs 113 BOX 4.4 Clinical Applications: The Treatment of Mixed Anxiety

and Depression 116

Mixed Designs 117 Strengths and Weaknesses of Research Methods 118

Statistical Versus Practical Significance 118 BOX 4.5 Graduate Student Perspective: Elizabeth A. Martin 119

Research and Ethics 120 BOX 4.6 Who Should Be Studied? 121

BOX 4.7 Sample Consent Form 122

CHAPTER SUMMARY 123 KEY TERMS 124 WEB SITES OF INTEREST 126

5 Diagnosis and Classification of Psychological Problems 128 What Is Abnormal Behavior? 130

Statistical Infrequency or Violation of Social Norms 130

The Case of Dmitri A. 130

The Case of Juanita L. 131

BOX 5.1 Clinical Psychologist Perspective:

Kenneth J. Sher, Ph.D. 132

The Case of Cynthia S. 135

Subjective Distress 135

The Case of Kwame G. 135

BOX 5.2 Focus on Professional Issues: Culture and Diagnosis 136

Disability, Dysfunction, or Impairment 137

The Case of Richard Z. 138

The Case of Phyllis H. 138

Where Does This Leave Us? 139 Mental Illness 139

BOX 5.3 Clinical Psychologist Perspective: Elaine

Walker, Ph.D. 140

The Importance of Diagnosis 142 Early Classification Systems 143

DSM-IV-TR 144

The Case of Michelle M. 146

General Issues in Classification 146

x CONTENTS

Causes of Abnormal Behavior and Mental Illness 153 Major Models of Psychopathology 153 Diathesis-Stress Model 153

The Value of Classification 155 CHAPTER SUMMARY 155 KEY TERMS 156 WEB SITES OF INTEREST 157