Fostering Ethical and Competent Practices in Modern Clinical Psychology

Defining nurses' ethical practices in the 21st century.

EDITORIAL Beyond Descriptions: Selected Aspects of Science and Practice in Clinical Psychology EDITORIAL Beyond Descriptions: Selected Aspects of Science and Practice in Clinical Psychology EDITORIAL Beyond Descriptions: Selected Aspects of Science and Practice in Clinical Psychology EDITORIAL Beyond Descriptions: Selected Aspects of Science and Practice in Clinical Psychology EDITORIAL Beyond Descriptions: Selected Aspects of Science and Practice in Clinical Psychology EDITORIAL Beyond Descriptions: Selected Aspects of Science and Practice in Clinical Psychology EDITORIAL Beyond Descriptions: Selected Aspects of Science and Practice in Clinical Psychology EDITORIAL Beyond Descriptions: Selected Aspects of Science and Practice in Clinical Psychology EDITORIAL Beyond Descriptions: Selected Aspects of Science and Practice in Clinical Psychology EDITORIAL Beyond Descriptions: Selected Aspects of Science and Practice in Clinical Psychology

The last three decades have witnessed significant advances in psychotherapy. Numerous scholarly articles and books have been devoted to pertinent topics in the field, making it difficult for the practicing clinician to keep up with this rapidly growing area. The purpose of this article is to provide some guidelines on how to evaluate the empirical literature in psychotherapy and then to explore three key areas: evidence-based psychotherapies for patients with psychiatric disorders, individual variables that predict differential outcome to treatment, and the therapeutic alliance. Finally, two case examples will be presented to illustrate how knowledge of the empirical literature can facilitate an evidence-based approach to the daily practice of psychotherapy in general psychiatry.

Aims Various issues related to assessment of student nurses’ clinical skills have been documented in the literature. The assessment of these skills is performed by designated qualifi ed health-care professionals, referred to here as mentors. Research suggests that during clinical placements, some mentors may be signing students’ practice competencies as pass without full evidence of their competence. If the student is not competent in those skills, they could unknowingly harm patients, which amounts to unethical practice on the part of the mentor. Content This article describes the reasons for exploring ethical practice in relation to assessments of clinical skills. It examines what ethical practice and ethical competence are, the importance of detecting student underachievement early, and the support available to mentors for resolving problems with assessment of clinical skills. Discussion and Conclusions It is suggested that education for ethical competence should be more emphatically incorporated in the educational preparation programmes for mentors and similar roles.

BackgroundEating disorders have serious psychological and physical consequences. Current evidence-based treatments for adolescents with eating disorders have modest effects, underscoring the need to improve current treatment approaches. Cognitive behavior therapy (CBT) and dialectical behavior therapy (DBT) have been proposed as alternative treatment options, with burgeoning research in this area. This review aims to summarize and critically analyze the current literature on the feasibility, acceptability, effectiveness, and efficacy of CBT and DBT for adolescent eating disorders, and then proposes areas of future research.MethodsPsycINFO and PubMed were searched using the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines to identify studies examining the feasibility, acceptability, effectiveness and/or efficacy of CBT or DBT for adolescent eating disorders.ResultsEligible studies (N = 50; CBT: n = 40, DBT: n = 10) indicated that both treatments are reasonably feasible, acceptable, and possibly effective for adolescent eating disorders across diagnoses and levels of care, though efficacy trials are lacking.ConclusionsCBT and DBT demonstrate promise as alternatives to family-based approaches for adolescent eating disorders. Adequately powered trials to establish the effectiveness and efficacy of CBT and DBT are needed, particularly ones that compare these treatments against other leading approaches.Plain English summaryDespite high rates of relapse and likelihood for severe and enduring illness, there is a dearth of evidence-based treatment options for adolescents with eating disorders. Potentially viable but less well-studied treatments for adolescents with eating disorders include cognitive behavior therapy (CBT) and dialectical behavior therapy (DBT). This systematic review of CBT and DBT for adolescent eating disorders focuses on feasibility (i.e., how easy it was to implement the treatment), acceptability (i.e., how well the intervention was received by patients and therapists), effectiveness (i.e., how well the intervention performed under routine, real-world circumstances), and efficacy (i.e., how well the intervention performed in highly-controlled research settings). This review concludes that research supports the feasibility and acceptability of these approaches, as well as preliminary evidence of their effectiveness. However, the field is lacking studies that systematically compare CBT and DBT to other evidence-based approaches. Recommendations to advance research on CBT and DBT for adolescent eating disorders are provided, including a call for efficacy studies that clarify their performance compared to other leading approaches.

In this study, key informant interviews were conducted with 13 administrators from nine community-based mental health agencies implementing dialectical behavior therapy in order to assess their perspectives on implementation. Four major themes were identified. They include opinions about dialectical behavior therapy and its fit with existing practices, resource concerns (for example, reimbursement issues, time commitment, and staff training), staff selection for training and staff turnover, and ongoing client referrals. Understanding agency administrators' unique perspectives and addressing their concerns is critical to treatment implementation given administrators' role in determining whether and how a treatment will be implemented. Better understanding of the fit between dialectical behavior therapy and existing service structures, the impact of staff turnover on implementation, and the resources required for implementation are all needed to ensure successful implementation and sustainability.

Several studies have demonstrated that in the mental health domain, experience does not always lead to better diagnostic decisions, suggesting that in clinical psychology experience-based intuition might actually not improve performance. The aim of the current study was to investigate differences in preferred reasoning styles of novice and experienced clinical psychologists as possible explanation of this surprising phenomenon. We investigated clinical and control decisions of novice (n = 20) and experienced (n = 20) clinical psychologists as well as age-matched controls (n = 20 and n = 20 respectively) by using vignettes and MouselabWeb matrices. We assessed their reasoning style preferences by using the Rational-Experiential Inventory (Pacini & Epstein, 1999). Results showed that experienced and novice clinical psychologists did not differ in diagnostic accuracy and that experienced psychologists had a higher preference for rational thinking than novices. We also found that in experienced psychologists a stronger preference for deliberation was associated with greater accuracy, and in novice psychologists a stronger preference for intuitive reasoning was associated with less accurate decisions. It might be that it is not a question of more experience but of deliberation about the task that could help clinicians perform more accurately.

Reflective practice is an essential competency in clinical psychology training and practice. However, evidence is limited to support the role of reflection in clinical practice. This study investigated the lived experiences of clinical psychologists’ use of reflective practice in the context of their clinical work. Seven clinical psychologists completed reflective diaries and semi-structured interviews to facilitate in-depth reflections on clinical events. Interview transcripts were analyzed using interpretative phenomenological analysis. Three superordinate themes and six subthemes were developed from the data: Exploratory Questioning (gaining a different perspective, new insight, and opening new possibilities), Containment of own Thoughts and Feelings in Practice, and Human Survival (managing the emotional impact, self-sustaining and leaving work at work). Consideration of these findings suggested that reflective practice plays a key role in clinical psychologists’ perspective-taking abilities; allowing them to maintain an open and curious clinical perspective. Reflective practice enables containment, which impacts the building and maintaining of therapeutic relationships. Reflective practice relieves discomfort and promotes personal resilience. Further research on clinician use of reflective practice can contribute to understanding this core competency which is highly relevant to the training and ongoing development of clinical psychologists.

To ensure public safety, duty of care, and professional advancement, scholars need to consider the competence, ethical practice, and well-being of sport psychology practitioners (SPPs). Despite the growth of sport psychology as a profession, scholars have predominantly focused on how to do applied sport psychology, with issues of professional formation, development, maturation, and SPPs’ well-being receiving limited attention. Yet, to safeguard the future of the field, we must better understand how SPPs develop as individuals and as professionals, the contextual factors that may affect their development, and how training and supervision may contribute to professionals’ experiences and development. In this invited article, we review “what we know” and “what we need to know” regarding the professional development of SPPs. In doing so, we hope to inform the reader on the critical developments in this area while presenting a commentary that facilitates discourse and future action. Lay summary: A field that aims to grow and evolve must understand the development of ethical and competent professionals. To aid in this understanding, we provide an overview of what we know and what we need to know about the development of sport psychology professionals. IMPLICATIONS FOR PRACTICE SPPs need to focus their attention on the development of themselves as persons and professionals regarding their competence development. SPPs may need to integrate who they are with what they do to promote an enriching, sustainable, competent, ethical, and effective practice. Supervisors on graduate and training programs should be aware of practitioner developmental processes and the factors that influence this for SPPs. Those leading training programs might adopt a developmental approach within their curricula, with priority given to assisting trainees to integrate their personal beliefs and professional philosophy into their service delivery.

This chapter provides an overview of the main ethical and legal issues in psychological therapies for the elderly. The issues to be considered are: diagnosis as an ethical problem; consent to therapy and research participation; confidentiality; and the role of the psychologist as clinician, scientist and bureaucrat. The interest in psychiatric ethics has spilled over into psychology, especially the practice of clinical psychology. The ethical dilemma of diagnosis is discussed because other professionals, especially clinical psychologists, often participate in assessment and diagnosis and are, therefore, frequently collaborators in curtailing patients' freedom. The issue of consent to treatment or research participation is one of the most contentious issues in health care. Most codes of ethical conduct for professionals allow for breaches of confidentiality under exceptional circumstances and if it is in the patient's interests. Ethical practice can be promoted through the teaching of ethics during the training of psychologists and other mental health care professionals.

As so-called third wave therapies, Dialectical Behavior Therapy (DBT) and Acceptance and Commitment Therapy (ACT), alongside with Mode Deactivation Therapy (MDT), are derivatives of Cognitive Behavioral Therapy (CBT). (Classical behavioral therapies are referred to as the first wave, and classical cognitive therapies as the second wave.) Currently these three types of therapy have been showing an increased amount of success with adolescent youth who have been suffering from disorders such as Conduct Disorder, post-traumatic stress symptomology, and other mood disorders (Apsche, DiMeo, & Kohlenberg, 2012; Apsche, Bass, & Backlund, 2012; Powers, Vording, & Emmelkamp, 2009). Dialectical Behavior Therapy DBT was developed in 1993 by Prof. Marsha Linehan, who wanted to adapt CBT when she recognized the shortcomings of the approach with her borderline personality disordered patients (Bayles, Blossom, & Apsche, 2014). The main objective was to accommodate those specific characteristics such as extreme emotional reactivity and high sensitivity to vulnerabilities like perceived rejection. DBT uses a variation of CBT that teaches the patient specific skills they will need to cope with stress, and to help in regulating their emotions (Apsche, 2010). Since then, it has been shown to be useful for treating a wide variety of presenting issues, including suicidal behaviors, substance abuse, eating disorders, and depression (Murphy & Siv, 2012; Dimeff & Koerner, 2007). The main goal of DBT is to teach the individual the skills that they will need to cope with stress (Apsche & DiMeo, 2012). This gives them tools that they will need to change their current negative coping mechanisms into positive ones that will help them to regulate their emotions and improve relationships with others around them (Apsche, 2010). It will then teach the individual the skills that are needed to cope in a positive manner to stress, regulate their emotions, and to help them improve relationships with other such as for adolescents their parents and other family members. There are four key components that make DBT successful; (a) cognitive behavioral theoretical framework, (b) validation, (c) dialectics, and (d) radical acceptance (Bayles, Blossom, & Apsche, 2014). DBT uses dialectics which applies the concept that everything is made up of opposites and the change that happens is when one opposing force is stronger than the other. This has three basic assumptions, first being; all things are interconnected. Second, change is constant and inevitable. Third, the opposites can be integrated to form a closer approximation (Apsche, 2010; Murphy & Siv; 2012, Apsche, DiMeo, & Kohlenberg, 2012). Today DBT is mainly used with individuals who present strong urges to harm themselves and or who have self-destructive behavior (Apsche, DiMeo, & Kohlenberg, 2012). This is one reason why this has been successful in adolescents, particularly young males. DBT also encourages acceptance and change. The acceptance is unconditional and change is brought about through the direct change of thoughts in a positive manner (Apsche, DiMeo, & Kohlenberg, 2012). DBT has been shown to improve behavior in three strong areas that disordered adolescents typically need help in improving: (a) lack of the needed behavioral coping skills, (b) accepting reality as it is, and (c) maintaining strong commitment to change (Arch, Eifert, Davies, Vilardaga, Rose, & Craske, 2012). DBT gives skills that are needed to become productive members of the outside community in which the individuals live in and helps them to gain a positive perspective on value and acceptance of their personal struggles, and enhances them for positive change (Apsche, Siv, & Matteson, 2005). A downfall to applying CBT elements in the DBT methodology is that since its nature is to constantly challenge the emotions of the individuals it is making it hard for them to accept their beliefs as real and reasonable. …

Manualized therapies continue to gain in popularity among therapists. These “newer” therapies have a growing body of evidence documenting their effectiveness in treating mental illness. These burgeoning efficacy data and the typically limited number of treatment sessions have not escaped third-party payers. In fact, insurance pressure has contributed to the momentum enjoyed recently by therapies such as interpersonal therapy (IPT), cognitive-behavioral therapy (CBT), and dialectical behavior therapy (DBT). Dialectical behavior therapy is the brainchild of Marsha Linehan, who created it to treat patients with borderline personality disorder. The central idea is that such patients have competing dialects that cause significant emotional stress. As a means of coping, these patients often engage in self-harm as a maladaptive means of regulating emotions. Traditional DBT requires significant resources as patients undergo both individual and group therapy during a course of treatment. The group component is psychoeducational and primarily didactic in nature. Several core modules of skill sets focusing on emotion regulation, distress tolerance, and mindfulness are presented to the patients. During individual sessions, parasuicidal behaviors are normally the primary target. Additionally, patients are coached in the application of skills taught during the group sessions with emphasis on practice to obtain skill mastery. Typically, a team of therapists skilled in DBT are required to coordinate both the group and individual sessions. These logistical challenges can restrict the practice of DBT to academic centers where educational or research subsidies are provided. Dialectical Behavior Therapy in Private Practice challenges the above assertions. The book provides an argument that DBT is not beyond the reach of a solo practitioner. Breaking with tradition, the author suggests that DBT can be used in a more piecemeal approach where limited resources require such an adaptation. Moreover, extensive research is presented that documents DBT's efficacy well beyond its original target of patients with borderline personality disorder. The book is designated for both seasoned as well as novice DBT therapists. In the first 2 chapters, the theoretical underpinnings of DBT are compared with other psychotherapy frameworks and evidence for the DBT approach is presented. Chapter 3 examines the possible psychological and neurobiological factors underlying a patient's emotional sensitivity. DBT's central thesis that emotional sensitivity (high emotional arousal, delayed return to baseline, and hypervigilance to threats) leads to maladaptive avoidance and escape behaviors is developed in the next chapter. This is followed by a chapter that establishes the goal of DBT as balancing acceptance of emotional problems and pain with specific skill strategies to change them. The author then illustrates the generalizability of DBT by applying it to various mental disorders outside of the traditional personality disorders. The final 2 chapters focus on the nuts and bolts of the specific skill sets patients need to master in DBT. Thomas Marra is obviously quite versed in the practice of DBT and has developed an exhaustive list of mnemonics aimed at assisting both clinicians and patients in remembering the specific skills. Typical patient dialects as well as excerpts of therapy sessions illustrating key conflicts are utilized to demonstrate how DBT can be used to understand a wide array of patients. These vignettes make the theory and practical skills much more understandable for the reader. Furthermore, the extensive citations to authority and research studies examining DBT across the mental health spectrum make the book a valuable addition to a reference library. However, these citations and instructional comments render the text quite dense and thus not appropriate for patients or individuals who want a brief introduction to DBT. Perhaps one of the greatest assets of the book is that Dr. Marra has included a CD-ROM with PowerPoint presentations for all of the key modules, which are turnkey for those interested in implementing a group therapy component. This CD-ROM also provides worksheets and handouts for individual therapy sessions aimed at skill building. Although the PowerPoint slides appear “homemade,” lacking slick graphics or animation, and carry an admonition that they cannot be changed or adapted by the purchaser, for the novice therapist they serve as an invaluable starting point. The countless hours of preparation they save make it possible to initiate a DBT program with only minimal additional outlay in terms of materials and are well worth the price of the text.

Clinical psychology plays a vital role in promoting mental health and well-being across the European Union (EU). With diverse cultural, social, and systemic contexts, understanding the best practices in clinical psychology is crucial for improving mental health care services. This article provides a comprehensive comparative analysis of clinical psychology practices across various EU member states, highlighting effective methodologies, training standards, and systemic frameworks. The primary aim of this article is to explore and evaluate the therapeutic approaches, training and professional development standards, and systemic frameworks utilized in clinical psychology across different EU countries. By identifying and comparing these practices, the article seeks to highlight the most effective methods and propose recommendations for enhancing mental health care in the region. The study employs a mixed-methods approach, including a thorough literature review, structured surveys, and semi-structured interviews with clinical psychologists, policymakers, and experts from various EU member states. Additionally, case studies from selected countries provide detailed insights into practical applications and outcomes. Quantitative data is analyzed using statistical methods, while qualitative data is interpreted through thematic analysis. The analysis reveals significant variation in therapeutic approaches, with the UK and Germany emphasizing evidence-based practices such as Cognitive Behavioral Therapy (CBT), while Sweden focuses on preventive strategies and public health integration. Training and professional development standards are most rigorous in Germany and the UK, ensuring high-quality practice. The Netherlands and Italy showcase the benefits of innovative and community-based care models. Overall, countries with robust mental health policies and integrated care systems tend to achieve better clinical outcomes. The findings underscore the importance of adopting evidence-based practices, enhancing training standards, and fostering therapeutic diversity to address complex mental health issues. Cross-border collaboration and knowledge exchange among EU member states can further refine and harmonize clinical psychology practices.

ObjectiveRecent years have seen a marked increase in attention to cultural competence in clinical psychology practice in Australia. While the body of literature on the need for cultural competence is expanding, this is the first study that analyses how cross‐cultural training and practice is experienced and related to standardised models of cultural competence.MethodTwelve participants (8 students and 4 academics; 9 females and 3 males, ages 22–57) in two Australian universities were interviewed on their experiences with cultural competence during clinical psychology training. Each semi‐structured interview took about 30 min and focused on identifying the training experiences and needs for cultural competence.ResultsInterpretative Phenomenological Analysis of the transcripts delivered three master themes: experiences of culture, strategies for culturally competent practice, and experiences of cultural competence development.ConclusionsStudents and academics experienced a “western” bias in training, and consequently adopted a variety of strategies to adapt their practice with culturally non‐western clients. These findings draw attention to the need for structured cultural competence development in professional training programs.

Dialectical Behavior Therapy With Suicidal Adolescents