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Development and Psychometric Evaluation of a Clinical Beliefs Questionnaire for Licensed Psychologists

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Development and Psychometric Evaluation of a Clinical Beliefs Questionnaire for Licensed Psychologists University of Rhode Island DigitalCommons@URI Open Access Dissertations 2015 DEVELOPMENT AND PSYCHOMETRIC EVALUATION OF A CLINICAL BELIEFS QUESTIONNAIRE FOR LICENSED PSYCHOLOGISTS Joseph F. Meyer III University of Rhode Island, [email protected] Follow this and additional works at: https://digitalcommons.uri.edu/oa_diss Recommended Citation Meyer, Joseph F. III, "DEVELOPMENT AND PSYCHOMETRIC EVALUATION OF A CLINICAL BELIEFS QUESTIONNAIRE FOR LICENSED PSYCHOLOGISTS" (2015). Open Access Dissertations. Paper 339. https://digitalcommons.uri.edu/oa_diss/339 This Dissertation is brought to you for free and open access by DigitalCommons@URI. It has been accepted for inclusion in Open Access Dissertations by an authorized administrator of DigitalCommons@URI. For more information, please contact [email protected]. DEVELOPMENT AND PSYCHOMETRIC EVALUATION OF A CLINICAL BELIEFS QUESTIONNAIRE FOR LICENSED PSYCHOLOGISTS BY JOSEPH F. MEYER III A DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN CLINICAL PSYCHOLOGY UNIVERSITY OF RHODE ISLAND 2015 DOCTOR OF PHILOSOPHY DISSERTATION OF JOSEPH F. MEYER III APPROVED: Dissertation Committee: Major Professor: David Faust, Ph.D. Robert Laforge, Sc.D. William Krieger, Ph.D. Nasser H. Zawia, Ph.D. DEAN OF THE GRADUATE SCHOOL UNIVERSITY OF RHODE ISLAND 2015 ABSTRACT In recent decades, a specific class of dubious clinical practices has been labeled pseudoscientific and highlighted as a growing area of concern in psychology. Experts have identified numerous examples of pseudoscientific treatments, which are troubling for various ethical reasons. In light of the absence of research investigating the nature of professional beliefs and knowledge associated with scientifically substantiated and unsubstantiated clinical interventions, the primary objective of this study was to develop a questionnaire (viz., the Clinical Attitudes and Knowledge Questionnaire, or CAKQ) to appraise specific clinical knowledge domains and attitudes toward science among licensed, doctoral-level practitioners of clinical psychology. This aim was pursued through generating items designed to detect the presence of knowledge pertaining to (a) legitimate and questionable treatment techniques used in contemporary clinical practice; (b) general clinical psychology research (e.g., controversies relevant to applied practice); and (c) clinical judgment and decision- making procedures. A preliminary scale consisting of items addressing practitioner attitudes toward science in clinical psychology was also created. A secondary study aim was to ascertain whether psychologists’ professed knowledge varied in relation to years involved in clinical practice. Two thousand randomly selected licensed psychologists in New England engaged in clinical practice were invited to participate in the study, and the final sample size was 324 participants. Statistical analyses indicated that the initial hypotheses were partially supported. The hypothesis that a four-component solution would best summarize the CAKQ data was not supported by principal components analysis results. However, the hypothesized relationship between clinical knowledge and critical thinking skills was partially supported. Consistent with expectations, a lower reliance on intuitive thinking styles was associated with greater clinical knowledge. Finally, the hypothesis that total number of years of clinical experience would not predict higher clinical knowledge scores was also upheld. Study limitations and future research directions were discussed. ACKNOWLEDGEMENTS The author would like to express his sincere gratitude to his major professor, David Faust, for his intellectual nurturance and guidance, invaluable corrective feedback, good-humored tolerance of his professional growing pains, and kind moral support during the vicissitudes of graduate school and fatherhood. Special thanks is also due to members of the author’s dissertation committee for their much-appreciated guidance, and to Bob Laforge and Will Krieger for their enthusiastic support of the author’s evolving program of scholarly work over the last several years. The author also conveys his heartfelt appreciation for the warm encouragement and forbearance of his family and close friends throughout the many late evenings of dissertation writing. iv TABLE OF CONTENTS ABSTRACT ……………………………………………………………………….... ii ACKNOWLEDGEMENTS ……………………………………………………….. iv TABLE OF CONTENTS …………………………………………………………... v LIST OF TABLES …………………………………………………………………. vi LIST OF FIGURES ……………………………………………………………….. vii CHAPTER 1 ………………………………………………………………………… 1 INTRODUCTION …………………………………………………………… 1 CHAPTER 2 ………………………………………………………………………… 7 REVIEW OF LITERATURE ………………………………………………... 7 CHAPTER 3 ……………………………………………………………………….. 68 METHODOLOGY ………………………………………………………….. 68 CHAPTER 4 ……………………………………………………………………….. 79 RESULTS ………………………………………………………………….. 79 CHAPTER 5 ……………………………………………………………………….. 86 DISCUSSION ………………………………………………………………. 86 FOOTNOTES …………………………………………………………………….. 100 APPENDIX ………………………………………………………………………. 125 CLINICIAN SURVEY …………………………………………………… 125 BIBLIOGRAPHY ………………………………………………………………. 133 v LIST OF TABLES TABLE PAGE Table 1. Demographic and Professional Characteristics of Participants ( N=324)…108 Table 2. Clinical Attitudes and Knowledge Questionnaire Item Responses ………111 Table 3. Scale Means, Standard Deviations, and Intercorrelations ………………..120 Table 4. Means, Standard Deviations, Rotated Factor Loadings, and Communalities for the Rational-Experiential Inventory Items …………………………………….. 121 Table 5. Multiple Regression Analysis Summary for Rational-Experiential Inventory Total Scores and Critical Thinking Questionnaire Subscale Scores Predicting Clinical Attitudes and Knowledge Questionnaire Total Scores ……………………………..122 vi LIST OF FIGURES FIGURE PAGE Figure 1. Pareto Bar Graph of “Not Familiar” Responses to Clinical Attitudes and Knowledge Questionnaire Items ……………………………………………………123 vii CHAPTER 1 INTRODUCTION Economist Alan Blinder (1987) eloquently argued that although having one’s heart in the right place, or “softheartedness,” was essential to guiding humane approaches to economic policies, a reticence to steer the development and implementation of such policies with well-informed critical thinking, or “hardheadedness,” may result in undesirable or even disastrous consequences. Likewise, in clinical psychology, effective practitioners should be capable of not only exhibiting warmth and empathy during therapeutic interactions with clients, but also be willing to keep strictly intuitive and emotionally-driven preferences at bay while scrutinizing the evidentiary value of assessments and treatments to be considered and implemented. Unfortunately, “hardheaded” critical thinking appears to be underutilized (and possibly underappreciated) among a considerable percentage of practitioners within the field (see Gaudiano, Brown, & Miller, 2011; 2012; Sharp, Herbert, & Redding, 2008), which is concerning given the potentially baneful ramifications for vulnerable mental health clients. A possible consequence of tenuous critical thinking habits combined with insufficient familiarity with peer-reviewed research (although additional factors are likely involved) is the proliferation of suboptimal clinical approaches (Beyerstein, 2001; Lilienfeld, Ruscio, & Lynn, 2008; Lohr, Fowler, & Lilienfeld, 2002, summer). A specific class of questionable clinical practices has been labeled pseudoscientific in 1 recent decades and highlighted as a special area of focus and concern in psychology (Lilienfeld et al., 2003; Pignotti & Thyer, 2009; Still & Dryden, 2004). Despite difficulties formally defining pseudoscience, which is largely attributable to the complexities of the enduring demarcation problem in philosophy of science (Derksen, 1993; Lakatos, 1974; Laudan, 1983; Pigliucci & Boudry, 2013; Resnik, 2000), there is some consensus on specific hallmarks or warning signs distinguishing pseudoscience from science. These include: (a) a disproportionate focus on hypothesis confirmation at the expense of adequate testing and refutation; (b) attempts to shield the fundamental principles (or hard core ) of a research program from falsification through an ongoing invocation of auxiliary hypotheses, which Lakatos (1970) termed a degenerative research program when taken to extremes; (c) evasion of the peer review process; (d) the use of obscurantist jargon to create a superficial veneer of scientific legitimacy; (e) a consistent lack of self-correction and subsequent stagnation of ideas; (f) shifting the burden of proof from claimants to skeptics (e.g., declaring that the onus lies squarely on the critics of an approach to adduce evidence against it); (g) an absence of specified conditions under which claims do not hold (i.e., the delineation of boundary conditions); (h) lack of connectivity with related areas of scientific knowledge; and (i) an overemphasis on personal anecdotes and testimonials to lend credence to claims (Bunge, 1984; Lilienfeld, 2005, September; Lilienfeld et al., 2003; see also Ruscio, 2005). Thus, pseudoscience can be conceptualized as “nonscience masquerading as genuine science” (Lilienfeld, 2010, p. 286) and often contains expansive or extraordinary claims that lack essential supportive evidence, contradict well-established scientific findings, and/or overstep the boundaries of 2 current scientific knowledge. Experts have identified numerous examples of pseudoscientific psychological
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