Transcript Current Issues in Clinical Psychology

Current Issues in
Clinical Psychology
Chapter 3
By: Farrah J. Cordero
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By: Farrah J. Cordero
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Models of Training in
Clinical Psychology
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The Scientist-Practitioner
The Training Model/ AKA Boulder Model
 Integrates Science and Clinical Practice
 Idea: Practitioners who can produce as well as
consume research
 Debate: Psychologists split in two groups
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Clinical Practice & Research
 Resulted in the Psy.D. degree
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Models of Training in
Clinical Psychology

The Doctor of Psychology (Psy.D.) Degree Model
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Emphasis on Development of Clinical Skills
De-emphasis on Research
Masters Thesis Not Required
Dissertation- a Report on a Professional Topic instead of an
Original Research Idea
Ph.D. and Psy.D. programs similar until 3rd year
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Third year- experience in therapeutic practice and assessment
becomes the focus
Fourth Year- clinical emphasis continues with internship assignments
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Models of Training in
Clinical Psychology
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Professional Schools
No affiliation with universities
 Autonomous w/ own financial and organizational
frameworks
 Faculty chiefly clinical in orientation
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Employed only as part-time w/ major employment elsewhere
Emphasis is on clinical not research orientations
 Accreditation by the APA nice but not necessary
 Award over ½ of the doctorates
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Admittance is higher compared to traditional university-based
program
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Models of Training in
Clinical Psychology
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Clinical Scientist Model
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Empirically Oriented Clinicians feel clinical psychology is not
well grounded in Science
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Resulted in the Academy of Psychological Clinical Science
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Research either has not been completed/ does not support the
therapy techniques
Focuses graduate training to produce “Clinical Scientists”
Persons who think and function as scientists in every respect &
setting
Academy affiliated with American Psychological Society
(APS)
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Over 50 member programs
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Clinical Scientist Model cont.
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Primary Goals
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Training geared to careers
in clinical science research
Advancing full range of
clinical science research &
theory and integrating
that w/other sciences
Foster timely
dissemination of clinical
science to policy makers,
psychologists, consumers,
etc.
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Development of and
access to resources &
opportunities for training,
research, funding, &
Clinical science careers
Application of clinical
science to human
problems
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Models of Training in
Clinical Psychology
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Combined Professional-Scientific Training
Programs
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Combined Specialties (Counseling, Clinical, & School
Psychology)
Assumption is:
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these specialties share common core areas of knowledge
The practices of psychologists who graduate from these
specialties are similar
Curriculum focuses on core areas w/i psychology
Exposes students to each subspecialty of Counseling,
Clinical, and School Psychology
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Models of Training in
Clinical Psychology
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Graduate Programs: Past & Future
Mid-1960’s shift from university-based academic jobs to
jobs in private practice occurred
 1973 Vail Training Conference resulted in endorsements of
Alternative Training Models
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Psy.D. degree and Professional School Model of Training traced
back to positions held by those attending the Vail Conference
Possible Trends that May Effect the Training Models
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Some feel there may be oversupply of Practice-oriented
Psychologists
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Graduate Programs: Past & Future cont.
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Possible Trends that May Affect the Training Models
Some feel there may be oversupply of Practice-oriented
Psychologists
 Managed Health Care likely to affect the demand for
Clinical Psychologists in the future as well as the
Curriculum in Training Programs
 There may be an Undersupply of Academic and
Research-Oriented Clinical Psychologists
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Professional Regulation
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Attempted to Protect the Public Interest by
Developing Standards of Competence
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CERTIFICATION
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Weak Form of Regulation
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Does not prevent persons from offering counseling as long as
“Psychologist” title is not used nor term used to describe services
Can not call oneself Psychologists unless they have been certified
by a state board of examiners
 Involves an Exam consisting of review of training and
professional experience
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Professional Regulation
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LICENSING
Stronger Form of Legislation than Certification
 Describes & Defines Title , Training Required, and Specific
Activities that are Offered to Public
 APA developed a Model for the Licensure of Psychologists
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Licensing Laws vary from State to State/Province to Province but there
are several commonalities (pg. 65, Table 3-1 Summary of Requirements)
Includes an Exam
 Board examines the applicant’s educational background and
sometimes requires several years of supervised experience beyond
doctorate
 Subsequent Continuing Education Requirements
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Professional Regulation
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American Board of Professional Psychology (ABPP)
Offers Certification of Professional Competence in the following
Fields:
 Behavioral, Clinical, Clinical Health, Clinical
Neuropsycholgoy, Counseling, Family, Forensic, Group,
Psychoanalysis, Rehabilitation, and School Psychology
 Candidates must have 5 years Postdoctoral Experience
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National Register
Type of Self-certification
 Include those who are Licensed/Certified in their own states
 Individuals submit their name and Pay to be listed
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Private Practice
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Independence & Economics
Psychiatric Profession opposed, early on, clinicians from
going into private practice
 Eventually won the right to practice Independently
 Psychiatrists accepted the new legal status accorded to
clinicians
 At this time more Health Insurance Plans became
Operative
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People who normally could not afford therapy were now covered
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Private Practice cont.
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Independence & Economics
Direct reimbursement of Psychologists by Insurance
Companies without a physician’s involvement became an
issue
 As a result of a Antitrust Action brought against a health
insurance company the victorious outcome signified
Psychologists as a fully independent profession able to
compete in the marketplace alongside Psychiatry
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Private Practice
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The Health Care Revolution
“Managed Health Care is an Integrated
Approach to financing and delivery of health
care”
 By end of 1997, 85% of Americans belonged to
some kind of managed health care
 Several Models of Managed Care, all attempt to
control costs and reduce use of services while at
the same time ensuring their quality…i.e.
HMO/PPO
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Private Practice cont.
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The Health Care Revolution
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New systems dictate new definitions of what
constitutes psychological treatment
Clients will be seen for a fewer number of sessions/ &
greater number of clients will be seen per year
 Treatment will be Brief and intermittent
 Therapist will serve as a catalyst for clients to make changes
in their lives
 Most changes will occur outside of treatment
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Private Practice cont.
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The Health Care Revolution
Treatment will not be terminated rather interrupted
after client’s progress evident
 Community Resources will be used to a greater extent
 Most treatment delivered in a group format & will
involve structured psychoeducational programs
 Master’s-level practitioners and paraprofessionals
much cheaper for same services
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Private Practice cont.
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The Health Care Revolution
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Scientist-practitioner/Clinical Scientist training offers
some opportunities in managed healthcare
Have an empirical orientation that emphasizes the study of
outcomes
 Have skills different from those of physicians
 Can bring an emphasis on preventing mental health
problems in individuals and focus on wellness rather than
sickness
 Know about the effects of the environment on behavior
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Prescription Privileges
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Controversial issue
Decision will have far-reaching implications for the
role definition of clinical psychologists, their training,
and actual practice
Pros
Enable psychologists to provide wider variety of treatments
and treat wider range of clients
 Potential increase in efficiency and cost-effectiveness of
care for patients needing both therapy and meds
 Give psychologists a competitive advantage in health care
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Prescription Privileges cont.
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Cons
May lead to de-emphasis of “psychological” forms of
treatment because meds are faster acting and more
profitable than psychotherapy
 May damage clinical psychology’s relationship with
psychiatry and general medicine
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Conflicts resulting in lawsuits
Increased Malpractice liability costs
 Financial burden of modifying training programs and
licensing laws
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Culturally Sensitive
Mental Health Services
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APA (2003) published guidelines on multicultural
education, training, research, practice, and
organizational change for psychologists
Make commitment to cultural awareness as well as
knowledge of self & others as cultural beings
 Recognize the importance of multicultural sensitivity
 Integrate multiculturalism & diversity into education and
training
 Recognize importance of culture in research and clinical
work
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Culturally Sensitive
Mental Health Services cont.
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S. Sue (1998) has advocated that psychologists
demonstrate cultural competence:
Scientific-mindedness: Clinicians must formulate and test
hypothesis regarding status of clients
 Dynamic sizing: Must be skilled in knowing “when to
generalize and be inclusive and when to individualize and
be exclusive”
 Culture-specific expertise: Understand their own culture
and perspectives, have knowledge of the cultural groups
with whom they work
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Ethical Standards
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Competence
Training must be represented accurately
 Present themselves correctly/regard to training and
all other aspects of competence
 Should not attempt treatment/assessment
procedures for which you lack specific
training/supervised experience
 Be sensitive to treatment/assessment issues that
could be influenced by pts’ gender, ethnicity, age,
sexual orientation, religion, disability, or
socioeconomic status
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Ethical Standards cont.
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Privacy & Confidentiality
Central to client-psychologist relationship
 Be clear and open about matters of confidentiality
and the conditions under which it could be breached
 1976 Tarasoff Case
 Each state has different standards
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Ethical Standards cont.
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Human Relations/ Client Welfare
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Sexual activities, Employing a client, selling a
product to a client, or even becoming friends with a
client after termination of therapy can lead to
exploitation of and harm to client
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