CLINICAL PSYCHOLOGY TRAINING IN THE UNITED STATES : PAST, PRESENT, & FUTURE

1. CLINICAL PSYCHOLOGY TRAINING IN THE UNITED STATES : PAST, PRESENT, & FUTURE JAMES E. MADDUX DEPARTMENT OF PSYCHOLOGY CENTER FOR THE ADVANCEMENT OF WELL-BEING GEORGE MASON UNIVERSITY JMADDUX@GMU.EDU

2. WHY DOES THIS MATTER? • WE CAN LEARN FROM THE SUCCESSES & FAILURES OF OTHERS. • MAY HELP YOU THINK MORE CRITICALLY ABOUT . . .YOUR OWN TRAINING • . . . AND YOUR CLINICAL WORK. • YOU MAY BE INVOLVED IN TRANING. • YOU MAY BE INVOLVED IN SELF-REGULATION OF PROFESSION.

3. MAJOR SOURCES • BAKER, T. B., MCFALL, R. M., SHOHAM, V. (2009). CURRENT STATUS AND FUTURE PROSPECTS OF CLINICAL PSYCHOLOGY. PSYCHOLOGICAL SCIENCE IN THE PUBLIC INTEREST, 9, 67-103. • BENJAMIN, L. T. (2005). HISTORY OF CLINICAL PSYCHOLOGY AS A PROFESSION IN AMERICA (AND A GLIMPSE AT ITS FUTURE. ANNUAL REVIEW OF CLINICAL PSYCHOLOGY, 1, 1-30. • BEUTLER, L. E. MAKING SCIENCE MATTER IN CLINICAL PRACTICE: REDEFINING PSYCHOTHERAPY. CLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE, 16, 301-322. • MCFALL, R.M., DOCTORAL TRAINING IN CLINICAL PSYCHOLOGY. ANNUAL REVIEW OF CLINICAL PSYCHOLOGY, 2, 21-49. • REISMAN, J. M. (1991). A HISTORY OF CLINICAL PSYCHOLOGY (2ND EDITION). NEW YORK: HEMISPHERE. • STRICKER, G. (1995). THE LOCAL CLINICAL SCIENTIST: A BRIDGE BETWEEN SCIENCE AND PRACTICE. AMERICAN PSYCHOLOGIST, 50, 995-102.

4. CLINICAL PSYCHOLOGY IN THE U.S. • ABOUT 125 YEARS OLD. • ABOUT 120,000 PSYCHOLOGISTS (POP. OF 310 MILLION) • ABOUT 90,000 PRACTITIONERS—MOSTLY CLINICAL OR COUNSELING. • 250+ DOCTORAL PROGRAMS IN CLINICAL AND 30+ IN COUNSELING PSYCHOLOGY • NATIONAL (NON-GOVT) ACCREDITING AGENCY (APA) • 53 DIFFERENT LICENSING AGENCIES (STATE GOVERNMENTS, DC, PUERTO RICO, GUAM) • AMERICAN PSYCHOLOGICAL ASSOCIATION—1892 • 150,OOO + MEMBERS

5. HISTORY OF CLINICAL PSYCHOLOGY IN THE US— A STRUGGLE FOR… •  IDENTITY— • THE PROFESSION’S ATTEMPTS TO DEFINE ITSELF. . . . . .AND

6. RESPECTABILITY WITH • OTHER DISCIPLINES WITHIN PSYCHOLOGY • SCIENCE VERSUS PRACTICE • OTHER HEALTH AND MENTAL HEALTH PROFESSIONS • ESPECIALLY MEDICINE AND PSYCHIATRY • POLICY MAKERS • THE PUBLIC

7. CONTINUAL INTERACTIONS AMONG… • PROFESSIONAL PSYCHOLOGY ORGANIZATIONS (APA) • OTHER DISCIPLINES (PSYCHIATRY) • STATE GOVERNMENTS • FEDERAL GOVERNMENT • UNIVERSITIES • PRIVATE INDUSTRY—INCLUDING HEALTH INSURANCE COMPANIES • CANADIAN PSYCHOLOGY • EUROPEAN PSYCHOLOGY

8. IT MAY HELP TO UNDERSTAND THE US CONSTITUTION • LIMITS POWERS OF FEDERAL GOVERNMENT. • GIVES A LOT OF POWER TO STATE GOVERNMENTS • PRO—50 + 10 LABORATORIES FOR INNOVATION • CON—DIFFICULT TO DEVELOP CONCENSUS AND CONSISTENCY • CREDENTIALING, TRAINING STANDARDS. ETC.

9. FOR THIS REASON . . . • NATIONAL LICENSING LAW WAS NEVER A POSSIBILITY • NOR WERE GOVERNMENT-MANDATED TRAINING STANDARDS. • RESPONSIBILITY LEFT TO STATES • AND PROFESSIONAL ORGANIZATIONS

10. ALSO . . . • INTER-CONNECTED WITH THE HISTORY OF PSYCHIATRY. • SOMETIMES AS ALLY AND CO-WORKER. • BUT OFTEN AS ADVERSARY. • PSYCHIATRY CHALLENGED PSYCHOLOGY FROM BEGINNING • FIRST REGARDING ASSESSMENT & DIAGNOSIS. • LATER REGARDING PSYCHOTHERAPY. • IRONY: PSYCHOLOGY NOW CHALLENGED BY SOCIAL WORK AND OTHERS WITH MASTER’S DEGREES.

11. SOME KEY DATES AND EVENTS • 1892: FORMATION OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (26 MEMBERS). • 1896: LIGHTNER WITMER (STUDENTS OF WUNDT) ESTABLISHED THE FIRST “PSYCHOLOGICAL CLINIC” AT UNIVERSITY OF PENNSYLVANIA. • WITMER WAS THE FIRST TO USE THE TERM “CLINICAL PSYCHOLOGIST.” • CONCERNED MAINLY WITH CHILDREN’S ACADEMIC PROBLEMS. • FIRST CLIENT—14 YEAR OLD BOY WITH “SPELLING PROBLEMS.” • MORE SIMILAR TO WHAT IS NOW CALLED SCHOOL PSYCHOLOGY.

12. 1907: NEW JOURNAL BY WITMER: “THE PSYCHOLOGICAL CLINIC.” • 1906: JOURNAL OF ABNORMAL PSYCHOLOGY (MORTON PRINCE). • 1908: H.H. GODDARD OF CLARK U. VISITS EUROPE TO STUDY TESTING WORK OF A. BINET & T. SIMON. • 1916—U.S. VERSION OF BINET-SIMON TEST OF INTELLIGENCE PUB. IN 1916 (“STANFORD BINET”). • “MENTAL TESTING” FIRMLY ESTAB. AS KEY ACTIVITY OF CLINICAL PSYCHOLOGISTS.

13. 1909 • FREUD AND JUNG VISIT CLARK UNIVERSITY (MASS.) • PSYCHOANALYTIC THEORY SOON FIRMLY ESTABLISHED IN U.S. • ALSO ESTABLISHED THE STUDY OF PERSONALITY AS A KEY INTEREST OF PSYCHOLOGISTS. • FURTHER ESTABLISHED WHEN DAVID LEVY BROUGHT BACK THE RORCHACH FROM SWITZERLAND IN 1921. • LATER CHALLENGED BY BEHAVIORAL (SKINNER) AND HUMANISTIC (MASLOW, ROGERS) THEORISTS.

14. 1917—ILLINOIS PASSED LAW ALLOWING PSYCHOLOGISTS TO CERTIFY ELIGIBILITY FOR COMMITMENT TO INSTITUTIONS FOR THE MENTALLY RETARDED.  • CHALLENGED IN COURT BY THE NEW YORK PSYCHIATRICAL SOCIETY • TRIED TO BAN PSYCHOLOGISTS FROM ANY KIND OF CLINICAL WORK.

15. PSYCHOLOGY TRIES TO ESTABLISH STANDARDS FOR PROFESSION • 1917—APA COMMISSION TO SET STANDARDS FOR “PSYCHOLOGICAL EXAMINER” • 1917—FOUNDING OF THE AMERICAN ASSOCIATION OF CLINICAL PSYCHOLOGISTS. • LATER BECAME SECTION OF CLINICAL PSYCHOLOGY WITHIN APA. • LETA HOLLINGSWORTH PROPOSES GUIDELINES FOR A “DOCTOR OF PSYCHOLOGY” DEGREE. • INCLUDED A ONE-YEAR “APPRENTICESHIP.”

16. 1918—AMERICAN MEDICO-PSYCHOLOGICAL ASSOCIATION (LATER AMERICAN PSYCHIATRIC ASSOCIATION) ISSUED FIRST OFFICIAL SET OF DIAGNOSTIC CATEGORIES. • STATISTICAL MANUAL FOR THE USE OF INSTITUTIONS OF THE INSANE. • EVENTUALLY DEVELOPED INTO THE FIRST DSM IN 1952. • ANOTHER AREA OF PSYCHOLOGY & PSYCHIATRY CONFLICT & COOPERATION.

17. ALSO IN 1917…U.S. ENTERS WORLD WAR I PSYCHOLOGISTS BECOME INVOLVED IN MILITARY: • PERSONNEL ASSESSMENT & SELECTION. • INTELLECTUAL ASSESSMENT & SCREENING. • PERSONALITY ASSESSMENT TO IDENTIFY SOLDIERS LIKELY TO DEVELOP “SHELL SHOCK” (NOW PTSD) • WORDSWORTH PERSONALTY DATA SHEET (1919). • ESTAB. PERSONALITY ASSESSMENT AS KEY ACTIVITY OF CLINICAL PSYCHOLOGISTS.

18. AFTER WORLD WAR I • 1921—FORMATION OF THE PSYCHOLOGICAL CORPORATION (TESTING) • BEGINNING OF PSYCHOLOGY AS A BIG BUSINESS IN THE PRIVATE SECTOR. • 1921—APA ISSUES GUIDELINES FOR THE CERTIFICATION OF CLINICAL PSYCHOLOGISTS. • ABONDONED EFFORT SEVERAL YEARS LATER DUE TO LACK OF IMPACT. • SEVERAL MAJOR UNIVERSITIES ESTABLISH PSYCHOLOGICAL CLINICS FOR STUDENTS.

19. 1924—EARLY ATTEMPT AT SELF-REGULATION • APA’S SECTION OF CLINICAL PSYCHOLOGY RECOMMENDS STANDARDS FOR PRACTICING CLINICAL PSYCHOLOGISTS • A PHD • FOUR YEARS OF PROFESSIONAL TRAINING • ONE YEAR OF SUPERVISED CLINICAL WORK • NOT FAR FROM WHAT WE HAVE NOW

20. H.G. WELLS IN THE AMERICAN MAGAZINE (1924) “THE ADVANCES THAT HAVE BEEN MADE IN PSYCHOLOGY . . .HAVE BEEN ENORMOUS. THE COMING HUNDRED YEARS OR SO WILL BE, I BELIEVE, ESSENTIALLY A CENTURY OF APPLIED PSYCHOLOGY. . . .IT WILL MARK A REVOLUTION IN HUMAN AFFAIRS.”

21. 1930s…CONTINUED GROWTH • 1930—OVER 500 CLINICS OFFER PSYCHOLOGICAL SERVICES. • 1932—FOUNDED THE JOURNAL OF CONSULTING PSYCHOLOGY. • LATER CHANGED TO JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY (APA). • 1935—APA REPORT DEFINES CLINICAL PSYCHOLOGY AS “THE ART AND TECHNOLOGY WHICH DEALS WITH THE ADJUSTMENT PROBLEMS OF HUMAN BEINGS.” • RECOMMENDS THAT ANYONE USING TITLE “CLINICAL PSYCHOLOGIST” SHOULD HAVE A PHD AND A YEAR OF SUPERVISED CLINICAL EXPERIENCE. • WILL RETURN LATER TO THE ISSUE OF PHD VERSUS OTHER DEGREES

22. WORLD WAR II • US MILITARY EMPLOYS OVER 1700 PSYCHOLOGISTS. • PERSONNEL SELECTION AND TRAINING. • EQUIPMENT DESIGN (HUMAN FACTORS) • COUNSELING AND PSYCHOTHERAPY. • END OF WORLD WAR II—ALMOST 45,000 PSYCHIATRIC PATIENTS IN HOSPITALS FOR VETERANS • VA CLAIMS IT NEEDS 4700 PSYCHOTHERAPISTS AND COUNSELORS. • PSYCHIATRY CANNOT MEET THIS NEED . . .THEREFORE. . .

23. 1942—CONGRESSIONAL ORDER TO VETERAN’S ADMINISTRATION • EXPAND THE POOL OF MENTAL HEALTH PROFESSIONALS, ESPECIALLY CLINICAL PSYCHOLOGISTS • 1944—US GOVERNMENT PROVIDES FUNDS FOR TRAINING CLINICAL PSYCHOLOGISTS IN UNIVERSITIES . • REQUIRES THAT THEY BE TRAINED IN PSYCHOTHERAPY. • PSYCHIATRY OBJECTS (BUT LOSES) • VA HOSPITALS PROVIDE PRATICUM TRAINING.

24. PSYCHOLOGISTS BECOME PSYCHOTHERAPISTS • BY 1947—1500 CLINICAL PSYCHOLOGY PHD STUDENTS FUNDED AT 50 UNIVERSITIES. • VA CREATES 100s OF NEW JOBS FOR CLINICAL PSYCHOLOGISTS. • LARGEST SINGLE EMPLOYER OF CLINICAL PSYCHOLOGISTS. • TODAY—THE VETERANS ADMINISTRATION REQUIRES AN APA-ACCREDITED DOCTORAL PROGRAM AND INTERNSHIP • BY 1970s CLINICAL PSYCHOLOGISTS ARE THE MAJOR PROVIDERS OF PSYCHOTHERAPY. 

25. 1946--LICENSING • 1946—CONNECTICUT BECOMES FIRST STATE TO PASS LAW REGULATING PRACTICE OF PSYCHOLOGY WITH LICENSE REQUIREMENTS. • 1948—VIRGINIA BECOMES FIRST STATE TO REQUIRE A DOCTORAL DEGREE FOR LICENSE. • 1977—MISSOURI BECOMES LAST STATE TO PASS PSYCHOLOGY LICENSING LAW. • 2004 NEW MEXICO AND LOUISIANA GRANT CLINICAL PSYCHOLOGIST PRESCRIPTION PREVILEGES. • WILL RETURN TO LICENSING ISSUE LATER

26. 1946--NIMH • PRESIDENT TRUMAN SIGNED INTO LAW BILL CREATING THE NATIONAL INSTITUTE OF MENTAL HEALTH. • OPENED IN 1946 • MISSION: “TO TRANSFORM THE UNDERSTANDING AND TREATMENT OF MENTAL ILLNESS THROUGH BASIC AND CLINICAL RESEARCH, PAVING THE WAY FOR PREVENTION, RECOVERY, AND CURE.” • NOW HAS ANNUAL BUDGET OVER $1.5 BILLION.

27. SO MANY NEW CLINICAL PSYCHOLOGY PROGRAMS SO QUICKLY • NEED FOR QUALITY CONTROL AND CONSISTENCY. • FEDERAL GOVERNMENT GIVES APA A CHOICE. . . • EITHER . . .YOU DEVELOP STANDARDS AND PROCESS FOR EVALUATION (ACCREDITATION) OR . . . • A FEDERAL AGENCY WILL DO FOR YOU. • SO APA TOOK ON THE TASK.

28. 1947—APA PROPOSES FOUR-YEAR PROGRAM FOR CLINICAL PHD • COURSEWORK IN MAJOR AREAS OF PSYCHOLOGY • COURSEWORK IN PSYCHOTHERAPY THEORY & RESEARCH • COURSEWORK IN RESEARCH METHODS & STATISTICS • RESEARCH TRAINING (DOCTORAL DISSERTATION) • PRACTICUM TRAINING • ONE-YEAR FULL-TIME INTERNSHIP DÉJÀ VU OF 1924

29. 1949—APA TRAINING CONFERENCE AT BOULDER, COLORADO • SPONSORED BY THE NATIONAL INSTITUTE OF MENTAL HEALTH—A FEDERAL GOVERNMENT AGENCY ESTABLISHED SHORTLY AFTER WORLD WAR 2. • US VETERANS ADMINISTRATION. • US PUBLIC HEALTH SERVICE • AMERICAN PSYCHOLOGICAL ASSOCIATION WE SHALL RETURN TO THIS CONFERENCE IN A MINUTE…

30. ONE MORE VERY IMPORTANT DATE…1963. • COMMUNITY MENTAL HEALTH CENTERS ACT. • INITIATIVE OF PRESIDENT JOHN F. KENNEDY. • OUTPATIENT TREATMENT CENTERS. • ALL COMMUNITIES OVER 30,000 • ACCOMPANIED BY “DEINSTITUTIONALIZATION” OF 1000s OF PEOPLE WITH SEVERAL MENTAL DISORDERS. • INCREASED NEED FOR PSYCHOLOGISTS. • FURTHER SHIFTED PROVISION OF MENTAL HEALTH SERVICES FROM PSYCHIATRY TO PSYCHOLOGY AND OTHER PROFESSIONS.

31. BACK TO 1949—APA TRAINING CONFERENCE AT BOULDER, COLORADO—THE “BOULDER MODEL” • CLINICAL PSYCHOLOGISTS SHOULD BE TRAINED AS SCIENTISTS AND PRACTITIONERS. • RESEARCH SKILLS AND CLINICAL SHOUD BE INTEGRATED. • CLINICAL PSYCHOLOGISTS SHOULD BE BOTH CLINICIANS & RESEARCHERS THROUGHOUT THEIR CAREERS. • SHOULD EMPIRICALLY EVALUATE THEIR CLINICAL WORK. • SHOULD MAINTAIN CURRENT KNOWLEDGE OF CLINICAL RESEARCH. • SHOULD CONTRIBUTE TO THE KNOWLEDGE BASE.

32. THIS MODEL WAS A COMPROMISE. • VETERANS ADMINISTRATION WAS FUNDING MOST OF THE CLINICAL TRAINING AND WANTED MAINLY PRACTIONER TRAINING. • APA COMPRISED MAINLY OF UNIVERSITY-BASED RESEARCH PSYCHOLOGISTS WHO BELIEVED THAT THE PHD SHOULD BE A RESEARCH DEGREE.

33. TRAINING WOULD INCLUDE • ACADEMIC COURSEWORK IN ALL MAJOR AREAS OF PSYCHOLOGY. • COURSES IN PSYCHOLOGICAL ASSESSMENT AND INTERVENTIONS (PSYCHOTHERAPY). • COURSES IN RESEARCH METHODS AND STATISTICS. • SUPERVISED CLINICAL PRACTICUM (IN HOUSE & EXTERNAL SETTINGS). • EMPIRICAL DISSERTATION (DATA BASED) • ONE-YEAR FULL-TIME CLINICAL INTERNSHIP IN SETTING EXTERNAL TO PROGRAM

34. REQUIRED COURSEWORK • Biological bases of behavior • cognitive-affective bases of behavior • social bases of behavior • lifespan development • Assessment & diagnosis • Treatment & interventionS • research methods & statistics • Ethical & professional standards.

35. FIRST CLINICAL PROGRAMS ACCREDITED BY APA IN 1948. • FIRST CLINICAL INTERNSHIPS ACCREDITED IN 1956. • BY 2005: • OVER 220 ACCREDITED DOCTORAL PROGRAMS IN US. • OVER 450 ACCREDITED INTERNSHIP PROGRAMS IN US. • GROWING PROBLEM: TOO MANY CLINICAL STUDENTS AND NOT ENOUGH INTERNSHIP POSITIONS.

36. BUT SKEPTICISM & DISSATISFACTION SOON SET IN • CAN YOU TRAIN SOMEONE TO BE COMPETENT AT BOTH PRACTICE AND RESEARCH IN 5 YEARS? • VAST MAJORITY OF CLINICAL PHD STUDENTS NEVER PUBLISHED RESEARCH AFTER GETTING DEGREE. • ALL CLINICAL PROGRAMS WERE IN UNIVERSITY DEPARTMENTS OF PSYCHOLOGY. • VAST MAJORITY OF UNIVERSITY PSYCHOLOGISTS WERE RESEARCHERS—NOT INTERESTED IN TRAINING IN CLINICAL PRACTICE. • TENSIONS QUICKLY DEVELOPED BETWEEN PRACTICE-ORIENTED CLINICAL FACULTY AND NON-CLINICAL FACULTY. • REMAINS A PROBLEM IN MOST DEPARTMENTS OF PSYCHOLOGY IN THE US.

37. RISE OF PROFESSIONAL SCHOOLS & THE ”DOCTOR OF PSYCHOLOGY”(PSYD) • 1951—FIRST PROFESSIONAL SCHOOL OF CLINICAL PSYCHOLOGY AT ADELPHI UNIVERSITY IN NEW YORK. • INDEPENDENT OF DEPARTMENT OF PSYCHOLOGY • 1970—FIRST FREE-STANDING (NOT AT A UNIVERSITY)-- PROFESSIONAL SCHOOL OF PSYCHOLOGY IN CALIFORNIA. • 1973—FIRST CONFERENCE OF PROFESSIONAL SCHOOLS AT VAIL COLORADO. • 1997—PSYD PROGRAMS WERE GRADUATING TWICE AS MANY STUDENTS AS CLINICAL PHD PROGRAMS

38. APA’S VAIL CONFERENCE--1973 • DEVELOPED THE SCHOLAR-PRACTITIONER MODEL OF CLINICAL TRAINING. • DOCTOR OF PSYCOLOGY OR PSYD. • EMPHASIZES TRAINING IN CLINICAL PRACTICE, NOT RESEARCH. • INFORMED AND CRITICAL CONSUMER OF RESEARCH. • “LOCAL CLINICAL SCIENTIST” • APPLICATION OF KNOWLEDGE TO CLINICAL PRACTICE.

39. SAME STANDARDS OF ACCREDITATION BY APA. • EQUALLY ELIGIBLE FOR LICENSURE. • BY 2005—57 APA- ACCREDITED PSYD PROGRAMS IN US • ACCOUNT FOR 30% OF ALL DEGREES IN PSYCHOLOGY

40. PSYD VS. PHD.PSYD PROGRAMS IN BOTH UNIVERSITIES AND FREE-STANDING PRIVATE SCHOOLS. • ACCEPT MORE STUDENTS • LOWER STANDARDS OF ADMISSION. • HIGHER RATE OF ACCEPTANCE (50% VS 11%). • LARGER ENTERING CLASSES (48 VS 10). • HIGHER FACULTY-TO-STUDENT RATION • MORE PART-TIME FACULTY. • HIGHER TUITION BUT LESS FINANCIAL AID • STUDENTS DO NOT PERFORM AS WELL ON EPPP. • BUT—NO EVIDENCE OF DIFFERENCES IN PERFORMANCE IN CLINICAL PRACTICE SETTINGS.

41. KEY IDEA IN PSY.D. PROGRAMS SCIENTIFIC PRACTITIONER OR “LOCAL CLINICAL SCIENTIST”

42. “THE CLINICAL SETTING CAN BE REGARDED AS THE LABORATORY FOR THE CLINICIAN, AND IT MUST BE APPROACHED WITH THE SAME DISCIPLINE, CRITICAL THINKING, IMAGINATION, OPENNES TO FALSIFICATION, AND RIGOR THAT CHARACTERIZES THE SCIENTIST IN THE TRADITIONAL LABORATORY.” GEORGE STRICKER (1995).

43. LOCAL CLINICAL SCIENTIST “THE LOCAL CLINICAL SCIENTIST MODEL RECOGNIZES THAT SCIENTIFIC TRAINING—EVEN WHEN IT DOES NOT PRESENT A SUBSTANTIVE SOLUTION—CAN PROVIDE AN ATTITUDE AND AN ORIENTATION TO THE PROBLEM AT HAND THAT WILL LEAD TO AN INFORMED SOLUTION THAT IS THE BEST THE STATE OF THE ART CAN GENERATE STRICKER (1995)

44. LOCAL CLINICAL SCIENTIST • OBSERVING SYSTEMATICALLY AND OBJECTIVELY. • FORMING HYPOTHESES. • GATHERING DATA TO TEST HYPOTHESES. • REFORMULATING HYPOTHESES IN RESPONSE TO DATA. • USES RESEARCH FINDINGS AS A SOURCE OF HYPOTHESES ABOUT CLIENTS. • BUT ALSO AWARE OF “LOCAL CONDITIONS” THAT INFLUENCE APPLICABILITY OF RESEARCH FINDINGS.

45. CHARACTERISTICS OF THE LOCAL CLINICAL SCIENTIST(STRICKER, 1995) • OPEN TO MULIPLE APPROACHES. • ABESENCE OF RIGIDITY & DOGMATISM. • VALUES EMPIRICAL SUPPORT—GENERAL & LOCAL. • CLINICAL PROCESS BEGINS WITH THE PATIENT, NOT THE RESEARCH. • SKEPTICAL ABOUT ONE’S OWN OBSERVATIONS AND HYPOTHESES. • AWARE OF PERSONAL VALUES AND BIASES. • NEED FOR COLLEGIAL INTERACTION & FEEDBACK.

46. ETHICAL OBLIGATIONS?(STRICKER, 1995) • IT IS NOT UNETHICAL TO PRACTICE WITHOUT COMPLETELY SUPPORTIVE SCIENTIFIC EVIDENCE. • BUT IS IT UNETHICAL TO PRACTICE IN WAYS THAT IGNORE OR CONTRADICT SCIENCE. • “PREFERED THEORIES AND TECHNIQUES MUST GIVE WAY OR BE REVISED IS DISCONFIRMATORY EVIDENCE EXISTS. • BUT THEY REMAIN THE BASIS FOR ACTION IN THE ABSENCE OF SUCH EVIDENCE” • CORNERSTONE OF “EVIDENCE-BASED PRACTICE.”

47. IS THE BOULDER SCIENTIST-PRACTITIONER MODEL WORKING? • RECENT SURVEY OF ALMOST 600 PSYCHOLOGISTS IN PRIVATE PRACTICE • MOST RELY MORE ON THEIR OWN CLINICAL EXPERIENCE AND THAT OF THEIR COLLEAGUES. • NOT ON RESEARCH • ALARMING NUMBER UNAWARE OF EXPERICALLY-SUPPPORTED INTERVENTIONS. • MANY DO NOT EVEN SEE THE UTILITY OF CLINICAL RESEARCH

48. HOW WELL DOES BOULDER MODEL MEET TODAY’S NEEDS? • DEVELOPED DURING 1945 & 1949 • NOW COMPETITION FROM OTHER DISCIPLINES • SOCIAL WORKERS PROVIDED ABOUT 5% OF MENTAL HEALTH SERVICES IN THE US IN 1991. • BY 1997, THEY WERE PROVIDING 56% (INCLUDING PSYCHOTHERAPY). • PSYCHOLOGY TRAINING HAS BECOME INCREASINGLY SPECIALIZED.

49. SCIENCE VERSUS PRACTICE: ACADEMY OF PSYCHOLOGICAL CLINICAL SCIENCE • BY EARLY 1990s MANY BELIEVED CLINICAL PSYCHOLOGY PROGRAMS WERE NOT UPHOLDING THE SCIENTIST SIDE OF THE MODEL. • 1994—FORMATION OF THE ACADEMY OF PSYCHOLOGICAL CLINICAL SCIENCE. • PROGRAMS “STRONGLY COMMITTTED TO RESEARCH TRAINING AND THE INTEGRATION OF SUCH TRAINING WITH CLINICAL TRAINING.” • NOW ALMOST 60 MEMBERS. • INCREASINGLY INVOLVED IN APA ACCREDITION. • ALSO DEVELOPING THEIR OWN ACCREDITATION STANDARDS.

50. WHAT IS “CLINICAL SCIENCE”ACADEMY OF PSYCHOLOGICAL CLINICAL SCIENCE (1995) • “CLINICAL SCIENCE” IS DEFINED AS A PSYCHOLOGICAL SCIENCE DIRECTED AT THE PROMOTION OF ADAPTIVE FUNCTIONING. • AT THE ASSESSMENT, UNDERSTANDING, AMELIORATION, AND PREVENTION OF HUMAN PROBLEMS IN BEHAVIOR, AFFECT, COGNITION, OR HEALTH. • AND THE APPLICATION OF KNOWLEDGE IN WAYS CONSISENT WITH SCIENTIFIC EVIDENCE. • [AND A] COMMITMENT TO EMPIRICAL APPROACHES TO EVALUATING THE VALIDITY AND UTILITY OF TESTABLE HYPOTHESES AND TO ADVANCING KNOWLEDGE BY THE METHOD