Clinical Psychology: Nature and Training (Chapter 1) PSYC 4500: Introduction to Clinical Psychology Brett Deacon, Ph.D.

1. Clinical Psychology: Nature and Training(Chapter 1)PSYC 4500: Introduction to Clinical PsychologyBrett Deacon, Ph.D.August 27, 2008

2. What is Clinical Psychology? • “The field of clinical psychology integrates science, theory, and practice to understand, predict, and alleviate maladjustment, disability, and discomfort as well as to promote human adaptation, adjustment, and personal development. Clinical psychology focuses on the intellectual, emotional, biological, psychological, social, and behavioral aspects of human functioning across the lifespan, in varying cultures, and at all socioeconomic levels” (Society of Clinical Psychology, 2002). • Emphasis on science • Emphasis on maladjustment • Emphasis on the individual • Emphasis on helping

3. What Do Clinical Psychologists Do? • Psychotherapy • Assessment • Research • Teaching • Supervision • Consultation • Administration • Hiking, camping, golf, travel, etc. (professors only)

4. Clinical Psychology vs. Related Professions • Psychiatry • Requires undergraduate background in physical sciences • Medical specialty - 4 years of medical school, one year internship in general medicine, three-year psychiatry residency, exams for board certification • Philosophy, training, and practice • Little training in research or the scientific method; emphasizes memorization over critical thinking • Strongly dominated by biological models of mental disorders • Treatment is overwhelmingly biological • Minimal psychotherapy training • See very large number of patients for small number of visits

5. National Trends in Psychotherapy by Office-Based Psychiatrists (Mojtabai & Olfson, 2008) • Examined trends in use of psychotherapy by psychiatrists from 1996 to 2005 • Percentage of psychiatrist patients receiving psychotherapy declined from 44.4% to 28.9% • Percentage of psychiatrists who provided psychotherapy to all of their patients declined from 19.1% to 10.8% • These trends are “attributable to a decrease in the number of psychiatrists specializing in psychotherapy and a corresponding increase in those specializing in pharmacotherapy – changes that were likely motivated by financial incentives and growth in psychopharmacological treatments in recent years.”

6. Clinical Psychology vs. Related Professions • Counseling psychology • School psychology • Counseling • Social work • Psychiatric nursing • Other professions

7. Getting into Graduate School in Clinical Psychology • Undergraduate course work • GPA, overall, last 2 years, and in major • GRE, both general and psychology tests • Research/scholarly experience • Clinically-relevant experience • Strong letters of recommendation • Personal statement • For Ph.D. programs: Clearly articulated research interests that match with a faculty member combined with some evidence of experience/expertise in the faculty member’s area of research

8. An Example: The UW Clinical Psychology Application Process • Application: http://uwadmnweb.uwyo.edu/psychology/application.asp • Relevant Data: http://uwadmnweb.uwyo.edu/psychology/studentdatatables2006.asp

9. Useful Resources about Graduate School • American Psychological Association (2005). Graduate study in psychology 2006. Washington, DC: Author.http://www.psichi.org/pubs/articles/article_540.asp- see also the library • Excellent links page about entire process: http://www.uni.edu/walsh/linda2.html • Difference between clinical & counseling psychology:http://www.psichi.org/pubs/articles/article_73.asp • Differences between Psy.D. and Ph.D.: http://www.psichi.org/pubs/articles/article_171.asp • Obtaining a good letter of recommendation: http://www.psichi.org/pubs/articles/article_75.asp • Writing a good personal statement: http://www.psichi.org/pubs/articles/article_98.asp

10. Graduate Training in Clinical Psychology • Depends on training model of program • Coursework: • Basic psychology: social, developmental, cognitive, biological • Statistics (typically 2-4 classes) • Clinical coursework: psychopathology, psychotherapy, cognitive and personality assessment, ethics and diversity • Often has either child or adult focus • Specialized coursework: neuropsychology, health psychology, forensic psychology, consultation in medical settings, psychopharmacology, etc. • No direct training for prescribing – this is postdoctoral

11. Graduate Training in Clinical Psychology • Research activities (for Ph.D. programs): • Relationship with research advisor • Masters thesis and oral defense • Doctoral dissertation and oral defense • Additional involvements: research assistantships, presenting posters or papers at conferences, publications • Teaching (if applicable) • Doctoral candidacy examination • Graduate assistantships

12. Graduate Training in Clinical Psychology • Practicum training • Often at in-house psychology clinic • Offsite community externships • Predoctoral internship • Yearlong, full-time internship, competitive application process (very much like grad school) • Postdoctoral training (if desired) • Opportunity to develop clinical specialty • Opportunity to further develop research specialty • Earn hours for licensure • Continuing education and credentialing

13. Training Models in Clinical Psychology • Boulder model • Also known as “scientist-practitioner” model • Usually associated with Ph.D. degree

14. Scientist-Practitioner Training • Training in three broad areas: • Research • Assessment • Intervention • Advanced education in core areas of psychology • Biological bases • Learning and cognition • Social influences • Individual differences • Experiential learning • Clinical practica (leading to pre-doctoral internship) • Research mentoring (leading to dissertation)

15. Common Criticisms of Boulder Model • Training is not integrated • Faculty are poor role-models • Most applicants interested in practice • Few clinical psychologist do research • Research training may not be necessary to be a good clinician

16. Training Models in Clinical Psychology • Vail model • Also known as “scholar-practitioner” model

17. Scholar-Practitioner Training • De-emphasis on research experience (although receive some training in research) • Greater emphasis on psychological service delivery • Usually associated with Psy.D. degree

18. The Psy.D. • Doctor of Psychology (Psy.D.) • Emphasis is on training for clinical practice • First program 1968 – University of Illinois • Currently – about 25% of APA accredited doctoral training programs in clinical psychology offer Psy.D.

19. Psy.D. vs. Ph.D. • Affiliation with a university • Financial costs • Class size • Admission requirements • Faculty involvements • Faculty theoretical orientation • Research training • Duration of training

20. Psy.D. Vs. Ph.D. Degrees • Average acceptance rate for clinical Ph.D. programs is about 11% • Average enrollment for Ph.D. programs is about 9 Source: http://www.psichi.org/pubs/articles/article_171.asp

21. Psy.D. Vs. Ph.D. Degrees • Average % with full funding in clinical Ph.D. programs = 70-80% • Mean Psy.D. student debt = $53,000-$60,000 • Mean Ph.D. student debt = $22,000 Source: http://www.psichi.org/pubs/articles/article_171.asp

22. Training Models in Clinical Psychology • Clinical scientist model and the Academy of Psychological Clinical Science • Excerpt from “Manifesto for a science of clinical psychology (McFall, 1991)

23. Training Models in Clinical Psychology • “The dichotomy between science and practice is the classic one-the one codified in the Boulder Model of clinical training with its hyphenated characterization of clinical psychologists as "scientist-practitioners." The implication commonly attributed to the hyphenated Boulder Model is that there are two legitimate types of clinical psychology: clinical science and clinical practice.”

24. Training Models in Clinical Psychology • “This is the dichotomy one hears, for example, from undergraduates who are applying to graduate training programs in clinical psychology and are struggling with making what they perceive to be the difficult, but necessary, career choice between science and practice. When I counsel these undergraduates, I try to persuade them that they are not framing the issue correctly-that there really is no choice between science and practice. I tell them that all clinical psychologists must be scientists first, regardless of the particular jobs they fill after they earn their degrees; that becoming a clinical scientist does not mean that they are committed to working in a laboratory or university; and that choosing not to receive the best scientific training possible, by purposely opting for a training program that does not emphasize scientific training, means that they will not be prepared to do any form of psychological activity as well.”

25. Training Models in Clinical Psychology • “What I am saying to them, of course, is that all forms of legitimate activity in clinical psychology must be grounded in science, that all competent clinical psychologists must be scientists first and foremost, and that clinicians must ensure that their practice is scientifically valid.”

26. Questions for Lilienfeld et al. (2003) chapter; Response paper due next Tuesday 9/1 • 1. Describe two reasons for the widespread use of pseudoscientific mental health practices. • 2. Describe three reasons why pseudoscientific mental health practices can be harmful. • 3. What level of scientific training (if any) is most desirable for people who want to be practitioners?

27. Questions for Lett (1990) article; Response paper due next Thursday 9/3 • 1. List and describe one example of a psychological claim you’ve previously encountered that cannot be falsified. • 2. When a person makes a claim, upon whom does the burden of proof rest for establishing its validity? Why? • 3. Why are testimonials and anecdotal evidence insufficient to establish the validity of a claim?