PSY 244 CLINICAL PSYCHOLOGY-I

1. PSY 244CLINICAL PSYCHOLOGY-I BAHAR BAŞTUĞ Assist. Prof. Dr.

2. Current and Future Trends and Challenges

3. Lecture Preview • Trends in Society • Research Issues • Practice Issues • Reaching Beyond Mental Health in Contemporary Clinical Psychology • Training Issues

4. Where Is Clinical Psychology Going and Should I Go with It? has changed rapidly and continues to change. This change has paralled with changes in society. Because of the recent advances in science and technology, clinical psychology has developed. • Where is clinical psychology going? • What is its future? • What are its current and future topics?

6. Health care and health care reform are the best examples of a current topic. Someonewho wanted to see a clinical psychologistfor psychotherapy could choose to be treated by any licensedpsychologist in his or her country.The psychologist would conduct as many sessionsas necessary to best treat the patient,using whatever theoretical orientation(s) andtechniques.

7. In more recent years, this situation has changed due to mental health reform. The patient contacts insurance company to determinewhich therapists in that areaare part of the psychologist. The insurance company allows a specific number ofsessions. The number of season is limited 3 to 6. Additional sessions or othertreatment options (e.g., inpatient care,group psychotherapy, family psychotherapy)must be approved by the insurance company.

8. These changes impact all major areas such as research, training, and practice. Since mostcompanies will not approve treatment conducted by trainees (interns), many hospitalsand clinics cannot continue to train psychology trainees.

9. Trends in Society Clinical psychology must change and adapt to a changing world. It must respond tochanges within the field as new research discoveriesand clinical practice strategies emerge.

10. Trends in Society • Changes in the Family • Multicultural and Diversity Issues • Advances in Science, Technology, and Medicine • Gender Shifts in Professions

11. Changes in the Family The family has changed in recent years. The traditional nucleous family exists no longer. About 50% of marriages end in divorce. About 55% of people live together prior to marriage. Families include adopted or “test tube” children, children and parents of mixed ethnicity, race, and religion, gay and lesbian parents, single parents, unmarried parents, and single mothers.

14. Lezbiyen çiftin velayet davası AİHM'de Avrupa İnsan Hakları Mahkemesi (AİHM), 22 yıldır birlikte yaşayan lezbiyen Fransız çiftin, çocuk velayeti konusunda yaptıkları ortak başvuruyu görüştü.

15. Multicultural and Diversity Issues The numbers of ethnic minorities and immigrants increase. Increasing attention and interest have been focused on the role of multicultural and diversityissues in all aspects of society. Psychologists have gained insight into the role of culture and diversity in the development of behavior and behavioral problems.

16. Multicultural and Diversity Issues Social context and culture have powerful influences on behavior. The understanding of culture is critical to the understanding of psychological and physical symptoms as well as in developing treatmentinterventions. These syndroms tend to be culture related: • Conversion disorder & postpartum psychosis • Koro, amok, latah • Voodoo and Couvade syndrome.

17. Multicultural and Diversity Issues Disorders appear universallyamong all cultures, but they manifest differentlydepending on the specific culture. In SCH, American and industrialized Western people experience auditoryhallucinations, but Latin American andAfrican people experience visualhallucinations . The APA has warned psychologists to “become familiar with different beliefs and practices and respect them”.

18. Advances in Science, Technology, and Medicine Recent advances and discoveries in science, technology, and medicine have impacted clinical psychology. They reinforces that biology is at the root of most human behavior. Prozac to treat depr,efforts to find the “fat gene”, and Ritalin to treat ADHD are examples about how scientific advances influenceattitudes on mind-body relationships.

19. New trend of treatmentof obesity is to discoverthe fat gene, ignoring the role of psychosocial factors. However, researchassociated with the Human Genome Projectcontinues to support the biopsychosocialperspective in obesity treatment. Ritalin for ADHD provides another example of the impact of scientificadvances. Many parentsand teachers show more interest inusing Ritalin to control the symptoms than in using psychosocial interventions. Research on ADHD supportsthe biopsychosocial perspective.

20. Advances in Science, Technology, and Medicine Technological advances (e.g., computer technology, fax machines, cellular phones, video, electronic mail, and virtual reality) have an impact on clinical psychology.

21. Maintaining confidentiality when using computers to be careful for patient informationis important. Potential access to computer files andpatientinformation are ethical issues. The use of the Internet and the telephone to conduct therapy or psychological cons is controversial. Some accept it, others state that it would be unethical. Some say that therapy via internet or telephone might have advantages for people who are in remote locations.

22. Virtual reality in exposure has also been used to treat anxiety, especially fears and phobias.Therapists can use virtual exposure with their patients to cope better with phobias such as airplane, driving, or spider phobias.

23. Virtual reality in exposure

24. Money As a result of wars and economic crisis, attempts to balance the financial policies have resulted in cuts in many programsaffecting clinical psychology. Money orthe lack of money is an important issue concerningresearch, practice, and training.

25. Gender Shifts in Professions The percentage of female clinical psychologistshas more than doubled between 1960 and2003. More women in the field adds new perspective,awareness, and approach. Professionsand services are enriched when peopleof different gender, ethnicity, and religionenter thediscipline. It allows more choice for those seeking psychologicalservices and role models forstudents.

26. Research Issues More complicated research designs and questions are being applied today. These research questions tend to look for interactions rather than main effects, under which conditions, with which patients, treated by which therapists, and using which techniques will interventions work best.

27. Research Issues In addition to traditional methods, qualitative, descriptive, and narrative approaches have been used to answer research questions. Investigating clinical rather than simply statistical significance has been advanced. The use of effect size and meta-analysis techniques, statistical analysis by computer technology has increased the utility of research methodologies and data analysis approaches. SPSS, AMOS and LISRELL.

28. Research Issues Significant contemporary research problems of society are homelessness, violence, racism, terrorism, and the role of psychology and behavior in diseases such as AIDS and obesity.

29. Practice Issues Managed Health Care and Health-Care Reform Physicians used to treatpatients and insurance company used to pay for whatever the doctors ordered.Lacking medical degrees, clinical psychologistscould not be payed back by insurancecompanies. In the 1970s, «freedom-of-choice” laws passed and allowed that psychologists were available for medical insurance. While physiciansargued that only psychiatrists should treatpatients in psychotherapy, psychologistsargued that a mentalhealth professional did not need to be aphysician in order to conduct psychotherapy.

30. After «freedom-of-choice” law, insurance companies pay back psychologists. Psychologists could offer varioustypes of psychotherapy. Insurancewould pay back 50 to 80% of the fees charged by the psychologist, and patients paidthe remaining part. These «fee-for-service» insurancearrangements began to change duringthe 1980s.Health carecosts rose.

31. According to fixed and predetermined fee, patients were categorized into diagnosis-related groups, and the costs were calculatedbased on the average cost per patient for a given diagnosis. A hospital would receivea fixed fee for treating a patient with a given diagnosis. If the hospital neededmore time or money to treat the patient,monies would not be available for the additionalservices.

32. Many psychologists are concerned about the growing use of capitationmethods. In a capitation program,the insurance company will pay a setfee for the treatment of a given patient nomatter what treatment or how many sessions are required.

33. Psychologists and other mental health professionals are unhappy with managed health care: 1.All professional decisionsmust be approved by the insurance company. 2. Patient confidentiality must be broken. Details about the patientmust be disclosed by the company. 3. Psychologists and patients oftenfeel that too few sessions are approved bythe company. 4. Many psychologistsresent having someone tell themhow they should treat their patients. A company might urgethe psychologist to have the patient entergroup rather than individual therapy to decrease costs.

34. Prescription Privileges Historically, psychiatrists have been the only mental health professionals legally allowed to prescribe medication. Although many psychologists conduct research on the neurobiology andpsychopharmacology, and graduate programs offer psychopharmacologycourses, psychologists have obtained legalpermission to prescribe medications only in Guam,New Mexico, and Louisiana.

35. Prescription Privileges The American Psychiatric Association are opposed to allowing psychologists the privilege of prescribing medication. Even many psychologists are opposed to having psychologists prescribe medication for their patients. But, the majority of clinical psychologists support prescription privileges.

36. Prescription Privileges The APA has outlined a curriculum for psychologists who are interested in being trained to prescribe medication. The program includes basic psychopharmacology education and prescription privilege.

37. Prescription Privileges By 1998, legislation for psychology prescription privileges was introduced in six states including California, Florida, Hawaii, Louisiana, Missouri, and Tennessee. In 2001, New Mexico became the first state to allow psychologists prescription privileges. Louisiana became the second state to award these privileges to psychologists in 2004.

38. Medical Staff Privileges Historically, only physicians were allowed to treat patients independently in a hospital setting and serve on the medical staff of a hospital. Medical staff privileges allowed a physician to admit and discharge patients and organize or manage the treatment plan of patients while hospitalized.

39. Medical Staff Privileges In 1978, legislation was passed allowing psychologists to be able to obtain medical staff privileges independently in California. Since that time, many states in USA have enacted similarlegislation.

41. Private Practice The number of clinical psychologists choose to work in full-time or part-time in solo or groupprivate practice. Managed health care has madeit difficult to develop and maintainan independent practice. The companieshave looked tomaster’s-degree trained counselors as a lowercost alternative to clinical psychologists. The companies find it more cost effective towork with large centers rather than solo private practices. Solo private practice might nolonger exist within the next years. 

42. Specialization The need for specializationhas become apparent. A general clinical psychologist isto have limitations. Specialization has resulted in furthercertification requirements.

43. Empirically Supported Treatments Historically psychologists couldevaluate and treat each patient as they saw fit. But, changes in health care have forcedmental health professionals to examine effective treatment outcome and clientsatisfaction, and have resulted in efforts to use empirically supported treatments.

44. Empirically Supported Treatments Empirically supported treatment approaches have been developed for depr, anx, OCD, bulimia nervosa, and conduct disorder. Some professionals state: «becauseindividuals are unique and have differentpersonalities, symptoms, and coping resources,it is impossible to fit the same treatmentapproach to every patient based onempirical research support». Others approve empirically supported treatments.

45. Evidence-based practice This discussion has resulted in evidence-based practice. Evidence-based practices utilize the findings of high-quality research. Evidence-based practices use the best that research has to offer with realities of professional practice with actual diverse client populations. It might be expected that evidence –based practice will increase in the future.

46. Reaching Beyond Mental Health in Contemporary Clinical Psychology Psychology is considered not only an independent mental health discipline but also an independent general health care discipline. APA agreed the motto: “health, education, and human welfare”

47. Training Issues Training models include the scientist-practitioner, or Boulder model; the scholar-practitioner, or Vail model; the PhD or the PsyD degree programs; and the university or the free standing professional school models. Which training models will survive and which will not have important questions for the future.

48. Many psychologistsare concerned that professional standardshave decreased with the professionalschools.Many free standing professionalschools are unaccredited by the APA. New discoveries, specializations, and thedemands of society influence training. Graduateand postgraduate training programs mayneed to provide training inpsychopharmacology. Focus on violence, ethnic diversity, technological advances, and cost-effective treatment influence the training.

49. New trends in training are necessary postdoctoral training and new joint degree programs. Joint degree programs combine psychologytraining with other fields, such as business and law. As clinical psychology matures,more emphasis in research and practicewill be placed on education,specialization, and interdisciplinary training.

50. The future of clinical psychology is uncertain. Future clinical psychologists must be flexible to adapt to changing needs and requirements as society and the discipline changes.