Current Issues in Clinical Psychology

1. Current Issues in Clinical Psychology Chapter 3 By: Farrah J. Cordero

2. By: Farrah J. Cordero

3. Models of Training in Clinical Psychology • 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 • Clinical Practice & Research • Resulted in the Psy.D. degree By: Farrah J. Cordero

4. Models of Training inClinical Psychology • The Doctor of Psychology (Psy.D.) Degree Model • 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 • Third year- experience in therapeutic practice and assessment becomes the focus • Fourth Year- clinical emphasis continues with internship assignments By: Farrah J. Cordero

5. Models of Training inClinical Psychology • Professional Schools • No affiliation with universities • Autonomous w/ own financial and organizational frameworks • Faculty chiefly clinical in orientation • 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 • Admittance is higher compared to traditional university-based program By: Farrah J. Cordero

6. Models of Training inClinical Psychology • Clinical Scientist Model • Empirically Oriented Clinicians feel clinical psychology is not well grounded in Science • Research either has not been completed/ does not support the therapy techniques • Resulted in the Academy of Psychological Clinical Science • 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) • Over 50 member programs By: Farrah J. Cordero

7. Primary Goals 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. Development of and access to resources & opportunities for training, research, funding, & Clinical science careers Application of clinical science to human problems Clinical Scientist Model cont. By: Farrah J. Cordero

8. Models of Training inClinical Psychology • Combined Professional-Scientific Training Programs • Combined Specialties (Counseling, Clinical, & School Psychology) • Assumption is: • 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 By: Farrah J. Cordero

9. Models of Training inClinical Psychology • 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 • 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 • Some feel there may be oversupply of Practice-oriented Psychologists By: Farrah J. Cordero

10. Graduate Programs: Past & Futurecont. • 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 By: Farrah J. Cordero

11. Professional Regulation • Attempted to Protect the Public Interest by Developing Standards of Competence • CERTIFICATION • Weak Form of Regulation • 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 By: Farrah J. Cordero

12. Professional Regulation • 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 • 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 By: Farrah J. Cordero

13. By: Farrah J. Cordero

14. Professional Regulation • 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 • 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 By: Farrah J. Cordero

15. Private Practice • 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 • People who normally could not afford therapy were now covered By: Farrah J. Cordero

16. Private Practice cont. • 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 By: Farrah J. Cordero

17. Private Practice • 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 By: Farrah J. Cordero

18. Private Practice cont. • The Health Care Revolution • 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 By: Farrah J. Cordero

19. Private Practice cont. • 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 By: Farrah J. Cordero

20. Private Practice cont. • The Health Care Revolution • 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 By: Farrah J. Cordero

21. Prescription Privileges • 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 By: Farrah J. Cordero

22. Prescription Privileges cont. • 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 • Conflicts resulting in lawsuits • Increased Malpractice liability costs • Financial burden of modifying training programs and licensing laws By: Farrah J. Cordero

23. Culturally Sensitive Mental Health Services • 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 By: Farrah J. Cordero

24. Culturally Sensitive Mental Health Services cont. • 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 By: Farrah J. Cordero

25. Ethical Standards • 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 By: Farrah J. Cordero

26. Ethical Standards cont. • 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 By: Farrah J. Cordero

27. Ethical Standards cont. • Human Relations/ Client Welfare • 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 By: Farrah J. Cordero

28. By: Farrah J. Cordero