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Chapter 3

Current Issues in Clinical Psychology

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Models of Training in Clinical Psychology

• The Scientist-Practitioner Model – Also known as the Boulder Model; 1949– Practice with skill while being able to conduct and

review research

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Models of Training in Clinical Psychology

• The Scientist-Practitioner Model – Pros• Balanced in the theoretical and the practical• Rooted in academia and research

– Cons• May polarize into camps• Excuse to de-emphasize research?

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Models of Training in Clinical Psychology

• The Doctor of Psychology (Psy.D.) Degree– emphasis on the development of clinical skills and

a relative de-emphasis on research competence – Higher acceptance rate

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Models of Training in Clinical Psychology

• The Doctor of Psychology (Psy.D.) Degree– Lower % who get financial assistance– Lower % get internship– More Psy.D.’s awarded than Ph.D.’s

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Models of Training in Clinical Psychology

• Professional Schools– Most offer Psy.D.– Most doctoral degrees awarded by professional

schools– Often accept 100+ students per year – Many have no affiliation with a university– Majority not APA accredited– May employ part time professors

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Models of Training in Clinical Psychology

• Clinical Scientist Model – 1991: McFall’s Manifesto• Scientific Basis• Establishing Criteria for Services• Focus in training

– Empirical Emphasis

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Models of Training in Clinical Psychology

• Clinical Scientist Model – Academy of Psychological Clinical Science– 50+ doctoral programs; 10 internships– Evidence-based assessments and interventions

taught

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Models of Training in Clinical Psychology

• Combined Professional-Scientific Training Programs – Combined specialty in counseling, clinical, and

school psychology – Breadth versus depth

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Models of Training in Clinical Psychology

• Graduate Programs: Past and Future– Training models influenced by marketplace– Over-supply of practitioners– Managed care– Under-supply of research-oriented clinical

psychologists

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Professional Regulation

• Certification (restricts use of psychologist title)– State by state basis

• Licensing (restricts use of psychologist title and professional activities)– APA Guidelines influence states– Potential limitations on academia

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Professional Regulation

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Professional Regulation

• American Board of Professional Psychology (ABPP)– Establishes competency certifications– Very rigorous

• National register

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Private Practice

• Has it peaked?• Economic squeeze• Today’s Ph.D. clinicians will be replaced by

tomorrow’s master’s-level mental health professionals

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The Costs of Health Care

• United States spent $2.26 trillion dollars on healthcare in 2007, approximately $7,439 per person (16% of GDP)

• From 2007 to 2017, it is predicted that the proportion of the GDP devoted to health care costs will rise to 19.5%

• Evidence-based treatments

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The Costs of Health Care

• HMOs vs. PPD– Fixed Cost against Variable– Pay for Performance

• Evolution of Managed Mental Health

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The Costs of Health Care

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Prescription Privileges

• Pros– Can provide wider variety of treatments to a

wider range of clients– Increase in efficiency and cost-effectiveness of

care – Will give clinical psychologists a competitive

advantage in the health care marketplace

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Prescription Privileges

• Cons– May lead to a de-emphasis of “psychological”

forms of treatment – May also damage clinical psychology’s relationship

with psychiatry and general medicine – Lead to increases in malpractice liability costs

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Prescription Privileges

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Prescription Privileges

• 3 Levels of Competency• Basic Pharmacology Training: – knowledge of the biological basis of

neuropsychopharmacology, mastery of medications that are used and abused

• Collaborative Practice: – competence in diagnostic and physical assessment, drug

interactions, and drug side effects; hands-on training in psychopharmacology

• Prescription Privileges: – can prescribe

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Prescription Privileges

• Implications for training– Programs that seek to prepare psychologists for

prescribing at a later point in their career may screen out applicants that do not have a good foundation in undergraduate courses in the physical sciences

– May change the very nature of the practice of clinical psychology as we know it

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Technological Innovations

• Tele-health• Ambulatory Assessment• Computer-assisted

treatment

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Culturally Sensitive Mental Health Services

• Make a commitment to cultural awareness as well as knowledge of self and others as cultural beings

• Recognize the importance of multicultural sensitivity

• Integrate multiculturalism and diversity into education and training

• Recognize the importance of culture in psychological research and clinical work

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Culturally Sensitive Mental Health Services

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Ethical Standards

• Beneficence & Non-Maleficence:– Psychologists strive to benefit those they serve

and to do no harm• Fidelity & Responsibility: – Psychologists have professional and scientific

responsibilities to society and establish relationships characterized by trust

• Integrity: – In all their activities, psychologists strive to be

accurate, honest, and truthful

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Ethical Standards

• Justice:– All persons are entitled to access to and benefit

from the profession of psychology; psychologists should recognize their biases and boundaries of competence

• Respect for people’s rights and dignity:– Psychologists respect the rights and dignity of all

people and enact safeguards to ensure protection of these rights

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Ethical Standards

• Competence – Represent training accurately – Clinicians should not attempt treatment or

assessment procedures for which they lack specific training or supervised experience

– Be sensitive to treatment or assessment issues that could be influenced by a patient’s gender, ethnic or racial background, age, sexual orientation, religion, disability, or socioeconomic status

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Ethical Standards

• Privacy and Confidentiality – Respect and protect the confidentiality of client

information– Be clear and open about matters of confidentiality

and the conditions under which it could be breached • Tarasoff case – duty to warn; psychologists must disclose

confidential information to protect the client/patient, psychologist, or others from harm

– -legal precedents vary by state

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Ethical Standards

• Human Relations– Dual relationships – Sexual harassment and sexual intimacies – Clinician’s willingness to terminate therapy when

it is no longer helping the client