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Chapter 3

Clinical Psychology Chapter 3.docx

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John Stephens

Chapter 3: Current Issues in Clinical Psychology Models of Training in Clinical Psychology • The Scientist-Practitioner Model – Also known as the Boulder Model; 1949 – An attempt to “marry” science and clinical practice, and it remains the most popular training model for clinical psychologists even to this day – It saw a profession comprised of skilled practitioners who could produce their own research as well as consume the research of others – The psychological clinician would practice with skill and sensitivity but would also contribute to the body of clinical knowledge by understanding how to translate experience into testable hypotheses and how to test these hypotheses – Practice with skill while being able to conduct and review research – Always assumed you would do the research yourself but counterargument was that you needed to be able to critique the research of others. Some would become primarily researchers and some primarily clinicians – Pros • Balanced in the theoretical and the practical • Rooted in academia and research – Cons • May polarize into camps • Excuse to de-emphasize research? • Some believe it is a poor educational model • The Doctor of Psychology (Psy.D.) Degree – Emphasis on the development of clinical skills and a relative de- emphasis on research competence – Very similar to a Ph. D. program in the first two years. In the third year, increasing experience in therapeutic practice and assessment becomes the rule. The fourth year continues the clinical emphasis with a series of internship assignments – Higher acceptance rate – Lower % of faculty with a cognitive-behavioural theoretical orientation – Lower % who get financial assistance – Lower % get internship – More Psy.D.’s awarded than Ph.D.’s • 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, they are autonomous, with their own financial and organizational framework – Majority not APA accredited – Many employ part time professors; difficult to develop a connection between students and professors • Clinical Scientist Model – 1991: McFall’s Manifesto 1. Scientific clinical psychology is the only legitimate and acceptable form of clinical psychology 2. Psychological services should not be administered to the public until they have satisfied these four criteria: – The nature of the service must be described clearly – The benefits must be stated explicitly – These claims must be validated scientifically – Possible negative side effects must be ruled out 3. The primary and overriding objectives of doctoral training programs in clinical psychology must be to produce the most competent clinical scientists possible • Clinical Scientist Model – Academy of Psychological Clinical Science – 50+ doctoral programs; 10 internships – Evidence-based assessments and interventions taught – It consists of graduate programs and internships that are committed to training in empirical methods of research and to the integration of this training with clinical training – Primary goals include: • Training • Research and theory • Resources and opportunities • Application • Dissemination • Combined Professional-Scientific Training Programs – Combined specialty in counseling, clinical, and school psychology – Assumes that these specialties share a number of core areas of knowledge and the actual practices of psychologists who graduate from each of these specialties are quite similar – Breadth versus depth which could cause problems in students not developing a specific subspecialty or area of expertise – Seems to be better suited for the future practitioner rather than the future academician or clinical scientist • Graduate Programs: Past and Future – Training models influenced by marketplace – Starting in the mid-1960’s, a shift occurred from university-based academic jobs to jobs in private practice – Over-supply of practitioners – Many more applicants for internship positions than slots available – Managed care • Attempt to decrease the health care which will likely affect the demand for clinical psychologists in the future as well as the curriculum in training programs – Under-supply of research-oriented clinical psychologists Professional Regulation - How is the public to know who is well trained and who is not? - Professional regulation has attempted to protect the public interest by developing explicit standards of competence for clinical psychologists - Can be complicated because no national standard exists; the requirements can vary from state to state • Certification (restricts use of psychologist title) – State by state basis – Relatively weak form of regulation in most cases – Often involves examination but sometimes consists only of a review of the applicant’s training and professional experience • Licensing (restricts use of psychologist title and professional activities) – Not only specifies the nature of the title and training required for licensure but it also usually defines what specific professional activities may be offered to the public for a fee – APA Guidelines influence states – Most states require applicants for licensure to take an examination sometimes written and oral. They also usually examine the applicant’s educational background and sometimes requires several years of supervised experience beyond the doctorate – Potential limitations on academia because some licensing requirements violate the academic freedom because they essentially dictate the coursework offered by clinical psychology programs • i.e. the requirements for licensure may make it difficult for academic clinical psychologists themselves to attain licensure • American Board of Professional Psychology (ABPP) – Was made because of the failure of individual states to take the lead on professional regulation – Establishes competency certifications in many different branches of psychology – Very rigorous examination is involved than those in state certification or licensing – Benefits to the clinical psychologist: • Reduced liability insurance • Increased status as a clinician or expert witness • Increased ease of mobility if one chooses to move to another state • National register – Is a kind of self-certification, listing only those practitioners who are licensed or certified in their own states and who submit their names for inclusion and pay to be listed Private Practice • Has it peaked? • Economic squeeze • The medical profession has experiences a great deal of criticism because it has appeared more concerned with economic privileges than with the welfare of patients • Often perceived not as the public’s guardian, but as the protector of the rights and advantages of the physician • Clinical psychology seems to be moving in the same direction • Is training clinicians for private practice an economical, efficient response to the nation’s mental health needs? • Managed health care now dominates the scene • Some predict that private practitioners will need to expand their roles to areas such as alternative medicine, telehealth, psychopharmacy, and life coaching • Today’s Ph.D. clinicians will be replaced by tomorrow’s master’s-level mental health professionals 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 • A health maintenance organization (HMO) employs a restricted number of providers to serve those who enroll in the plan; costs for all services are fixed • A preferred provider organization (PPO) has contracts with outside providers at discounted prices to meet the needs of its memberships. They theoretically receive more referrals for the discounted price • A point of service (POS) plan combines features of HMOs and PPOs in that members have more options regarding how managed their health care choices are
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