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 in Clinical 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 in Clinical 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 in Clinical 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. Clinical Scientist Model cont.
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
By: Farrah J. Cordero

8. Models of Training in Clinical 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 in Clinical 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 & Future cont.
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