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

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Presentation on theme: "By: Farrah J. Cordero 1 Current Issues in Clinical Psychology Chapter 3."— Presentation transcript:

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

2 2By: Farrah J. Cordero

3 3 Models of Training in Clinical Psychology The Scientist-Practitioner The Scientist-Practitioner The Training Model/ AKA Boulder Model The Training Model/ AKA Boulder Model Integrates Science and Clinical Practice Integrates Science and Clinical Practice Idea: Practitioners who can produce as well as consume research Idea: Practitioners who can produce as well as consume research Debate: Psychologists split in two groups Debate: Psychologists split in two groups Clinical Practice & Research Clinical Practice & Research Resulted in the Psy.D. degree Resulted in the Psy.D. degree

4 4By: Farrah J. Cordero Models of Training in Clinical Psychology The Doctor of Psychology (Psy.D.) Degree Model The Doctor of Psychology (Psy.D.) Degree Model Emphasis on Development of Clinical Skills Emphasis on Development of Clinical Skills De-emphasis on Research De-emphasis on Research Masters Thesis Not Required Masters Thesis Not Required Dissertation- a Report on a Professional Topic instead of an Original Research Idea Dissertation- a Report on a Professional Topic instead of an Original Research Idea Ph.D. and Psy.D. programs similar until 3 rd year Ph.D. and Psy.D. programs similar until 3 rd year Third year- experience in therapeutic practice and assessment becomes the focus Third year- experience in therapeutic practice and assessment becomes the focus Fourth Year- clinical emphasis continues with internship assignments Fourth Year- clinical emphasis continues with internship assignments

5 5By: Farrah J. Cordero Models of Training in Clinical Psychology Professional Schools Professional Schools No affiliation with universities No affiliation with universities Autonomous w/ own financial and organizational frameworks Autonomous w/ own financial and organizational frameworks Faculty chiefly clinical in orientation Faculty chiefly clinical in orientation Employed only as part-time w/ major employment elsewhere Employed only as part-time w/ major employment elsewhere Emphasis is on clinical not research orientations Emphasis is on clinical not research orientations Accreditation by the APA nice but not necessary Accreditation by the APA nice but not necessary Award over ½ of the doctorates Award over ½ of the doctorates Admittance is higher compared to traditional university-based program Admittance is higher compared to traditional university-based program

6 6By: Farrah J. Cordero Models of Training in Clinical Psychology Clinical Scientist Model Clinical Scientist Model Empirically Oriented Clinicians feel clinical psychology is not well grounded in Science Empirically Oriented Clinicians feel clinical psychology is not well grounded in Science Research either has not been completed/ does not support the therapy techniques Research either has not been completed/ does not support the therapy techniques Resulted in the Academy of Psychological Clinical Science Resulted in the Academy of Psychological Clinical Science Focuses graduate training to produce Clinical Scientists Focuses graduate training to produce Clinical Scientists Persons who think and function as scientists in every respect & setting Persons who think and function as scientists in every respect & setting Academy affiliated with American Psychological Society (APS) Academy affiliated with American Psychological Society (APS) Over 50 member programs Over 50 member programs

7 7By: Farrah J. Cordero Clinical Scientist Model cont. Primary Goals Primary Goals Training geared to careers in clinical science research Training geared to careers in clinical science research Advancing full range of clinical science research & theory and integrating that w/other sciences 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. 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

8 8By: Farrah J. Cordero Models of Training in Clinical Psychology Combined Professional-Scientific Training Programs Combined Professional-Scientific Training Programs Combined Specialties (Counseling, Clinical, & School Psychology) Combined Specialties (Counseling, Clinical, & School Psychology) Assumption is: Assumption is: these specialties share common core areas of knowledge these specialties share common core areas of knowledge The practices of psychologists who graduate from these specialties are similar The practices of psychologists who graduate from these specialties are similar Curriculum focuses on core areas w/i psychology Curriculum focuses on core areas w/i psychology Exposes students to each subspecialty of Counseling, Clinical, and School Psychology Exposes students to each subspecialty of Counseling, Clinical, and School Psychology

9 9By: Farrah J. Cordero Models of Training in Clinical Psychology Graduate Programs: Past & Future Graduate Programs: Past & Future Mid-1960s shift from university-based academic jobs to jobs in private practice occurred Mid-1960s shift from university-based academic jobs to jobs in private practice occurred 1973 Vail Training Conference resulted in endorsements of Alternative Training Models 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 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 Possible Trends that May Effect the Training Models Some feel there may be oversupply of Practice-oriented Psychologists Some feel there may be oversupply of Practice-oriented Psychologists

10 10By: Farrah J. Cordero Graduate Programs: Past & Future cont. Possible Trends that May Affect the Training Models Possible Trends that May Affect the Training Models Some feel there may be oversupply of Practice-oriented Psychologists 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 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 There may be an Undersupply of Academic and Research- Oriented Clinical Psychologists

11 11By: Farrah J. Cordero Professional Regulation Attempted to Protect the Public Interest by Developing Standards of Competence Attempted to Protect the Public Interest by Developing Standards of Competence CERTIFICATION CERTIFICATION Weak Form of Regulation 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 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 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 Involves an Exam consisting of review of training and professional experience

12 12By: Farrah J. Cordero Professional Regulation LICENSING LICENSING Stronger Form of Legislation than Certification Stronger Form of Legislation than Certification Describes & Defines Title, Training Required, and Specific Activities that are Offered to Public Describes & Defines Title, Training Required, and Specific Activities that are Offered to Public APA developed a Model for the Licensure of Psychologists 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) 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 Includes an Exam Board examines the applicants educational background and sometimes requires several years of supervised experience beyond doctorate Board examines the applicants educational background and sometimes requires several years of supervised experience beyond doctorate Subsequent Continuing Education Requirements Subsequent Continuing Education Requirements

13 13By: Farrah J. Cordero

14 14By: Farrah J. Cordero Professional Regulation American Board of Professional Psychology (ABPP) American Board of Professional Psychology (ABPP) Offers Certification of Professional Competence in the following Fields: Offers Certification of Professional Competence in the following Fields: Behavioral, Clinical, Clinical Health, Clinical Neuropsycholgoy, Counseling, Family, Forensic, Group, Psychoanalysis, Rehabilitation, and School Psychology Behavioral, Clinical, Clinical Health, Clinical Neuropsycholgoy, Counseling, Family, Forensic, Group, Psychoanalysis, Rehabilitation, and School Psychology Candidates must have 5 years Postdoctoral Experience Candidates must have 5 years Postdoctoral Experience National Register National Register Type of Self-certification Type of Self-certification Include those who are Licensed/Certified in their own states Include those who are Licensed/Certified in their own states Individuals submit their name and Pay to be listed Individuals submit their name and Pay to be listed

15 15By: Farrah J. Cordero Private Practice Independence & Economics Independence & Economics Psychiatric Profession opposed, early on, clinicians from going into private practice Psychiatric Profession opposed, early on, clinicians from going into private practice Eventually won the right to practice Independently Eventually won the right to practice Independently Psychiatrists accepted the new legal status accorded to clinicians Psychiatrists accepted the new legal status accorded to clinicians At this time more Health Insurance Plans became Operative At this time more Health Insurance Plans became Operative People who normally could not afford therapy were now covered People who normally could not afford therapy were now covered

16 16By: Farrah J. Cordero Private Practice cont. Independence & Economics Independence & Economics Direct reimbursement of Psychologists by Insurance Companies without a physicians involvement became an issue Direct reimbursement of Psychologists by Insurance Companies without a physicians 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 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

17 17By: Farrah J. Cordero Private Practice The Health Care Revolution The Health Care Revolution Managed Health Care is an Integrated Approach to financing and delivery of health care 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 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 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

18 18By: Farrah J. Cordero Private Practice cont. The Health Care Revolution The Health Care Revolution New systems dictate new definitions of what constitutes psychological treatment 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 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 Treatment will be Brief and intermittent Therapist will serve as a catalyst for clients to make changes in their lives Therapist will serve as a catalyst for clients to make changes in their lives Most changes will occur outside of treatment Most changes will occur outside of treatment

19 19By: Farrah J. Cordero Private Practice cont. The Health Care Revolution The Health Care Revolution Treatment will not be terminated rather interrupted after clients progress evident Treatment will not be terminated rather interrupted after clients progress evident Community Resources will be used to a greater extent Community Resources will be used to a greater extent Most treatment delivered in a group format & will involve structured psychoeducational programs Most treatment delivered in a group format & will involve structured psychoeducational programs Masters-level practitioners and paraprofessionals much cheaper for same services Masters-level practitioners and paraprofessionals much cheaper for same services

20 20By: Farrah J. Cordero Private Practice cont. The Health Care Revolution The Health Care Revolution Scientist-practitioner/Clinical Scientist training offers some opportunities in managed healthcare Scientist-practitioner/Clinical Scientist training offers some opportunities in managed healthcare Have an empirical orientation that emphasizes the study of outcomes Have an empirical orientation that emphasizes the study of outcomes Have skills different from those of physicians 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 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 Know about the effects of the environment on behavior

21 21By: Farrah J. Cordero Prescription Privileges Controversial issue Controversial issue Decision will have far-reaching implications for the role definition of clinical psychologists, their training, and actual practice Decision will have far-reaching implications for the role definition of clinical psychologists, their training, and actual practice Pros Pros Enable psychologists to provide wider variety of treatments and treat wider range of clients 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 Potential increase in efficiency and cost-effectiveness of care for patients needing both therapy and meds Give psychologists a competitive advantage in health care Give psychologists a competitive advantage in health care

22 22By: Farrah J. Cordero Prescription Privileges cont. Cons Cons May lead to de-emphasis of psychological forms of treatment because meds are faster acting and more profitable than psychotherapy May lead to de-emphasis of psychological forms of treatment because meds are faster acting and more profitable than psychotherapy May damage clinical psychologys relationship with psychiatry and general medicine May damage clinical psychologys relationship with psychiatry and general medicine Conflicts resulting in lawsuits Conflicts resulting in lawsuits Increased Malpractice liability costs Increased Malpractice liability costs Financial burden of modifying training programs and licensing laws Financial burden of modifying training programs and licensing laws

23 23By: Farrah J. Cordero Culturally Sensitive Mental Health Services APA (2003) published guidelines on multicultural education, training, research, practice, and organizational change for psychologists 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 Make commitment to cultural awareness as well as knowledge of self & others as cultural beings Recognize the importance of multicultural sensitivity Recognize the importance of multicultural sensitivity Integrate multiculturalism & diversity into education and training Integrate multiculturalism & diversity into education and training Recognize importance of culture in research and clinical work Recognize importance of culture in research and clinical work

24 24By: Farrah J. Cordero Culturally Sensitive Mental Health Services cont. S. Sue (1998) has advocated that psychologists demonstrate cultural competence: S. Sue (1998) has advocated that psychologists demonstrate cultural competence: Scientific-mindedness: Clinicians must formulate and test hypothesis regarding status of clients 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 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 Culture-specific expertise: Understand their own culture and perspectives, have knowledge of the cultural groups with whom they work

25 25By: Farrah J. Cordero Ethical Standards Competence Competence Training must be represented accurately Training must be represented accurately Present themselves correctly/regard to training and all other aspects of competence 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 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 Be sensitive to treatment/assessment issues that could be influenced by pts gender, ethnicity, age, sexual orientation, religion, disability, or socioeconomic status

26 26By: Farrah J. Cordero Ethical Standards cont. Privacy & Confidentiality Privacy & Confidentiality Central to client-psychologist relationship Central to client-psychologist relationship Be clear and open about matters of confidentiality and the conditions under which it could be breached Be clear and open about matters of confidentiality and the conditions under which it could be breached 1976 Tarasoff Case 1976 Tarasoff Case Each state has different standards Each state has different standards

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

28 28By: Farrah J. Cordero


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