Presentation on theme: "The Future of Clinical Training in Psychology: How Technology Matters Steven R. Thorp, Ph.D."— Presentation transcript:
The Future of Clinical Training in Psychology: How Technology Matters Steven R. Thorp, Ph.D.
Aims of Presentation Discuss how technology is shaping psychological services so that clinical training can provide relevant knowledge and skills Focus of presentation is on assessment and treatment issues that can be discussed in supervision settings
Context Clinical trainees live in a multimedia world, with many competing demands for attention Static lectures and supervision will miss opportunities provided by new technologies Clinical training should include discussions of technology and utilize the technology to enhance training
Possibilities for Enhanced Clinical Training Interactive Webinars and Live Meetings (at a distance) In slide presentations to students, true integration of diagrams and charts, measures, videos, and websites in discussions of important clinical issues (e.g., skills training, suicide assessment, gifts from clients, aggressive clients, etc.) Portable video recording and viewing of psychotherapy sessions for optimal supervision Supervision topics may be less relevant by the next session: Bug in the ear and bug in the eye techniques allow for immediate feedback
Telepsychology Telepsychology refers to psychological services provided using communication technology Examples: Conducting assessments or providing psychoeducation or psychotherapy skills by telephone, recording devices, video conferencing, interactive monitoring equipment, personal data assistants, or computers Provides increased access to care
Videoconferencing Psychotherapy 1 1 Backhaus, Agha, Maglione, Repp, Ross, Zuest, Rice-Thorp, Lohr, & Thorp (in press) Systematic review found 65 articles on videoconferencing psychotherapy (VCP) VCP is feasible, has been used in a variety of therapeutic formats and with diverse populations, has good user satisfaction, and has similar clinical outcomes to traditional face-to-face psychotherapy
VCP Grants Two studies comparing modalities of one-on- one psychotherapies for PTSD (in person vs. videoconferencing) –143 Veterans received prolonged exposure therapy (Department of Defense; Thorp, PI) –208 Veterans received cognitive processing therapy (VA; Thorp and Agha, Co-PIs) Are outcomes as good? Is satisfaction as good for clients and therapists? Is therapeutic alliance as good?
Locations Therapist Site (Mission Valley) Remote Site (La Jolla)
Two Telemedicine Grants
Lessons Learned About Videoconferencing Psychotherapy (So Far) 1 1 Thorp, Fidler, Moreno, Floto, & Agha (in press).
Monitoring and Equipment Using digital recorders and video players and training in their use Cameras and digital video recording Paperwork and fax machines Thorp et al. (in press).
Other Logistical Issues Visual artifacts: Frozen image, ghost images, tracer images, poor resolution (especially with regard to facial features); Lighting and background Audio: Delay, echo, or mechanical sounds Sitting close (cameras) and eye contact Movement off screen (heavy chairs help) Dropped calls Thorp et al. (in press).
Potential Pros and Cons of VCP Potential Pros: At a distance from contagious diseases At a distance from intimidating clients Easier to stop sessions on time Implied authority of being on TV Potential Cons: Harder to read emotions (e.g., sniffling due to sadness or cold symptoms) Cant see all of client (e.g., fidgeting hands; wheelchair) Cannot touch (e.g., shake hands) or smell clients or offer them a tissue Thorp et al. (in press).
Satisfaction Some therapists and clients had difficulty with the audio delays and video artifacts Several therapists and clients reported that they were surprised how quickly they became comfortable with VCP Some therapists and clients reported preferring VCP to in-person therapy Thorp et al. (in press).
VCP Grants Summary These projects test a newer technology to demonstrate whether it can improve access to care for veterans Although the technology holds promise, there are several issues to consider before beginning treatment in this modality
Psychological Services by Computer: Assessments Examples: Self-reports, SCID, MMPI, neuropsychological batteries Eliminates data entry, administration errors (e.g., in timing or remembering rules), reduces data transfer errors, automated scoring of scales (and subscales), ease of visual displays for clients and trainees, ease of transfer for statistical analyses
Psychological Services by Computer: Interventions: Utility Joseph Weizenbaum and ELIZA Some have praised computers as therapeutic, as they have good memories and can be nonthreatening, patient, and consistent Computers have since been used for counseling, hypnosis, biofeedback, psychoeducation, and it has been called the perfect marriage for some aspects of cognitive and behavioral treatments (e.g., teaching common errors in thinking) Will never replace human interactions, but, like self- help books, can augment the treatments we provide
Psychological Services by Computer: Interventions: Examples Cognitive Skills Training (e.g., learning, memory, reaction time, discrimination tasks, switching tasks) Training in Cognitive Restructuring and Behavioral Activation Attention Training Virtual Reality and Therapeutic Video Games Online Chat Therapy
Psychological Services by Smart Phone Applications Portable: Can be used by active duty military in the field; emergency personnel; clients who have limited mobility or who are in institutions far from specialists; actigraphy Example: PTSD Coach 1: Information on PTSD and treatments; Tools for screening and tracking symptoms; Convenient, easy-to-use skills to help manage symptoms; Direct links to support and help 1 Created by the VA's National Center for PTSD and the DoDs National Center for Telehealth and Technology.
PTSD Coach Screenshots
and Social Media is used increasingly in primary care settings for appointment management and dialogue: Potentially useful form of communication in psychological treatment Social Media (Facebook, MySpace, Twitter) offer good opportunities for psychoeducation and behavioral activation for clients Both require precise clarification about therapist availability and confidentiality
Issues to Consider VHA Telepsychology Workgroup 1 requested that 11 issues be addressed by the APA/ASPPB/APAIT Telepsychology Task Force Guidelines: Client Safety Home-Based Telepsychology Services Information Security Jurisdictional Issues Third Party Reimbursement Appropriate Clients Therapeutic Relationship Cost-Effectiveness Clinical Outcomes Ethical Principles Training and Licensure Requirements 1 Thorp (Chair), Acierno, Morland, Smith, & Tuerk (2011)
Older Adults are the Future Aging population and some aging- specific issues (e.g., comfort with technology, vision and hearing difficulties, limitations to mobility and transportation) suggest importance of research Some small studies have suggested that using remote technologies has worked well for conducting assessments, treatments, and care management with older adults
Discussion Many different modalities for services, but increasingly false dichotomies between computers, smart phones, videoconferencing, etc.: These functions are becoming truly integrated Many of these technologies will augment traditional services rather than replace them Excellent opportunities to use technology to optimize training Many issues to consider when providing technology to students for psychological services, but there are many helpful resources (articles, books, Internet)