What are the advantages and disadvantages of various models of training for clinical psychologists? Why is a firm grounding in psychological science important for future clinical psychologists?
2. What obstacles face clinical psychologists who specialize in private practice?
3. How will managed care affect the practice of clinical psychology? What advantages might clinical psychologists have in a managed care environment?
4. What are the advantages and disadvantages of obtaining prescription privileges? How might this pursuit affect graduate training?
5. What technological innovations are likely to influence the practice of clinical psychology?
6. What important diversity and ethical issues guide the practice of clinical psychology?
1. Current Issues in Clinical
Psychology
[Emily S. Canada, RPm]
[College of Arts and Sciences]
[University of Cebu Main Campus]
2. Focus Questions
• What are the advantages and disadvantages of various
models of training for clinical psychologists? Why is a firm
grounding in psychological science important for future clinical
psychologists?
• 2. What obstacles face clinical psychologists who specialize in
private practice?
• 3. How will managed care affect the practice of clinical
psychology? What advantages might clinical psychologists
have in a managed care environment?
• 4. What are the advantages and disadvantages of obtaining
prescription privileges? How might this pursuit affect graduate
training?
• 5. What technological innovations are likely to influence the
practice of clinical psychology?
• 6. What important diversity and ethical issues guide the
3. MODELS OF TRAINING IN
CLINICALPSYCHOLOGY
The Scientist- Practitioner Model/Boulder Model
This model represents an attempt to “marry”
science and clinical practice, and it remains the
most popular training model for clinical
psychologists even to this day.
it is intended that the scientist-practitioner
model would help students of clinical psychology
“think” like a scientist in what-ever activities they
engaged in.
But the controversy of this model, no one
intended to have a clinician devote exactly 50%
of their time in clinical practice and 50% to
4. Boulder Model
• The Boulder model has been durable, but the
debate continues. The mood of professionalism
seems to grow every year. Increasingly, clinical
psychologists are split into two groups: those
interested primarily in clinical practice and those
interested primarily in research.
• The prospect of totally abandoning the model
worrisome to many as Meltzoff (1984).
To train a new strain of purely applied psychologists who will be obliged to accept on
faith what is handed down to them without being able to evaluate it or advance it, is
the certain pathway to mediocrity. Research training conveys a mode of thought. It
teaches how to be inquisitive and skeptical, how to think logically, how to formulate
hypotheses and to test them, how to gather data rather than opinion, how to analyze
those data and draw inferences from them, and how-to make a balanced
presentation of the findings. These are skills that help...professional psychologists to
rise above the technician level.
5. The Doctor of Psychology
(Psy.D.)Degree
• Emphasis on the development of clinical competence,
de-emphasis on research competence.
• Dissertation is about professional subject and not
research contribution.
• Increasing experience in therapeutic practice (3rd year
divergence)
• Differences between Psy.D. and Ph.D.
• Great Psy.D. acceptance rate
• Lower percent receive full financial assistance
• Lower percent of faculty with a cognitive-behavioral
orientation
• Lower percentage obtain internships at top-facilities
• Shorter period to complete degree (5.1 years).
6. Clinical Scientist Model
• Scientific clinical psychology is the only legitimate and
acceptable form of clinical psychology”(p. 76).
• “Psychological services should not be administered to
the public (except under strict experimental control) until
they have satisfied these four minimal criteria:
a) The exact nature of the service must be described
clearly.
b) The claimed benefits of the service must be stated
explicitly.
c) These claimed benefits must be validated scientifically.
d) Possible negative side effects that outweigh any
benefits must be ruled out empirically”
• The primary and overriding objectives of doctoral training
programs in clinical psychology must be to produce the
7. The Primary Goal is:
• Training: To foster the training of students for careers in
clinical science research, who skill-fully will produce and apply
scientific knowledge.
• Research and Theory: To advance the full range of clinical
science research and theory and their integration with other
relevant sciences.
• Resources and Opportunities: To foster the development of
and access to resources and opportunities for training,
research, funding, and careers in clinical science.
• Application: To foster the broad application of clinical science
to human problems in responsible and innovative ways.
• Dissemination: To foster the timely dissemination of clinical
science to policy-making groups, psychologists, and other
scientists, practitioners, and consumers
(http://acadpsychclinicalscience.org/index.php?page=mission)
.
8. Combined Professional-Scientific
Training Programs
• The curriculum in these combined training
programs focuses on core areas within
psychology and exposes students to each
subspecialty of counseling, clinical, and school
psychology.
• This training model assumes that (a) these
special ties share a number of core areas of
knowledge and
• The actual practices of psychologists who
graduate from each of these specialties are
quite similar (Beutler & Fisher, 1994; Beutler,
Givener,Mowder, Fisher, & Reeve, 2004)
9. Weakness of this model
• The combined training model emphasizes
breadth rather than depth of psychological
knowledge. However, this feature can also be
seen as a potential weakness of the model.
• Further, this model of training appears to be
better suited for the future practitioner than for
the future academician or clinical scientist
(Beutler & Fisher, 1994).
10. Graduate Programs: Past and
Future
• 1960’s: Shift from university based jobs to private
practice work.
• • Vail Training Conference (1973): Alternative training
models to meet the needs of future
• practitioners. Psy.D. degree and professional school
model arose from this conference.
• • As a result of the excessive number of applicants,
many graduate students have been unable
• to acquire an internship position (25%).
• • Curriculum will place an emphasis on empirically
supported psychological intervention and
• focal assessment.
11. PROFESSIONAL
REGULATION
• How is the public to know who is well trained
and who is not?
• What is the role of PRC?
• What is more sophisticated, reliable and
competent? Certificate or Licensure?
12. CERTIFICATION
• Certification is a relatively weak form of
regulation in most cases.
• Originally developed by state psychological
associations, it guarantees that people cannot
call themselves “psychologists” while offering
services to the public for a fee unless they have
been certified by a state board of examiners.
13. Licensing
• Licensing is a stronger form of legislation than
certification.
• It not only specifies the nature of the title
(“psychologist”) and training required for
licensure but it also usually defines what specific
professional activities may be offered to the
public for a fee
14. Licensing
• APA developed a model act for licensure of psychologists
• Applicants for licensure are required to take an exam (can be oral +
written)
• • May require supervised experience beyond doctorate
• Licensing boards are starting to become increasing picky about the
requirements and
• restrictions placed on those that qualify and those that can obtain
licensure.
• Some argue that both licensing and certification are invalid
measures of competence, others say that regulating licensing
measures will ensure competence.
• Challenges include establishment of a national standard, deciding
between oral or written exams and licensing over the internet.
15. Summary of Typical Requirements
for Licensure
Education
A masteral degree from an PAP-accredited program in professional
psychology (e.g., clinical) is required.
Experience
One to two years of supervised postdoctoral clinical experience is
required.
Examinations
A candidate for licensure must pass (i.e., score at or above a certain
threshold score) the Examination for Professional Practice in
Psychology (EPPP). In addition, some states and provinces require an
oral or essay examination.
Administrative Requirements
Additional requirements include citizenship or residency, age, evidence
of good moral character, and so on.
Specialties
Licensure to practice psychology is generic. However, psychologists
16. Psychological Association of the
Philippines (PAP)
• The PAP is the Accredited Integrated
Professional Organization (AIPO) for registered
psychometricians and psychologists of the
Professional Regulation Commission (PRC). It is
the oldest and largest professional organization
of psychologists in the country.
• The Psychological Association of the Philippines
(PAP), founded in 1962, is committed to
promoting excellence in psychology`s teaching,
research, and practice and its recognition as a
scientifically oriented discipline for human and
social development.
17. National Register
• The Register(http://www.nationalregister.org/) 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.
18. Private Practice
• Clinical Psychology moving in the direction of
policies, legislation and greater emphasis on
practice than on research.
• A fee for private-practice service is now the past,
and managed health care now dominates.
19. The Cost of Health Care
• Predicted that from 2009 to 2019 proportion of
GDP costs devoted to health care will rise by
19.6%.
• Managed Care: Profit driven corporate approach
to health care that attempts to contain costs by
controlling the length and frequency of service
utilization and restricting the types of services
provided
• Shift in control from practitioners to those that
pay the bills (employers)
20. Three managed care types:
• Health Maintenance Organization (HMO’s):
restricted number of providers and serves those
who enroll in the service plan at a fixed cost for
all services.
• Preferred Provider Organization (PPO’s): have
contracts with outside providers at a discounted
rate for membership and in exchange providers
get more referrals.
• Point of Service Plan (PPO’s): managed
members have more choices at their health care
choices but may more for non-managed features
(incorporates HMO and PPO features)
21. Two Models of Health Care
• Consumer-Directed Health Care Plan: Shift cost
and responsibility to consumer
• Performance Disease Management Models: Pay
for performance incentives to clinicians to
provide high-quality effective services (fewer
sessions).
• Self-help methods may increase—books,
pamphlets, handouts, computer/internet therapy
22. Prescription and Privileges
Background
• Argument that it will allow for autonomy of
clinical psychologists as health service providers
• Help with continuous care from one physician
• Argument of professional boundaries and
bridging the gap between psychology &
psychiatry.
23. Pro Arguments for Prescription
Privileges
• Enable practitioners to provide a wider variety of
treatments to a wider number of people.
• Increase in efficiency and cost-effective of care for
patients who need psychological treatment and
medication.
• Provide clinical psychologists an advantage in the
marketplace (e.g. over social workers)
• May be more qualified to consider
psychopharmacological treatment due to them spending
longer sessions with clients.
• Better able to offer combined treatment (psychosocial +
psychopharmacological).
24. Con Arguments for Prescription
Privileges
• De-emphasis on psychological forms of
treatment as medication is faster and brings
more money.
• May result in conflict between members of the
fields of psychology and psychiatry.
• May lead to more drug-company sponsored
research.
25. Implications for Training
• Technological Innovations Ad Hoc Task Force for
Psychopharmacology—three levels of competence and training.
• Level 1—Basic Pharmacology Training: knowledge of medication
and substances that may be addictive. Recommended: a course on
psychopharmacology.
• Level 2—Collaborative Practice: Psychopharmacology consultant
with knowledge as well as diagnostic assessment skills.
Recommended: coursework and practical exposure.
• Level 3—Prescription Privileges: Practice independently and
prescribe medication. Recommended: Intensive science based
coursework, 2 years of graduate training in psychopharmacology
and postdoctoral residency in psychopharmacology.
• Only Level 3 individuals are qualified to prescribe.
• Additional course requirements would make it longer to complete
graduate school; prescription privilege programs may thus only be
offered at the post-doctoral level.
26. Telehealth
• Delivery and oversight of health services using
telecommunication technologies (ex: websites,
email, videoconferencing).
• Increased accessibility to services, efficiency,
reducing stigma.
27. Ambulatory Assessment
• Involves assessing the emotions, behaviors and
cognitions of individuals as they are interacting
with their environment in real time.
• Requires very little retrospection of the client
(reflection).
• More ecologically valid (ex: tracking mood via
phone throughout the day).
• Multiple assessments on the same client are
possible; multiple forms of ambulatory
assessment focusing on different response
across domains can also be done.
28. Computer-Assisted Therapy
• Clients who don't have access to mental health
professionals for face-to-face time or
embarrassment may choose to use this method.
• If mental health services are accessible through
telephone, internet or videoconferencing it could
aid those that have lack of accessibility,
inconvenience or fear treatment.
• Electronic health records can be maintained and
clinicians can view clients Web-based
homework's.
29. Culturally Sensitive Mental
Health Services
• Given the plurality of U.S. culture, mental health
services need to serve ethnically diverse
populations.
• Clinical psychologists must demonstrate cultural
competence—knowledge and appreciation of
other cultural groups and the skills to deal with
other cultures.
• Scientific-mindedness
• Dynamic sizing; when to generalize vs. when to
individualize
• Culture specific expertise; have knowledge of
the groups that they work with
30. Ethical Standards
• 1953: Publication of the Ethical Standards of
Psychologists
• General principles of ethical standards:
• o Beneficence and non-maleficence (strive to
benefit others and do not harm)
• Fidelity and responsibility: professional and
scientific responsibility to society
• Integrity: strive to accurate, honest and truthful
• Justice: all people are entitled to access and to
benefit from knowledge generated by psychology
• Respect for people's rights and dignity: enact
safeguards and protection measures.
31. Specific ethical standards underlined under APA
membership are enforceable rules, the general principles
are not.
Rule 1: Competence
• Clinicians must only provide services within the
boundaries of their training.
• Clinicians should not provide treatment for
assessment procedures of which they have no
knowledge.
• Tool kits to ensure competence: performance
reviews, case presentation reviews, client
outcome data.
32. Privacy and Confidentiality
• Respect and protect confidentiality of their patients.
• Clinicians should be clear about confidentiality and the
conditions under which it can be broken.
• Tasaroff Case: A 1976 case in which California Supreme
Court deemed that therapist was remiss for not informing
all parties of the clients intention to harm his girlfriend.
• Being aware that confidentiality may need to be broken
in certain instances (e.g. child abuse, potential suicide or
murder).
• Jaffe vs. Redmond: 1996 Supreme Court case that
permits communication between licensed mental health
professionals and individual adult patients in
psychotherapy.
33. Human Relations
• Client-Welfare: The best interests of the client
and as such this condones relations of a sexual
nature, relationships, sexual harassment.
• Most common ethical dilemma for
psychologists—confidentiality (breach of
potential risk due to abuse or other reasons).
![Current Issues in Clinical
Psychology
[Emily S. Canada, RPm]
[College of Arts and Sciences]
[University of Cebu Main Campus]](https://image.slidesharecdn.com/irqhcnq4iit465mmwkdq-current-issues-in-clinical-psychology-new-ppt-220907085700-433ead1d/85/Current_Issues_in_Clinical_Psychology_new_ppt-pptx-1-320.jpg)
