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

By: Farrah J. Cordero 1

Current Issues in Current Issues in Clinical Clinical

PsychologyPsychology

Current Issues in Current Issues in Clinical Clinical

PsychologyPsychologyChapter 3Chapter 3

2By: Farrah J. Cordero


Models of Training in Models of Training in Clinical PsychologyClinical Psychology

Models of Training in Models of Training in Clinical PsychologyClinical Psychology

The Scientist-PractitionerThe Scientist-Practitioner The Training Model/ AKA The Training Model/ AKA Boulder Boulder

ModelModel Integrates Science and Clinical PracticeIntegrates Science and Clinical Practice Idea: Practitioners who can produce as Idea: Practitioners who can produce as

well as consume researchwell as consume research Debate: Psychologists split in two Debate: Psychologists split in two

groupsgroups Clinical Practice & ResearchClinical Practice & Research Resulted in the Psy.D. degreeResulted in the Psy.D. degree


Models of Training inModels of Training inClinical PsychologyClinical Psychology


The Doctor of Psychology (Psy.D.) Degree The Doctor of Psychology (Psy.D.) Degree ModelModel Emphasis on Development of Clinical SkillsEmphasis on Development of Clinical Skills De-emphasis on ResearchDe-emphasis on Research Masters Thesis Not RequiredMasters Thesis Not Required Dissertation- a Report on a Professional Topic Dissertation- a Report on a Professional Topic

instead of an Original Research Ideainstead of an Original Research Idea Ph.D. and Psy.D. programs similar until 3Ph.D. and Psy.D. programs similar until 3rdrd year year

Third year- experience in therapeutic practice and Third year- experience in therapeutic practice and assessment becomes the focusassessment becomes the focus

Fourth Year- clinical emphasis continues with internship Fourth Year- clinical emphasis continues with internship assignmentsassignments




Professional SchoolsProfessional Schools No affiliation with universitiesNo affiliation with universities Autonomous w/ own financial and organizational Autonomous w/ own financial and organizational

frameworksframeworks Faculty chiefly clinical in orientationFaculty chiefly clinical in orientation

Employed only as part-time w/ major employment Employed only as part-time w/ major employment elsewhereelsewhere

Emphasis is on clinical not research orientationsEmphasis is on clinical not research orientations Accreditation by the APA nice but not necessaryAccreditation by the APA nice but not necessary Award over ½ of the doctoratesAward over ½ of the doctorates

Admittance is higher compared to traditional Admittance is higher compared to traditional university-based programuniversity-based program




Clinical Scientist ModelClinical Scientist Model Empirically Oriented Clinicians feel clinical Empirically Oriented Clinicians feel clinical

psychology is not well grounded in Sciencepsychology is not well grounded in Science Research either has not been completed/ does not Research either has not been completed/ does not

support the therapy techniquessupport the therapy techniques Resulted in the Academy of Psychological Resulted in the Academy of Psychological

Clinical ScienceClinical Science Focuses graduate training to produce “Clinical Focuses graduate training to produce “Clinical

Scientists”Scientists” Persons who think and function as scientists in every Persons who think and function as scientists in every

respect & settingrespect & setting Academy affiliated with American Psychological Academy affiliated with American Psychological

Society (APS)Society (APS) Over 50 member programsOver 50 member programs


Clinical Scientist Model Clinical Scientist Model cont.cont.

Clinical Scientist Model Clinical Scientist Model cont.cont.

Primary GoalsPrimary Goals Training geared to Training geared to

careers in clinical careers in clinical science researchscience research

Advancing full range of Advancing full range of clinical science clinical science research & theory and research & theory and integrating that integrating that w/other sciencesw/other sciences

Foster timely Foster timely dissemination of dissemination of clinical science to clinical science to policy makers, policy makers, psychologists, psychologists, consumers, etc.consumers, etc.

Development of and Development of and access to resources access to resources & opportunities for & opportunities for training, research, training, research, funding, & Clinical funding, & Clinical science careersscience careers

Application of Application of clinical science to clinical science to human problemshuman problems




Combined Professional-Scientific Training Combined Professional-Scientific Training ProgramsPrograms Combined Specialties (Counseling, Clinical, & Combined Specialties (Counseling, Clinical, &

School Psychology)School Psychology) Assumption is: Assumption is:

these specialties share common core areas of these specialties share common core areas of knowledgeknowledge

The practices of psychologists who graduate from The practices of psychologists who graduate from these specialties are similarthese specialties are similar

Curriculum focuses on core areas w/i Curriculum focuses on core areas w/i psychology psychology

Exposes students to each subspecialty of Exposes students to each subspecialty of Counseling, Clinical, and School Psychology Counseling, Clinical, and School Psychology




Graduate Programs: Past & FutureGraduate Programs: Past & Future Mid-1960’s shift from university-based academic Mid-1960’s shift from university-based academic

jobs to jobs in private practice occurredjobs to jobs in private practice occurred 1973 Vail Training Conference resulted in 1973 Vail Training Conference resulted in

endorsements of Alternative Training Modelsendorsements of Alternative Training Models Psy.D. degree and Professional School Model of Psy.D. degree and Professional School Model of

Training traced back to positions held by those Training traced back to positions held by those attending the Vail Conferenceattending the Vail Conference

Possible Trends that May Effect the Training Possible Trends that May Effect the Training ModelsModels

Some feel there may be oversupply of Practice-Some feel there may be oversupply of Practice-oriented Psychologistsoriented Psychologists


Graduate Programs: Past & Graduate Programs: Past & FutureFuture contcont..

Graduate Programs: Past & Graduate Programs: Past & FutureFuture contcont..

Possible Trends that May Affect the Possible Trends that May Affect the Training ModelsTraining Models Some feel there may be oversupply of Some feel there may be oversupply of

Practice-oriented PsychologistsPractice-oriented Psychologists Managed Health Care likely to affect the Managed Health Care likely to affect the

demand for Clinical Psychologists in the demand for Clinical Psychologists in the future as well as the Curriculum in Training future as well as the Curriculum in Training ProgramsPrograms

There may be an Undersupply of Academic There may be an Undersupply of Academic and Research-Oriented Clinical and Research-Oriented Clinical PsychologistsPsychologists


Professional RegulationProfessional RegulationProfessional RegulationProfessional Regulation Attempted to Protect the Public Interest Attempted to Protect the Public Interest

by Developing Standards of Competenceby Developing Standards of Competence CERTIFICATIONCERTIFICATION

Weak Form of RegulationWeak Form of Regulation Does not prevent persons from offering counseling as Does not prevent persons from offering counseling as

long as “Psychologist” title is not used nor term used to long as “Psychologist” title is not used nor term used to describe services describe services

Can not call oneself Psychologists unless they Can not call oneself Psychologists unless they have been certified by a state board of examinershave been certified by a state board of examiners

Involves an Exam consisting of review of training Involves an Exam consisting of review of training and professional experienceand professional experience


Professional RegulationProfessional RegulationProfessional RegulationProfessional Regulation LICENSINGLICENSING

Stronger Form of Legislation than CertificationStronger Form of Legislation than Certification Describes & Defines Title , Training Required, and Describes & Defines Title , Training Required, and

Specific Activities that are Offered to Public Specific Activities that are Offered to Public APA developed a Model for the Licensure of APA developed a Model for the Licensure of

PsychologistsPsychologists Licensing Laws vary from State to State/Province to Licensing Laws vary from State to State/Province to

Province but there are several commonalities (pg. 65, Province but there are several commonalities (pg. 65, Table 3-1 Summary of Requirements)Table 3-1 Summary of Requirements)

Includes an ExamIncludes an Exam Board examines the applicant’s educational Board examines the applicant’s educational

background and sometimes requires several years background and sometimes requires several years of supervised experience beyond doctorateof supervised experience beyond doctorate

Subsequent Continuing Education RequirementsSubsequent Continuing Education Requirements



Professional RegulationProfessional RegulationProfessional RegulationProfessional Regulation American Board of Professional Psychology American Board of Professional Psychology

(ABPP)(ABPP) Offers Certification of Professional Competence in the Offers Certification of Professional Competence in the

following Fields:following Fields: Behavioral, Clinical, Clinical Health, Clinical Behavioral, Clinical, Clinical Health, Clinical

Neuropsycholgoy, Counseling, Family, Forensic, Neuropsycholgoy, Counseling, Family, Forensic, Group, Psychoanalysis, Rehabilitation, and School Group, Psychoanalysis, Rehabilitation, and School PsychologyPsychology

Candidates must have 5 years Postdoctoral ExperienceCandidates must have 5 years Postdoctoral Experience National RegisterNational Register

Type of Self-certificationType of Self-certification Include those who are Licensed/Certified in their own Include those who are Licensed/Certified in their own

statesstates Individuals submit their name and Pay to be listedIndividuals submit their name and Pay to be listed


Private PracticePrivate PracticePrivate PracticePrivate Practice Independence & EconomicsIndependence & Economics

Psychiatric Profession opposed, early on, Psychiatric Profession opposed, early on, clinicians from going into private practiceclinicians from going into private practice

Eventually won the right to practice Eventually won the right to practice IndependentlyIndependently

Psychiatrists accepted the new legal status Psychiatrists accepted the new legal status accorded to cliniciansaccorded to clinicians

At this time more Health Insurance Plans At this time more Health Insurance Plans became Operativebecame Operative People who normally could not afford therapy People who normally could not afford therapy

were now coveredwere now covered


Private Practice Private Practice cont.cont.Private Practice Private Practice cont.cont.

Independence & EconomicsIndependence & Economics Direct reimbursement of Psychologists by Direct reimbursement of Psychologists by

Insurance Companies without a physician’s Insurance Companies without a physician’s involvement became an issueinvolvement became an issue

As a result of a Antitrust Action brought As a result of a Antitrust Action brought against a health insurance company the against a health insurance company the victorious outcome signified Psychologists as victorious outcome signified Psychologists as a fully independent profession able to a fully independent profession able to compete in the marketplace alongside compete in the marketplace alongside PsychiatryPsychiatry


Private PracticePrivate PracticePrivate PracticePrivate Practice

The Health Care RevolutionThe Health Care Revolution ““Managed Health Care is an Managed Health Care is an

Integrated Approach to financing and Integrated Approach to financing and delivery of health care”delivery of health care”

By end of 1997, 85% of Americans By end of 1997, 85% of Americans belonged to some kind of managed belonged to some kind of managed health carehealth care

Several Models of Managed Care, all Several Models of Managed Care, all attempt to control costs and reduce attempt to control costs and reduce use of services while at the same time use of services while at the same time ensuring their quality…i.e. HMO/PPOensuring their quality…i.e. HMO/PPO


Private Practice Private Practice cont.cont.Private Practice Private Practice cont.cont. The Health Care RevolutionThe Health Care Revolution

New systems dictate new definitions of New systems dictate new definitions of what constitutes psychological what constitutes psychological treatmenttreatment Clients will be seen for a fewer number of Clients will be seen for a fewer number of

sessions/ & greater number of clients will be sessions/ & greater number of clients will be seen per yearseen per year

Treatment will be Brief and intermittentTreatment will be Brief and intermittent Therapist will serve as a catalyst for clients Therapist will serve as a catalyst for clients

to make changes in their livesto make changes in their lives Most changes will occur outside of treatmentMost changes will occur outside of treatment



The Health Care RevolutionThe Health Care Revolution Treatment will not be terminated rather Treatment will not be terminated rather

interrupted after client’s progress interrupted after client’s progress evidentevident

Community Resources will be used to a Community Resources will be used to a greater extentgreater extent

Most treatment delivered in a group Most treatment delivered in a group format & will involve structured format & will involve structured psychoeducational programspsychoeducational programs

Master’s-level practitioners and Master’s-level practitioners and paraprofessionals much cheaper for paraprofessionals much cheaper for same servicessame services



The Health Care RevolutionThe Health Care Revolution Scientist-practitioner/Clinical Scientist Scientist-practitioner/Clinical Scientist

training offers some opportunities in training offers some opportunities in managed healthcaremanaged healthcare Have an empirical orientation that Have an empirical orientation that

emphasizes the study of outcomesemphasizes the study of outcomes Have skills different from those of physiciansHave skills different from those of physicians Can bring an emphasis on preventing mental Can bring an emphasis on preventing mental

health problems in individuals and focus on health problems in individuals and focus on wellness rather than sicknesswellness rather than sickness

Know about the effects of the environment Know about the effects of the environment on behavioron behavior


Prescription PrivilegesPrescription PrivilegesPrescription PrivilegesPrescription Privileges Controversial issueControversial issue Decision will have far-reaching implications for Decision will have far-reaching implications for

the role definition of clinical psychologists, the role definition of clinical psychologists, their training, and actual practicetheir training, and actual practice

ProsPros Enable psychologists to provide wider variety of Enable psychologists to provide wider variety of

treatments and treat wider range of clients treatments and treat wider range of clients Potential increase in efficiency and cost-Potential increase in efficiency and cost-

effectiveness of care for patients needing both effectiveness of care for patients needing both therapy and medstherapy and meds

Give psychologists a competitive advantage in Give psychologists a competitive advantage in health carehealth care


Prescription PrivilegesPrescription Privileges cont.cont.

Prescription PrivilegesPrescription Privileges cont.cont.

ConsCons May lead to de-emphasis of “psychological” May lead to de-emphasis of “psychological”

forms of treatment because meds are faster forms of treatment because meds are faster acting and more profitable than psychotherapyacting and more profitable than psychotherapy

May damage clinical psychology’s relationship May damage clinical psychology’s relationship with psychiatry and general medicinewith psychiatry and general medicine Conflicts resulting in lawsuitsConflicts resulting in lawsuits

Increased Malpractice liability costsIncreased Malpractice liability costs Financial burden of modifying training Financial burden of modifying training

programs and licensing lawsprograms and licensing laws


Culturally Sensitive Culturally Sensitive Mental Health ServicesMental Health Services

Culturally Sensitive Culturally Sensitive Mental Health ServicesMental Health Services

APA (2003) published guidelines on APA (2003) published guidelines on multicultural education, training, research, multicultural education, training, research, practice, and organizational change for practice, and organizational change for psychologistspsychologists Make commitment to cultural awareness as well Make commitment to cultural awareness as well

as knowledge of self & others as cultural beingsas knowledge of self & others as cultural beings Recognize the importance of multicultural Recognize the importance of multicultural

sensitivitysensitivity Integrate multiculturalism & diversity into Integrate multiculturalism & diversity into

education and trainingeducation and training Recognize importance of culture in research and Recognize importance of culture in research and

clinical workclinical work


Culturally Sensitive Culturally Sensitive Mental Health ServicesMental Health Services cont. cont.

Culturally Sensitive Culturally Sensitive Mental Health ServicesMental Health Services cont. cont.

S. Sue (1998) has advocated that S. Sue (1998) has advocated that psychologists demonstrate cultural psychologists demonstrate cultural competence:competence: Scientific-mindedness: Clinicians must formulate Scientific-mindedness: Clinicians must formulate

and test hypothesis regarding status of clientsand test hypothesis regarding status of clients Dynamic sizing: Must be skilled in knowing Dynamic sizing: Must be skilled in knowing

“when to generalize and be inclusive and when “when to generalize and be inclusive and when to individualize and be exclusive”to individualize and be exclusive”

Culture-specific expertise: Understand their Culture-specific expertise: Understand their own culture and perspectives, have knowledge own culture and perspectives, have knowledge of the cultural groups with whom they workof the cultural groups with whom they work


Ethical StandardsEthical StandardsEthical StandardsEthical Standards CompetenceCompetence

Training must be represented accuratelyTraining must be represented accurately Present themselves correctly/regard to Present themselves correctly/regard to

training and all other aspects of competencetraining and all other aspects of competence Should not attempt treatment/assessment Should not attempt treatment/assessment

procedures for which you lack specific procedures for which you lack specific training/supervised experiencetraining/supervised experience

Be sensitive to treatment/assessment issues Be sensitive to treatment/assessment issues that could be influenced by pts’ gender, that could be influenced by pts’ gender, ethnicity, age, sexual orientation, religion, ethnicity, age, sexual orientation, religion, disability, or socioeconomic statusdisability, or socioeconomic status


Ethical StandardsEthical Standards cont. cont.Ethical StandardsEthical Standards cont. cont. Privacy & ConfidentialityPrivacy & Confidentiality

Central to client-psychologist Central to client-psychologist relationshiprelationship

Be clear and open about matters of Be clear and open about matters of confidentiality and the conditions under confidentiality and the conditions under which it could be breachedwhich it could be breached

1976 Tarasoff Case1976 Tarasoff Case Each state has different standardsEach state has different standards


Ethical StandardsEthical Standards cont. cont.Ethical StandardsEthical Standards cont. cont. Human Relations/ Client WelfareHuman Relations/ Client Welfare

Sexual activities, Employing a client, Sexual activities, Employing a client, selling a product to a client, or even selling a product to a client, or even becoming friends with a client after becoming friends with a client after termination of therapy can lead to termination of therapy can lead to exploitation of and harm to clientexploitation of and harm to client


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

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