PSY 244 CLINICAL PSYCHOLOGY-I

BAHAR BAŞTUĞAssist. Prof. Dr.

Lecture PreviewTrends in Society

Research Issues

Practice Issues

Reaching Beyond Mental Health in Contemporary Clinical Psychology

Training Issues

Where Is Clinical Psychology Going and Should I Go with It?

has changed rapidly and continues to change. This change has paralled with changes in society. Because of the recent advances in science and technology, clinical psychology has developed.

oWhere is clinical psychology going? oWhat is its future?oWhat are its current and future topics?

Health care and health care reform are the best examples of a current topic.

Someone who wanted to see a clinical psychologist for psychotherapy could choose to be treated by any licensed psychologist in his or her country. The psychologist would conduct as many sessions as necessary to best treat the patient, using whatever theoretical orientation(s) and techniques.

In more recent years, this situation has changed due to mental health reform. The patient contacts insurance company to determine which therapists in that area are part of the psychologist.

The insurance company allows a specific number of sessions. The number of season is limited 3 to 6. Additional sessions or other treatment options (e.g., inpatient care, group psychotherapy, family psychotherapy) must be approved by the insurance company.

These changes impact all major areas such as research, training, and practice.

Since most companies will not approve treatment conducted by trainees (interns), many hospitals and clinics cannot continue to train psychology trainees.

Trends in Society Clinical psychology must change and adapt to a changing world.

It must respond to changes within the field as new research discoveries and clinical practice strategies emerge.

Trends in Society

Changes in the FamilyMulticultural and Diversity IssuesAdvances in Science, Technology, and

MedicineGender Shifts in Professions

Changes in the Family

The family has changed in recent years. The traditional nucleous family exists no longer. About 50% of marriages end in divorce. About 55% of people live together prior to marriage.

Families include adopted or “test tube” children, children and parents of mixed ethnicity, race, and religion, gay and lesbian parents, single parents, unmarried parents, and single mothers.

Lezbiyen çiftin velayet davası AİHM'de

Avrupa İnsan Hakları Mahkemesi (AİHM), 22 yıldır birlikte yaşayan lezbiyen Fransız çiftin, çocuk velayeti konusunda yaptıkları ortak başvuruyu görüştü.

Multicultural and Diversity Issues

The numbers of ethnic minorities and immigrants increase. Increasing attention and interest have been focused on the role of multicultural and diversity issues in all aspects of society. Psychologists have gained insight into the role of culture and diversity in the development of behavior and behavioral problems.

Multicultural and Diversity IssuesSocial context and culture have powerful influences on behavior. The understanding of culture is critical to the understanding of psychological and physical symptoms as well as in developing treatment interventions. These syndroms tend to be culture related:Conversion disorder & postpartum psychosisKoro, amok, latah Voodoo and Couvade syndrome.

Multicultural and Diversity IssuesDisorders appear universally among all cultures, but they manifest differently depending on the specific culture. In SCH, American and industrialized Western people experience auditory hallucinations, but Latin American and African people experience visual hallucinations .

The APA has warned psychologists to “become familiar with different beliefs and practices and respect them”.

Advances in Science, Technology, and Medicine

Recent advances and discoveries in science, technology, and medicine have impacted clinical psychology. They reinforces that biology is at the root of most human behavior.

Prozac to treat depr, efforts to find the “fat gene”, and Ritalin to treat ADHD are examples about how scientific advances influence attitudes on mind-body relationships.

New trend of treatment of obesity is to discover the fat gene, ignoring the role of psychosocial factors. However, research associated with the Human Genome Project continues to support the biopsychosocial perspective in obesity treatment.

Ritalin for ADHD provides another example of the impact of scientific advances. Many parents and teachers show more interest in using Ritalin to control the symptoms than in using psychosocial interventions. Research on ADHD supports the biopsychosocial perspective.

Advances in Science, Technology, and Medicine

Technological advances (e.g., computer technology, fax machines, cellular phones, video, electronic mail, and virtual reality) have an impact on clinical psychology.

Maintaining confidentiality when using computers to be careful for patient information is important. Potential access to computer files and patient information are ethical issues.The use of the Internet and the telephone to conduct therapy or psychological cons is controversial. Some accept it, others state that it would be unethical. Some say that therapy via internet or telephone might have advantages for people who are in remote locations.

Virtual reality in exposure

has also been used to treat anxiety, especially fears and phobias.Therapists can use virtual exposure with their patients to cope better with phobias such as airplane, driving, or spider phobias.

Virtual reality in exposure

MoneyAs a result of wars and economic crisis, attempts to balance the financial policies have resulted in cuts in many programs affecting clinical psychology.

Money or the lack of money is an important issue concerning research, practice, and training.

Gender Shifts in ProfessionsThe percentage of female clinical psychologists has more than doubled between 1960 and 2003.

More women in the field adds new perspective, awareness, and approach. Professions and services are enriched when people of different gender, ethnicity, and religion enter the discipline. It allows more choice for those seeking psychological services and role models for students.

Research Issues

More complicated research designs and

questions are being applied today. These

research questions tend to look for

interactions rather than main effects, under

which conditions, with which patients,

treated by which therapists, and using which

techniques will interventions work best.

Research Issues

In addition to traditional methods, qualitative, descriptive, and narrative approaches have been used to answer research questions.Investigating clinical rather than simply statistical significance has been advanced. The use of effect size and meta-analysis techniques, statistical analysis by computer technology has increased the utility of research methodologies and data analysis approaches. SPSS, AMOS and LISRELL.

Research Issues

Significant contemporary research problems of society are homelessness, violence, racism, terrorism, and the role of psychology and behavior in diseases such as AIDS and obesity.

Practice Issues Managed Health Care and Health-Care ReformPhysicians used to treat patients and insurance company used to pay for whatever the doctors ordered. Lacking medical degrees, clinical psychologists could not be payed back by insurance companies. In the 1970s, «freedom-of-choice” laws passed and allowed that psychologists were available for medical insurance.

While physicians argued that only psychiatrists should treat patients in psychotherapy, psychologists argued that a mental health professional did not need to be a physician in order to conduct psychotherapy.

After «freedom-of-choice” law, insurance companies pay back psychologists. Psychologists could offer various types of psychotherapy. Insurance would pay back 50 to 80% of the fees charged by the psychologist, and patients paid the remaining part.

These «fee-for-service» insurance arrangements began to change during the 1980s. Health care costs rose.

According to fixed and predetermined fee, patients were categorized into diagnosis-related groups, and the costs were calculated based on the average cost per patient for a given diagnosis. A hospital would receive a fixed fee for treating a patient with a given diagnosis. If the hospital needed more time or money to treat the patient, monies would not be available for the additional services.

Many psychologists are concerned about the growing use of capitation methods. In a capitation program, the insurance company will pay a set fee for the treatment of a given patient no matter what treatment or how many sessions are required.

Psychologists and other mental health professionals are unhappy with managed health care:

1. All professional decisions must be approved by the insurance company.

2. Patient confidentiality must be broken. Details about the patient must be disclosed by the company.

3. Psychologists and patients often feel that too few sessions are approved by the company.

4. Many psychologists resent having someone tell them how they should treat their patients. A company might urge the psychologist to have the patient enter group rather than individual therapy to decrease costs.

Prescription PrivilegesHistorically, psychiatrists have been the only mental health professionals legally allowed to prescribe medication.

Although many psychologists conduct research on the neurobiology and psychopharmacology, and graduate programs offer psychopharmacology courses, psychologists have obtained legal permission to prescribe medications only in Guam, New Mexico, and Louisiana.

Prescription Privileges

The American Psychiatric Association are opposed to allowing psychologists the privilege of prescribing medication. Even many psychologists are opposed to having psychologists prescribe medication for their patients. But, the majority of clinical psychologists support prescription privileges.

Prescription Privileges

The APA has outlined a curriculum for psychologists who are interested in being trained to prescribe medication. The program includes basic psychopharmacology education and prescription privilege.

Prescription PrivilegesBy 1998, legislation for psychology prescription privileges was introduced in six states including California, Florida, Hawaii, Louisiana, Missouri, and Tennessee. In 2001, New Mexico became the first state to allow psychologists prescription privileges. Louisiana became the second state to award these privileges to psychologists in 2004.

Medical Staff Privileges

Historically, only physicians were allowed to treat patients independently in a hospital setting and serve on the medical staff of a hospital.

Medical staff privileges allowed a physician to admit and discharge patients and organize or manage the treatment plan of patients while hospitalized.

Medical Staff Privileges

In 1978, legislation was passed allowing

psychologists to be able to obtain medical staff

privileges independently in California. Since

that time, many states in USA have enacted

similar legislation.

Private PracticeThe number of clinical psychologists choose to work in full-time or part-time in solo or group private practice.Managed health care has made it difficult to develop and maintain an independent practice. The companies have looked to master’s-degree trained counselors as a lower cost alternative to clinical psychologists. The companies find it more cost effective to work with large centers rather than solo private practices. Solo private practice might no longer exist within the next years.

Specialization

The need for specialization has become apparent. A general clinical psychologist is to have limitations. Specialization has resulted in further certification requirements.

Empirically Supported Treatments

Historically psychologists could evaluate and treat each patient as they saw fit. But, changes in health care have forced mental health professionals to examine effective treatment outcome and client satisfaction, and have resulted in efforts to use empirically supported treatments.

Empirically Supported TreatmentsEmpirically supported treatment approaches have been developed for depr, anx, OCD, bulimia nervosa, and conduct disorder. Some professionals state: «because individuals are unique and have different personalities, symptoms, and coping resources, it is impossible to fit the same treatment approach to every patient based on empirical research support». Others approve empirically supported treatments.

Evidence-based practice

This discussion has resulted in evidence-based practice. Evidence-based practices utilize the findings of high-quality research. Evidence-based practices use the best that research has to offer with realities of professional practice with actual diverse client populations. It might be expected that evidence –based practice will increase in the future.

Reaching Beyond Mental Health in Contemporary Clinical Psychology

Psychology is considered not only an independent mental health discipline but also an independent general health care discipline.

APA agreed the motto: “health, education, and human

welfare”

Training Issues

Training models include the scientist-practitioner, or Boulder model; the scholar-practitioner, or Vail model; the PhD or the PsyD degree programs; and the university or the free standing professional school models.

Which training models will survive and which will not have important questions for the future.

Many psychologists are concerned that professional standards have decreased with the professional schools. Many free standing professional schools are unaccredited by the APA.

New discoveries, specializations, and the demands of society influence training. Graduate and postgraduate training programs may need to provide training in psychopharmacology. Focus on violence, ethnic diversity, technological advances, and cost-effective treatment influence the training.

New trends in training are necessary postdoctoral training and new joint degree programs.

Joint degree programs combine psychology training with other fields, such as business and law. As clinical psychology matures, more emphasis in research and practice will be placed on education, specialization, and interdisciplinary training.

The future of clinical psychology

is uncertain.

Future clinical psychologists must be flexible to adapt to changing needs and requirements as society and the discipline changes.