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Title: CLINICAL PSYCHOLOGY TRAINING IN THE UNITED STATES : PAST, PRESENT,


1
CLINICAL PSYCHOLOGY TRAINING IN THE UNITED
STATES PAST, PRESENT, FUTURE
  • JAMES E. MADDUX
  • DEPARTMENT OF PSYCHOLOGY
  • CENTER FOR THE ADVANCEMENT OF WELL-BEING
  • GEORGE MASON UNIVERSITY
  • JMADDUX_at_GMU.EDU

2
WHY DOES THIS MATTER?
  • WE CAN LEARN FROM THE SUCCESSES FAILURES OF
    OTHERS.
  • MAY HELP YOU THINK MORE CRITICALLY ABOUT . .
    .YOUR OWN TRAINING
  • . . . AND YOUR CLINICAL WORK.
  • YOU MAY BE INVOLVED IN TRANING.
  • YOU MAY BE INVOLVED IN SELF-REGULATION OF
    PROFESSION.

3
MAJOR SOURCES
  • BAKER, T. B., MCFALL, R. M., SHOHAM, V. (2009).
    CURRENT STATUS AND FUTURE PROSPECTS OF CLINICAL
    PSYCHOLOGY. PSYCHOLOGICAL SCIENCE IN THE PUBLIC
    INTEREST, 9, 67-103.
  • BENJAMIN, L. T. (2005). HISTORY OF CLINICAL
    PSYCHOLOGY AS A PROFESSION IN AMERICA (AND A
    GLIMPSE AT ITS FUTURE. ANNUAL REVIEW OF CLINICAL
    PSYCHOLOGY, 1, 1-30.
  • BEUTLER, L. E. MAKING SCIENCE MATTER IN CLINICAL
    PRACTICE REDEFINING PSYCHOTHERAPY. CLINICAL
    PSYCHOLOGY SCIENCE AND PRACTICE, 16, 301-322.
  • MCFALL, R.M., DOCTORAL TRAINING IN CLINICAL
    PSYCHOLOGY. ANNUAL REVIEW OF CLINICAL PSYCHOLOGY,
    2, 21-49.
  • REISMAN, J. M. (1991). A HISTORY OF CLINICAL
    PSYCHOLOGY (2ND EDITION). NEW YORK HEMISPHERE.
  • STRICKER, G. (1995). THE LOCAL CLINICAL
    SCIENTIST A BRIDGE BETWEEN SCIENCE AND PRACTICE.
    AMERICAN PSYCHOLOGIST, 50, 995-102.

4
CLINICAL PSYCHOLOGY IN THE U.S.
  • ABOUT 125 YEARS OLD.
  • ABOUT 120,000 PSYCHOLOGISTS (POP. OF 310 MILLION)
  • ABOUT 90,000 PRACTITIONERSMOSTLY CLINICAL OR
    COUNSELING.
  • 250 DOCTORAL PROGRAMS IN CLINICAL AND 30 IN
    COUNSELING PSYCHOLOGY
  • NATIONAL (NON-GOVT) ACCREDITING AGENCY (APA)
  • 53 DIFFERENT LICENSING AGENCIES (STATE
    GOVERNMENTS, DC, PUERTO RICO, GUAM)
  • AMERICAN PSYCHOLOGICAL ASSOCIATION1892
  • 150,OOO MEMBERS

5
HISTORY OF CLINICAL PSYCHOLOGY IN THE US
  • A STRUGGLE FOR
  •  IDENTITY
  • THE PROFESSIONS ATTEMPTS TO DEFINE ITSELF. . .
  • . . .AND

6
RESPECTABILITY WITH
  • OTHER DISCIPLINES WITHIN PSYCHOLOGY
  • SCIENCE VERSUS PRACTICE
  • OTHER HEALTH AND MENTAL HEALTH PROFESSIONS
  • ESPECIALLY MEDICINE AND PSYCHIATRY
  • POLICY MAKERS
  • THE PUBLIC

7
CONTINUAL INTERACTIONS AMONG
  • PROFESSIONAL PSYCHOLOGY ORGANIZATIONS (APA)
  • OTHER DISCIPLINES (PSYCHIATRY)
  • STATE GOVERNMENTS
  • FEDERAL GOVERNMENT
  • UNIVERSITIES
  • PRIVATE INDUSTRYINCLUDING HEALTH INSURANCE
    COMPANIES
  • CANADIAN PSYCHOLOGY
  • EUROPEAN PSYCHOLOGY

8
IT MAY HELP TO UNDERSTAND THE US CONSTITUTION
  • LIMITS POWERS OF FEDERAL GOVERNMENT.
  • GIVES A LOT OF POWER TO STATE GOVERNMENTS
  • PRO50 10 LABORATORIES FOR INNOVATION
  • CONDIFFICULT TO DEVELOP CONCENSUS AND
    CONSISTENCY
  • CREDENTIALING, TRAINING STANDARDS. ETC.
  •  
  •   

9
FOR THIS REASON . . .
  • NATIONAL LICENSING LAW WAS NEVER A POSSIBILITY
  • NOR WERE GOVERNMENT-MANDATED TRAINING STANDARDS.
  • RESPONSIBILITY LEFT TO STATES
  • AND PROFESSIONAL ORGANIZATIONS

10
ALSO . . .
  • INTER-CONNECTED WITH THE HISTORY OF PSYCHIATRY.
  • SOMETIMES AS ALLY AND CO-WORKER.
  • BUT OFTEN AS ADVERSARY.
  • PSYCHIATRY CHALLENGED PSYCHOLOGY FROM BEGINNING
  • FIRST REGARDING ASSESSMENT DIAGNOSIS.
  • LATER REGARDING PSYCHOTHERAPY.
  • IRONY PSYCHOLOGY NOW CHALLENGED BY SOCIAL WORK
    AND OTHERS WITH MASTERS DEGREES.

11
SOME KEY DATES AND EVENTS
  • 1892 FORMATION OF THE AMERICAN PSYCHOLOGICAL
    ASSOCIATION (26 MEMBERS).
  • 1896 LIGHTNER WITMER (STUDENTS OF WUNDT)
    ESTABLISHED THE FIRST PSYCHOLOGICAL CLINIC AT
    UNIVERSITY OF PENNSYLVANIA.
  • WITMER WAS THE FIRST TO USE THE TERM CLINICAL
    PSYCHOLOGIST.
  • CONCERNED MAINLY WITH CHILDRENS ACADEMIC
    PROBLEMS.
  • FIRST CLIENT14 YEAR OLD BOY WITH SPELLING
    PROBLEMS.
  • MORE SIMILAR TO WHAT IS NOW CALLED SCHOOL
    PSYCHOLOGY.

12
  • 1907 NEW JOURNAL BY WITMER THE PSYCHOLOGICAL
    CLINIC.
  • 1906 JOURNAL OF ABNORMAL PSYCHOLOGY (MORTON
    PRINCE).
  • 1908 H.H. GODDARD OF CLARK U. VISITS EUROPE TO
    STUDY TESTING WORK OF A. BINET T. SIMON.
  • 1916U.S. VERSION OF BINET-SIMON TEST OF
    INTELLIGENCE PUB. IN 1916 (STANFORD BINET).
  • MENTAL TESTING FIRMLY ESTAB. AS KEY ACTIVITY OF
    CLINICAL PSYCHOLOGISTS.

13
1909
  • FREUD AND JUNG VISIT CLARK UNIVERSITY (MASS.)
  • PSYCHOANALYTIC THEORY SOON FIRMLY ESTABLISHED IN
    U.S.
  • ALSO ESTABLISHED THE STUDY OF PERSONALITY AS A
    KEY INTEREST OF PSYCHOLOGISTS.
  • FURTHER ESTABLISHED WHEN DAVID LEVY BROUGHT BACK
    THE RORCHACH FROM SWITZERLAND IN 1921.
  • LATER CHALLENGED BY BEHAVIORAL (SKINNER) AND
    HUMANISTIC (MASLOW, ROGERS) THEORISTS.

14
  • 1917ILLINOIS PASSED LAW ALLOWING PSYCHOLOGISTS
    TO CERTIFY ELIGIBILITY FOR COMMITMENT TO
    INSTITUTIONS FOR THE MENTALLY RETARDED. 
  • CHALLENGED IN COURT BY THE NEW YORK PSYCHIATRICAL
    SOCIETY
  • TRIED TO BAN PSYCHOLOGISTS FROM ANY KIND OF
    CLINICAL WORK.

15
PSYCHOLOGY TRIES TO ESTABLISH STANDARDS FOR
PROFESSION
  • 1917APA COMMISSION TO SET STANDARDS FOR
    PSYCHOLOGICAL EXAMINER
  • 1917FOUNDING OF THE AMERICAN ASSOCIATION OF
    CLINICAL PSYCHOLOGISTS.
  • LATER BECAME SECTION OF CLINICAL PSYCHOLOGY
    WITHIN APA.
  • LETA HOLLINGSWORTH PROPOSES GUIDELINES FOR A
    DOCTOR OF PSYCHOLOGY DEGREE.
  • INCLUDED A ONE-YEAR APPRENTICESHIP.

16
  • 1918AMERICAN MEDICO-PSYCHOLOGICAL ASSOCIATION
    (LATER AMERICAN PSYCHIATRIC ASSOCIATION) ISSUED
    FIRST OFFICIAL SET OF DIAGNOSTIC CATEGORIES.
  • STATISTICAL MANUAL FOR THE USE OF INSTITUTIONS OF
    THE INSANE.
  • EVENTUALLY DEVELOPED INTO THE FIRST DSM IN 1952.
  • ANOTHER AREA OF PSYCHOLOGY PSYCHIATRY CONFLICT
    COOPERATION.

17
ALSO IN 1917U.S. ENTERS WORLD WAR I
  • PSYCHOLOGISTS BECOME INVOLVED IN MILITARY
  • PERSONNEL ASSESSMENT SELECTION.
  • INTELLECTUAL ASSESSMENT SCREENING.
  • PERSONALITY ASSESSMENT TO IDENTIFY SOLDIERS
    LIKELY TO DEVELOP SHELL SHOCK (NOW PTSD)
  • WORDSWORTH PERSONALTY DATA SHEET (1919).
  • ESTAB. PERSONALITY ASSESSMENT AS KEY ACTIVITY OF
    CLINICAL PSYCHOLOGISTS.

18
AFTER WORLD WAR I
  • 1921FORMATION OF THE PSYCHOLOGICAL CORPORATION
    (TESTING)
  • BEGINNING OF PSYCHOLOGY AS A BIG BUSINESS IN THE
    PRIVATE SECTOR.
  • 1921APA ISSUES GUIDELINES FOR THE CERTIFICATION
    OF CLINICAL PSYCHOLOGISTS.
  • ABONDONED EFFORT SEVERAL YEARS LATER DUE TO LACK
    OF IMPACT.
  • SEVERAL MAJOR UNIVERSITIES ESTABLISH
    PSYCHOLOGICAL CLINICS FOR STUDENTS.

19
1924EARLY ATTEMPT AT SELF-REGULATION
  • APAS SECTION OF CLINICAL PSYCHOLOGY RECOMMENDS
    STANDARDS FOR PRACTICING CLINICAL PSYCHOLOGISTS
  • A PHD
  • FOUR YEARS OF PROFESSIONAL TRAINING
  • ONE YEAR OF SUPERVISED CLINICAL WORK
  • NOT FAR FROM WHAT WE HAVE NOW

20
H.G. WELLS IN THE AMERICAN MAGAZINE (1924)
  • THE ADVANCES THAT HAVE BEEN MADE IN PSYCHOLOGY
    . . .HAVE BEEN ENORMOUS. THE COMING HUNDRED
    YEARS OR SO WILL BE, I BELIEVE, ESSENTIALLY A
    CENTURY OF APPLIED PSYCHOLOGY. . . .IT WILL MARK
    A REVOLUTION IN HUMAN AFFAIRS.

21
1930sCONTINUED GROWTH
  • 1930OVER 500 CLINICS OFFER PSYCHOLOGICAL
    SERVICES.
  • 1932FOUNDED THE JOURNAL OF CONSULTING
    PSYCHOLOGY.
  • LATER CHANGED TO JOURNAL OF CONSULTING AND
    CLINICAL PSYCHOLOGY (APA).
  • 1935APA REPORT DEFINES CLINICAL PSYCHOLOGY AS
    THE ART AND TECHNOLOGY WHICH DEALS WITH THE
    ADJUSTMENT PROBLEMS OF HUMAN BEINGS.
  • RECOMMENDS THAT ANYONE USING TITLE CLINICAL
    PSYCHOLOGIST SHOULD HAVE A PHD AND A YEAR OF
    SUPERVISED CLINICAL EXPERIENCE.
  • WILL RETURN LATER TO THE ISSUE OF PHD VERSUS
    OTHER DEGREES

22
WORLD WAR II
  • US MILITARY EMPLOYS OVER 1700 PSYCHOLOGISTS.
  • PERSONNEL SELECTION AND TRAINING.
  • EQUIPMENT DESIGN (HUMAN FACTORS)
  • COUNSELING AND PSYCHOTHERAPY.
  • END OF WORLD WAR IIALMOST 45,000 PSYCHIATRIC
    PATIENTS IN HOSPITALS FOR VETERANS
  • VA CLAIMS IT NEEDS 4700 PSYCHOTHERAPISTS AND
    COUNSELORS.
  • PSYCHIATRY CANNOT MEET THIS NEED . . .THEREFORE.
    . .

23
1942CONGRESSIONAL ORDER TO VETERANS
ADMINISTRATION
  • EXPAND THE POOL OF MENTAL HEALTH PROFESSIONALS,
    ESPECIALLY CLINICAL PSYCHOLOGISTS
  • 1944US GOVERNMENT PROVIDES FUNDS FOR TRAINING
    CLINICAL PSYCHOLOGISTS IN UNIVERSITIES .
  • REQUIRES THAT THEY BE TRAINED IN PSYCHOTHERAPY.
  • PSYCHIATRY OBJECTS (BUT LOSES)
  • VA HOSPITALS PROVIDE PRATICUM TRAINING.

24
PSYCHOLOGISTS BECOME PSYCHOTHERAPISTS
  • BY 19471500 CLINICAL PSYCHOLOGY PHD STUDENTS
    FUNDED AT 50 UNIVERSITIES.
  • VA CREATES 100s OF NEW JOBS FOR CLINICAL
    PSYCHOLOGISTS.
  • LARGEST SINGLE EMPLOYER OF CLINICAL
    PSYCHOLOGISTS.
  • TODAYTHE VETERANS ADMINISTRATION REQUIRES AN
    APA-ACCREDITED DOCTORAL PROGRAM AND INTERNSHIP
  • BY 1970s CLINICAL PSYCHOLOGISTS ARE THE MAJOR
    PROVIDERS OF PSYCHOTHERAPY. 

25
1946--LICENSING
  • 1946CONNECTICUT BECOMES FIRST STATE TO PASS LAW
    REGULATING PRACTICE OF PSYCHOLOGY WITH LICENSE
    REQUIREMENTS.
  • 1948VIRGINIA BECOMES FIRST STATE TO REQUIRE A
    DOCTORAL DEGREE FOR LICENSE.
  • 1977MISSOURI BECOMES LAST STATE TO PASS
    PSYCHOLOGY LICENSING LAW.
  • 2004 NEW MEXICO AND LOUISIANA GRANT CLINICAL
    PSYCHOLOGIST PRESCRIPTION PREVILEGES.
  • WILL RETURN TO LICENSING ISSUE LATER

26
1946--NIMH
  • PRESIDENT TRUMAN SIGNED INTO LAW BILL CREATING
    THE NATIONAL INSTITUTE OF MENTAL HEALTH.
  • OPENED IN 1946
  • MISSION TO TRANSFORM THE UNDERSTANDING AND
    TREATMENT OF MENTAL ILLNESS THROUGH BASIC AND
    CLINICAL RESEARCH, PAVING THE WAY FOR PREVENTION,
    RECOVERY, AND CURE.
  • NOW HAS ANNUAL BUDGET OVER 1.5 BILLION.

27
SO MANY NEW CLINICAL PSYCHOLOGY PROGRAMS SO
QUICKLY
  • NEED FOR QUALITY CONTROL AND CONSISTENCY.
  • FEDERAL GOVERNMENT GIVES APA A CHOICE. . .
  • EITHER . . .YOU DEVELOP STANDARDS AND PROCESS FOR
    EVALUATION (ACCREDITATION) OR . . .
  • A FEDERAL AGENCY WILL DO FOR YOU.
  • SO APA TOOK ON THE TASK.

28
1947APA PROPOSES FOUR-YEAR PROGRAM FOR CLINICAL
PHD
  • COURSEWORK IN MAJOR AREAS OF PSYCHOLOGY
  • COURSEWORK IN PSYCHOTHERAPY THEORY RESEARCH
  • COURSEWORK IN RESEARCH METHODS STATISTICS
  • RESEARCH TRAINING (DOCTORAL DISSERTATION)
  • PRACTICUM TRAINING
  • ONE-YEAR FULL-TIME INTERNSHIP
  • DÉJÀ VU OF 1924

29
1949APA TRAINING CONFERENCE AT BOULDER, COLORADO
  • SPONSORED BY THE NATIONAL INSTITUTE OF MENTAL
    HEALTHA FEDERAL GOVERNMENT AGENCY ESTABLISHED
    SHORTLY AFTER WORLD WAR 2.
  • US VETERANS ADMINISTRATION.
  • US PUBLIC HEALTH SERVICE
  • AMERICAN PSYCHOLOGICAL ASSOCIATION
  • WE SHALL RETURN TO THIS CONFERENCE IN A
    MINUTE

30
ONE MORE VERY IMPORTANT DATE1963.
  • COMMUNITY MENTAL HEALTH CENTERS ACT.
  • INITIATIVE OF PRESIDENT JOHN F. KENNEDY.
  • OUTPATIENT TREATMENT CENTERS.
  • ALL COMMUNITIES OVER 30,000
  • ACCOMPANIED BY DEINSTITUTIONALIZATION OF 1000s
    OF PEOPLE WITH SEVERAL MENTAL DISORDERS.
  • INCREASED NEED FOR PSYCHOLOGISTS.
  • FURTHER SHIFTED PROVISION OF MENTAL HEALTH
    SERVICES FROM PSYCHIATRY TO PSYCHOLOGY AND OTHER
    PROFESSIONS.

31
BACK TO 1949APA TRAINING CONFERENCE AT BOULDER,
COLORADOTHE BOULDER MODEL
  • CLINICAL PSYCHOLOGISTS SHOULD BE TRAINED AS
    SCIENTISTS AND PRACTITIONERS.
  • RESEARCH SKILLS AND CLINICAL SHOUD BE INTEGRATED.
  • CLINICAL PSYCHOLOGISTS SHOULD BE BOTH CLINICIANS
    RESEARCHERS THROUGHOUT THEIR CAREERS.
  • SHOULD EMPIRICALLY EVALUATE THEIR CLINICAL WORK.
  • SHOULD MAINTAIN CURRENT KNOWLEDGE OF CLINICAL
    RESEARCH.
  • SHOULD CONTRIBUTE TO THE KNOWLEDGE BASE.

32
  • THIS MODEL WAS A COMPROMISE.
  • VETERANS ADMINISTRATION WAS FUNDING MOST OF THE
    CLINICAL TRAINING AND WANTED MAINLY PRACTIONER
    TRAINING.
  • APA COMPRISED MAINLY OF UNIVERSITY-BASED RESEARCH
    PSYCHOLOGISTS WHO BELIEVED THAT THE PHD SHOULD BE
    A RESEARCH DEGREE.

33
TRAINING WOULD INCLUDE
  • ACADEMIC COURSEWORK IN ALL MAJOR AREAS OF
    PSYCHOLOGY.
  • COURSES IN PSYCHOLOGICAL ASSESSMENT AND
    INTERVENTIONS (PSYCHOTHERAPY).
  • COURSES IN RESEARCH METHODS AND STATISTICS.
  • SUPERVISED CLINICAL PRACTICUM (IN HOUSE
    EXTERNAL SETTINGS).
  • EMPIRICAL DISSERTATION (DATA BASED)
  • ONE-YEAR FULL-TIME CLINICAL INTERNSHIP IN SETTING
    EXTERNAL TO PROGRAM

34
REQUIRED COURSEWORK
  • Biological bases of behavior
  • cognitive-affective bases of behavior
  • social bases of behavior
  • lifespan development
  • Assessment diagnosis
  • Treatment interventionS
  • research methods statistics
  • Ethical professional standards.

35
  • FIRST CLINICAL PROGRAMS ACCREDITED BY APA IN
    1948.
  • FIRST CLINICAL INTERNSHIPS ACCREDITED IN 1956.
  • BY 2005
  • OVER 220 ACCREDITED DOCTORAL PROGRAMS IN US.
  • OVER 450 ACCREDITED INTERNSHIP PROGRAMS IN US.
  • GROWING PROBLEM TOO MANY CLINICAL STUDENTS AND
    NOT ENOUGH INTERNSHIP POSITIONS.

36
BUT SKEPTICISM DISSATISFACTION SOON SET IN
  • CAN YOU TRAIN SOMEONE TO BE COMPETENT AT BOTH
    PRACTICE AND RESEARCH IN 5 YEARS?
  • VAST MAJORITY OF CLINICAL PHD STUDENTS NEVER
    PUBLISHED RESEARCH AFTER GETTING DEGREE.
  • ALL CLINICAL PROGRAMS WERE IN UNIVERSITY
    DEPARTMENTS OF PSYCHOLOGY.
  • VAST MAJORITY OF UNIVERSITY PSYCHOLOGISTS WERE
    RESEARCHERSNOT INTERESTED IN TRAINING IN
    CLINICAL PRACTICE.
  • TENSIONS QUICKLY DEVELOPED BETWEEN
    PRACTICE-ORIENTED CLINICAL FACULTY AND
    NON-CLINICAL FACULTY.
  • REMAINS A PROBLEM IN MOST DEPARTMENTS OF
    PSYCHOLOGY IN THE US.

37
RISE OF PROFESSIONAL SCHOOLS THE DOCTOR OF
PSYCHOLOGY (PSYD)
  • 1951FIRST PROFESSIONAL SCHOOL OF CLINICAL
    PSYCHOLOGY AT ADELPHI UNIVERSITY IN NEW YORK.
  • INDEPENDENT OF DEPARTMENT OF PSYCHOLOGY
  • 1970FIRST FREE-STANDING (NOT AT A UNIVERSITY)--
    PROFESSIONAL SCHOOL OF PSYCHOLOGY IN CALIFORNIA.
  • 1973FIRST CONFERENCE OF PROFESSIONAL SCHOOLS AT
    VAIL COLORADO.
  • 1997PSYD PROGRAMS WERE GRADUATING TWICE AS MANY
    STUDENTS AS CLINICAL PHD PROGRAMS

38
APAS VAIL CONFERENCE--1973
  • DEVELOPED THE SCHOLAR-PRACTITIONER MODEL OF
    CLINICAL TRAINING.
  • DOCTOR OF PSYCOLOGY OR PSYD.
  • EMPHASIZES TRAINING IN CLINICAL PRACTICE, NOT
    RESEARCH.
  • INFORMED AND CRITICAL CONSUMER OF RESEARCH.
  • LOCAL CLINICAL SCIENTIST
  • APPLICATION OF KNOWLEDGE TO CLINICAL PRACTICE.

39
  • SAME STANDARDS OF ACCREDITATION BY APA.
  • EQUALLY ELIGIBLE FOR LICENSURE.
  • BY 200557 APA- ACCREDITED PSYD PROGRAMS IN US
  • ACCOUNT FOR 30 OF ALL DEGREES IN PSYCHOLOGY

40
PSYD VS. PHD.PSYD PROGRAMS IN BOTH UNIVERSITIES
AND FREE-STANDING PRIVATE SCHOOLS.
  • ACCEPT MORE STUDENTS
  • LOWER STANDARDS OF ADMISSION.
  • HIGHER RATE OF ACCEPTANCE (50 VS 11).
  • LARGER ENTERING CLASSES (48 VS 10).
  • HIGHER FACULTY-TO-STUDENT RATION
  • MORE PART-TIME FACULTY.
  • HIGHER TUITION BUT LESS FINANCIAL AID
  • STUDENTS DO NOT PERFORM AS WELL ON EPPP.
  • BUTNO EVIDENCE OF DIFFERENCES IN PERFORMANCE IN
    CLINICAL PRACTICE SETTINGS.

41
KEY IDEA IN PSY.D. PROGRAMS
  • SCIENTIFIC PRACTITIONER
  • OR
  • LOCAL CLINICAL SCIENTIST

42
  • THE CLINICAL SETTING CAN BE REGARDED AS THE
    LABORATORY FOR THE CLINICIAN, AND IT MUST BE
    APPROACHED WITH THE SAME DISCIPLINE, CRITICAL
    THINKING, IMAGINATION, OPENNES TO FALSIFICATION,
    AND RIGOR THAT CHARACTERIZES THE SCIENTIST IN THE
    TRADITIONAL LABORATORY.
  • GEORGE STRICKER (1995).

43
LOCAL CLINICAL SCIENTIST
  • THE LOCAL CLINICAL SCIENTIST MODEL RECOGNIZES
    THAT SCIENTIFIC TRAININGEVEN WHEN IT DOES NOT
    PRESENT A SUBSTANTIVE SOLUTIONCAN PROVIDE AN
    ATTITUDE AND AN ORIENTATION TO THE PROBLEM AT
    HAND THAT WILL LEAD TO AN INFORMED SOLUTION THAT
    IS THE BEST THE STATE OF THE ART CAN GENERATE
  • STRICKER (1995)

44
LOCAL CLINICAL SCIENTIST
  • OBSERVING SYSTEMATICALLY AND OBJECTIVELY.
  • FORMING HYPOTHESES.
  • GATHERING DATA TO TEST HYPOTHESES.
  • REFORMULATING HYPOTHESES IN RESPONSE TO DATA.
  • USES RESEARCH FINDINGS AS A SOURCE OF HYPOTHESES
    ABOUT CLIENTS.
  • BUT ALSO AWARE OF LOCAL CONDITIONS THAT
    INFLUENCE APPLICABILITY OF RESEARCH FINDINGS.

45
CHARACTERISTICS OF THE LOCAL CLINICAL
SCIENTIST(STRICKER, 1995)
  • OPEN TO MULIPLE APPROACHES.
  • ABESENCE OF RIGIDITY DOGMATISM.
  • VALUES EMPIRICAL SUPPORTGENERAL LOCAL.
  • CLINICAL PROCESS BEGINS WITH THE PATIENT, NOT THE
    RESEARCH.
  • SKEPTICAL ABOUT ONES OWN OBSERVATIONS AND
    HYPOTHESES.
  • AWARE OF PERSONAL VALUES AND BIASES.
  • NEED FOR COLLEGIAL INTERACTION FEEDBACK.

46
ETHICAL OBLIGATIONS?(STRICKER, 1995)
  • IT IS NOT UNETHICAL TO PRACTICE WITHOUT
    COMPLETELY SUPPORTIVE SCIENTIFIC EVIDENCE.
  • BUT IS IT UNETHICAL TO PRACTICE IN WAYS THAT
    IGNORE OR CONTRADICT SCIENCE.
  • PREFERED THEORIES AND TECHNIQUES MUST GIVE WAY
    OR BE REVISED IS DISCONFIRMATORY EVIDENCE EXISTS.
  • BUT THEY REMAIN THE BASIS FOR ACTION IN THE
    ABSENCE OF SUCH EVIDENCE
  • CORNERSTONE OF EVIDENCE-BASED PRACTICE.

47
IS THE BOULDER SCIENTIST-PRACTITIONER MODEL
WORKING?
  • RECENT SURVEY OF ALMOST 600 PSYCHOLOGISTS IN
    PRIVATE PRACTICE
  • MOST RELY MORE ON THEIR OWN CLINICAL EXPERIENCE
    AND THAT OF THEIR COLLEAGUES.
  • NOT ON RESEARCH
  • ALARMING NUMBER UNAWARE OF EXPERICALLY-SUPPPORTED
    INTERVENTIONS.
  • MANY DO NOT EVEN SEE THE UTILITY OF CLINICAL
    RESEARCH

48
HOW WELL DOES BOULDER MODEL MEET TODAYS NEEDS?
  • DEVELOPED DURING 1945 1949
  • NOW COMPETITION FROM OTHER DISCIPLINES
  • SOCIAL WORKERS PROVIDED ABOUT 5 OF MENTAL HEALTH
    SERVICES IN THE US IN 1991.
  • BY 1997, THEY WERE PROVIDING 56 (INCLUDING
    PSYCHOTHERAPY).
  • PSYCHOLOGY TRAINING HAS BECOME INCREASINGLY
    SPECIALIZED.

49
SCIENCE VERSUS PRACTICE ACADEMY OF
PSYCHOLOGICAL CLINICAL SCIENCE
  • BY EARLY 1990s MANY BELIEVED CLINICAL PSYCHOLOGY
    PROGRAMS WERE NOT UPHOLDING THE SCIENTIST SIDE OF
    THE MODEL.
  • 1994FORMATION OF THE ACADEMY OF PSYCHOLOGICAL
    CLINICAL SCIENCE.
  • PROGRAMS STRONGLY COMMITTTED TO RESEARCH
    TRAINING AND THE INTEGRATION OF SUCH TRAINING
    WITH CLINICAL TRAINING.
  • NOW ALMOST 60 MEMBERS.
  • INCREASINGLY INVOLVED IN APA ACCREDITION.
  • ALSO DEVELOPING THEIR OWN ACCREDITATION
    STANDARDS.

50
WHAT IS CLINICAL SCIENCEACADEMY OF
PSYCHOLOGICAL CLINICAL SCIENCE (1995)
  • CLINICAL SCIENCE IS DEFINED AS A PSYCHOLOGICAL
    SCIENCE DIRECTED AT THE PROMOTION OF ADAPTIVE
    FUNCTIONING.
  • AT THE ASSESSMENT, UNDERSTANDING, AMELIORATION,
    AND PREVENTION OF HUMAN PROBLEMS IN BEHAVIOR,
    AFFECT, COGNITION, OR HEALTH.
  • AND THE APPLICATION OF KNOWLEDGE IN WAYS
    CONSISENT WITH SCIENTIFIC EVIDENCE.
  • AND A COMMITMENT TO EMPIRICAL APPROACHES TO
    EVALUATING THE VALIDITY AND UTILITY OF TESTABLE
    HYPOTHESES AND TO ADVANCING KNOWLEDGE BY THE
    METHOD

51
5 TRAINING GOALS
  1. TRAIN STUDENTS FOR CAREERS IN CLINICAL SCIENCE
    RESEARCH.
  2. ADVANCE FULL RANGE OF CLINICAL SCIENCE THEORY AND
    RESEARCH.
  3. FOSTER DEVELOPMENT OF AND ACCESS TO RESOURCES AND
    OPPORTUNITIES FOR TRAINING, RESEARCH, FUNDING,
    AND CAREERS IN CLINICAL SCIENCE.
  4. FOSTER THE APPLICATION OF CLINICAL SCIENCE TO
    HUMAN PROBLEMS IN RESPONSIBLE AND INNOVATIVE
    WAYS.
  5. FOSTER DISSEMINATION OF CLINICAL SCIENCE TO
    POLICY-MAKING GROUPS, PSYCHOLOGISTS AND OTHER
    SCIENTISTS, PRACTITIONERS, AND CONSUMERS.

52
COMPARISONS OF THE 3 MODELS
  • CLINICAL SCIENCE PHD FACULTY MOST ENGAGED IN
    RESEARCHPSYD FACULTY THE LEAST.
  • CLINICAL SCIENCE FACULTY PUBLISH PRESENT THE
    MOSTPSYD FACULTY THE LEAST.
  • SAME PATTERN FOR STUDENTS

53
IMPACT OF MANAGED CARE
  • SHIFT FROM FEE-FOR-SERVICE MODEL TO
    THIRD-PARTY-PAYER MODEL.
  • ACCOUNTABILITY AND EVIDENCE-BASED DECISIONS.
  • QUALITY CONTROL COST-EFFECTIVENESSGETTING THE
    MOST FOR YOUR MONEY.
  • EVEN GREATER SHRINKING OF PSYCHOLOGYS SHARE OF
    MENTAL HEALTH CARE.
  • SOCIAL WORKERS NOW THE MAJOR PROVIDERS OF
    TRADITIONAL MENTAL HEALTH SERVICES.
  • DIMINISHING DEMAND FOR PSYCHOLOGISTS AS PROVIDERS
    OF DIRECT SERVICESTHAT IS, PSYCHOTHERAPY.

54
NEW ROLES FOR PSYCHOLOGISTS(IN ADDITION TO
PROVIDING DIRECT SERVICES)
  • DEVELOPING NEW ASSESSMENTS INTERVENTIONS.
  • RESEARCH ON ASSESSMENTS INTERVENTION
    EFFECTIVENESS.
  • PROGRAM DEVELOPMENT EVALUATION.
  • INDIRECT SERVICES (SUPERVISION, CONSULTATION,
    TEACHING).
  • ADMINISTRATION MANAGMENT
  • MENTAL HEALTH POLICY (COMMUNITY PSYCHOLOGY)

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THE PROBLEM . . .
  • THE FAILURE TO TRANSLATE SCIENCE INTO PRACTICE
    HAS MARGINALIZED CLINICAL PSYCHOLOGY WITHIN THE
    EMERGING HEALTH CARE SYSTEM AND LIMITED THE
    PUBLICS ACCESS TO BENEFICIAL INTERVENTIONS.
  • BAKER, MCFALL, SHOHAM (2009)

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  • THE SOLUTIONS?

57
APA TASK FORCE ON FUTURE OF PSYCHOLOGY PRACTICE
(2009)
  1. EXPANDING FOCUS OF TRADITIONAL PSYCHOLOGY
    PRACTICE (INCLUDE RESEARCH AND EVALUATION
    SKILLS).
  2. INTEGRATING MENTAL HEALTH CARE AND HEALTH CARE.
  3. INTEGRATING TECHNOLOGY INTO PRACTICE.
  4. ACCOUNTABILITYSHOW THAT WHAT WE DO WORKS.
  5. EVIDENCE-BASED PRACTICE
  6. MEETING NEEDS OF DIVERSE SOCIETY
  7. MOBILITY ISSUES (LICENSING LAWS)
  8. PUBLIC EDUCATION AND BRANDING
  9. CHANGE TRAINING PROGRAMS TO MEET CHANGING WORLD.

58
THE FUTURE OF CLINICAL PSYCHOLOGY?
  • THE CLINICAL PSYCHOLOGISTS TRAINED AS
    SCIENTIST-PRACTITIONERS SHOULD HAVE NO DIFFICULTY
    FINDING INTERESTING WORK IN THE FUTURE. THEY ARE
    TRAINED TO SOLVE BEHAVIORAL PROBLEMS, AND THE
    WORLD PROMISES TO PROVIDE NO SHORTAGE OF THOSE
  • LUDY BENJAMIN, 2005
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