1. Evolution of Clinical Psychology
Tonight we will discuss the major issues surrounding the following current controversies in the field of Psychology.

2. Evolution of Clinical Psychology
Prescription Privileges
Manualized Therapy
Effect of payment method / managed care on diagnosis and treatment.
We will discuss your professional opinion* about each controversy?
*The major difference between a lay opinion and a professional opinion is that professional opinions are based on a thorough knowledge of the research in the field as well as the thinking and theories of other scholars.  In this course, be sure to incorporate research findings, scholarly thought, and theories into your answers.  This way, when you state your opinion, it is an informed professional opinion rather than a lay opinion.

3. Evolution of Assessment: Diagnostic Issues
Currently, numerous disorders are under consideration for inclusion in the next DSM
Premenstrual dysphoric disorder
Minor depressive disorder
Recurrent brief depressive disorder
Binge eating disorder
Can you think of others?

4. Development of the Profession
In the 1980s,
Psychotherapy thrived, in part due to increasing respect from medical professionals and insurance companies
The number of training programs and new clinical psychologists increased

5. Development of the Profession
In the 1990s and 2000s,
The size and scope of the field continues to grow
Multiple training model options are available
Empirical support of clinical techniques, prescription privileges, and new technologies are among major contemporary issues

6. Current Controversies
Prescription Privileges
Evidence-Based Treatments/Manualized Therapy
Payment Methods
The Influence of Technology

7. Prescription Privileges
Historically, prescribing has distinguished psychiatrists from psychologists
However, in recent decades, clinical psychologists have actively pursued prescription privileges

8. Prescription Privileges
Since 2002, two states have agreed to grant prescription privileges to appropriately trained psychologists
New Mexico
Louisiana
Other states have considered similar legislation, and may pass it soon

9. Prescription Privileges Question
Do you think clinical psychologists should be granted prescription privileges? Why or why not? How, if at all, might the ability to write prescriptions affect the practice of clinical psychology?

10. Prescription Privileges
Why psychologists should prescribe:
Shortage of psychiatrists
Especially in rural areas
Important factor in NM and LA decisions
Other non-physicians have privileges
Dentists, podiatrists, optometrists, and some nurses, among others
“one-stop” shopping for clients

11. Prescription Privileges
Why psychologists should prescribe (continued):
Professional autonomy
Professional identification
Evolution of the profession
Revenue for the profession

12. Prescription Privileges
Why psychologists should not prescribe:
Training issues
Which courses? When? Taught by whom?
Threats to psychotherapy
Would medications replace talk therapy?
Identity confusion
Especially when only some prescribe
Influence of pharmaceutical industry

13. Evidence-Based Treatments/Manualized Therapy
When researchers measure therapy outcome, they often use therapy manuals
To ensure uniformity across therapists
To minimize variability
When outcome data supports the use of a manualized therapy, the treatment is known as “evidence based”

14. Evidence-Based Treatments/Manualized Therapy Question
What do you think about manualized treatments? What are some benefits of manualized treatments? What are some disadvantages? If you were a client, would you want your treatment course to be manualized, open to your psychologist’s clinical judgment, or some combination of the two? Why?

15. Advantages of Evidence-Based/Manualized Therapy
Scientific legitimacy
Establishing minimal levels of competence
Training Improvements
Decreased reliance on clinical judgment

16. Disadvantages of Evidence-Based/Manualized Therapy
Threats to the psychotherapy relationship
Diagnostic complications
Restrictions on practice
Debatable criteria for empirical evidence

17. Payment Methods
Early in the history of clinical psychology, clients paid for services directly out of pocket
With time, health insurance companies began covering mental health
Today, many clients use health insurance/managed care benefits to pay for services
Often called “third-party payers”

18. Payment Methods Question
If you were a psychologist, do you think the way in which your clients paid for services would affect your treatment decisions? If so, how might method of payment affect your client’s course of treatment, and how would your sessions vary between self-pay and managed-care-pay clients?

19. Effect of Third-Party Payment on Therapy
Surveys of psychologists suggest that third-party payment can result in
Negative impact on quality
Too little control over clinical decisions
Ethical problems, including confidentiality
Confusion about informed consent (what to tell clients about payment method)
Greater affordability for many clients

20. Effect of Third-Party Payment on Diagnosis
Surveys of psychologists suggest that third-party payment can result in
Increased likelihood of being diagnosed with a mental disorder
Certain diagnostic categories being used more or less often

21. The Influence of Technology
In recent years, clinical psychologists have increasingly used technology in the direct delivery of psychological services
Assessment
Treatment
Telehealth can replace or supplement face-to-face meetings
Benefits can include accessibility, affordability, and anonymity, and more

22. The Influence of Technology Question
What are some potential ethical dilemmas of online psychotherapy and assessment provision? What benefits might online psychological treatments possess?

23. Applications of Technology in Clinical Psychology--Examples
Videoconferencing to interview or treat
psychotherapy
Interactive Internet sites
Online psychotherapy programs
Virtual reality therapeutic experiences
Computer-based self-instruction
Therapist/client interaction via hand-held devices (e.g., PDAs)

24. Technology—Suggestions for Emerging Professional Issues
Obtain informed consent about the technology
Follow relevant telehealth laws
Follow APA ethical code
Ensure confidentiality via encryption
Make efforts to appreciate culture
Obtain relevant training
Know client’s local emergency resources

25. Questions?