1. © 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Chapter 3 Current Issues in Clinical Psychology

2. © 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Models of Training in Clinical Psychology The Scientist-Practitioner Model – Also known as the Boulder Model; 1949 – Practice with skill while being able to conduct and review research

3. © 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Models of Training in Clinical Psychology The Scientist-Practitioner Model – Pros Balanced in the theoretical and the practical Rooted in academia and research – Cons May polarize into camps Excuse to de-emphasize research?

4. © 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Models of Training in Clinical Psychology The Doctor of Psychology (Psy.D.) Degree – emphasis on the development of clinical skills and a relative de-emphasis on research competence – Higher acceptance rate

5. © 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Models of Training in Clinical Psychology The Doctor of Psychology (Psy.D.) Degree – Lower % who get financial assistance – Lower % get internship – More Psy.D.’s awarded than Ph.D.’s

6. © 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Models of Training in Clinical Psychology Professional Schools – Most offer Psy.D. – Most doctoral degrees awarded by professional schools – Often accept 100+ students per year – Many have no affiliation with a university – Majority not APA accredited – May employ part time professors

7. © 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Models of Training in Clinical Psychology Clinical Scientist Model – 1991: McFall’s Manifesto Scientific Basis Establishing Criteria for Services Focus in training – Empirical Emphasis

8. © 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Models of Training in Clinical Psychology Clinical Scientist Model – Academy of Psychological Clinical Science – 50+ doctoral programs; 10 internships – Evidence-based assessments and interventions taught

9. © 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Models of Training in Clinical Psychology Combined Professional-Scientific Training Programs – Combined specialty in counseling, clinical, and school psychology – Breadth versus depth

10. © 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Models of Training in Clinical Psychology Graduate Programs: Past and Future – Training models influenced by marketplace – Over-supply of practitioners – Managed care – Under-supply of research-oriented clinical psychologists

11. © 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Professional Regulation Certification (restricts use of psychologist title) – State by state basis Licensing (restricts use of psychologist title and professional activities) – APA Guidelines influence states – Potential limitations on academia

12. © 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Professional Regulation

13. © 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Professional Regulation American Board of Professional Psychology (ABPP) – Establishes competency certifications – Very rigorous National register

14. © 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Private Practice Has it peaked? Economic squeeze Today’s Ph.D. clinicians will be replaced by tomorrow’s master’s-level mental health professionals

15. © 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. The Costs of Health Care United States spent $2.26 trillion dollars on healthcare in 2007, approximately $7,439 per person (16% of GDP) From 2007 to 2017, it is predicted that the proportion of the GDP devoted to health care costs will rise to 19.5% Evidence-based treatments

16. © 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. The Costs of Health Care HMOs vs. PPD – Fixed Cost against Variable – Pay for Performance Evolution of Managed Mental Health

17. © 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. The Costs of Health Care

18. © 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Prescription Privileges Pros – Can provide wider variety of treatments to a wider range of clients – Increase in efficiency and cost-effectiveness of care – Will give clinical psychologists a competitive advantage in the health care marketplace

19. © 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Prescription Privileges Cons – May lead to a de-emphasis of “psychological” forms of treatment – May also damage clinical psychology’s relationship with psychiatry and general medicine – Lead to increases in malpractice liability costs

20. © 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Prescription Privileges

21. © 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Prescription Privileges 3 Levels of Competency Basic Pharmacology Training: – knowledge of the biological basis of neuropsychopharmacology, mastery of medications that are used and abused Collaborative Practice: – competence in diagnostic and physical assessment, drug interactions, and drug side effects; hands-on training in psychopharmacology Prescription Privileges: – can prescribe

22. © 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Prescription Privileges Implications for training – Programs that seek to prepare psychologists for prescribing at a later point in their career may screen out applicants that do not have a good foundation in undergraduate courses in the physical sciences – May change the very nature of the practice of clinical psychology as we know it

23. © 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Technological Innovations Tele-health Ambulatory Assessment Computer-assisted treatment

24. © 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Culturally Sensitive Mental Health Services Make a commitment to cultural awareness as well as knowledge of self and others as cultural beings Recognize the importance of multicultural sensitivity Integrate multiculturalism and diversity into education and training Recognize the importance of culture in psychological research and clinical work

25. © 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Culturally Sensitive Mental Health Services

26. © 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Ethical Standards Beneficence & Non-Maleficence: – Psychologists strive to benefit those they serve and to do no harm Fidelity & Responsibility: – Psychologists have professional and scientific responsibilities to society and establish relationships characterized by trust Integrity: – In all their activities, psychologists strive to be accurate, honest, and truthful

27. © 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Ethical Standards Justice: – All persons are entitled to access to and benefit from the profession of psychology; psychologists should recognize their biases and boundaries of competence Respect for people’s rights and dignity: – Psychologists respect the rights and dignity of all people and enact safeguards to ensure protection of these rights

28. © 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Ethical Standards Competence – Represent training accurately – Clinicians should not attempt treatment or assessment procedures for which they lack specific training or supervised experience – Be sensitive to treatment or assessment issues that could be influenced by a patient’s gender, ethnic or racial background, age, sexual orientation, religion, disability, or socioeconomic status

29. © 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Ethical Standards Privacy and Confidentiality – Respect and protect the confidentiality of client information – Be clear and open about matters of confidentiality and the conditions under which it could be breached Tarasoff case – duty to warn; psychologists must disclose confidential information to protect the client/patient, psychologist, or others from harm – -legal precedents vary by state

30. © 2013 Cengage Learning. All Rights Reserved. This edition is intended for use outside of the U.S. only, with content that may be different from the U.S. Edition. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Ethical Standards Human Relations – Dual relationships – Sexual harassment and sexual intimacies – Clinician’s willingness to terminate therapy when it is no longer helping the client