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

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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

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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.

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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.

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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

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HISTORY OF CLINICAL PSYCHOLOGY IN THE US

• A STRUGGLE FOR
•  IDENTITY
• THE PROFESSIONS ATTEMPTS TO DEFINE ITSELF. . .
• . . .AND

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RESPECTABILITY WITH

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

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CONTINUAL INTERACTIONS AMONG

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

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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.
•  
•   

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FOR THIS REASON . . .

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

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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.

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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.

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• 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.

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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.

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• 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.

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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.

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• 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.

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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.

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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.

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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

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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.

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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

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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.
  . .

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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.

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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. 

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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

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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.

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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.

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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

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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

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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.

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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.

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• 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.

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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

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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.

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• 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.

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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.

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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

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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.

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• 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

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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.

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KEY IDEA IN PSY.D. PROGRAMS

• SCIENTIFIC PRACTITIONER
• OR
• LOCAL CLINICAL SCIENTIST

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• 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).

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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)

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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.

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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.

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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.

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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)

55
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)

56

• 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