Chapter 15

Chapter 15: Training and Practice Issues in Clinical Psychology

Overview

Changes in clinical psychology are shaped by developments in several key areas:

• Professional Training: Understanding the required training for clinical psychologists.

• Professional Regulation: Mechanisms ensuring that psychologists possess the necessary skills.

• Professional Ethics: Ethical principles guiding clinical practice.

• Professional Independence: The relationship between clinical psychology and other mental health professions.

• Professional Multicultural Competence: Addressing diversity within the field.

Professional Training

Key Recommendations in the Shakow Report (1947)

1. Psychological Scientist Focus: Clinical psychologists should be primarily trained as psychological scientists, rather than merely clinicians.

2. Rigorous Training: Clinical training should match the rigor of training in non-clinical psychology fields.

3. Broad Preparation: Preparation should be comprehensive, focusing on assessment, research, and therapy.

Conferences Shaping Training Models

• Boulder Conference: Advocated for PhD training emphasizing research and science.

• Vail Conference: Supported the PsyD degree with practice-oriented training.

• Salt Lake City Conference: Suggested reducing tensions between scientists and practitioners, focusing on training alignment.

• Delaware Conference: Stressed core psychological knowledge in accredited programs.

Current Training Structures

• The Academy of Psychological Clinical Science (APCS) has developed a training model that is more stringent than that of the American Psychological Association (APA). Programs accredited by the Psychological Clinical Science Accreditation System (PCSAS) play a crucial role in promoting a scientific, evidence-based approach in clinical psychology.

• Professional Schools and PsyD Programs: Focus on practice, offering less emphasis on research; commonly have lower admission standards and do not require research dissertations.

• Internship Admission Rates: Slightly fewer PsyD students gain acceptance into APA-accredited internships compared to PhD students.

Clinical Training Models

• Clinical Scientist: Strong emphasis on scientific research, typically found in university settings.

• Scientist-Practitioner: Balanced focus on research and practice, common in traditional PhD programs.

• Practitioner-Scholar: Emphasizes human services delivery with less focus on scientific training, often seen in professional schools and many PsyD programs.

Evaluating Clinical Psychology Training

Research comparing training models primarily examines time spent in various activities, employment opportunities, publication output, and subjective evaluations of training experience. Little knowledge exists about how different training models affect client treatment outcomes.

Internship Imbalance

• Graduate programs typically require students to complete a full year of clinical internship, often APA-approved.

• An internship imbalance has emerged due to increased graduate enrollment and shrinking internship slots, leading to efforts for acquiring more funding, creating additional internship opportunities, and enhancing student competitiveness in applications.

Professional Regulation

• Certification & Licensure: State certification ensures the use of the title psychologist involves meeting set criteria, while licensure defines psychologists' practices and authorized services.

• The Association of State and Provincial Psychology Boards (ASPPB) works towards standardizing regulations across state boards, which set licensure and certification standards.

• The American Board of Professional Psychology (ABPP) provides specialty diplomas for exemplary psychologists.

Professional Ethics

Ethical Standards of the APA

• Ethical principles embody the best ideals for psychologists and offer guidance on professional conduct.

• Implementation often varies, with unclear optimal courses of action; consulting with colleagues is encouraged, provided confidentiality is maintained.

Addressing Ethical Violations

Complaints may arise regarding unprofessional actions like misconduct or improper records. The APA or state boards can review such cases.

Other Ethical Considerations

• The APA has guidelines for specialties, and local laws may supersede APA standards.

• Clinicians have a duty to breach client confidentiality if there is a potential danger to others, reflecting insights from the Tarasoff decision.

Malpractice Concerns

Laws dictate client procedures for negligence; however, malpractice suits are infrequent among clinicians.

Professional Independence

Financial Practices

• Practice Models: Includes sole, group, and mixed-model practices, impacting service delivery.

• Insurance Coverage: Federal mandates promote equal coverage for mental and physical health, but restrict payment to deemed effective treatments.

Prescription Privileges

• Some trained clinical psychologists can prescribe medication, promoting efficiency but raising concerns about adequacy of training and potential overemphasis on biological factors in client treatment.

Professional Multicultural Competence

• As the U.S. population diversifies, clinical psychologists are increasingly called to address varied client backgrounds.

• Diversity Training: Ongoing education, scientific training, and adherence to APA multicultural guidelines are vital for contemporary practice.

Future Directions in Clinical Psychology

Training and Integration

• Advocacy exists for maintaining broad-based, scientifically grounded training instead of narrowly focused vocational education.

• Combining Theoretical Elements: Systematic integration of various therapeutic theories must be rooted in empirical evidence and monitored outcomes.

Interdisciplinary Approaches

• Collaborations with fields such as genetics and neuroscience are crucial for comprehensive care, involving various professionals for client assessment and treatment.

Emphasis on Positive Psychology

• This branch of study focuses on human flourishing and prevention of psychological issues, endorsing social and environmental changes for optimal functioning.

Value of Spirituality

• Ongoing studies recognize the impact of spirituality and prayer on coping mechanisms in various health challenges, revealing a need for greater understanding in clinical practice.

Technological Innovations

• Advances like virtual reality and neuroimaging promise to broaden clinical methods and outcomes.

Dissemination and Outreach

• Sharing research findings and targeting underserved populations are essential steps toward better clinical practices and wider support for those in need, including addressing global issues like human trafficking.

Conclusion

Clinical psychologists strive to enhance their field by expanding options beyond symptom relief, focusing instead on recovery, prevention, and the overall betterment of individuals' lives while being responsive to changes in society.