Transcript psy 402 clinical psychology

BAHAR BAŞTUĞ
Assist. Prof. Dr.
Current and Future Trends and
Challenges
Lecture Preview
 Trends in Society
 Research Issues
 Practice Issues
 Reaching Beyond Mental Health in Contemporary
Clinical Psychology
 Training Issues
Where Is Clinical Psychology Going
and Should I Go with It?
has changed rapidly and continues to change. This
change has paralled with changes in society. Because
of the recent advances in science and technology,
clinical psychology has developed.
o Where is clinical psychology going?
o What is its future?
o What are its current and future topics?
Health care and health care reform are the best examples
of a current topic.
Someone who wanted to see a clinical psychologist for
psychotherapy could choose to be treated by any
licensed psychologist in his or her country. The
psychologist would conduct as many sessions as
necessary to best treat the patient, using whatever
theoretical orientation(s) and techniques.
In more recent years, this situation has changed due to
mental health reform. The patient contacts insurance
company to determine which therapists in that area are
part of the psychologist.
The insurance company allows a specific number of
sessions. The number of season is limited 3 to 6.
Additional sessions or other treatment options (e.g.,
inpatient care, group psychotherapy, family
psychotherapy) must be approved by the insurance
company.
These changes impact all major areas such as research,
training, and practice.
Since most companies will not approve treatment
conducted by trainees (interns), many hospitals and
clinics cannot continue to train psychology trainees.
Trends in Society
Clinical psychology must
change and adapt to a
changing world.
It must respond to changes
within the field as new
research discoveries and
clinical practice strategies
emerge.
Trends in Society
 Changes in the Family
 Multicultural and Diversity Issues
 Advances in Science, Technology, and Medicine
 Gender Shifts in Professions
Changes in the Family
The family has changed in recent years. The
traditional nucleous family exists no longer. About
50% of marriages end in divorce. About 55% of
people live together prior to marriage.
Families include adopted or “test tube” children,
children and parents of mixed ethnicity, race, and
religion, gay and lesbian parents, single parents,
unmarried parents, and single mothers.
Lezbiyen çiftin velayet davası AİHM'de
Avrupa İnsan Hakları Mahkemesi (AİHM), 22 yıldır
birlikte yaşayan lezbiyen Fransız çiftin, çocuk
velayeti konusunda yaptıkları ortak başvuruyu
görüştü.
Multicultural and Diversity Issues
The numbers of ethnic minorities and immigrants
increase. Increasing attention and interest have been
focused on the role of multicultural and diversity
issues in all aspects of society. Psychologists have
gained insight into the role of culture and diversity in
the development of behavior and behavioral
problems.
Multicultural and Diversity Issues
Social context and culture have powerful influences
on behavior. The understanding of culture is critical
to the understanding of psychological and physical
symptoms as well as in developing treatment
interventions.
These syndroms tend to be culture related:
 Conversion disorder & postpartum psychosis
 Koro, amok, latah
 Voodoo and Couvade syndrome.
Multicultural and Diversity Issues
Disorders appear universally among all cultures, but
they manifest differently depending on the specific
culture. In SCH, American and industrialized Western
people experience auditory hallucinations, but Latin
American and African people experience visual
hallucinations .
The APA has warned psychologists to “become familiar
with different beliefs and practices and respect them”.
Advances in Science, Technology, and
Medicine
Recent advances and discoveries in science, technology,
and medicine have impacted clinical psychology. They
reinforces that biology is at the root of most human
behavior.
Prozac to treat depr, efforts to find the “fat gene”, and
Ritalin to treat ADHD are examples about how scientific
advances influence attitudes on mind-body relationships.
New trend of treatment of obesity is to discover the fat
gene, ignoring the role of psychosocial factors. However,
research associated with the Human Genome Project
continues to support the biopsychosocial perspective in
obesity treatment.
Ritalin for ADHD provides another example of the impact
of scientific advances. Many parents and teachers show
more interest in using Ritalin to control the symptoms
than in using psychosocial interventions. Research on
ADHD supports the biopsychosocial perspective.
Advances in Science, Technology, and
Medicine
Technological advances (e.g., computer technology, fax
machines, cellular phones, video, electronic mail, and
virtual reality) have an impact on clinical psychology.
Maintaining confidentiality when using computers to be
careful for patient information is important. Potential
access to computer files and patient information are
ethical issues.
The use of the Internet and the telephone to conduct
therapy or psychological cons is controversial. Some
accept it, others state that it would be unethical. Some
say that therapy via internet or telephone might have
advantages for people who are in remote locations.
Virtual reality in exposure
has also been used to treat anxiety, especially fears and
phobias.Therapists can use virtual exposure with their
patients to cope better with phobias such as airplane,
driving, or spider phobias.
Virtual reality in exposure
Money
As a result of wars and economic crisis, attempts to
balance the financial policies have resulted in cuts in
many programs affecting clinical psychology.
Money or the lack of money is an important issue
concerning research, practice, and training.
Gender Shifts in Professions
The percentage of female clinical psychologists has more
than doubled between 1960 and 2003.
More women in the field adds new perspective,
awareness, and approach. Professions and services are
enriched when people of different gender, ethnicity, and
religion enter the discipline. It allows more choice for
those seeking psychological services and role models for
students.
Research Issues
More complicated research designs and questions are
being applied today. These research questions tend to
look for interactions rather than main effects, under
which conditions, with which patients, treated by
which therapists, and using which techniques will
interventions work best.
Research Issues
In addition to traditional methods, qualitative,
descriptive, and narrative approaches have been used
to answer research questions.
Investigating clinical rather than simply statistical
significance has been advanced. The use of effect size
and meta-analysis techniques, statistical analysis by
computer technology has increased the utility of
research methodologies and data analysis approaches.
SPSS, AMOS and LISRELL.
Research Issues
Significant contemporary research problems of society
are homelessness, violence, racism, terrorism, and the
role of psychology and behavior in diseases such as AIDS
and obesity.
Practice Issues
Managed Health Care and Health-Care Reform
Physicians used to treat patients and insurance company
used to pay for whatever the doctors ordered. Lacking
medical degrees, clinical psychologists could not be
payed back by insurance companies. In the 1970s,
«freedom-of-choice” laws passed and allowed that
psychologists were available for medical insurance.
While physicians argued that only psychiatrists should
treat patients in psychotherapy, psychologists argued
that a mental health professional did not need to be a
physician in order to conduct psychotherapy.
After «freedom-of-choice” law, insurance companies pay
back psychologists. Psychologists could offer various
types of psychotherapy. Insurance would pay back 50 to
80% of the fees charged by the psychologist, and
patients paid the remaining part.
These «fee-for-service» insurance arrangements began
to change during the 1980s. Health care costs rose.
According to fixed and predetermined fee, patients were
categorized into diagnosis-related groups, and the costs
were calculated based on the average cost per patient for
a given diagnosis. A hospital would receive a fixed fee for
treating a patient with a given diagnosis. If the hospital
needed more time or money to treat the patient, monies
would not be available for the additional services.
Many psychologists are concerned about the growing use
of capitation methods. In a capitation program, the
insurance company will pay a set fee for the treatment of
a given patient no matter what treatment or how many
sessions are required.
Psychologists and other mental health professionals are
unhappy with managed health care:
1. All professional decisions must be approved by the
insurance company.
2. Patient confidentiality must be broken. Details about
the patient must be disclosed by the company.
3. Psychologists and patients often feel that too few
sessions are approved by the company.
4. Many psychologists resent having someone tell them
how they should treat their patients. A company might
urge the psychologist to have the patient enter group
rather than individual therapy to decrease costs.
Prescription Privileges
Historically, psychiatrists have been the only mental
health professionals legally allowed to prescribe
medication.
Although many psychologists conduct research on the
neurobiology and psychopharmacology, and graduate
programs offer psychopharmacology courses,
psychologists have obtained legal permission to
prescribe medications only in Guam, New Mexico, and
Louisiana.
Prescription Privileges
The American Psychiatric Association are opposed to
allowing psychologists the privilege of prescribing
medication. Even many psychologists are opposed to
having psychologists prescribe medication for their
patients. But, the majority of clinical psychologists
support prescription privileges.
Prescription Privileges
The APA has outlined a curriculum for psychologists
who are interested in being trained to prescribe
medication. The program includes basic
psychopharmacology education and prescription
privilege.
Prescription Privileges
By 1998, legislation for psychology prescription
privileges was introduced in six states including
California, Florida, Hawaii, Louisiana, Missouri, and
Tennessee.
In 2001, New Mexico became the first state to allow
psychologists prescription privileges. Louisiana
became the second state to award these privileges
to psychologists in 2004.
Medical Staff Privileges
Historically, only physicians were allowed to treat
patients independently in a hospital setting and serve on
the medical staff of a hospital.
Medical staff privileges allowed a physician to admit
and discharge patients and organize or manage the
treatment plan of patients while hospitalized.
Medical Staff Privileges
In 1978, legislation was passed allowing psychologists to
be able to obtain medical staff privileges independently
in California. Since that time, many states in USA have
enacted similar legislation.
Private Practice
The number of clinical psychologists choose to work in
full-time or part-time in solo or group private practice.
Managed health care has made it difficult to develop and
maintain an independent practice. The companies have
looked to master’s-degree trained counselors as a lower
cost alternative to clinical psychologists. The companies
find it more cost effective to work with large centers
rather than solo private practices. Solo private practice
might no longer exist within the next years.  
Specialization
The need for specialization has become apparent. A
general clinical psychologist is to have limitations.
Specialization has resulted in further certification
requirements.
Empirically Supported Treatments
Historically psychologists could evaluate and treat each
patient as they saw fit. But, changes in health care have
forced mental health professionals to examine effective
treatment outcome and client satisfaction, and have
resulted in efforts to use empirically supported
treatments.
Empirically Supported Treatments
Empirically supported treatment approaches have been
developed for depr, anx, OCD, bulimia nervosa, and
conduct disorder.
Some professionals state: «because individuals are
unique and have different personalities, symptoms, and
coping resources, it is impossible to fit the same
treatment approach to every patient based on empirical
research support». Others approve empirically
supported treatments.
Evidence-based practice
This discussion has resulted in evidence-based practice.
Evidence-based practices utilize the findings of highquality research. Evidence-based practices use the best that
research has to offer with realities of professional practice
with actual diverse client populations.
It might be expected that evidence –based practice will
increase in the future.
Reaching Beyond Mental Health in Contemporary
Clinical Psychology
Psychology is considered not only an independent mental
health discipline but also an independent general health
care discipline.
APA agreed the motto:
“health, education, and human welfare”
Training Issues
Training models include the scientist-practitioner, or
Boulder model; the scholar-practitioner, or Vail model;
the PhD or the PsyD degree programs; and the
university or the free standing professional school
models.
Which training models will survive and which will not
have important questions for the future.
Many psychologists are concerned that professional
standards have decreased with the professional schools.
Many free standing professional schools are
unaccredited by the APA.
New discoveries, specializations, and the demands of
society influence training. Graduate and postgraduate
training programs may need to provide training in
psychopharmacology. Focus on violence, ethnic
diversity, technological advances, and cost-effective
treatment influence the training.
New trends in training are necessary postdoctoral
training and new joint degree programs.
Joint degree programs combine psychology training with
other fields, such as business and law. As clinical
psychology matures, more emphasis in research and
practice will be placed on education, specialization, and
interdisciplinary training.
The future of clinical psychology
is uncertain.
Future clinical psychologists must be flexible to adapt to
changing needs and requirements as society and the
discipline changes.