CHAPTER 3

Question 1

Many contemporary issues challenge the field of clinical psychology. To begin with, several training models are available, each with different emphases and outcomes.

Answer 1

MODELS OF TRAINING IN CLINICAL PSYCHOLOGY

Question 2

This model integrates scientific principles with clinical practice, aiming to produce professionals who can both conduct research and provide clinical services.

• There is an ongoing debate about the effectiveness of this model. Some argue that it remains a durable and balanced approach, while others criticize it as a poor educational model. The profession is increasingly divided between those focused on clinical practice and those interested in research.

Answer 2

The Scientist Practitioner Model

Question 3

This model emphasizes clinical skills with less emphasis on research, as reflected in the Doctor of Psychology (Psy.D) degree. Initially questioned for employability, but studies show Psy.D. graduates face no significant issues.

• Concerns have been raised about the perceived qualifications of Psy.D. graduates compared to those with Ph.D.s. However, studies have shown that Psy.D. graduates do not necessarily face more challenges in employment.

Answer 3

The Doctor of Psychology (Psy. D) Degree

Question 4

These autonomous schools, often offering the Psy.D., prioritize clinical functions over research. Challenges include funding instability and reliance on part-time faculty.

• Funding instability is a significant problem for professional schools, which heavily depend on tuition. Additionally, reliance on part-time faculty poses a shaky foundation for academic structure.

Answer 4

Professional Schools

Question 5

This model emerged as a response to concerns that clinical psychology lacks a strong scientific foundation. It emphasizes research and empirically supported approaches to assessment and intervention.

• Concerns have been raised about the lack of empirical support for certain clinical techniques and questioning the reliability of certain assessment techniques within the field of clinical psychology.

Answer 5

Clinical Scientist Model

Question 6

This model combines counseling, clinical, and school psychology, emphasizing breadth over depth in psychological knowledge.

• Graduates may lack a specific subspecialty or area of expertise, making this model more suitable for future practitioners than academics or clinical scientists.

Answer 6

Combined Professional-Scientific Training Programs

Question 7

Changes in graduate training have mirrored shifts in the marketplace for clinical psychologists, with criticisms of the inadequacy of the Boulder model or inadequacies in clinical skills training.

• There are concerns about an oversupply of practice-oriented psychologists and the potential impact of the managed health care revolution on the demand for clinical psychologists.

Answer 7

Graduate Programs: Past and Future

Question 8

Involves methods aimed at protecting the public interest and assuring competence. It is, however, complicated by the fact that no national standard exists; the requirements for both certification and for licensure can vary markedly from state to state.

Answer 8

Professional Regulation

Question 9

A relatively weak form of regulation, restricting the use of the title “psychologist” to those certified by a state board.

• does not prevent unqualified individuals from offering psychological services as long as they avoid using the title “psychologist”

Answer 9

Certification

Question 10

A stronger form of regulation than certification, specifying training requirements, professional activities, and often excluding master’s candidates. Increasingly restrictive, facing challenges in standardization and academic freedom concerns.

• There are debates about the validity of licensing measures for professional competence. Academic freedom concerns are raised, and challenges include establishing a national standard for licensure and addressing issues related to telehealth.

Answer 10

Licensing

Question 11

was established in 1947

Answer 11

American Board of Examiners in Professional Psychology

Question 12

In 1968, ABEPP was shortened to _______________

• it offers certification of professional competence in the fields:

● Clinical child and adolescent psychology
● clinical psychology
● clinical health psychology
● clinical neuropsychology
● cognitive and behavioral psychology
● counseling psychology
● couple and family psychology
● forensic psychology
● group psychology
● organization and business consulting psychology
● police and public safety psychology
● psychoanalysis in psychology
● rehabilitation psychology
● and school psychology

Benefits:

• reduced liability insurance, increased status as a clinician or expert witness, and increased ease of mobility if one chooses to move to another state

Answer 12

American Board of Professional Psychology (ABPP)

Question 13

American Board of Professional Psychology (ABPP) candidates are required to submit:

Answer 13

practice samples (videotaped), provide a written statement regarding professional expertise and handling of clinical cases, and successfully complete an oral examination conducted by three expert peers.

Question 14

In 1975, the first ________ of Health Service Providers in Psychology was published.

● is a kind of self certification
● listing only those practitioners who are licensed or certified in their own states and
● who submit their names for inclusion and pay to be listed.

Answer 14

National Register

Question 15

The idea that began as an honest and dedicated attempt to improve training, provide continuing professional growth, protect the public, and improve the common good will end in a selfish posture of vested interest.

• Traditional fee-for-service __________ is a thing of the past (Baker et al., 2009; McFall, 2002, 2006); managed health care now dominates the scene.
• Training programs must ensure that future clinical psychologists are not sent out into the real world lacking the requisite skills and knowledge demanded by managed health care systems.

Answer 15

Private Practice

Question 16

What Future Practicing Clinical Psychologists Need to Know?

Answer 16

1. Knowledge of new and evolving health care delivery systems.
2. Sensitivity to ethical issues relevant to managed care settings.
3. Experience in multidisciplinary environments
4. Managed-care-relevant clinical skills
5. Expertise in “applied” research.
6. Management and business skills.
7. Technology
8. Empirically supported and evidenced-based practices (EBPs) in clinical assessment and intervention
9. Training in supervision
10. Sensitivity to cultural differences and knowledge of empirical findings

Question 17

Health care costs continue to rise. According to the World Health Organization the United States spends more money on health care. It is estimated that the United States spent $2.5 trillion dollars on health care in 2009, approximately $8,086 per person.

Answer 17

The Costs of Healthcare

Question 18

The initial attempt to address high costs for health care in general and mental health care in particular.

• The focus became cost containment, with corporations expanding into a kind of medical-industrial complex and emphasizing a marketplace mentality (Kiesler & Morton, 1988)

Answer 18

Managed Care

Question 19

The old, traditional, fee-for-service mental health care system was “__________” in the sense that there was little control over which doctoral-level practitioners could be used, the amount paid for services, the quality of services, and the frequency of service utilization.

Answer 19

Unmanaged

Question 20

Insurance plans become “_______________” as provider networks become more selective, as utilization of services is evaluated with regard to appropriateness and effectiveness, and as managed care organizations institute quality improvement programs.

Answer 20

More Managed

Question 21

Three Major Types of Managed Care Systems:

Answer 21

1) Health Maintenance Organization (HMO)
2) Preferred Provider Organization (PPO)
3) Point of Service (POS)

Question 22

employs a restricted number of providers to serve those who enroll in the plan; costs for all services are fixed.

Answer 22

Health Maintenance Organization (HMO)

Question 23

has contracts with outside providers (at a discounted rate) to meet the needs of its membership; in exchange for the discounted rate, the providers theoretically receive an increased number of referrals.

Answer 23

Preferred Provider Organization (PPO)

Question 24

plan combines features of HMOs and PPOs in that members have more options regarding how “managed” their health care choices are but pay more for these non-managed features

Answer 24

Point of Service (POS)

Question 25

this first iteration of managed care, especially as applied to mental health

• failed
• As Cummings notes, costs have continued to increase, clinicians are receiving less money for their services, and clinicians spend an increasing proportion of their time on paperwork and getting reimbursed than on direct care.

Answer 25

Behavioral Health Care

Question 26

What is the next stage of behavioral health care likely to involve? Cummings (2006) predicts two major models that are likely to be implemented:

Answer 26

1) Consumer-Directed Healthcare Plans
2) Pay-For Performance Disease Management Models

Question 27

shift the cost and responsibility of behavioral health care services to the consumer. Individuals will be spending more out-of-pocket

Answer 27

Consumer-Directed Healthcare Plans

Question 28

provides pay-for-performance incentives to clinicians to provide high-quality, effective services

Answer 28

Pay-For Performance Disease Management Models

Question 29

What are all these changes in behavioral health care management likely to mean for clinical Psychologist?

Answer 29

1. clients are likely to be seen for fewer sessions and the psychological treatments administered are likely to be from a list of evidence-based treatments
2. some predict that self-care or self-help methods will be used more
3. predicted that more and more behavioral health services will occur in primary care and other less traditional settings like schools and the workplace.

Question 30

Recent Developments Relevant to Behavioral Health Care

Answer 30

1. Costs of healthcare are expected to rise again.
2. Psychotherapists are adopting novel approaches to managed care and may expand their roles.
3. Consumer-driven health plans are likely to become more popular.

Question 31

The American Psychological Association endorsed this pursuit in 1995,.

Pros:

• would enable clinical psychologists to provide a wider variety of treatments and to treat a wider range of clients or patients
• potential increase in efficiency and cost-effectiveness of care for patients who need both psychological treatment and medication
• will give clinical psychologists a competitive advantage in the healthcare market
• as a natural progression in clinical psychology’s quest to become a “full-fledged” health care profession rather than just a mental health care profession

Cons:

• critics point out that prescription privileges may lead to a de-emphasis of “psychological” forms of treatment because medications are often faster acting and potentially more profitable than psychotherapy.
• may also damage clinical psychology’s relationship with psychiatry and general medicine.
• would likely lead to increases in malpractice liability costs. In short, it may not be worth it.
• ## psychologists’ ability to prescribe medications would lead to more drug company-sponsored research.

Answer 31

Prescription Privileges (Prescriptive Authority)

Question 32

In 1993, the __________ on Psychopharmacology of the American Psychological Association published its recommendations regarding competence criteria for training psychologists to provide services to individuals who receive psychotropic medication.

• This Task Force outlined the following three levels of competence and training in psychopharmacology. Note that, according to the Task Force’s recommendations, only those who successfully complete Level 3 training would be qualified to prescribe.

Answer 32

Ad Hoc Task Force

Question 33

include knowledge of the biological basis of neuropsychopharmacology and a mastery of the classes of medication used for treatment as well as knowledge of substances that are abused (e.g., alcohol or cocaine).

• To achieve this level of training, a one-semester survey course in psychopharmacology is recommended

Answer 33

Level 1: Basic Pharmacology Training

Question 34

Essentially enabling one to serve as a psychopharmacology consultant, would involve a more in-depth knowledge of psychopharmacology and drugs of abuse; competence in diagnostic assessment, physical assessment, drug interactions, and drug side effects; and practical (hands-on) training in psychopharmacology.

• Specifically, the committee recommended coursework in the areas just mentioned as well as supervised practical experience.

Answer 34

Level 2: Collaborative Practice

Question 35

practice independently as a prescribing psychologist. The committee recommended a strong undergraduate background in biological sciences (including multiple courses in biology, chemistry, mathematics, and pharmacology)

• 2 years of graduate training in psychopharmacology (26 credit hours), and a postdoctoral psychopharmacology residency

Answer 35

Level 3: Prescription Privileges

Question 36

refers to the delivery and oversight of health services using telecommunication technologies. For example, Web sites, e-mail, telephones, online video conferencing, and transmitting medical images for diagnosis are often used as a means to assess, evaluate, and treat psychological and behavioral problems.

Answer 36

Telehealth

Question 37

involves assessing the emotions, behaviors, and cognitions of individuals as they are interacting with the environment in real time

● One advantage of ambulatory assessment is that very little, if any, retrospection is required of the client. For example, to track a client’s mood state, an electronic diary or smart phone might be used to prompt the client to complete mood ratings at various points throughout the day and night.
● Second advantage of ambulatory assessment—it is more ecologically valid. That is, ratings and assessments are collected on the client’s experiencing in his or her natural environment
● Third advantage is that multiple assessments on the same client are possible, enabling the clinician to explore the variability of moods states.
● Fourth advantage for ambulatory assessment is the possibility that multiple forms of ambulatory assessment, focusing on different response domains, can be conducted and combined for the single client. For example, a client with an anxiety disorder could provide ambulatory assessment data in three realms: psychological, psychophysiological, and behavioral
● Final advantage is that ambulatory assessment can be easily incorporated with treatment or even computer-assisted therapy

Answer 37

Ambulatory assessment

Question 38

Has the potential to be less stigmatizing, more efficient, more accessible, and more convenient for clients.

• To the extent clients are able to access mental health services from any location that has telephone or Internet service, this would mitigate the problem or concern.

● There are many efficiencies afforded by computer-assisted treatment. For example, electronic record of all interactions between client and clinician are stored, the viewing of Web pages and completion of homework assignments can be timestamped, and these interactions can more easily be incorporated into electronic health records

Answer 38

Computer-Assisted Therapy

Question 39

The American Psychological Association (2003) published guidelines on multicultural education, training, research, practice, and organizational change for psychologists.

● 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; and
● recognize the importance of culture in psychological research and clinical work.

Answer 39

Culturally Sensitive Mental Health Services

Question 40

a knowledge and appreciation of other cultural groups and the skills to be effective with members of these groups

Answer 40

Cultural Competence

Question 41

Clinicians must formulate and test hypotheses regarding the status of their culturally different clients; clinicians must not adhere to the “myth of sameness.”

Answer 41

Scientific-mindedness

Question 42

Clinicians must be skilled in knowing “when to generalize and be inclusive and when to individualize and be exclusive”. This allows the clinician to avoid stereotypes but still appreciate the importance and influence of the culture in question.

Answer 42

Dynamic Sizing

Question 43

Clinicians must understand their own culture and perspectives, have knowledge of the cultural groups with whom they work, and if indicated, be able to use culturally informed interventions.

Answer 43

Culture-specific expertise

Question 44

The 2002 version of the Ethical Principles of Psychologists and Code of Conduct presents five general principles as well as specific ethical standards relevant to various activities of clinical psychologists

• The general principles include the following:

Answer 44

1) Beneficence and non-maleficence
2) Fidelity and responsibility
3) Integrity
4) Justice
5) Respect for people’s rights and dignity

Question 45

Psychologists strive to benefit those they serve and
to do no harm

Answer 45

Beneficence and non-maleficence

Question 46

In all their activities, psychologists strive to be accurate, honest, and truthful

Answer 46

Integrity

Question 47

Psychologists have professional and scientific responsibilities to society and establish relationships characterized by trust.

Answer 47

Fidelity and responsibility

Question 48

All persons are entitled to access to and benefit from the profession of psychology; psychologists should recognize their biases and boundaries of competence.

Answer 48

Justice

Question 49

Psychologists respect the rights and dignity of all people and enact safeguards to ensure protection of these rights

Answer 49

Respect for people’s rights and dignity

Question 50

● First, clinicians must always represent their training accurately. Clinicians should not attempt treatment or assessment procedures for which they lack specific training or supervised experience

● It is equally important that clinicians 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.

● Finally, to the extent that clinicians have personal problems or sensitive spots in their own personality that could affect performance, they must guard against the adverse influence
of these problems on their encounters with patients.

Answer 50

Competence

Question 51

have been developed to allow for the assessment of competence in the practice of clinical psychology, this tools include: performance reviews, case presentation reviews, client outcome data, consumer surveys, self-assessments, and both oral and written examinations.

Answer 51

Toolkits

Question 52

is central to the client–psychologist relationship. When information is released without the client’s consent, the trusting relationship can be irreparably harmed.

Answer 52

Confidentiality

Question 53

Finally, it is worth noting that a 1996 Supreme Court ruling, Jaffe v. Redmond, provides for privileged communication between licensed mental health professionals and individual adult patients in psychotherapy

Answer 53

Privacy

Question 54

● Dual relationships pose many ethical questions regarding client welfare: Sexual activities with clients, employing a client, selling a product to a client, or even becoming friends with a client after the termination of therapy are all behaviors that can easily lead to exploitation of and harm to the client.

● Another aspect of client welfare involves the clinician’s willingness to terminate therapy when it is no longer helping the client.

Answer 54

Human Relations