Evolution of Clinical Evolution of Clinical PsychologyPsychology

Tonight we will discuss the major Tonight we will discuss the major issues surrounding the following issues surrounding the following current controversies in the field of current controversies in the field of Psychology.Psychology.

Evolution of Clinical Evolution of Clinical PsychologyPsychology Prescription PrivilegesPrescription Privileges Manualized TherapyManualized Therapy Effect of payment method / managed care on Effect of payment method / managed care on

diagnosis and treatment.diagnosis and treatment.

We will discuss your professional opinion* We will discuss your professional opinion* about each controversy?about each controversy?

**The major difference between a lay opinion and a professional opinion is The major difference between a lay opinion and a professional opinion is that professional opinions are based on a thorough knowledge of the research that professional opinions are based on a thorough knowledge of the research in the field as well as the thinking and theories of other scholars.  In this in the field as well as the thinking and theories of other scholars.  In this course, be sure to incorporate research findings, scholarly thought, and course, be sure to incorporate research findings, scholarly thought, and theories into your answers.  This way, when you state your opinion, it is an theories into your answers.  This way, when you state your opinion, it is an informed professional opinion rather than a lay opinion.informed professional opinion rather than a lay opinion.

Evolution of Evolution of Assessment: Assessment: Diagnostic IssuesDiagnostic Issues Currently, numerous disorders are Currently, numerous disorders are

under consideration for inclusion under consideration for inclusion in the next DSMin the next DSM– Premenstrual dysphoric disorderPremenstrual dysphoric disorder– Minor depressive disorderMinor depressive disorder– Recurrent brief depressive disorderRecurrent brief depressive disorder– Binge eating disorderBinge eating disorderCan you think of others? Can you think of others?

Development of the Development of the ProfessionProfession In the 1980s,In the 1980s,

– Psychotherapy thrived, in part due Psychotherapy thrived, in part due to increasing respect from medical to increasing respect from medical professionals and insurance professionals and insurance companiescompanies

– The number of training programs The number of training programs and new clinical psychologists and new clinical psychologists increasedincreased

Development of the Development of the ProfessionProfession In the 1990s and 2000s,In the 1990s and 2000s,

– The size and scope of the field The size and scope of the field continues to growcontinues to grow

– Multiple training model options are Multiple training model options are availableavailable

– Empirical support of clinical Empirical support of clinical techniques, prescription privileges, techniques, prescription privileges, and new technologies are among and new technologies are among major contemporary issuesmajor contemporary issues

Current ControversiesCurrent Controversies

Prescription PrivilegesPrescription Privileges Evidence-Based Evidence-Based

Treatments/Manualized TherapyTreatments/Manualized Therapy Payment MethodsPayment Methods The Influence of TechnologyThe Influence of Technology

Prescription PrivilegesPrescription Privileges

Historically, prescribing has Historically, prescribing has distinguished psychiatrists from distinguished psychiatrists from psychologistspsychologists

However, in recent decades, However, in recent decades, clinical psychologists have clinical psychologists have actively pursued prescription actively pursued prescription privilegesprivileges

Prescription PrivilegesPrescription Privileges

Since 2002, two states have agreed Since 2002, two states have agreed to grant prescription privileges to to grant prescription privileges to appropriately trained psychologists appropriately trained psychologists – New MexicoNew Mexico– LouisianaLouisiana

Other states have considered Other states have considered similar legislation, and may pass it similar legislation, and may pass it soonsoon

Prescription PrivilegesPrescription PrivilegesQuestionQuestion

Do you think clinical psychologists Do you think clinical psychologists should be granted prescription should be granted prescription privileges? Why or why not? How, privileges? Why or why not? How, if at all, might the ability to write if at all, might the ability to write prescriptions affect the practice prescriptions affect the practice of clinical psychology?of clinical psychology?

Prescription PrivilegesPrescription Privileges

Why psychologists Why psychologists shouldshould prescribe:prescribe:– Shortage of psychiatristsShortage of psychiatrists

Especially in rural areasEspecially in rural areas Important factor in NM and LA decisionsImportant factor in NM and LA decisions

– Other non-physicians have privilegesOther non-physicians have privileges Dentists, podiatrists, optometrists, and Dentists, podiatrists, optometrists, and

some nurses, among otherssome nurses, among others

– ““one-stop” shopping for clientsone-stop” shopping for clients

Prescription PrivilegesPrescription Privileges

Why psychologists Why psychologists shouldshould prescribe (continued):prescribe (continued):– Professional autonomyProfessional autonomy– Professional identificationProfessional identification– Evolution of the professionEvolution of the profession– Revenue for the professionRevenue for the profession

Prescription PrivilegesPrescription Privileges

Why psychologists Why psychologists should notshould not prescribe:prescribe:– Training issuesTraining issues

Which courses? When? Taught by Which courses? When? Taught by whom?whom?

– Threats to psychotherapyThreats to psychotherapy Would medications replace talk therapy?Would medications replace talk therapy?

– Identity confusionIdentity confusion Especially when only some prescribeEspecially when only some prescribe

– Influence of pharmaceutical industryInfluence of pharmaceutical industry

Evidence-Based Evidence-Based Treatments/Manualized Treatments/Manualized TherapyTherapy When researchers measure therapy When researchers measure therapy

outcome, they often use therapy outcome, they often use therapy manualsmanuals– To ensure uniformity across therapistsTo ensure uniformity across therapists– To minimize variability To minimize variability

When outcome data supports the use When outcome data supports the use of a manualized therapy, the of a manualized therapy, the treatment is known as “evidence treatment is known as “evidence based”based”

Evidence-Based Evidence-Based Treatments/Manualized Treatments/Manualized Therapy Therapy QuestionQuestion

What do you think about manualized What do you think about manualized treatments? What are some benefits treatments? What are some benefits of manualized treatments? What are of manualized treatments? What are some disadvantages? If you were a some disadvantages? If you were a client, would you want your treatment client, would you want your treatment course to be manualized, open to your course to be manualized, open to your psychologist’s clinical judgment, or psychologist’s clinical judgment, or some combination of the two? Why?some combination of the two? Why?

Advantages of Evidence-Advantages of Evidence-Based/Manualized Based/Manualized TherapyTherapy Scientific legitimacyScientific legitimacy Establishing minimal levels of Establishing minimal levels of

competencecompetence Training ImprovementsTraining Improvements Decreased reliance on clinical Decreased reliance on clinical

judgmentjudgment

Disadvantages of Disadvantages of Evidence-Based/ManualizEvidence-Based/Manualized Therapyed Therapy Threats to the psychotherapy Threats to the psychotherapy

relationshiprelationship Diagnostic complicationsDiagnostic complications Restrictions on practiceRestrictions on practice Debatable criteria for empirical Debatable criteria for empirical

evidenceevidence

Payment MethodsPayment Methods

Early in the history of clinical Early in the history of clinical psychology, clients paid for services psychology, clients paid for services directly out of pocketdirectly out of pocket

With time, health insurance companies With time, health insurance companies began covering mental healthbegan covering mental health

Today, many clients use health Today, many clients use health insurance/managed care benefits to insurance/managed care benefits to pay for servicespay for services– Often called “third-party payers” Often called “third-party payers”

Payment Methods Payment Methods QuestionQuestion

If you were a psychologist, do you If you were a psychologist, do you think the way in which your clients think the way in which your clients paid for services would affect your paid for services would affect your treatment decisions? If so, how might treatment decisions? If so, how might method of payment affect your client’s method of payment affect your client’s course of treatment, and how would course of treatment, and how would your sessions vary between self-pay your sessions vary between self-pay and managed-care-pay clients? and managed-care-pay clients?

Effect of Third-Party Effect of Third-Party Payment on TherapyPayment on Therapy Surveys of psychologists suggest that Surveys of psychologists suggest that

third-party payment can result inthird-party payment can result in– Negative impact on qualityNegative impact on quality– Too little control over clinical decisionsToo little control over clinical decisions– Ethical problems, including confidentialityEthical problems, including confidentiality– Confusion about informed consent (what Confusion about informed consent (what

to tell clients about payment method)to tell clients about payment method)– Greater affordability for many clientsGreater affordability for many clients

Effect of Third-Party Effect of Third-Party Payment on DiagnosisPayment on Diagnosis Surveys of psychologists suggest Surveys of psychologists suggest

that third-party payment can that third-party payment can result inresult in– Increased likelihood of being Increased likelihood of being

diagnosed with a mental disorderdiagnosed with a mental disorder– Certain diagnostic categories being Certain diagnostic categories being

used more or less oftenused more or less often

The Influence of The Influence of TechnologyTechnology In recent years, clinical psychologists In recent years, clinical psychologists

have increasingly used technology in have increasingly used technology in the direct delivery of psychological the direct delivery of psychological servicesservices– AssessmentAssessment– TreatmentTreatment

Telehealth can replace or supplement Telehealth can replace or supplement face-to-face meetingsface-to-face meetings

Benefits can include accessibility, Benefits can include accessibility, affordability, and anonymity, and moreaffordability, and anonymity, and more

The Influence of The Influence of Technology Technology QuestionQuestion

What are some potential ethical What are some potential ethical dilemmas of online psychotherapy and dilemmas of online psychotherapy and assessment provision? What benefits assessment provision? What benefits might online psychological treatments might online psychological treatments possess?possess?

Applications of Applications of Technology in Clinical Technology in Clinical Psychology--ExamplesPsychology--Examples Videoconferencing to interview or treatVideoconferencing to interview or treat Email psychotherapyEmail psychotherapy Interactive Internet sitesInteractive Internet sites Online psychotherapy programsOnline psychotherapy programs Virtual reality therapeutic experiencesVirtual reality therapeutic experiences Computer-based self-instructionComputer-based self-instruction Therapist/client interaction via hand-Therapist/client interaction via hand-

held devices (e.g., PDAs) held devices (e.g., PDAs)

Technology—Suggestions Technology—Suggestions for Emerging for Emerging Professional IssuesProfessional Issues Obtain informed consent about the Obtain informed consent about the

technologytechnology Follow relevant telehealth lawsFollow relevant telehealth laws Follow APA ethical code Follow APA ethical code Ensure confidentiality via encryptionEnsure confidentiality via encryption Make efforts to appreciate cultureMake efforts to appreciate culture Obtain relevant trainingObtain relevant training Know client’s local emergency resources Know client’s local emergency resources

Questions?Questions?