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@GMU.EDU
WHY DOES THIS MATTER?
1. WE CAN LEARN FROM THE SUCCESSES &
FAILURES OF OTHERS.
2. MAY HELP YOU THINK MORE CRITICALLY
ABOUT . . .YOUR OWN TRAINING
3.
. . . AND YOUR CLINICAL WORK.
4. YOU MAY BE INVOLVED IN TRANING.
5. YOU MAY BE INVOLVED IN SELFREGULATION OF PROFESSION.
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.
CLINICAL PSYCHOLOGY IN THE U.S.
• ABOUT 125 YEARS OLD.
• ABOUT 120,000 PSYCHOLOGISTS (POP. OF 310 MILLION)
• ABOUT 90,000 PRACTITIONERS—MOSTLY 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 ASSOCIATION—1892
• 150,OOO + MEMBERS
HISTORY OF CLINICAL PSYCHOLOGY IN THE
US—
A STRUGGLE FOR…
• IDENTITY—
• THE PROFESSION’S ATTEMPTS
TO DEFINE ITSELF. . .
. . .AND
RESPECTABILITY WITH
•OTHER DISCIPLINES WITHIN PSYCHOLOGY
•SCIENCE VERSUS PRACTICE
•OTHER HEALTH AND MENTAL HEALTH
PROFESSIONS
•ESPECIALLY MEDICINE AND PSYCHIATRY
•POLICY MAKERS
•THE PUBLIC
CONTINUAL INTERACTIONS AMONG…
 PROFESSIONAL PSYCHOLOGY ORGANIZATIONS (APA)
 OTHER DISCIPLINES (PSYCHIATRY)
 STATE GOVERNMENTS
 FEDERAL GOVERNMENT
 UNIVERSITIES
 PRIVATE INDUSTRY—INCLUDING HEALTH INSURANCE COMPANIES
 CANADIAN PSYCHOLOGY
 EUROPEAN PSYCHOLOGY
IT MAY HELP TO UNDERSTAND THE US
CONSTITUTION
• LIMITS POWERS OF FEDERAL GOVERNMENT.
• GIVES A LOT OF POWER TO STATE
GOVERNMENTS
• PRO—50 + 10 LABORATORIES FOR INNOVATION
• CON—DIFFICULT TO DEVELOP CONCENSUS
AND CONSISTENCY
• CREDENTIALING, TRAINING STANDARDS. ETC.
FOR THIS REASON . . .
 NATIONAL LICENSING LAW WAS NEVER A
POSSIBILITY
 NOR WERE GOVERNMENT-MANDATED TRAINING
STANDARDS.
 RESPONSIBILITY LEFT TO STATES
 AND PROFESSIONAL ORGANIZATIONS
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 MASTER’S DEGREES.
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 CHILDREN’S ACADEMIC PROBLEMS.
 FIRST CLIENT—14 YEAR OLD BOY WITH “SPELLING PROBLEMS.”
 MORE SIMILAR TO WHAT IS NOW CALLED SCHOOL
PSYCHOLOGY.
• 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.
• 1916—U.S. VERSION OF BINET-SIMON TEST OF
INTELLIGENCE PUB. IN 1916 (“STANFORD BINET”).
• “MENTAL TESTING” FIRMLY ESTAB. AS KEY ACTIVITY
OF CLINICAL PSYCHOLOGISTS.
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.
• 1917—ILLINOIS 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.
PSYCHOLOGY TRIES TO ESTABLISH
STANDARDS FOR PROFESSION
 1917—APA COMMISSION TO SET STANDARDS FOR
“PSYCHOLOGICAL EXAMINER”
 1917—FOUNDING 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.”
•1918—AMERICAN 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.
ALSO IN 1917…
U.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.
AFTER WORLD WAR I
 1921—FORMATION OF THE PSYCHOLOGICAL
CORPORATION (TESTING)
 BEGINNING OF PSYCHOLOGY AS A BIG BUSINESS IN
THE PRIVATE SECTOR.
 1921—APA 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.
1924—EARLY ATTEMPT AT SELFREGULATION
 APA’S 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
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.”
1930s…CONTINUED GROWTH
• 1930—OVER 500 CLINICS OFFER PSYCHOLOGICAL
SERVICES.
• 1932—FOUNDED THE JOURNAL OF CONSULTING
PSYCHOLOGY.
• LATER CHANGED TO JOURNAL OF CONSULTING AND
CLINICAL PSYCHOLOGY (APA).
• 1935—APA 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
WORLD WAR II
 US MILITARY EMPLOYS OVER 1700 PSYCHOLOGISTS.
 PERSONNEL SELECTION AND TRAINING.
 EQUIPMENT DESIGN (HUMAN FACTORS)
 COUNSELING AND PSYCHOTHERAPY.
 END OF WORLD WAR II—ALMOST 45,000 PSYCHIATRIC
PATIENTS IN HOSPITALS FOR VETERANS
 VA CLAIMS IT NEEDS 4700 PSYCHOTHERAPISTS AND
COUNSELORS.
 PSYCHIATRY CANNOT MEET THIS NEED . . .THEREFORE. . .
1942—CONGRESSIONAL ORDER TO
VETERAN’S ADMINISTRATION
• EXPAND THE POOL OF MENTAL HEALTH
PROFESSIONALS, ESPECIALLY CLINICAL
PSYCHOLOGISTS
• 1944—US 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.
PSYCHOLOGISTS BECOME
PSYCHOTHERAPISTS
 BY 1947—1500 CLINICAL PSYCHOLOGY PHD
STUDENTS FUNDED AT 50 UNIVERSITIES.
• VA CREATES 100s OF NEW JOBS FOR CLINICAL
PSYCHOLOGISTS.
• LARGEST SINGLE EMPLOYER OF CLINICAL
PSYCHOLOGISTS.
• TODAY—THE VETERANS ADMINISTRATION
REQUIRES AN APA-ACCREDITED DOCTORAL
PROGRAM AND INTERNSHIP
• BY 1970s CLINICAL PSYCHOLOGISTS ARE THE MAJOR
PROVIDERS OF PSYCHOTHERAPY.
1946--LICENSING
 1946—CONNECTICUT BECOMES FIRST STATE TO PASS
LAW REGULATING PRACTICE OF PSYCHOLOGY WITH
LICENSE REQUIREMENTS.
 1948—VIRGINIA BECOMES FIRST STATE TO REQUIRE A
DOCTORAL DEGREE FOR LICENSE.
 1977—MISSOURI BECOMES LAST STATE TO PASS
PSYCHOLOGY LICENSING LAW.
 2004 NEW MEXICO AND LOUISIANA GRANT CLINICAL
PSYCHOLOGIST PRESCRIPTION PREVILEGES.
 WILL RETURN TO LICENSING ISSUE LATER
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.
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.
1947—APA PROPOSES FOUR-YEAR
PROGRAM FOR CLINICAL PHD
1.
COURSEWORK IN MAJOR AREAS OF PSYCHOLOGY
2.
COURSEWORK IN PSYCHOTHERAPY THEORY & RESEARCH
3.
COURSEWORK IN RESEARCH METHODS & STATISTICS
4.
RESEARCH TRAINING (DOCTORAL DISSERTATION)
5.
PRACTICUM TRAINING
6.
ONE-YEAR FULL-TIME INTERNSHIP
DÉJÀ VU OF 1924
1949—APA TRAINING CONFERENCE AT
BOULDER, COLORADO
 SPONSORED BY THE NATIONAL INSTITUTE OF MENTAL
HEALTH—A 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…
ONE MORE VERY IMPORTANT DATE…1963.
 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.
BACK TO 1949—APA TRAINING CONFERENCE
AT BOULDER, COLORADO—THE “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.
 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.
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
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.
 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.
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
RESEARCHERS—NOT 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.
RISE OF PROFESSIONAL SCHOOLS
& THE ”DOCTOR OF PSYCHOLOGY”
(PSYD)
 1951—FIRST PROFESSIONAL SCHOOL OF CLINICAL
PSYCHOLOGY AT ADELPHI UNIVERSITY IN NEW YORK.
• INDEPENDENT OF DEPARTMENT OF PSYCHOLOGY
• 1970—FIRST FREE-STANDING (NOT AT A UNIVERSITY)-PROFESSIONAL SCHOOL OF PSYCHOLOGY IN
CALIFORNIA.
• 1973—FIRST CONFERENCE OF PROFESSIONAL SCHOOLS
AT VAIL COLORADO.
• 1997—PSYD PROGRAMS WERE GRADUATING TWICE AS
MANY STUDENTS AS CLINICAL PHD PROGRAMS
APA’S 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.
 SAME STANDARDS OF ACCREDITATION BY APA.
 EQUALLY ELIGIBLE FOR LICENSURE.
 BY 2005—57 APA- ACCREDITED PSYD
PROGRAMS IN US
 ACCOUNT FOR 30% OF ALL DEGREES IN
PSYCHOLOGY
PSYD VS. PHD.
PSYD PROGRAMS IN BOTH UNIVERSITIES AND FREESTANDING 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.
• BUT—NO EVIDENCE OF DIFFERENCES IN PERFORMANCE IN
CLINICAL PRACTICE SETTINGS.
KEY IDEA IN PSY.D. PROGRAMS
SCIENTIFIC PRACTITIONER
OR
“LOCAL CLINICAL SCIENTIST”
“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).
LOCAL CLINICAL SCIENTIST
“THE LOCAL CLINICAL SCIENTIST MODEL
RECOGNIZES THAT SCIENTIFIC TRAINING—
EVEN WHEN IT DOES NOT PRESENT A
SUBSTANTIVE SOLUTION—CAN 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)
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.
CHARACTERISTICS OF THE LOCAL
CLINICAL SCIENTIST
(STRICKER, 1995)
1. OPEN TO MULIPLE APPROACHES.
2. ABESENCE OF RIGIDITY & DOGMATISM.
3. VALUES EMPIRICAL SUPPORT—GENERAL & LOCAL.
4. CLINICAL PROCESS BEGINS WITH THE PATIENT,
NOT THE RESEARCH.
5. SKEPTICAL ABOUT ONE’S OWN OBSERVATIONS
AND HYPOTHESES.
6. AWARE OF PERSONAL VALUES AND BIASES.
7. NEED FOR COLLEGIAL INTERACTION & FEEDBACK.
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.”
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 EXPERICALLYSUPPPORTED INTERVENTIONS.
• MANY DO NOT EVEN SEE THE UTILITY OF
CLINICAL RESEARCH
HOW WELL DOES BOULDER MODEL
MEET TODAY’S 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.
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.
 1994—FORMATION 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.
WHAT IS “CLINICAL SCIENCE”
ACADEMY 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
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 POLICYMAKING GROUPS, PSYCHOLOGISTS AND OTHER SCIENTISTS,
PRACTITIONERS, AND CONSUMERS.
COMPARISONS OF THE 3 MODELS
 CLINICAL SCIENCE PHD FACULTY MOST ENGAGED IN
RESEARCH—PSYD FACULTY THE LEAST.
 CLINICAL SCIENCE FACULTY PUBLISH & PRESENT THE
MOST—PSYD FACULTY THE LEAST.
 SAME PATTERN FOR STUDENTS
IMPACT OF MANAGED CARE
 SHIFT FROM FEE-FOR-SERVICE MODEL TO THIRD-PARTY-PAYER
MODEL.
 ACCOUNTABILITY AND EVIDENCE-BASED DECISIONS.
 QUALITY CONTROL &COST-EFFECTIVENESS—GETTING THE MOST
FOR YOUR MONEY.
 EVEN GREATER SHRINKING OF PSYCHOLOGY’S SHARE OF MENTAL
HEALTH CARE.
 SOCIAL WORKERS NOW THE MAJOR PROVIDERS OF TRADITIONAL
MENTAL HEALTH SERVICES.
 DIMINISHING DEMAND FOR PSYCHOLOGISTS AS PROVIDERS OF
DIRECT SERVICES—THAT IS, PSYCHOTHERAPY.
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)
THE PROBLEM . . .
“THE FAILURE TO TRANSLATE SCIENCE INTO
PRACTICE HAS MARGINALIZED CLINICAL
PSYCHOLOGY WITHIN THE EMERGING HEALTH
CARE SYSTEM AND LIMITED THE PUBLIC’S ACCESS
TO BENEFICIAL INTERVENTIONS.”
BAKER, MCFALL, & SHOHAM (2009)
THE SOLUTIONS?
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.
ACCOUNTABILITY—SHOW 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.
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