A new role for psychologists--hospital ethics committees

Over the past decade psychology has begun to appreciate that it represents more than "merely mental health care" and has become increasingly involved in the generic health care arena. The participation of psychologists in Hospital Ethics Committees (HECs) is presented as a professional activity for which psychologists are particularly well suited. The clinical mission of HECs, the historical importance of ethical considerations to psychology, and the field's specific training and psycho-social expertise suggest valuable contributions that psychologists can make in this particular area. Further, as psychology actively increases its participation in HECs, other professional disciplines outside of the mental health field will systematically have the opportunity to become more familiar with psychology and its clinical and research expertise.     

Professional education of psychologists using online problem‐based learning methods: Experience at Charles Sturt University

Abstract: Problem‐based learning (PBL) is a pedagogical approach to professional training that emphasises the development of clinical reasoning skills and self‐directed learning. In contrast to more traditional lecture‐based approaches that focus upon the linear acquisition of course content, PBL is undertaken in the context of actual case presentations. Although PBL has been adopted widely in the professional training of medical practitioners and nurses, it is only just beginning to be used in the professional education of psychologists. This paper examines the nature and benefits of PBL for education in clinical and forensic psychology by outlining its implementation and development at Charles Sturt University, located in a rural area of Australia. Although a full and independent evaluation of PBL for education in clinical or forensic psychology is yet to be undertaken, this paper argues that PBL can make a significant contribution to professional training in psychology.     

Training in clinical child psychology: doing it right

Discusses (a) what roles the specialty of clinical child psychology fulfills and how societal and professional changes have enhanced the need for the specialty, (b) how the field defines itself, (c) how models of training are conceptualized for the specialty, and (d) how some training programs implement specialty training with broad, interdisciplinary components. Clinical child psychology is a professional field of research and practice that, when adequate training is provided, properly deserves a places as a specialty. The dangers of overspecialization and narrowness are more likely present in traditional clinical (adult) psychology than in clinical child psychology, especially when the clinical child training is done in a broadly comprehensive and integrated manner.     

Ethical Training in Sport Psychology Programs: Current Training Standards

Ethical training in graduate programs is an important part of the professional development process. Such training has taken a position of prominence in both counseling and clinical psychology but seems to be lagging behind in the field of sport psychology. A debate exists about whether such training is necessary and, if so, how it should be provided. An important step in better understanding these issues is to identify how such training is currently taking place. This study surveyed the program directors of sport psychology programs listed in the Directory of Graduate Programs in Applied Sport Psychology (Burke, Sachs, & Schrader, 2002) about the ethical training that takes place in their programs and their perceptions of the preparedness of the students in their programs. Of those contacted, 54% (n = 47) responded to the e-mail based survey. The results from these respondents indicated that 64.4% of programs require training in ethics and that the training was most commonly integrated into other nonethics courses. Overall, respondents did not feel as if students were completely prepared for either the ethical or legal issues that they will face in their professional careers. The importance of ethical training and suggestions for improving ethical training are discussed.     

Making Sense of the APA: A History of the Relationship Between Psychology and the Military

The American Psychological Association (APA) has been steadfast in its position that psychologists must have the right to participate in interrogations in U.S.-run illegal detention centers. One wonders why the APA is so resolute in this view especially in light of the opposition to involvement in these sites by all other relevant professional organizations. This paper offers an answer to this question by means of an exploration of the historical bond between American psychology and the military. It is demonstrated that the dramatic growth of psychology after World War II is attributable to resources supplied by the Department of Defense and the Central Intelligence Agency. It is argued that the historical and current dependency of psychology on the military for research funds as well as clinical training and treatment has resulted in a historical and current debt on the part of psychology to both of these organizations. This debt is repaid by an unquestioned endorsement of military policy, no matter how questionable its ethical or legal basis might be.     

A call for dialogue: psychotherapists and psychologists specialising in psychotherapy

The development of psychotherapy as an independent discipline in many countries in Europe has stimulated debate within the field of psychology as to what constitutes psychotherapy as a specialism of psychology. The authors, both clinical psychologists who pursued further training in psychotherapy, offer a reflection in this paper on the historical battle between psychiatry and psychology for ‘ownership’ of psychotherapy, describe recent developments in Europe to clarify this specialism within psychology and discuss the distinctive contributions that psychologists offer in developing psychotherapy as a specialism within the discipline. The aim of the paper is to begin a dialogue both within the profession of psychology and outside the profession, with our psychotherapy colleagues, that can develop into an interdisciplinary discourse and a more mutually respectful professional environment.     

Implementing the Boulder Model of Training in a Psychology Training Clinic

The scientist–practitioner (S–P) model of training has guided professional psychology in the United States for nearly six decades. However, since its inception, the model has been hotly debated and implementation of the model has been chronically problematic. One counseling psychologist who is working as both a faculty member and psychology training clinic director describes how scientific principles can be retained in a practice setting. He overviews the Boulder model of training, provides a brief review of the psychology training clinic (PTC), describes his current work setting and unique faculty appointment, and outlines five strategies for integrating science and practice in applied clinical settings. He also highlights how embracing the Boulder model has promoted a strong professional identity and presents the PTC as a model professional home for S–Ps.     

Historical understanding and teaching in professional psychology

The teaching of the history of psychology in professional psychology training programs presents to students and teachers any number of opportunities and challenges. The increasing number of professional psychologists teaching the history of psychology coupled with advances in historical scholarship point to an ongoing evolution in the teaching of the history of psychology. In this introduction to the articles that follow, issues of content and context in teaching the history of psychology in professional psychology are discussed and affirmations offered.     

Evaluation of a Combined Cognitive Behavioural Therapy and Interpersonal Process Group in the Psychotherapy Training of Clinical Psychologists

It is now widely acknowledged that both content and process elements of psychotherapy play a part in client treatment outcomes. Despite this, there are pressures on Australian clinical psychology training programs to teach evidence‐based approaches in a relatively short time frame. Producing clinical psychology graduates who have an adequate level of competence in evidence‐based practice and meeting the demands of professional accreditation requirements can mean that less time is available to teach the process elements of psychotherapy. The aim of this study was to conduct a preliminary evaluation of a clinical psychology psychotherapy training program that combines an interpersonal process group with a cognitive behavioural therapy training model that incorporates self‐reflection and self‐practice. Eleven participants who participated in the training in 2008 completed the Counseling Self‐Estimate Inventory at pre‐ and post‐training. Significant improvements on the majority of the subscales of this inventory were found. A separate sample of nine trainees and clinical psychology registrars who also previously completed the program attended individual interviews in 2010 aimed at gaining their perspective regarding various aspects of the program. Self‐practice of cognitive behavioural therapy techniques was found to be important in the identification and management of trainees’ own core beliefs, and to their appreciation of how challenging this process may be for clients. The interpersonal process group was described by participants as enhancing their competency as psychotherapists. Common themes included the experience of anxiety and a high level of emotion, and understanding how this experience might be similar for clients; increased self‐awareness; and increased competence in process issues. Many participants believed the process and content components of training were equally important to their development as psychotherapists.     

Establishing Clinical Neuropsychology in Germany Scientific,Professional, Political,and Legal Issues

German psychologists may have been first to establish a university curriculum in psychology with the expressed purpose to provide—after its successful completion—a certificate of professional qualification. This Diplom-Prüfungsordnung (Diploma Examination Regulation) was accepted nationwide in 1941. However, it took over fifty more years before some progress toward the political and legal acceptance of autonomous clinical activities of psychologists was made. Legislation to secure these advances is still pending. In this context the efforts to establish the profession of clinical neuropsychology are described and discussed within the historical development of professional psychology in Germany with special emphasis on the problems of compromises within the force fields of science and professional politics. Finally, the postgraduate training as well as the certification and accreditation procedures developed by the Gesellschaft für Neuropsychologie, the Society of German-speaking neuropsychologists, are presented.     

Integrating emotion and other nonrational factors into ethics education and training in professional psychology

ABSTRACT

Any professional or scientific discipline has a responsibility to do what it can to ensure ethical behavior on the part of its members. In this context, this paper outlines and explores the criticism that to date the emphasis in ethics training in professional psychology, as with other disciplines, has been on the rational elements of ethical decision making, with insufficient attention to the role of emotions and other nonrational elements. After a brief outline of some of the historical background to the development and understanding of ethical decision making, relevant theoretical and empirical literature on the influence of emotional and other nonrational factors on our ethical decisions is reviewed. The implications of this literature for ethics education and training are outlined, particularly with respect to the use of case studies. An integrative approach is proposed, and conclusions and recommendations are offered with respect to such an approach.     

American psychology's struggles with its curriculum. Should a thousand flowers bloom?

Although discussions of a core curriculum in doctoral training in psychology can be heard in contemporary psychology, there is no such common core, nor has one ever existed in American psychology's history. Advocates of a core curriculum argue that it ensures breadth of training, an outcome made even more important by growing specialization in psychology, and that it provides psychologists with a needed common identity as members of a recognized professional discipline. Opponents argue that a core curriculum places unwanted constraints on a program of study, prohibiting the kind of diversity needed to keep abreast of changes in psychology and related fields of study. The author reviews the history of this struggle within American psychology and discusses its implications for the science and practice of psychology.     

Raising Our Game: The Necessity and Progression of Expertise-Based Training in Applied Sport Psychology

At present, training in applied sport psychology chiefly targets and accelerates professional competence. However, theory and evidence suggests that our clients would experience significant benefit if our training targeted and accelerated professional expertise rather than just competence. Specifically, we argue that expertise-based training can (a) help trainees to go on to break the “thinking ceiling” of competence; (b) foster a more independent, flexible, and creative form of practice; and (c) support a longer term and more practitioner-centered training philosophy. To deliver these benefits, we then conclude by outlining some key principles for the progression of expertise-based training in applied sport psychology.

Lay Summary: In light of the inconsistencies that still surround professional training in ASP, we discuss the merits that a more expertise-based agenda can bring to practitioners and, most important, our clients. We also discuss ways in which this agenda can be progressed to support an evidence-informed evolution of ASP training systems.     

Pediatric Psychology: Child Psychological Health in the Next Century

The future of pediatric psychology is reviewed and placed in brief historical context in relation to children's psychological health care. Contemporary trends affecting the delivery of psychological services, research, and clinical training are highlighted, with suggestions for future development. Pediatric psychology is a child-based, developmentally-focused multidisciplinary practice directed toward psychosocial and neuropsychological issues of health and illness in children and youth. Pediatric psychologists need to develop strong professional identities as health care psychologists combined with a collegial and collaborative arrangement with physicians to ensure the future growth and development of pediatric psychology in the next century as a major vehicle to promote children's health care.     

When Personal and Professional Values Conflict: Trainee Perspectives on Tensions Between Religious Beliefs and Affirming Treatment of LGBT Clients

At times the personal beliefs or values of graduate students in training programs for professional psychology can create complications in their providing therapy for certain patient populations. This issue has been brought to national attention recently through several prominent legal cases in which students have contested their expulsion from graduate programs due to their assertions that they were unable to treat clients in same-sex relationships because of their own religious beliefs. The goals of the current article are to (a) review the literature on values conflicts, (b) provide an analysis of how portions of our professional Ethics Code directly relate to this issue, (c) describe a developmentally sensitive theoretical framework that is designed to foster the growth of ethical reasoning over time, and (d) provide a forum for trainee perspectives on this issue based on trainees’ responses to an ethical vignette describing an intern struggling with a values conflict. The trainee quotations are used to structure a discussion of practical recommendations for how to handle values conflicts within the context of training and clinical supervision in professional psychology.     

The affirmation of the scientist-practitioner. A look back at Boulder

In the aftermath of World War II, several influences were paramount in forcing academic psychology to recognize, albeit reluctantly, the coming professionalization of psychology. The federal government, wishing to avoid a repeat of blunders following World War I that led to significant dissatisfaction among veterans, took proactive steps to ensure that mental health needs of the new veterans would be met. The USPHS and the VA were mandated to expand significantly the pool of mental health practitioners, a direction that led not only to the funding of the Boulder conference but also to the development of APA's accreditation program, funded practical and internship arrangements with the VA, and the USPHS grants to academic departments for clinical training. The GI Bill, amended to include payment for graduate education, created tremendous interest in graduate programs in psychology. As a result, psychology programs were inundated with funded applicants, most of whom were interested in the application of psychology to clinical and other applied fields. Graduate psychology departments were mixed in their views of this "blessing." The reality of a separate curriculum for professional training in psychology was a bitter pill for some academic psychologists to swallow. Graduate departments feared that control of their programs would be taken over by external forces and that they would lose their right to determine their own curriculum. Further, they feared the domination of clinical training within their own departments and the effects of such educational emphasis on their traditional experimental programs. The Boulder conference brought together these disparate needs and concerns, although one can argue about how well some points of view were represented with respect to others. It was a time of high anticipation and fear. The conference could easily have ended in failure, with such diverse interests being unable to reach any consensus. There are many letters in the correspondence of committee members that suggest disagreements serious enough to prevent the development of any single model of training. Instead, by most yardsticks that one could apply, the conference succeeded, perhaps beyond the dreams of many of those in attendance who were most invested in a model for professional training. In evaluating the legacy of Boulder, several points are apparent. First, the conference succeeded because 73 individuals were able to agree to some 70 resolutions in 15 days, creating the scientist-practitioner model of professional training. Such consensus was arguably a remarkable achievement. The endorsement of the model by academic units followed with little evident resistance, although it is clear that some Boulder-model programs were developed that bore little resemblance to the model's insistence on significant training in both research and practice. Second, as a response to social and political needs, the conference was clearly a success. The cooperation of the APA, the USPHS, and the VA benefited all three entities. Clinical psychology was given the financial support and backing to advance it as a profession, and the federal government was able to begin the process of securing the personnel needed to address the mental health needs of the nation. The architects of Boulder were clear that their vision of training for professional psychology should be viewed as dynamic and experimental rather than fixed and prescribed. Certainly there are several variants of professional training extant today, yet the overwhelming majority of currently accredited programs in psychology label themselves as "Boulder-model" programs or "scientist-practitioner" programs. Still, new national conferences on professional training in psychology occur with some regularity as participants seek to resolve many of the same concerns debated by those at Boulder. The grand experiment goes on.     

Stress in Clinical Psychology Trainees: Current Research Status and Future Directions

The purpose of this article is to present the current status of the literature related to stress in clinical psychology trainees (CPTs), and to offer research directions for investigating stress in this population and ways to enhance self‐care in these individuals. The following conclusions emerge from the review: (1) CPTs are vulnerable to elevated stress; (2) undue stress can negatively impact CPTs' personal and professional functioning and, in turn, result in less than optimal standards of care for clients; (3) there is a dearth of studies on stress in this population and no published intervention studies; (4) incorporating self‐care strategies into clinical psychology training is recommended; and (5) “third‐wave” cognitive behaviour therapy stress management interventions have been efficacious in comparable populations. In view of the potential costs of elevated stress to trainees themselves and their clients, research on stress and stress management in this population is of a high priority. Broad research agendas are proposed for these two domains. Modifications to clinical training programmes to reduce trainee stress are required and should be evidence‐based and systematically revaluated.     

Clinical Expertise: A Preliminary Attempt to Clarify Its Core Elements

The recent emphasis on evidence-based practice revolves around an integration of three domains: client characteristics, relevant research, and clinical expertise. Unfortunately, most reports focus on the examination of current research, while few guidelines exist for clarifying or developing expertise in clinical psychology. Although expertise is more advanced than competence, basic clinical competence can set the foundation for the development of more sophisticated skills. It is best to strive for narrow domains of expertise instead of global ratings of a professional as an “expert”. Five criteria are proposed for evaluating, developing, and maintaining clinical expertise: (1) the professional must possess a terminal degree in the field, (2) the professional has accumulated multiple years of clinical experience in the direct provision of clinical assessment, psychological testing, or psychological treatment, (3) the professional has attained advanced credentials in a specific area of psychology, (4) the professional is visible in the professional community at a national level, and (5) the professional has demonstrated evidence of superior clinical skills in a specific application of psychology. Together, these five criteria help to objectify the evaluation and cultivation of clinical expertise in psychology. Because each criterion is weak and flawed if used alone, it is recommended that multiple criteria are used in combination to define clinical expertise.     

University psychology clinics in Australia: Their place in professional training

Abstract: There is universal recognition of the need for developmentally appropriate supervised clinical experience in professional psychology training. University clinics were established to provide a bridging function for postgraduate clinical psychology students, assisting the integration of psychological theory and research into real‐world clinical applications and professional identity development. The aim of training in university clinics is to provide opportunities for clinical practice and high‐quality supervision to monitor and shape clinical skills. The experiences gained in external practicum settings complement this initial training but cannot replace it. The recent introduction of Medicare rebates for psychology services has threatened the survival of university clinics because low‐cost psychological treatment is now available from experienced practitioners. This paper provides data on Australian university clinics collected before the introduction of Medicare. Concerted efforts are needed to protect university clinics in order to maintain standards required for accreditation of clinical psychology training programs. The potential impact of the loss of university training clinics is discussed and strategies to ensure their survival are suggested.     

TOWARDS AN INTERNATIONAL PROFESSION OF CLINICAL PSYCHOLOGY: AN ANGLO-SWEDISH PERSPECTIVE

Previous reviews of the international trends in the development of clinical psychology as a profession have identified the United Kingdom and the Nordic States as countries where the role of the psychologist is approximating that in North America. The article presents a review of the historical and current influences on the development of clinical psychology in the United Kingdom and in Sweden. In Europe, where clinical psychology is mainly a Health Service profession rather than a private practice, independence of the management and medical responsibility of the psychiatrist has become more of a key issue. Of the two major ‘schools’ of clinical psychology, identified in Britain with the behavioral approach of the Maudsley Institute of Psychiatry and the psychodynamic approach of the Tavistock Clinic, the behavioral school tended to dominate in Britain until the 1970s. In Sweden, the psychodynamic approach importing many of the aspects of British Object Relations Theory, gained ascendence. This resulted in a split between the more academic form of clinical psychology in Sweden, which had produced research of international importance (e.g. the role of psychological factors in stress-related illness), and professional education in psychology with its emphasis on psychotherapeutic training. Whereas in Britain, during the 1970s, clinical psychology broke away from psychiatry, became more eclectic, and entered the general medical and health areas, these changes failed to take place in Sweden. On the other hand, private practice amongst psychologists in Sweden has shown a dramatic increase during recent years and there are now some clear trends towards eclecticism in the education of psychologists. The issue of medical responsibility remains unresolved in Sweden. That British clinical psychology has reached more progressive and cordial professional relationships in this respect may be, in part, due to the status of the scientist-practitioner role that the initial behavioral emphasis achieved. The major contributions of and trends in British and Swedish clinical psychology are discussed with a view to identifying international trends.