The Future of Psychology in Medical Specialities: Introduction to the Special Issue

The continuing evolution of the health care delivery system in the United States presents threats and opportunities to psychologists in medical settings. This special issue explores the future of psychology in psychiatry, family medicine, rehabilitation, geriatric medicine, and pediatric medicine. The challenges facing neuropsychology and pain management are explored also. Finally, the professional issues of ethics in managed care, psychology in the public sector, and training future psychologists are addressed. Each paper summarizes concerns and provides recommendations for clinical practice, research, and training.     

An Essay on the Houston Conference Policy Statement: Static Yet Incomplete or a Work in Progress?

Ardila (Neuropsychol. Rev. 12: 3, 2002) criticizes the Policy Statement from the Houston Conference on Specialty Education and Training in Clinical Neuropsychology (Hannay et al., Arch. Clin. Neuropsychol. 13: 157–250, 1998) as possessing deficiencies in the training of clinical neuropsychologists in three fundamental knowledge areas: the history of the discipline, neuropsychological syndromes, and neuropsychological theory. These problems are seen here as a result of a more pervasive problem associated with the Houston Conference training model's emphasis on technical skill over science and the attempt to micromanage the training of the clinical neuropsychologist at the administrative level.     

Delivery of Psychological Interventions by Clinical Neuropsychologists: Current Practice in Australia and Implications for Training

Clinical neuropsychologists are increasingly involved in delivering psychological interventions to people with neurological conditions. This is a key competency for accredited Australian postgraduate neuropsychology courses; however it is not clear how effective courses are in preparing neuropsychologists to deliver interventions. The study aims were to (a) determine the frequency and confidence with which particular types of interventions are delivered by Australian neuropsychologists, (b) examine the availability of opportunities to deliver interventions on clinical placements, (c) identify barriers to delivering interventions in current workplaces; and (d) determine which factors influence the frequency and confidence with which neuropsychologists deliver interventions. An online survey was completed by 114 participants who had graduated from a postgraduate neuropsychology program. Results indicated that respondents delivered different intervention types with varying frequency. They reported limited opportunities to practice these interventions on placements. The majority wanted to be doing more interventions, with lack of time, resources, and adequate training being the major barriers. There were several significant relationships between the frequency and confidence with which respondents delivered interventions and the perceived quality of their postgraduate training. These results highlight the need to consider appropriate postgraduate training options in delivery of interventions, including increasing opportunities to practice interventions on placements.     

Houston Conference: Need for More Fundamental Knowledge in Neuropsychology

Two training models in neuropsychology have been recently proposed (Guidelines of the INS-Division 40 Task Force on Education, Accreditation, and Credentialing, Clin. Neuropsychol. 1: 29–34, 1987; Hannay, H. J. et al., Arch. Clin. Neuropsychol. 13: 157–250, 1998). When comparing both educational models, similarities but also differences are found. According to the Houston Conference model—but not to the former model—neuropsychology represents a specialty of psychology. In the Houston Conference training model, applied knowledge is overtly emphasized, whereas fundamental or basic knowledge in neuropsychology appears weak. The proposed program does not seem to provide sufficient emphasis and background knowledge in (1) History of neuropsychology, (2) Neuropsychological syndromes, and (3) Neuropsychology theory.     

The Future of Neuropsychology in Medical Specialties

Although neuropsychology continues to grow as a valued service in most medical specialties, because of its multiple uses with diverse populations, it is necessary to evaluate the specialty critically in order to ensure continued future success. This article reviews areas in which neuropsychology is most firmly established, potential growth areas, and likely obstacles to success in the future. Suggestions are provided for ways in which neuropsychology can be improved/adapted in clinical, business, research, and training areas. On sabattical at Bebek University, Instanbul, Turkey     

Hospital referral patterns in pediatric neuropsychology

The practice of pediatric neuropsychologists was examined by reviewing all referrals made in 1 year to neuropsychology programs located in three children's hospitals. The review identified 472 cases, 75% of whom were between the ages of 7 and 11. The sample included 86 inpatients and 386 outpatients. The most common diagnoses, accounting for 87% of the cases, were learning disability, traumatic brain injury, attention deficit-hyperactivity disorder, seizure disorder, primary psychiatric disorder, phenylketonuria, idiopathic mental retardation, brain tumor, leukemia, stroke, and encephalitis. The most common referral sources, accounting for 92% of the cases, were neurologists, pediatricians, parents, physiatrists, neurosurgeons, oncologists, specialists in metabolic disease, psychologists, rheumatologists, and psychiatrists. The distribution of diagnoses and referral sources differed significantly for inpatients and outpatients and across the three hospitals. The results may distinguish child neuropsychology from adult neuropsychology and highlight the diversity that characterizes its practitioners.     

Ethical and Legal Considerations in the Training of Mental Health Professionals

Summary

A discussion is provided regarding ethical and legal considerations that relate to the training of mental health professionals. A training program which emphasizes a proactive approach to identifying and resolving potential ethical and legal problems, and their close connection with clinical issues is described, as are the responsibilities of supervisors and supervisees in such a program. For illustrative purposes, a training vignette and a clinical vignette conclude the article.     

Considerations on medical training for gender-affirming care: Motivations and perspectives

Abstract

Background: Many transgender individuals lack access to needed medical care, partially due to a lack of providers with experience in gender-affirming healthcare.

Aims: The purpose of this study was to identify professional motivators for medical providers seeking out training in gender-affirming care and to define which training experiences were most beneficial to their career development. By identifying experienced providers’ recommendations on which training modalities are most relevant to their practice, we aim to suggest future directions for medical education initiatives to effectively expand the transgender care workforce.

Methods: A voluntary cross-sectional electronic survey was distributed through professional listservs and publicly-available referral lists to interdisciplinary providers who self-identified as having experience in providing care to transgender individuals.

Results: One hundred and fifty-three (n?=?153) physicians, physician assistants, or advance-practice nurses responded to the survey. The majority (96.7%) were located in the United States, representing 37 states. The two most common motivators for seeking out training in gender-affirming care were filling a need in the community (73.0%) and/or having met a transgender-identified person in a clinical setting who requested care (63.8%). While many providers gained skills independently (57.3%), the two most commonly-available training opportunities were professional conferences (57.3%) and mentorship (41.3%). Respondents were most likely to recommend that others in their field be trained via structured clinical experience (e.g., a rotation or longitudinal exposure during training), rather than additional didactic training.

Discussion: This study identifies key high-yield training methodologies which could improve access to quality gender-affirming healthcare. Through integration of structured clinical experiences during training, direct clinical mentorship, and professional development at conferences on gender-affirming care, the workforce of welcoming and prepared healthcare providers for transgender patients will increase. This will lead to a tremendous improvement on access to gender-affirming care in our communities.     

The Effect of Racial and Ethnic Diversity on the Delivery of Mental Health Services in Pediatric Primary Care

The effects of racial and ethnic diversity on the detection and management of behavioral and emotional problems in pediatric primary care are addressed. Service access and utilization as a function of race and culture are initially examined. Important barriers within pediatric training including minimal emphases on behavioral training and the limited supply of minority physicians are underscored. The impact of ethnicity on the development and maintenance of the clinical relationship that is critical to accurately and sensitively identifying and managing behavioral and developmental problems is briefly addressed. Recommendations for further integration of racial/ethnic issues into mental health service provision within the pediatric primary care arena are presented.     

Continuity and Change in Role Definitions and Training Models of School Psychologists in Israel

Abstract

In accordance with one of the major challenges of psychology research and practice worldwide, school psychology in Israel has setas its aim the promotion of the emotional well-being of students. These aims are achieved through psychological evaluation and intervention, at the systemic and individual-student level. School psychology emerged in Israel in the 1930s, as a relatively narrow field, focused mainly on the placement of students in special education settings. Over the decades, major changes occurred in Israeli society, including waves of immigration, coping with security situations and additional socio-political challenges. In light of these transformations, the discipline grew and broadened, encompassing additional areas of professional practice. The training of school psychologists evolved in relation to these processes. From unsystematic training procedures, mostly embedded in child-clinical psychology and relying on on-the-job training, to a well-established system of graduate school programs producing dozens of school psychologists every year. Academic pre-service training is followed by a post-graduate internship in the public-school system. The developments in the field of school psychology brought about a host of challenges and dilemmas. These issues are discussed in relation to the broad aim of school psychology in Israel: the promotion of the emotional well-being of all students.     

A brief primer on sleep for pediatric and child clinical neuropsychologists

Sleep problems are common in the children seen by pediatric and child clinical neuropsychologists, and these problems have the potential to significantly impact the child and his or her family. All are treatable to some degree, and some respond extremely well to existing treatments. This article provides a brief overview of the impact, nature, screening, and treatment for childhood sleep problems, with a particular emphasis on issues relevant to practicing neuropsychologists.     

Multiple Chemical Sensitivity: A Review of the Theoretical and Research Literature

Multiple chemical sensitivity (MCS) is a term used to describe a disorder characterized by a vast array of somatic, cognitive, and affective symptoms, the cause of which is attributed to exposure to extremely low levels of a variety of chemicals. Upon examination of the patient with a diagnosis of MCS, objective physical findings and consistent laboratory abnormalities are typically nonexistent. The concept of MCS has ignited considerable controversy in the fields of toxicology, immunology, allergy, psychology, and neuropsychology. Central to the controversy is the disagreement over the extent to which the manifestation of MCS is mediated by psychological factors. Because of the large number of neuropsychological symptoms associated with a diagnosis of MCS, neuropsychologists are increasingly receiving referrals for the assessment of these patients. It is important, therefore, that neuropsychologists become aware of the variety of clinical issues that must be taken into account when assessing an individual with a diagnosis of MCS. The theoretical and research literature on individuals with a diagnosis of MCS is reviewed here.     

Family finances: The missing link in mft training

Abstract

After reviewing 25 accredited Marriage and Family Therapy programs, only one was found to require a course in family finances. This article addresses the issues associated with the absence of family finance training in most MFT programs. The omission persists in spite of ample evidence as to the influential role family finances play with regard to marital stability and satisfaction. Suggestions are made regarding course outlines and content that could be helpful in correcting this deficiency.     

Response to Critics

In this “Response to Critics,” Cathleen Kaveny continues the conversation in the JRE symposium centered on her recent book, Prophecy without Contempt: Religious Discourse in the Public Square. The book's central argument is that adequate discussion of contention in the contemporary public square requires attending to matters of rhetoric, particularly the rhetoric of prophetic indictment. Kaveny engages the comments of four interlocutors: Alda Balthrop‐Lewis, James Childress, William Hart, and Martin Kavka. The first section, “Overarching Goals,” summarizes the objectives of the book. The second section, “Methodology,” engages critics regarding methodological issues, highlighting Kaveny's commitment to a version of MacIntyre's tradition theory and her indebtedness to her legal training. The third section, “Structure,” responds to particular questions her interlocutors raise about the four parts of the book. The fourth section, “Larger Questions,” ponders the next stages of the academic and political discussion about contention in the public square.     

Critical issues confronting the advancement of applied sport psychology

Abstract

Despite considerable progress over the last 10 years, applied sport psychology confronts several persistent issues that continue to limit the growth and development of the field. Specifically, issues requiring more comprehensive and proactive attention and initiatives include: the training of graduate students, the accreditation of graduate programs, the job market, and the establishment of systematic educational outreach programs. Suggestions are offered regarding how enhancements in each of the aforementioned issues can be initiated, and potential benefits gained by students, faculty, and the general public are identified and discussed. Given the climate in many academic institutions emphasizing program downsizing, sport psychology may be approaching and confronting one of the most crucial crossroads in its existence. Without direct efforts to assure academic credibility and public confidence in the standards of training and practice, sport psychology may fail to actualize a meaningful future role in the competitive field of allied health service provision.     

Abstracts

Abstract

This special issue of the American Journal of Family Therapy focuses on recent developments in Behavioral Marital Therapy (BMT). At first glance, one might expect an issue with such a title to be devoted exclusively to clinical practice. Yet only three of the six papers bear directly on clinical issues, although all of them have clinical implications. Two of the nonclinical papers are validational studies of assessment instruments associated with BMT. The sixth paper explores an important theoretical question regarding the relationship between childbirth and marital distress.     

Neuropsychology in Denmark

The origins and development of neuropsychology in Denmark are briefly overviewed, as are the education and training opportunities for Danish neuropsychologists. Areas of application and research are presented, and the role of the rehabilitation of brain injury is emphasized, with specific reference being made to the Center for the Rehabilitation of Brain Injury at Copenhagen University, wherein the rehabilitation program and pertinent research ensuing from the center is presented. Future trends in Danish neuropsychology are also considered.     

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.     

Introduction to the Special Section on Teaching,Training, and Supervision in Personality and Psychological Assessment

This special section contains empirical and conceptual articles pertaining to the broad topic of teaching, training, and supervision of assessment. Despite some evidence of a decline in recent decades, assessment remains a defining practice of professional psychologists in many subfields, including clinical, counseling, school, and neuropsychology, that consumes a consequential proportion of their time. To restore assessment to its rightful place of prominence, a clear agenda needs to be developed for advancing teaching and training methods, increasing instruction to state-of-the-art methods, and defining aims that could be elucidated through empirical inquiry. The 7 articles in this special section provide a developmental perspective of these issues that collectively provide practical tools for instructors and begin to set the stage for a research agenda in this somewhat neglected area of study that is vital to the identity of professional psychology. Additionally, 2 comments are provided by distinguished figures in the field concerning the implications of the articles in the special section to health services psychology and the competencies-based movement in applied psychology.     

Forensic neuropsychology: A reply to the method skeptics

Various critics or method skeptics have contended that clinical neuropsychology is not sufficiently developed as a science to be offered as evidence in legal or trial proceedings. The present article attempts to balance the extreme position of the method skeptics with an overview of legal and research data that support forensic applications of neuropsychology. It is suggested that clinical evidence can usefully inform legal decision making and that the modern trend has been for courts to be increasingly open to such expert testimony. The relevance of studies of clinical judgment, experience, and actuarial prediction is discussed, and neuropsychological assessment validity is specifically addressed. It is concluded that the arguments of the method skeptics should guide future research and caution forensic neuropsychologists, but that a retreat from the courtroom is unwarranted.