CURRENT ISSUES

IN CLINICAL
PSYCHOLOGY
PSYCHOLOGY
CLINICAL
Clinical Scientist Model
Over the past several decades, empirically oriented clinical psychologists have
become increasingly concerned that clinical psychology, as currently practiced, is not
well grounded in science.

According to this view, many of the methods that practitioners employ in their
treatment have not been demonstrated to be effective in controlled clinical studies.
In some cases, empirical studies of these techniques have not been completed; in
other cases, research that has been completed does not support continued use of the
technique. Similarly, the use of assessment techniques that have not been shown to
be reliable and valid and to lead to positive treatment outcome has been called into
question. These concerns led to a proposed new model of training for clinical
psychologists, the clinical scientist model.
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The “call to action” for clinical scientists appeared
in 1991, in the “Manifesto for a Science
of Clinical Psychology”.
In this document, McFall argued:

1. “Scientific clinical psychology is the only

legitimate and acceptable form of clinical psychology”

2. “Psychological services should not be administered

to the public (except under strict experimental control)
until they have satisfied these four minimal criteria:
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a. The exact nature of the service must be described clearly.
b. The claimed benefits of the service must be stated explicitly.
c. These claimed benefits must be validated scientifically.
d. Possible negative side effects that outweigh any benefits must be
ruled out empirically”
3. “The primary and
overriding objectives of
doctoral training programs
in clinical psychology
must be to produce the
most competent
clinical scientists possible”
 Like-minded clinical psychologists were
urged to help build a science of clinical
psychology by integrating scientific
principles into their own clinical work,
differentiating between scientifically valid
techniques and pseudoscientific ones and
focusing graduate training on methods
that produce clinical scientists—
individuals who “think and function as
scientists in every respect and setting in
their professional lives”
TRAINING
To foster the training of students for careers in clinical science research, who
skillfully will produce and apply scientific knowledge.

RESEARCH AND THEORY

To advance the full range of clinical science research and theory and their
integration with other relevant sciences.

RESOURCES AND OPPORTUNITIES

To foster the development of and access to resources and opportunities for
training, research, funding, and careers in clinical science.

APPLICATION
To foster the broad application of clinical science to human problems in
responsible and innovative ways.
 As clinical psychology grew and
the number of its practitioners
multiplied, issues of professional
competence began to arise.
How is the public to know who is
well trained and who is not? Many
people have neither the time,
inclination, nor sophistication to
distinguish the well-trained
professional from the charlatan.
Classwork:
WHAT IS PROFESSIONAL
REGULATION,
CERTIFICATION AND
LICENSING?
PRESCRIPTION
PRIVILEGES
Historically, the ability to prescribe
medication has been one of the
primary distinctions between
psychiatrists and psychologists. In fact,
in the eyes of the general public, it is a
defining difference between the
professions.

However, in recent years, some clinical

psychologists have actively pursued
prescription privileges.
 Why Clinical Psychologists Should
Prescribe
1) Shortage of psychiatrists.
In some parts of the country, there simply aren’t enough psychiatrists to serve the
population adequately. Especially in some rural areas, there is a strikingly low ratio
of professionals with the training and ability to prescribe psychoactive medications to
the number of people who need them.
2) Clinical psychologists are more expert than primary
care physicians.
Although psychiatrists have specialized training in mental health issues, they aren’t the
only ones prescribing psychoactive medications. In fact, by some estimates, more than
80% of the prescriptions written for psychoactive medications come from primary care
physicians. When it comes to expertise in mental health problems, clinical
psychologists’ training is more extensive and specialized than physicians’; therefore,
clinical psychologists could be better able to diagnose problems correctly and select
effective medications.
3) Other nonphysician professionals already have
prescription privileges.
Dentists, podiatrists, optometrists, and advanced practice nurses are among the
professionals who are not physicians but have some rights to prescribe medication to
their patients.
Their success in this activity sets a precedent for specially trained clinical
psychologists to do the same.

4) Convenience for clients.

Antonio is a 9-year-old boy with attention-deficit/ hyperactivity disorder (ADHD).
Angela is a 38-year-old woman with major depression. Antonio and Angela could
benefit from both nonpharmacological interventions (psychotherapy, counseling, etc.)
and prescription medications. Without prescription privileges, clinical psychologists
can provide the therapy, but they cannot provide the medication. The result is that
Antonio (and his parents) and Angela will both need to be referred to a physician, such
as a psychiatrist, to be evaluated for medication. Of course, this increases the time
and money that these clients must spend on appointments.
5) Professional identification.
In the eyes of the general public, psychologists may be difficult to distinguish from
other nonprescribing therapists or counselors such as licensed professional
counselors, social workers, and the like. The ability to prescribe immediately sets
psychologists apart from—and, many would argue, above—these other professions.

6) Evolution of the profession.

Clinical psychology has undergone many significant changes in its brief history. It has
incorporated many treatment techniques that were initially unfamiliar, and in the
process, the profession has thrived. Embracing prescription privileges is seen by many
as the next logical step in the progression.
Prescription Privileges: What
if You Were the Client?
If you were the client, would you prefer that your clinical psychologist
have the ability to prescribe medication? Does your answer depend on
the amount or type of training the clinical psychologist has received?
Or on the availability of other qualified prescribers (primary care
physicians, psychiatrists, etc.)? Which of the pros and cons listed in the
text have the greatest influence on your answer?
THE INFLUENCE
OF TECHNOLOGY
Cybertherapy and More
Like many other professions, especially in the health care field, clinical psychology has
been significantly affected by technological advances in recent years. Particularly
groundbreaking—and controversial—is the use of technological tools in the direct delivery
of psychological services.

Contemporary clinical psychologists can perform assessments and treatments via

computer or smartphone as a supplement to, or instead of, traditional in-person meetings
with clients. This use of technology, and particularly the Internet, by clinical psychologists
often goes by the name cybertherapy but is also called telehealth and telemental health,
among other labels.