Thought I would chip in since I have been teaching in PhD Clinical Psych
programs and graduated from one. I have also taught at a
clinical program within a medical school (Hahnemann) and those from
traditional Arts & Sciences (Memphis, Drexel).
I am pessimistic that Scott's future world of BA's working in medical
centers supervised by PsyDs and PhDs will ever work. Medicare does
not reimburse anyone below the licensed doctoral level. The focus on
empirically supported treatments is not something invented by
cognitive-behavioral psychologists who conduct a lot of research. It is
a process of review put in place by insurance companies to deny
treatment. Psychology is such a minor cost that I am sure they could
care less to even get documentation from us. The insurance
companies will always up the anti and require higher and higher levels
of empirical support that only obvious, life-saving medical interventions
will be compensated.
I find it very interesting how the empirically supported therapies
arguments have factored into the theoretical differences in clinical
psychology.
Groups that have been at it for years, such as psychoanalytic and other
dynamic therapies vs behavior therapies are fighting it out over
who has empirical support. Since CBT and BT have always had more
empirical study than the others, the advocates for CPT and BT have
held that these therapies are superior to therapies that are unstudied.
Clinical Psychology psychotherapy and psychotropic medication therapies
will never have sufficient empirical support simply because the
subjects are never blind to the treatment condition. All the
investigators are doing is training the subjects to endorse change on the
dependent measures. That's why the meta-analyses conclude that any
therapy is effective. I have never seen an analysis that addressed this
research problem. It's similar to the obesity researchers who never
notice that their entire field is based on the dieting behavior of young
women.
The best research in my specialty of neuropsychology is done in the
clinic. There are even private practice neuropsychologists who
conduct a lot of research. You can't sit up in an Ivory Tower and
conduct clinical psychology research.
I'm sure that Scott has noticed that the number of available PhD slots
is getting smaller. It reminds me of the history of the English and French
in Quebec. The French just eventually overpopulated the English. If
clinical psychology is just practitioners then we have failed. We had a
chance of
being unique with the Boulder or Vail models. My interpretation of the
models was that we should train practitioners who conduct clinical
research. Many of our PhD graduates actually do this. There are
actually PsyD graduates who do this.
Working in a medical setting, I was often consulted by physicians
because of my research training. Although physicians often master the
most esoteric calculus, molecular biology and genetics in order to get
into and through medical school, they are often surprised by this thing
called
the t test. We have this unique scientist practitioner training that is
best implemented when a trained scientist is confronted with a real,
clinical problem.
The last point I want to make is that the base of academic jobs is not
high enough to employ all these Ivory Tower, academic-only graduates.
Mike Williams
Drexel University
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