1
|
Levendosky AA, Turchan JE, Luo X, Good E. A re-introduction of the psychodynamic approach to the standard clinical psychology curriculum. J Clin Psychol 2023; 79:2439-2451. [PMID: 37310149 DOI: 10.1002/jclp.23551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 05/02/2023] [Accepted: 05/28/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE There is a strong evidence-base for a psychodynamic approach, supporting primary theoretical tenets as well as the treatment effectiveness. Additionally, there are increasing calls from the field for more individualized treatment for clients, and the lack of training in multiple orientations limits the ability of students in clinical psychology Ph.D. programs in the United States to personalize their treatments. The accumulated evidence-base for contemporary relational psychodynamic theory and therapy places it in good standing to return to the standard clinical psychology curriculum, along with other evidence-based approaches. METHODS We use data from the Insider's Guide (which describes clinical Ph.D. programs in the United States) from three time points over 20 years to document the waning psychodynamic approach in clinical psychology programs. We review the scientific evidence for four primary tenets of a contemporary psychodynamic approach: three related to development-from healthy to psychopathological: (1) unconscious processes; (2) internal representations of self and other; (3) dimensional model of psychopathology, and a fourth tenet that builds on these three and is the foundation for a contemporary psychodynamic approach to psychotherapy: (4) therapeutic relationship as a primary mechanism of change. RESULTS/CONCLUSIONS Based on the review of the evidence, we make specific recommendations for clinical psychology training programs about how to include a psychodynamic approach in the curriculum.
Collapse
Affiliation(s)
- Alytia A Levendosky
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - Joshua E Turchan
- Counseling and Psychiatric Services, Michigan State University, East Lansing, Michigan, USA
| | - Xiaochen Luo
- Department of Counseling Psychology, Santa Clara University, Santa Clara, California, USA
| | - Evan Good
- Austen Riggs Center, Stockbridge, Massachusetts, USA
| |
Collapse
|
2
|
Cooper CM, Rosen T, Kim H, Eaton NR, Cohn E, Drahota A, Moskowitz LJ, Lerner MD, Kerns CM. Predictors of expert providers' familiarity with intervention practices for school- and transition-age youth with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:331-343. [PMID: 35722950 DOI: 10.1177/13623613221100787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
LAY ABSTRACT School-age children, adolescents, and young adults with autism spectrum disorder encounter many different types of providers in their pursuit of treatment for anxiety, behavior problems, and social difficulties. These providers may all be familiar with different types of intervention practices. However, research has not yet investigated patterns in expert providers' familiarity with different practices nor how these patterns are related to the characteristics of providers (years in practice, academic discipline, setting) and the youth (age and intellectual disability) they typically support. A panel of 53 expert transdisciplinary providers rated their familiarity with 55 intervention practices (derived from research and expert nominations) via an online Delphi poll. Advanced statistical methods were used to identify types of intervention practices with which providers were familiar, which included two approaches (cognitive and behavioral) and two strategies (engagement and accessibility). Providers who practiced outside a school setting or treated clients without intellectual disability were more familiar with cognitive approaches. Clinical psychologists, behavior analysts, and school-based providers were more familiar with behavioral approaches. Providers practicing outside school settings were also more familiar with engagement strategies, and providers with more years in practice were more familiar with accessibility strategies. These results may help families and researchers to better anticipate how services may vary depending on the types of autism spectrum disorder providers seen and work to reduce disparities in care that may result.
Collapse
|
3
|
Impala T, Khosugi Y, Kazantzis N. A national study of the psychological theories and therapies covered within clinical psychology training programs in Australia. AUSTRALIAN PSYCHOLOGIST 2022. [DOI: 10.1080/00050067.2022.2140581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Tara Impala
- Cognitive Behaviour Therapy Research Unit, Melbourne, Australia
| | - Yogi Khosugi
- Cognitive Behaviour Therapy Research Unit & La Trobe University, Melbourne, Australia
| | | |
Collapse
|
4
|
Peipert A, Krendl AC, Lorenzo-Luaces L. Waiting Lists for Psychotherapy and Provider Attitudes Toward Low-Intensity Treatments as Potential Interventions: Survey Study. JMIR Form Res 2022; 6:e39787. [PMID: 36112400 PMCID: PMC9526124 DOI: 10.2196/39787] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/19/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background Common mental disorders, including depression and anxiety, are leading causes of disability worldwide. Digital mental health interventions, such as web-based self-help and other low-intensity treatments (LITs) that are not digital (eg, bibliotherapy), have the potential to reach many individuals by circumventing common barriers present in traditional mental health care. It is unclear how often LITs are used in clinical practice, or whether providers would be interested in their use for treatment waiting lists. Objective The aims of this study were to (1) describe current practices for treatment waiting lists, (2) describe providers’ attitudes toward digital and nondigital LITs for patients on a waiting list, and (3) explore providers’ willingness to use digital and nondigital LITs and their decisions to learn about them. Methods We surveyed 141 practicing mental health care providers (eg, therapists and psychologists) and provided an opportunity for them to learn about LITs. Results Most participants reported keeping a waiting list. Few participants reported currently recommending digital or nondigital LITs, though most were willing to use at least one for patients on their waiting list. Attitudes toward digital and nondigital LITs were neutral to positive. Guided digital and nondigital LITs were generally perceived to be more effective but less accessible, and unguided interventions were perceived to be less effective but more accessible. Most participants selected to access additional information on LITs, with the most popular being web-based self-help. Conclusions Results suggest providers are currently not recommending LITs for patients on treatment waiting lists but would be willing to recommend them. Future work should explore barriers and facilitators to implementing digital and nondigital LITs for patients on treatment waiting lists.
Collapse
Affiliation(s)
- Allison Peipert
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, IN, United States
| | - Anne C Krendl
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, IN, United States
| | - Lorenzo Lorenzo-Luaces
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, IN, United States
| |
Collapse
|
5
|
Neal TM, Line EN. Income, Demographics, and Life Experiences of Clinical-Forensic Psychologists in the United States. Front Psychol 2022; 13:910672. [PMID: 35874388 PMCID: PMC9302360 DOI: 10.3389/fpsyg.2022.910672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
We provide aggregate data about income, demographics, and life experiences of women and men practicing clinical-forensic psychology primarily in the United States (N = 376). We examine how these variables relate to one another, as well as how gender demographics of the field have changed over time. The average hourly rate charged by psychologists for forensic work, aggregated across all types of referral questions, regions, and employment settings is $280.23 (US Dollars; SD = $108.12; median and mode = $250). Total median annual income is = $125,000 - $149,999 and mode is = $100,000 - $124,999. Men’s annual income (median = $175,000 - $199,000) is significantly higher than women’s (median = $100,000 - $124,999) even while controlling for years of experience and number of hours worked per week. Women forensic psychologists earn $0.83 for every $1.00 men make. Having a Ph.D. is disproportionately associated with men and PsyD with women; however, the difference is not significant once controlling for years of experience. Employment type related to pay, such that people in private practice make significantly more than those who work in institutions (e.g., prisons, hospitals) or universities. Year of highest degree associated with employment type, such that people in practice longer are more likely to be in private practice. Although we expected caretaking responsibilities and children would relate to gender and pay, no differences emerged in this sample. Women are more likely than men to have completed a formal postdoctoral fellowship in forensic psychology, even when controlling for year of highest degree. Regarding the gender composition of the field over time, we calculated the Index of Dissimilarity for each five year increment spanning 1965-2019. Before the late 1990s, proportionally more men entered the field; after the late 1990s, proportionally more women entered. We discuss the promising and less promising implications of these findings for gender equity and work-life management in forensic psychology, as well as how professionals in the field and students might make use of these data.
Collapse
Affiliation(s)
- Tess M.S. Neal
- New College of Interdisciplinary Arts and Sciences, Arizona State University, Phoenix, AZ, United States
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
- *Correspondence: Tess M.S. Neal,
| | - Emily N. Line
- Department of Psychology, University of Illinois Urbana-Champaign, Champaign, IL, United States
| |
Collapse
|
6
|
Gonsalvez CJ. On accreditation standards, competence assessments and gate-keeping: Houston, we have a problem! CLIN PSYCHOL-UK 2022. [DOI: 10.1080/13284207.2022.2035652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
7
|
Klein AB, Kline AC, Bowling AR, Feeny NC. Bridging the science-practice gap in treatment for posttraumatic stress disorder: Testing strategies to enhance beliefs toward exposure therapy. J Clin Psychol 2021; 77:2765-2780. [PMID: 34273910 DOI: 10.1002/jclp.23221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/27/2021] [Accepted: 06/23/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Exposure therapies (e.g., prolonged exposure [PE]), are first-line interventions for posttraumatic stress disorder but remain underutilized, partially due to providers' negative beliefs about these interventions. We examined two experimental strategies aimed at enhancing beliefs towards PE and subsequent utilization. METHOD Clinicians (N = 155) were randomized to one of three conditions presenting a PE rationale: basic, empirically-based, or emotionally-based description. Participants were rerandomized to write or not write arguments for utilizing PE. Before and after PE rationales and 1-month later, participants completed questions about PE beliefs and utilization. RESULTS Participants reported small yet durable belief change across all rationale conditions, with greatest change following the empirically-based description. Across conditions, belief change was not impacted by writing condition or associated with utilization. CONCLUSION Addressing negative beliefs with empirical information may be a brief, cost-effective strategy to improve clinicians' beliefs toward PE. Complementary strategies that leverage belief modification to increase utilization are needed.
Collapse
Affiliation(s)
- Alexandra B Klein
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Alexander C Kline
- Clinical Psychology, VA San Diego Healthcare System, San Diego, California, USA
| | - Alexandra R Bowling
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Norah C Feeny
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| |
Collapse
|
8
|
Kline AC, Klein AB, Bowling AR, Feeny NC. Exposure Therapy Beliefs and Utilization for Treatment of PTSD: A Survey of Licensed Mental Health Providers. Behav Ther 2021; 52:1019-1030. [PMID: 34134819 DOI: 10.1016/j.beth.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 01/04/2021] [Accepted: 01/08/2021] [Indexed: 11/15/2022]
Abstract
Exposure-based therapies for posttraumatic stress disorder (PTSD) and anxiety disorders remain underutilized, despite their effectiveness and widescale dissemination efforts. This study surveyed a broad range of licensed providers (N = 155) to examine rates at which prolonged exposure (PE) and other interventions are used to treat PTSD and to investigate provider characteristics linked to exposure beliefs and utilization. While 92.3% of clinicians reported understanding of or training in exposure, only 55.5% of providers reported use of PE to treat PTSD. Clinicians with current cognitive behavioral therapy (CBT) orientation, CBT training orientation, a doctoral degree, and training in PE endorsed greater likelihood of exposure utilization for PTSD (ps < .001, ds = 0.82-1.98) and less negative beliefs about exposure (ps < .01, ds = 0.55-2.00). Exposure beliefs also differed based on healthcare setting (p < .001). Among providers trained in exposure (n = 106), master's degree and non-CBT current theoretical orientation were associated with high utilization yet also negative beliefs. Results suggest exposure training, accurate beliefs, and utilization still lag among some groups of providers. Additionally, negative beliefs and misunderstanding of the exposure rationale may persist even among providers who are trained and report high utilization.
Collapse
Affiliation(s)
- Alexander C Kline
- VA San Diego Healthcare System, University of California San Diego; Case Western Reserve University.
| | | | | | | |
Collapse
|
9
|
Impala T, Burn K, Kazantzis N. To what extent are cognitive behaviour therapy competencies incorporated into clinical psychology training? A national survey of Australian universities. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Tara Impala
- Cognitive Behaviour Therapy Research Unit, School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Victoria, Australia
| | - Kim Burn
- The Psychology School, LaTrobe University, Melbourne, Victoria, Australia
| | - Nikolaos Kazantzis
- Cognitive Behaviour Therapy Research Unit, School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Victoria, Australia
- The Psychology School, LaTrobe University, Melbourne, Victoria, Australia
| |
Collapse
|