Perspectives on education and training in clinical psychology: integrating reactions

Reacting to the conceptual matrix of C.R. Snyder and T.R. Elliott as described in their article, "Twenty-First Century Graduate Education in Clinical Psychology: A Four Level Matrix Model" (this issue, pp. 1033-1054), a perspective is provided through the roles of a clinical training director and a clinical child and pediatric psychologist. Changing the direction of clinical psychology is complicated but the subfield of pediatric psychology demonstrates how such changes can be integrated with a focus on healthy development and promotion of strengths, on policy and public health concerns, and on program evaluation.     

Family Context in Pediatric Psychology: A Transactional Perspective

The degree to which the family is seen as a significant contributorto child health conditions impacts directly on the successfulfunctioning of the pediatric psychologist. A transactional modelof family functioning is proposed for pediatric psychology.Development is considered to be the result of a three-part processthat starts with child behavior that triggers family interpretationthat produces a parental response. Family interpretation ispresented as part of a regulatory system that includes familyparadigms, family stories, and family rituals. Correspondingto the proposed three-part regulation model, three forms ofintervention are discussed: remediation, redefinition, and reeducation.Clinical decision making based on this model is outlined withexamples given from different treatment approaches. Implicationsfor the treatment of families in pediatric psychology are discussed.     

The Professional Adolescence of Clinical Child and Adolescent Psychology and Pediatric Psychology: Grown Up and Striving for Autonomy

We review the present and future of the specialty field of clinical child and pediatric psychology. The progress in education and training, science, practice, and organizational developments in this specialty is described with attention to the special issues of the developing field. Clinical child and pediatric psychology are well positioned for continued healthy development.     

Training in Pediatric Psychology: Survey Results and Recommendations

Little specific information is available on the types of experiencesthat are important for training in pediatric psychology. Toaddress this need, the membership of the Society of PediatricPsychology (SPP) was surveyed regarding their views on the structureand content of training. A total of 160 completed forms werereceived, representing a return rate of approximately 32%. Surveyresults suggested that training in pediatric psychology should(a) encompass course work and applied experiences in developmentaland clinical child psychology, behavioral assessment and intervention,and child health psychology; (b) move from broad-based activitiesoccurring early in graduate training, to more specialized experienceslater on (internship and postdoc); (c) consider viewing postdoctoraltraining as a necessary step in the preparation of pediatricpsychologists. Distinctions between pediatric psychology andclinical-child and health psychology are discussed with respectto training needs.     

Internship and postdoctoral training in pediatric and clinical child psychology: a survey

A survey was designed to obtain data from pediatric psychology,clinical child psychology, and combined training centers. Sixtyprogram directors provided identifying characteristics aboutthe facility, application information for internship and postdoctoraltraining, information on clientele and case load of trainees,and specific training information. In addition, respondentsprovided definitions of the two areas and suggested differentiatingfeatures. It was concluded that the similarities are more numerousthan are the differences in training. Definitions suggest that(a) clinical child psychology has broader application than pediatricpsychology despite the latter's broader principles of application,and (b) pediatric psychologists rely heavily on the traditionalskills and techniques of clinical child psychology. The onlydifferentiating features identified were in terms of medicallyrelated populations of children served, collaboration with healthcare disciplines, and a specialized focus of viewing psychologicaldifficulties within the medical culture by pediatric psychologists.     

Munchausen Syndrome by Proxy: A Review and Case Study

This paper reviews for the psychology community a life-threateningform of child abuse. Munchausen Syndrome by Proxy describesa situation in which a parent creates or fabricates an illnessin his or her child as a result of the parent's own psychopathology.The sparse literature on Munchausen syndrome by proxy suggeststhat these children often die and typically suffer unnecessaryintrusive and dangerous medical treatments. The presented caseillustrates several of the difficulties in working with andidentifying Munchausen syndrome by proxy cases. The role ofthe pediatric psychologist is discussed in terms of teaching,liaison work, and psychotherapy.     

A history of Combined-Integrated doctoral training in psychology

The history of doctoral training in psychology is reviewed, with special emphasis on the development of training models for applied psychology. Among applied psychology doctoral programs, most label themselves as being one of the three currently recognized practice areas: clinical, counseling, and school psychology; however, since the 1970s, APA also has accredited "combined" programs. The history of the development of the combined model is traced, including information from the programs themselves about the manner in which each evolved. Recently, new interest in the combined category -or Combined-Integrated (C-I) as these programs wish to become known-has emerged, and an organization representing these programs has formed. The C-I model is described, and the potential that the model may serve as a template for the future of professional training in psychology is discussed.     

Society of pediatric psychology task force report: recommendations for the training of pediatric psychologists

OBJECTIVE: To provide an overview of the types of training experiences considered most important to the development of competency in pediatric psychology. METHODS: This is the work of a task force commissioned by the Society of Pediatric Psychology, Division 54 of the American Psychological Association. RESULTS: Twelve topic areas, adapted from Roberts et al. (1998), deemed important for obtaining knowledge and expertise in pediatric psychology, were identified. These topics include life span developmental psychology; life span developmental psychopathology; child, adolescent, and family assessment; intervention strategies; research methods and systems evaluation; professional, ethical, and legal issues pertaining to children, adolescents, and families; issues of diversity; the role of multiple disciplines in service-delivering systems; prevention, family support, and health promotion; social issues affecting children, adolescents, and families; consultant and liaison roles; and disease process and medical management. Each area is briefly described and recommendations for obtaining training in these areas are offered. CONCLUSIONS: The Society of Pediatric Psychology offers this document as a comprehensive review of the ideal types of training experiences most important to developing competencies in pediatric psychology. These recommendations can be used by graduate students and graduate programs in shaping a training plan for students interested in pediatric psychology training.     

Unified professional psychology: implications for the Combined-Integrated model of doctoral training

The authors outline a new identity for the professional psychologist termed Unified Professional Psychology (UPP). UPP combines recent movements toward a unified psychological science, an independent professional psychology, and Combined-Integrated (C-I) doctoral training programs in psychology. The value in the synthesis of these ideas is that they (a) provide a comprehensive system of thought that defines the science and practice of psychology in a commensurable manner, (b) offer a clear identity for the professional psychologist, and (c) set the stage for a training model that develops competencies that will prepare graduates to serve as leaders and advocates in a wide array of health settings. Issues pertaining to why a new view is needed and how UPP specifies the science-practice relationship are addressed in detail.     

Development of a global curriculum for professional psychology: implications of the Combined-Integrated model of doctoral training

This article considers the development of a global training curriculum and qualification in professional psychology, with particular emphasis on the Combined-Integrated (C-I) model. The C-I model exposes professional psychology trainees to two or more of the practice areas (i.e., clinical, counseling, school/educational). The authors argue that the C-I approach is one that is well suited to the development of a global training curriculum due to its emphasis on broadly training psychologists as well as its respect for diversity and integration of various theoretical and professional orientations. A survey of training programs in 16 countries/regions on six continents found significant variation in training, minimal qualifications, and roles of the professional psychologist. The authors recommend that an international group of psychologists develop a regionally flexible, but common, training curriculum and qualification that would include a five- to six-year competency-based qualification. Ways in which the C-I training model may serve to integrate and globalize professional psychology are discussed.     

Family Context in Pediatric Psychology from a Transactional Perspective: Family Rituals and Stories as Example

Reviewed the transactional model as applied to the family contextof pediatric psychology. A three-part sequence of child behavior,parent behaviour, and family interpretation was used to describedevelopmental adaptation and trasitions. It was proposed thatfamilies are regulated by practices that are proximal to thechild's experience and representations thatare more distal tothe child's experience. Family practices are examined throughfamily routines and rituals. Family representations are examinedthrough family stories. Case examples of low birth weight prematureinfants and an adolescent referred for repeated hospitalizationsdue to diabetic ketoacidosis were presented to illustrate themodel. Guidelines for thepracticing pediatric psychologist arepresented to asses family organization through family ritualsand family meaning-making in the telling of family stories.     

Society of pediatric psychology presidential address: opportunities for health promotion in primary care

OBJECTIVE: To set an agenda for health promotion in primary care settings. METHODS: This is a review of the scientific bases of child development as applied to pediatric psychology and health promotion. RESULTS: Primary care is an ideal setting for health promotion because there is a "hidden morbidity" of children with unrecognized and untreated behavioral and developmental problems that, if unresolved, may lead to psychiatric and physical disorders and increased use of the health care system. Although pediatric psychologists endorse the importance of health promotion, there are few examples in the literature involving pediatric psychologists. Recommendations are provided for a proactive agenda for health promotion programs involving pediatric psychologists in primary care. CONCLUSIONS: With conceptual homes in clinical and developmental psychology, expertise in theories of clinical and child development, scientific methods, and collaborative relationships with pediatricians, pediatric psychologists are in a unique position to develop and evaluate health promotion programs for use in primary care.     

Developmental Theory and the Practice of Clinical Child Psychology

Examined developmental theory and its relevance for the practice of clinical child psychology. Following a brief review of basic principles of developmental psychology and developmental psychopathology, implications of a developmental perspective are explored for the diagnosis, assessment, and treatment of childhood disorders. Although it is obvious that many developmental issues confront the clinical child psychologist and that we have learned much about translating developmental theory into clinical practice, we conclude we have a long way to go before we can assert that a true developmental-clinical child interface has been realized.     

Preparing psychologists to link systems of care in managing and preventing children's health problems

OBJECTIVE: To describe the need for innovations in training to link health, educational, and family systems and to illustrate how this can be accomplished through child-oriented psychology training programs. METHODS: We describe multiple pathways for the preparation of child-oriented psychologists to link health, educational, and family systems, in keeping with the National Institute of Mental Health guidelines for preparing professionals in child and adolescent psychology. These pathways include training embedded in graduate programs specializing in clinical child, pediatric, school, community, and family psychology. This article highlights a training initiative for preparing child-oriented psychologists based in a school psychology program. RESULTS: A partnership between Lehigh University and The Children's Hospital of Philadelphia has been developed to prepare school psychologists to coordinate community-based systems of care to promote positive educational and health outcomes for children. This program emphasizes both intervention and prevention and provides a set of integrated experiences in both health care and educational settings. CONCLUSIONS: We highlight components of this program relevant to the preparation of pediatric psychologists. We identify and discuss potential challenges in establishing training programs for the preparation of professionals to link health, school, and family systems.     

BOOK REVIEW: Preventing Childhood Disorders,Substance Abuse,and Delinquency

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.     

The Places Rated Almanac and Training in Clinical Child Psychology

A recent chapter by Routh (1985) listed programs and rated the "quality" of graduates who were members of Section 1 of Division 12 (Section on Clinical Child Psychology). I question several assumptions and conclusions of this chapter. Particular issue is taken with the use of numbers of graduates as an indicator of who is training clinical child psychology Without examination of the training content. Additionally, the definitions of quality and excellence are not indisputable. Alternative procedures to find clinical child psychology training are outlined for the prospective students.     

Specialized Training in APA-Accredited Clinical Psychology Doctoral Programs: Findings From a Review of Program Websites

The current study examined the websites of the 231 clinical psychology doctoral programs accredited by the American Psychological Association (APA) in 2007 and found that more than half described themselves as offering a track, emphasis, certificate, or degree in a specialized training area. About 18% of programs required students to enroll in a specialized training stream. The most common areas of specialized training were clinical child, clinical health, forensic, family, and clinical neuropsychology. The most common format for specialized training was a track within a general clinical training program. A greater percentage of PsyD programs than PhD programs offered specialized training, and PsyD programs offered more areas of specialization than PhD programs. Overall, results indicate that specialized training is common among APA-accredited clinical psychology doctoral programs.     

Structural equation modeling in pediatric psychology: overview and review of applications

OBJECTIVE: To describe the use of structural equation modeling (SEM) in the Journal of Pediatric Psychology (JPP) and to discuss the usefulness of SEM applications in pediatric psychology research. METHOD: The use of SEM in JPP between 1997 and 2006 was examined and compared to leading journals in clinical psychology, clinical child psychology, and child development. RESULTS: SEM techniques were used in <4% of the empirical articles appearing in JPP between 1997 and 2006. SEM was used less frequently in JPP than in other clinically relevant journals over the past 10 years. However, results indicated a recent increase in JPP studies employing SEM techniques. CONCLUSIONS: SEM is an under-utilized class of techniques within pediatric psychology research, although investigations employing these methods are becoming more prevalent. Despite its infrequent use to date, SEM is a potentially useful tool for advancing pediatric psychology research with a number of advantages over traditional statistical methods.     

The end of clinical psychology as we know it? A response to Snyder and Elliott's four level matrix model

C.R. Snyder and T.R. Elliott's proposed model (this issue, pp. 1033-1054) represents a good effort toward reexamining the premises of clinical psychology education. However, there are several concepts left underdeveloped and inadequately defined. Furthermore, their ideas for improving clinical training seem largely divorced from the model proposed. Before making propositions toward a "new clinical psychology," clarification of the constructs and model is needed to understand how it can better educate and prepare future clinical psychologists for the demands of tomorrow's marketplaces.     

What do students want? Perspectives from the front line of doctoral training in professional and Combined-Integrated psychology

Doctoral students in professional psychology face broad challenges, such as changing market demands and increased competition for careers in traditional practice settings. To prepare for these demands, students must decide how much and when to specialize, if at all, predoctorally. Complicating matters, students in single practice area programs (clinical, counseling, or school) may risk becoming insulated within the culture of their practice area, which can limit exposure and understanding of the larger practice field. Despite conditions that may drive potential students away from psychology, little research exists on efforts to address student needs, or on student perspectives of doctoral training in general. One training model that is sensitive to these student needs and concerns is the Combined-Integrated (C-I) model. An exploratory study of C-I student and graduate opinions, experiences, and aspirations revealed that C-I students value breadth of training, diversity of experience, and professional flexibility, and that they experience diverse training opportunities and socialization experiences. Implications of these results vis-à-vis the larger framework of student concerns are examined.