No Job Nametelliott.education.tamu.edu/sites/telliott.education.tamu.edu/files/documents/snyder...educates our clinical psychology graduates for the contemporary marketplace (Spruill,

Twenty-First Century Graduate Education in ClinicalPsychology: A Four Level Matrix Model

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C. R. Snyder

The University of Kansas, Lawrence

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Timothy R. Elliott

The University of Alabama at Birmingham

Clinical psychology is positioned to play key roles in mental and physicalhealth issues of 21st century America. In this regard, however, the presentBoulder model of educating clinical psychologists is not preparing ourgraduates to meet the diverse demands of either today’s or tomorrow’smarketplaces. Accordingly, we introduce a new, four level “matrix model”for the education of future clinical psychologists. The core focus of theproposed matrix model is on the weaknesses and strengths of people intheir personalities and their environments. Moreover, this matrix modeloperates at the individual, interpersonal, institutional, and societal–community levels of analyses. The details and implications of this pro-posed educational curriculum are described. © 2005 Wiley Periodicals,Inc. J Clin Psychol

Keywords: Boulder model; clinical psychology graduate education; four levelmatrix model

Using the ideas of its post-World War II founders, clinical psychology has prospered inthe ensuing 60 years. Having worked the last four decades as educators, researchers, andpractitioners in clinical psychology, we are very familiar with much of this “living his-tory.” As with any field seeking to maintain its viability, however, we believe that clinicalpsychology (we use “clinical” to refer to both clinical and counseling) periodically mustreexamine its premises and educational practices. Furthermore, we no longer perceivethat the prevailing “scientist–practitioner” Boulder model (Strupp & Hadley, 1977) fully

We thank Kevin Rand and Hal S. Shorey for their comments on an earlier version of this article.Correspondence concerning this article should be addressed to: C.R. Snyder, Department of Psychology, 1415Jayhawk Boulevard, 340 Fraser Hall, University of Kansas, Lawrence, Kansas 66045; e-mail: [email protected].

JOURNAL OF CLINICAL PSYCHOLOGY © 2005 Wiley Periodicals, Inc.

Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jclp.20164

educates our clinical psychology graduates for the contemporary marketplace (Spruill,Kohout, & Gehlmann, 1997). In this article, therefore, we propose a new four levelmatrix model for preparing our clinical psychology graduate students to face the profes-sional challenges of the 21st century.

The Core Matrix Model

The previous emphasis in clinical psychology has been on “mental illness” rather than“mental health” (Snyder, Rand, & Berg, 2004). Unfortunately, this focus upon people’sweaknesses and pathologies often has produced imbalanced and less than fully usefulrepresentations of our research participants and clients (Snyder & McCullough, 2000).For the future, we suggest a greater emphasis on people’s positive assets (see Seligman &Csikszentmihalyi, 2000; Snyder & Lopez, 2002a). We are not proposing, however, thatthe exploration of human psychological weaknesses and frailties be abandoned. Rather,we are suggesting that strengths be examined along with weaknesses to provide completepictures of people. Thus, we believe that it is crucial to take a balanced approach inlooking at the “good” along with the “bad” in people (Lopez & Snyder, 2003a, 2003b;Lopez, Snyder, & Rasmussen, 2003; Snyder et al., 2003). Furthermore, such changes arewarranted because we seriously doubt that the general public and influential policymak-ers will continue to support the previous monolithically negative views presented byclinical psychologists.

To achieve a balanced perspective in understanding the individual (whether a researchparticipant or a client), we suggest a four-quadrant matrix (see Figure 1; Snyder et al.,2003, p. 31), which is derived from the ideas of Beatrice Wright (Wright, 1991; Wright &Fletcher, 1982; see also Wright & Lopez, 2002). One dimension of this matrix is Valence,or the degree to which any given diagnostic focus is either positive or negative. As such,valence includes two categories—the person’s strengths and weaknesses. A second dimen-sion is Source, or the location of the particular diagnostic focus. The source dimension

Figure 1. The matrix model.

2 Journal of Clinical Psychology

includes two categories—factors within the person and within the person’s environment.This two (Valence: Assets vs. Weaknesses) by two (Source: Person vs. Environment)matrix yields four quadrants: #1 � Assets; Within Person; #2 � Assets; Within Environ-ment; #3 � Weaknesses; Within Person; and #4 � Weaknesses; Within Environment.Quadrant #3 has been the focal point of the traditional pathology approach emphasizingintrapsychic, personality-based deficiencies. There is more to people than quadrant #3,however, and the use of quadrants #1, #2, and #4 would insure that future clinical psy-chology assessors explore these other aspects.

The Four Levels of the Matrix Model

In an update of the Strupp and Hadley (1977) tripartite model of therapeutic mental healthactivities and outcomes for the profession, we have reasoned elsewhere (Elliott & Klapow,1997; Elliott & Shewchuk, 1996) that activities at the individual, institutional, and societal–community levels require skills and technological applications that most clinical psychol-ogists are capable of, but presently do not possess. The previous educational emphasis hasbeen on the individual level, with some, albeit far lesser, attention having been given to theinterpersonal level. On this latter issue, we believe that the interpersonal level warrants muchgreater attention in the future. Both the individual and interpersonal levels are subsumedwithin the larger institutional and societal–community levels (see Figure 2). Bronfen-brenner (1979) proposes a similar, four-layer model as applied to human development. Theissues at each level of our new model are discussed next.

The Individual Level

The individual level historically has aimed its research, diagnosis, and therapeutic activi-ties toward an identified person who is called a research participant (a.k.a., subject) or apatient (a.k.a., client). Many people, both inside and outside of the field, hold this image ofone clinical psychologist working with a single person in a laboratory or therapy room.

Overwhelmingly, the previous curricula for educating graduate students aimed theirresearch and applied “lessons” toward weaknesses at this individual level. The matrixmodel, however, would necessitate additional instruction about strengths. As such, itwould direct future students to attend to those portions of pathology continua that por-tend “lack of weaknesses.” But, is this lack of negative the same as the presence ofpositive characteristics? We think not. Positive dimensions of appraisal are needed, andthere already is a handbook dedicated to validated self-report variables on personal strengths(e.g., control, emotional intelligence, hope, optimism, self-efficacy, and self-esteem; seeLopez & Snyder, 2003a).

Additionally, Buckingham and Clifton (2001) have developed a strengths-based diag-nostic system based on matching persons’ on-the-job activities to their natural assets andskills rather than attempting to force all employees to the same skill levels. Also, as acounterpoint to the traditional, widely used pathology-oriented Diagnostic and StatisticalManual of Mental Disorders (DSM-IV; American Psychiatric Association [APA], 1994),Peterson and Seligman (2004) have assembled the Values in Action (VIA) classificationfor measuring human strengths.

Clients often have a mixture of weaknesses and strengths, and it is important tosearch for these to produce a full and accurate diagnosis, as well as to form the bestsubsequent interventions. In this regard, the matrix model fosters a thorough “search” ofthe total person. We are reminded here of a story about the couple who go to the shopping

Twenty-First Century Clinical Psychology 3

mall and park their car in the nearby lot. Finished shopping, the man cannot find his carkeys. Thinking he may have dropped them in the parking lot, he begins to look around thepavement. Watching him for a while, the bewildered woman eventually asks, “Why areyou looking only under this lamppost?” He replies, “Because the light is better here.” Inthinking about the previous efforts to train clinical psychology students to find the “keys”to understanding the activities of their research participants or clients, we may havebehaved as rigidly, illogically, and ineffectively as this man looking for his keys onlyunder the lamppost.

The Interpersonal Level

In our estimation, interpersonal matters have been given far too little attention previouslyin the education of clinical psychologists. Humans are social creatures in which virtually

Figure 2. The matrix model embedded in the individual, interpersonal, institutional, and societal–communitylevels.


everything we learn and do across the life span is based on interpersonal issues. Accord-ingly, more attention needs to be paid to educating clinical psychologists about the inher-ent social nature of human goal-directed activities.

It also will be crucial that our future students understand how their own professionalbehaviors (including diagnosis, therapy, consultation, and research) take place in inter-personal contexts. For diagnosis, our students will need to be apprised about the nature ofdyadic interactions. Couples increasingly are seeking treatment (see Baucom, 2000), andmore attention must be given to identifying the characteristics of enduring intimate rela-tionships (Gottman, 1994). Furthermore, with the growing viability of the various groupapproaches to treatment (see Forsyth, 1999), our students should receive training in suchgroup dynamics.

The Institutional Level

The institutional level involves research, consultation, administration, and liaison rolesconducted in schools, hospitals, companies, etc. Ideally, the infusion of psychologicalexpertise at this level would promote a coordinated provision of psychological researchand applied services across institutions. Although psychologists have worked previouslyin various institutional administrative roles, most have used the traditional pathology-oriented model.

Beyond the research and psychological health care activities that most readily areassociated with the institutional level, we also believe that our students need to be edu-cated about physical health care systems. In this latter regard, there are dramatic changesin the American population that portend far-reaching implications for future clinical psy-chologists. For example, over half of our citizens have at least one chronic health condi-tion persisting longer than 3 months, and almost half of these people have more than onesuch condition. Moreover, these chronic health conditions are the leading causes of dis-abilities and deaths in the United States (Institute of Medicine, 2001). Furthermore, therates of disability associated with chronic health conditions are increasing among 18- to51-year-old adults (Lakdawalla, Bhattacharya, & Goldman, 2004), and the managementof chronic health conditions accounts for approximately two-thirds of all health careexpenditures. Obviously, modern Western health care systems are facing huge challenges(Frank, 1997).

With the exception of those programs with health specialties, present clinical psy-chology curricula do not educate would-be 21st century graduate students about the psy-chological components of health problems. As such, most of our students are unawarethat approximately 50% of presenting problems in primary care settings have a psycho-logical component or origin (Levant et al., 2001). Although behavioral and social mech-anisms have profound impacts on the physical health and psychological well-being ofpersons with chronic conditions (Israel, Schulz, Parker, & Becker, 1998), we unfortu-nately still are operating out of the 20th century training model that ignores these impor-tant psychological factors (Snyder & Feldman, 2000). As physician Leonard Saganconcluded in his The Health of Nations, “It is the brain that is the true health provider”(1987, p. 185).

The Societal–Community Level

Activities at the societal–community level address the large issues and challenges thatface all service delivery systems, including those that subsume both mental and physical


health care. Clinical psychologists have been limited previously by their lack of prepa-ration in using their technologies and skills to promote an empirical, science-based agendaat this societal–community level. Accordingly, future education is needed in how to: (a)conduct research in these settings (including large, archival data sets), (b) allocate resourcesand services, and (c) influence the formation of health care policies (Kaplan, 1994).

Although clinical psychology has been wedded to an educational model that focuseson delivering services to the single client, it is possible to have more of a “top-down”impact on our citizens’ welfares. Research is warranted on how the societal–communityprocesses gravitate downward to the individual. In this regard, not only should we learnto conduct research at this level, but clinical psychology also needs to become a primestakeholder in health care policy, development, programming, administration, and imple-mentation (Elliott & Klapow, 1997).

As can be seen in Figure 2, the thick-lined arrows going inward depict our belief thatthe stronger forces for change emanate from the societal–community level. It is impor-tant that clinical psychologists become educated and involved in research, along with theestablishment, operation, and maintenance of matters that occur at the societal–community level. We would note, however, that there is a smaller possibility for the flowof influence to go “bottom-up” from the individual level (see the thin-lined arrows goingoutward in Figure 2).

Similar to our previous suggestions about the institutional level, clinical psychologyalso needs to improve and expand its contributions at the societal–community level inconducting research on, and delivering services to, people with chronic health conditions.Such people previously were within the strict purview of the medical model, and thisperspective limited our ability to recognize positive assets and strengths among thosewho were physically or socially different. We are not surprised, then, that consumershave complained about being stigmatized and having their overall “personhoods” ignoredby psychological and medical professionals (Olkin & Pledger, 2003). The matrix modelwould help to counteract such stigmatization.

With the dramatic increase of chronic health conditions, future clinical psychologistsmust be skilled at influencing policies and developing cost-effective, relevant, and valuedservice programs for these consumers. Although there are advantages to huge medicalcenters, they are not accessible to many needy Americans with physical problems. Asexamples for solving this problem, clinical psychologists could establish: (a) satelliteclinics in locations such as shopping centers with easy access, and (b) mobile psycho-logical and physical outreach units.

Presently, the prevention and management of health conditions do not constitute“mental health” issues as traditionally defined in our field. Because of the costs associ-ated with chronic health conditions, resources have been pulled from other areas of ser-vice in inefficient “band aid” attempts to defray losses. Moreover, clinical psychologistshave had difficulty in envisioning the far-reaching financial implications of these strainson all health care systems. In contrast to this present norm, we foresee future clinicalpsychologists playing more active roles in health maintenance organizations (HMOs).For example, we should teach HMOs about the economic incentives of increasing long-term prevention and health maintenance activities.

We also could become role models for promoting less costly forms of psychologicaltreatment. Instead of resisting treatments by BA- or MA-level psychologists, PhD-levelpersons could help to educate and supervise these therapists, and perform a myriad ofother activities involving diagnosis, research, program evaluation, etc. Although the chal-lenges at this societal–community level are large and complicated, we believe that therewill be many new opportunities for our future students (see Drum & Sekel, 2003).


The Details of the Matrix Model

Mentoring as the Foundation

Implementing the matrix model will depend on a supportive and yet catalytic faculty.Beyond the classroom, vital graduate education is built on extensive mentor and clinicalstudent one-on-one interchanges (Snyder, 2002b). We suggest that future students have acourse or practicum in mentoring. Whereas students presently gain considerable trainingin how to support their clients, they receive no feedback about supporting their protégés.Therefore, we should teach our students about maintaining hope for their own graduateschool careers, along with how to impart this hope in their eventual students (Snyder,1994, in press).

The Issues

Prevention. Prevention should be an essential feature of our science, education,research, and practice (Kaplan, 2000). Unfortunately, from policy and institutional per-spectives, prevention often is seen as nothing more than occasional medical tests andprophylactic interventions. From our perspective, prevention invokes attention to life-style factors and accompanying behaviors that are essential components of health for allcitizens. When applied to people with chronic diseases, such prevention efforts can lessencomplications, add quality years, and diminish the monetary costs to patients and societymore generally (Rimmer & Braddock, 2002). It is not likely, however, that such preven-tion programs will prosper in the face-to-face interactions of traditional clinic settings.For future prevention programs to be effective, we will need novel strategies with long-distance technologies for health interventions, disease management programs, and publicand health policies. Clinical psychologists should play leadership roles in discoveringand implementing these prevention techniques.

To educate our students about prevention, we suggest both didactic and applied course-work. Additionally, we would encourage the embedding of prevention principles intovarious required courses. Unfortunately, the effects of preventions do not appear imme-diately, and clinicians are not remunerated for such activities. Therefore, a crucial aspectof future education will entail teaching our students to “sell” preventions as yieldingpsychological, physical, and financial benefits over time. Thus, if local city and businessorganizations can be shown the benefits of preventions, they may be more likely to fundthem. Also, granting and government agencies should underwrite prevention programs(Snyder & Ingram, 2000).

In recent years, clinical psychologists have become more involved in the productionof public service announcements (on television and in magazines) where well-knownpeople recount their stories of having undertaken prevention efforts to improve theirlives. Clinical psychology science and applied skills can help in such prevention-orientedpublic service activities (Snyder & Ingram, 1983).

Several clinical psychology programs already have health specialties where the cur-ricula pertain to helping people to lower their risk factors to preclude later health prob-lems. Our recommendation is that these health specialties within clinical programs beincreased, along with establishing clinical programs and postdoctoral programs that focuson prevention and health.

Problems of passion. “Problems of passion” involve chronic health problems andthe exacerbation of secondary complications. Included here are tobacco use, excessive


alcohol consumption, dietary excess, lack of exercise, sedentary lifestyles, imprudentrisk-taking and impulsivity, and inattention to safety (Snyder, Tennen, Affleck, & Cheavens,2000). Over time, these lifestyle practices contribute to severe disabilities, motor vehicleaccidents, obesity, diabetes, AIDS, drug and alcohol abuse, and heart disease. Thus, theseproblems of passion become carousels of ever-worsening outcomes whose financial costsare passed to all citizens.

It is inexplicable that granting agencies continue to fund acute medical care at theexpense of health improvement and secondary prevention of behaviors. For example,roughly 95% of budgeted grant allotments go to acute care and only 5% to long-termprevention (McGinnis, Williams-Russo, & Knickman, 2002). This disparity is compli-cated by the fact that several of these targeted behaviors are “ . . . products . . . of strongcommercial forces” (McGinnis et al., 2002, p. 85) that contribute to variants of “afflu-enza” (e.g., obesity). Likewise, powerful industries promote the purchase and ingestionof their products to reap financial profits—without attending to the potential harmfuleffects on people. Clinical psychologists can and should become involved in teachinginstitutional clients about the advantages of “people accounting” in which business trans-actions are examined not only with an eye toward the immediate financial profits, butalso their long-term effects on the welfare of people.

The challenges of strengths. Although the matrix model emphasizes the importantroles that strengths play in the psychological and physical health of clients, implementingthis approach will not come easily. Almost all clinical psychologists have been taught tofocus on weaknesses, and have been applying this perspective for decades. Also, individ-ual or institutional clients expect clinical psychologists to ameliorate their problems becausethey have seen television and movies depicting one-on-one diagnosing and “curing” ofhuman pathologies. Likewise, books and magazines still depict this problem-focused,“mental illness” emphasis.

What realistically can be done to alter the pathology model? As a start, by educatingthe next generations of students (via the matrix model) to look at weaknesses and strengths,clinical psychologists eventually will move toward this balanced approach. In the interim,the “baby boomer” academicians with the pathology orientations will be retiring. In theinterim, we would suggest educating print and television media sources about this “newclinical psychology.” Of course, if research increasingly shows benefits in assessing andfostering human strengths, then consumers are likely to demand this approach. We alreadyare seeing some public interest in positive psychology, and the viability of this movementas a science and practice eventually may necessitate that educators include strength-related information in their curricula.

Good clinical psychology science also should be built upon a balanced weakness andstrength focus. Individuals possessing positive resources may be more likely to adjustoptimally to their chronic health conditions, and thus they may require fewer communityservices as they independently manage their conditions. In contrast, those who lack pos-itive qualities may have difficulties in managing their conditions. They may be at risk forsecondary complications (Snyder, 2002a), and burden tax health systems with their repeatedvisits to high-cost professionals (Snyder & Pulvers, 2000). We only have begun to con-duct the kind of prospective research that could identify clients’ strengths and weak-nesses (Lopez & Snyder, 2003a), along with the relationships between positive attributesand adjustment over time (Keyes & Haidt, 2003; Snyder & Lopez, 2002b). Such infor-mation will be essential to the development of strategic services for persons at risk, andfor developing efficient methods for distinguishing those who will live well on their ownfrom those who may require supportive services.


Populations of Clients

Children. Taking care of children, in our estimation, is not given sufficient impor-tance in our society (Snyder & Feldman, 2000). As but one example, childcare workersare in the lowest 10% of wage earners (Etzioni, 1993). Many of the problems that resultin adulthood in American society can be traced to our economic structure that does notreward or allow parents, teachers, and mental health professionals to spend enough timeinteracting with children.

In present clinical psychology education, the curricula pertaining to children are verylimited. Clinical students need more preparation to work directly with children and thecaregivers of children (parents, teachers, etc.). We know what the crucial contents are ineducating clinical child psychologists (Roberts et al., 1998), we need more predoctoraland postdoctoral clinical psychology programs aimed expressly at using these in instruct-ing students. At the University of Kansas, for example, we recently have developed anAPA-approved PhD clinical program focused on research and practice with children,adolescents, and their families (for reviews, see Roberts, 1998; Roberts & Steele, 2003).

Education pertaining to children inherently addresses the previously discussed pre-vention activities. If clinical psychologists can help greater numbers of young children,then many of the later adolescent and adult problems can be avoided (Roberts, 1991).Likewise, more emphasis should be placed on examining children’s strengths along withtheir weaknesses (Roberts, Brown, Johnson, & Reinke, 2002). Related to this latter point,Dryfoos (1998) concluded that the very best adolescent intervention programs empha-sized growth-enhancing activities.

Elderly. America is “graying” at an accelerating rate. For example, the 75 millionbaby-boomers born between 1946 and 1964 are becoming seniors. Likewise, in 45 years,we will more than double the number of Americans who are over age 65 (Blazer, 1989).Finally, it is the “old old” (age 85 or beyond), who are increasing most rapidly in numbersamong the elderly (American Association of Retired Persons, 1995).

Physical and psychological health are two of the most important issues for the elderly(Gallagher-Thompson et al., 2000). Most physical problems involve pain, and depressionis the most widely reported psychological concern (Cheavens & Gum, 2000), and ourfuture students should play important roles in helping with these two age-related issues.Our 21st century students also should learn how to disabuse our society of its sometimesnegative, prejudicial views about older people. We Americans should realize that theelderly are the only minority group that we will be joining after a few more birthdays. Wealso suggest that more such education on elders should be part of the core curricula for allclinical psychology programs, along with the development of PhD and postdoctoral pro-grams aimed especially at education pertaining to the elderly.

Minorities. The term minority soon will be an oxymoron. Although the “Americansof color” (i.e., African American, Asian Americans, Hispanic or Latinos, and NativeAmericans) presently are in the numerical minority, as we move farther into the 21stcentury, they will form the majority in terms of being the largest percentage of our pop-ulation. So, in the ensuing discussion, realize that minorities cannot be so labeled formuch longer.

Unfortunately, persons who are of an ethnic minority or elderly are not likely to usemental health services (Ivey, Scheffler, & Zazzali, 1998). Also, even if these two groupsof people were to become more open to the seeking of our services, the reality is that ourpresent clinical psychology graduate students have received little education in understanding


and working with them. The ironies here are palpable for a discipline that espouses goodcare for all people.

Accreditation guidelines by the APA already mandate some attention to minorityissues. Additionally, as we suggested for children and the elderly, we need new PhD andpostdoctoral clinical psychology programs focused upon minorities. Equally important,we must attract more minority students to study clinical psychology. Many people fromthis huge cohort of Americans eventually may expect psychological services, as well asto see therapists from their minority groups. Obviously, new and more effective methodsmust be found to recruit minorities to clinical psychology.

Last, we have two suggestions about research related to minorities. First, attemptsmust be made to understand why members of ethnic minorities so infrequently use theservices of clinical psychologists. Second, given that there are very few minority peoplein psychotherapy, they naturally will not be in psychotherapy research outcomes studies.This means that we will not be well informed about the efficacy of these treatment forminorities (Gray-Little & Kaplan, 2000). Of note here, National Institutes of Health (NIH)grant guidelines (NIH, 1994) already require the inclusion of minority samples, and wemust find additional ways to include ethnic minorities in research.

Prescribing Drugs

The battle largely appears to be over in that the issue is not if, but when such prescriptionrights will be made available. We (the authors) originally were quite resistant to clinicalpsychologists having prescription rights. As advocates of psychotherapy research, how-ever, we reconsidered our objection in that clinical psychologists with prescription priv-ileges could facilitate the conduct of research involving adjunctive psychotherapeuticmedications, as well as play important roles in testing the efficacy of new drugs in clin-ical trials.

Increasingly in the 21st century, qualified clinical psychologists will be able to dis-pense medications. The key word here is qualified. This leads to the crucial question ofwhat education will be required to prescribe medications. We concur with the recommen-dations of a task force on this topic (see APA, 1992), which suggested three levels ofeducation. To begin, Level 1 would involve a comprehensive predoctoral course in psy-chopharmacology (or obtained as a continuing education course). These Level 1 peoplewould not have prescription privileges, but they would be informed about the adjunctiveroles of such drugs in treatments. Level 2 would be for those with doctorates who were incollaborative practices with other clinical psychologists or other professionals. It wouldinclude specific training in “psychodiagnostics, pathophysiology, therapeutics, emer-gency treatment, substance abuse treatment, developmental psychopharmacology, drugresearch, and supervised clinical experience” (APA, 1992, pp. 63– 64). Last, Level 3would entail people having independent prescribing capacities, and it would involvegraduate courses in biochemistry, physiology, pharmacology, biological basis of behav-ior, behavioral pharmacology, clinical pharmacology, professional pharmacology, and aspecialized internship in psychopharmacology.

Views of Reality

Clinical psychology students historically have been taught the views about the nature ofreality that reflected the zeitgeists of given periods. From the mid-1940s onward, stu-dents learned the psychoanalytic view that people were ruled by aggressive or sexual thoughts


and feelings developed in their childhoods. This started the negative, pathology views thatcontinue today. Two schools of thought emerged in opposition to the Freudian perspectivein the 1950s. One was the Rogerian nondirective model, where the idea regarding views ofreality was that people were good, and that this good would emerge in supportive thera-peutic atmospheres. The behavioral view defined reality as reflecting an understanding ofparticular stimulus and response contingencies, and it provided a more neutral view of humannature than the Rogerian goodness perspective. Although strict behavioral visions of real-ity wanes in popularity by the 1970s, the behavioral analytic principles still are influential.In the 1980s and 1990s, clinical psychologists were influenced by developments in the largerfield of psychology about thinking and memory processes, and the brain in particular. Inthis “cognitive revolution,” reality was seen as a series of mental events. Thus, the psycho-dynamic, nondirective, behavioral, and cognitive perspectives, in that order, have wieldedinfluences regarding people’s views about reality.

Systemic constructivism. We would suggest yet another perspective, systemic con-structivism, for understanding how people form mental models of themselves and theirworlds. Realities, in this perspective, are not veridical matters residing outside of people,but rather they are mental representations that enable people to cope. Systemic construc-tivism allows for the possibility that such working models then actually cause a person(or persons) to change the environments, with the changed environments then alteringpersons’ working models of reality. In this latter sense, this is a reciprocal systemic con-structivism. Also, systemic constructivism assumes that two or more persons will formshared views of reality for the purposes of human commerce. Also, in the degree to whichthere is a majority of people sharing a similarly constructed reality, then that becomes theprevailing paradigm. Systemic constructivism would allow psychologists to understandhow individual working models (at the individual level) operate to take into account thesurrounding environment and the importance of others’ views of reality. Although impor-tant applications have been made of such constructivism views of reality (see Mahoney,2003; Neimeyer & Mahoney, 1995), to date such models have not been widely acceptedin our field.

Clinical cognitive neuroscience. We already are beginning to see the emerging roleof cognitive neuroscience. This is a burgeoning research area, which should have impli-cations for understanding the weaknesses and strengths of people as they cope. More-over, this cognitive neuroscience perspective will allow future clinical graduate studentsto interact with scholars from other disciplines outside of the social sciences. We do notsee this cognitive neuroscience approach as being antithetical to the previously describedsystemic constructivism view in that the former should inform our understanding of howsuch constructions of reality are built. We do not agree with a reductionist view thatclinical psychology should focus on biological and neurological processes to the exclu-sion of understanding how people use those processes to form working models of reality.As such, we think that clinical psychologists should retain their core focus on psycho-logical analyses.

Spirituality. Two of the founding fathers of psychology, G. Stanley Hall and WilliamJames, viewed spirituality as being central to human existence (Pargament & Mahoney,2002). Nevertheless, spirituality today remains a relatively unexplored topic for clinicalpsychologists. In this context, we distinguish spirituality from religion, with the formerrepresenting the various forms of belief in higher powers intervening in the lives ofhumans, whereas religion represents the formal systems of worship (defined differently


across specific religions), including specified rules for practice. Therefore, although wedo not advocate becoming more involved with religion per se, we do see spirituality asbeing a worthwhile topic for our field.

Among Americans, 95% believe in God and 86% say that religion is important orvery important in their lives (Gallup Poll Organization, 1995). Nevertheless, from aninternational perspective, the practice of spirituality in terms of religious views and theattendant differences in premises and policies are great sources of misunderstanding,tensions, and conflicts between people both within and across cultures. Despite thesedifferences, we see spirituality as a wellspring of strength for helping people in coping. Inthe past decade in clinical psychology, for example, some empirical literature has appearedon the meaningful roles of spirituality in the lives of people. Our view is that we would bewise to acknowledge and study the needs of people to connect to the perceived forces thattranscend their personal powers.

Wielding the Blade of Science

Statistical tool box. Additional statistical tools may be necessary to help us movebeyond the overused correlation procedures, particularly in situations in which we needto develop active partnerships with research participants. Qualitative assessment devicescan be useful in this regard, and other new techniques may be tailored to identify theunique needs of our consumers. Statistics now include advanced structural equation-modeling procedures for obtaining an inferential picture of how several variables relate.Also, there are multilevel-modeling techniques for understanding intraindividual trajec-tories of growth and adjustment. Moreover, many of these new techniques handle dichot-omous, ordinal, and missing data points. These statistics thus can help us to understandindividual rates of change unencumbered by group averages. Likewise, as startling as itmay sound, mean group comparisons in prospective and longitudinal designs may becomeobsolete in the 21st century.

There also are important implications of these statistics for program evaluation. Insteadof the previous tedious and piecemeal data analytic procedures, these new techniques canhandle many variables in a comprehensible “all-at-once” framework. Moreover, theseapproaches to data analyses should help to promote better theorization in the comingdecades. These newer statistics should be useful with large, archival data sets that arecommon in service delivery systems. This type of research often is crucial in determiningpolicy decisions, service effectiveness, and the allocation of resources. Finally, theseincreasingly sophisticated statistics should facilitate accurate inferences.

Hypothesis disconfirmation. We have concerns that our present research programshave grown rather stilted in their strict adherence to traditional templates. More trainingis warranted on the testing of hypotheses so that nonconfirmation becomes plausible. Inother words, we need to work against the present biases in gathering data so that theconfirmation of the proposed hypothesis is virtually assured. As an example of teachingaimed at more robust hypotheses disconfirmations, consider psychotherapy outcomeresearch. A crucial issue in testing the effectiveness of a therapeutic treatment is to ascer-tain whether persons who have undergone a treatment have superior outcomes (on vari-ous markers of coping) relative to those who only have had a placebo experience inwhich they expect to change. Unfortunately, in many outcome studies, researchers haveselected placebo experiences that did not elicit truly active expectancies for change (seeBarker, Funk, & Houston, 1988). Thus, if in actuality the comparison placebo is inert,then the fact that the persons in the experimental treatment condition had better outcomes


relative to the placebo is scientifically meaningless. This particular example and relatedproblem often are seen in psychotherapy outcome studies involving a pill placebo (Fisher& Greenberg, 1997). In the authors’ roles as journal editors, we have found that problemswith incorrectly conceptualized and operationalized comparison conditions are wide-spread in submitted manuscripts. We can and must do better in educating our 21st cen-tury students about methodologies that truly yield robust possibilities of hypothesesdisconfirmations.

Within-group similarities. Clinical psychology researchers also should give moreemphasis to the huge overlap in within-group behaviors, instead of focusing solely on theless powerful between-group differences. Although it is true that the null hypothesiscannot be proven, large probability values do confirm the hypotheses that group differ-ences are either nonexistent or small in magnitude. By paying attention to these similar-ities, along with the present approach of looking at the differences between groups, clinicalscience of the 21st century would attain a more complete understanding of our data. Also,instead of the 20th century approach of concluding that any obtained group differencesare solely due to our labels, we suggest greater attention to the differences in the lifecircumstances (and myriad of other factors) of the two groups. Thus, more must be donein therapy outcome research to understand the comorbidity of the people who are assignedto supposedly distinct experimental groups.

Linking Practice to Academia and Vice Versa

Although clinical psychologists have been successful in obtaining grants (Elliott & Shew-chuk, 1999), we have been criticized for the “disconnect” between our academic researchand the applied clinical arenas (DeLeon, Hagglund, Ragusea, & Sammons, 2003). Assuch, we must broaden our scholarship in the 21st century to do a better job of addressingclinical applied issues. We will give some examples of how this can be accomplished inthe ensuing paragraphs.

It is essential that future service delivery systems in clinical psychology identifycost-effective programs for meeting consumers’ needs. Our research expertise can beused to “triage” persons who require the services of high-cost, doctoral-level serviceproviders such as clinical psychologists or psychiatrists, as compared to those personswho may fare well on their own recognizance or with relatively low-cost service provid-ers (Hayes, 1997). This example illustrates at least three issues involved in clinicallyrelevant and policy-relevant research. It highlights the need to: (a) think beyond profes-sional boundaries to actively collaborate in meeting societal needs; (b) listen actively toothers and be facile at forming alliances; and (c) conduct meaningful research that addressesshared priorities.

Added emphasis also should be given to theory development in educating futureclinical psychology graduate students. Generally, we hold that clinical psychology placesless emphasis on theory than do the other subareas of psychology. Perhaps this is due tothe problem-solving, applied nature of many clinical psychology activities. Whatever thecause, however, it places our present students at a disadvantage in developing program-matic, model-based research and, to some degree, probably weakens attempts to securegrants. By securing such grants, clinical psychologists potentially can influence policy,along with shaping future priorities and policies (Weiss & Weiss, 1996).

Clinical psychology research expertise also may impose unintentional barriers fortranslating our experimentation into practice. For example, intervention research uses the


“gold standard” of randomized clinical trials, which, as a logical extension of experimen-tal methods, represent the “ . . . the closest science has come to a means for demonstratingcausality” (Haaga & Stiles, 2000, p. 14). This clinical trials model may not translate verywell, however, to the often-messy worlds in which applied clinicians conduct their inter-ventions. Indeed, real-world therapeutic interventions are replete with confounds, medi-ators, outliers, and covariates, which cannot either ethically or practically be dismissedby the exclusionary criteria used in the typical psychotherapy outcome research protocol.Furthermore, the evidence from randomized clinical trials often lacks external validity,particularly in light of the comorbidity issues of people with multiple diagnoses andhealth conditions (Levant, 2004; Seligman & Levant, 1998).

Our intervention research may benefit by examining existing clinic practices (Horn,1997). We advocate improving clinical practice methods that integrate the “in the trenches”therapists in determining research questions, data collection, and measures. Such scien-tist and practitioner collaboration would help move away from simplistic, reductionismviews of linear causality. Instead, we suggest the plotting of multiple, reciprocally inter-acting constructed realities (consonant with our previous notion of systemic construc-tivism). Practically, this approach would unite academicians and the practicingpsychotherapists in joint scholarship and program evaluation pursuits. Any “bashing” byacademicians of practitioners, or vice versa, needs to cease because both groups dependon each other. Accordingly, new clinical psychology curricula should emphasize mutu-ally rewarding arenas for frequent interactions.

Preparing Graduates for Strategic Service Delivery

Our traditional commitment to the “ . . . psychotherapy office and the 50-minute hour”(Hayes, 1997, p. 522) needs rethinking. Modern health care systems are fast evolving“ . . . away from strict jurisdictional boundaries that separate each profession” towardenvironments in which “flexibility and teamwork” are valued in the pursuit of cost-effective services (Schneller & Ott, 1996, p. 127). Several future areas of opportunity forclinical psychology reflect collaborative roles in the development, provision, and evalu-ation of services in prison and forensic settings, interventions and support for at-riskfamilies, and the use of telecommunication technologies in developing long-distance,home, and community-based services (DeLeon et al., 2003). Family educational andsupport services and long-distance technologies are likely to be primary features of emerg-ing chronic disease management programs (Drum & Sekel, 2003).

In our program evaluation efforts, we need to determine those who can be assistedeffectively with low-cost services, and those who need or prefer doctoral-level serviceproviders (Elliott, 2002). Our future graduates also will need to have skills in developingprograms that target persons in high-risk groups who are unwilling to change their behav-iors. To develop such programs, 21st century clinical psychologists must understandcommunity and public health strategies (Frank, Farmer, & Klapow, 2003). We are heart-ened that some clinical psychologists are involved in community-based programs, andthat our profile in policy formation has increased recently. Our roles in actually develop-ing, administrating, providing, and evaluating long-distance services within these sys-tems, however, have yet to be achieved. Additionally, we have not realized our roles inthe “participatory ethic” model (Mechanic, 1998), which builds partnerships with per-sons who live with chronic conditions, and acknowledges individuals’ needs to operatecompetently and independently in managing their health (Wagner, Austin, & Von Korff,1996). For such partnerships to be effective, the expertise of future clinical psychologists


will be essential in assessing, evaluating, and constructing written materials and coun-seling strategies.

We are becoming a female dominated discipline, with a 4:1 ratio of women over menin the educational pipeline (Snyder, McDermott, Leibowitz, & Cheavens, 2000). Weforesee the growing number of women in clinical psychology as being drawn towardthese interactive and participatory activities. As we move to that time where persons ofcolor form the majority in our society, many more Latinos, African American, AsianAmerican, and Native Americans must be recruited into our profession. Contrary to theCaucasian males who previously formed the majority in our field, we anticipate thatwomen and minorities will be more favorably disposed toward such cooperative, strengths-based mental health approaches.

Future doctoral-level expertise in clinical psychology may be better suited for admin-istrative, program development, supervisory, and evaluative roles in various programs atthe four levels of the matrix model. Individual interventions, as performed in traditionalsettings, are limited to persons who seek these services and live nearby. Moreover, suchinterventions are costly and labor-intensive (Leviton, 1996). Community-based serviceprograms, on the other hand, can reach more people and be more cost-effective in theirapplications (Schneiderman & Speers, 2001). For example, low-cost professionals haveprovided effective telephone counseling to chronic health patients (Grant, Elliott, Weaver,Bartolucci, & Giger, 2002), and assisted such people in obtaining employment (Bondet al., 2001).

Positive Ethics

Ethics as presently conceived in graduate education teaches would-be clinical psycholo-gists how to prevent bad things from happening. With the matrix model influence through-out the curriculum, we would have more attention being paid to the positive ethics of howto foster the greater good for others (Handelsman, Knapp, & Gottlieb, 2002). Part of oursuggested ethics changes also relate to exposing our future students to the institutionaland the societal–community levels. One example of how ethics would apply at theselatter levels would pertain to the “tragedy of the commons” (Hardin, 1968), which involvespeople behaving so as to pursue individual, short-term gains, thereby depleting the scarceresources for the group in the long-term. Our students, therefore, would be taught inethics about forming shared goals and balancing personal and group needs (Tversky &Kahneman, 1981).

Ethics lessons also would apply to HMOs, where short-term economic profits shouldbe balanced more by considerations of the long-term implications for people (and even,sometimes, the long-term financial profits of the HMOs). Part of these ethics lessons,therefore, would involve an understanding of how zero-sum situations with an advan-taged winner and a disadvantaged loser (Morgenstern, 1953) can be supplanted by nonzero-sum situations, where all parties profit either financially or psychologically (Wright,2001). Such positive ethics could be taught through formal coursework, or via an implicitcurriculum in which ethics are modeled by faculty as part of the teaching atmosphere(Branstetter & Handelsman, 2000).

Changing the Accreditation Process

The notion of accreditation is to insure minimal educational standards, especially whenthe graduates’ work pertains to human welfare. As the APA applied this accreditation idea


to clinical psychology programs over the past three decades, an increasingly restrictive setof required courses and experiences were mandated and “policed.” We understand the needto have standards, but the degree of oversight by theAPAhas reached a level where the abil-ity to craft a creative curriculum has become almost nonexistent. Likewise, in the interpre-tation and application of their accreditation guidelines, the APA has been rather rigid inapplying one viewpoint—typically the majority perspective existing for many years.

The conundrum is that we do need standards for educating our students, but how canwe have this without them becoming unduly restrictive? First, we would have the accred-itation process handled by a representative subset of the directors of all clinical programs.Second, we would ask the directors to develop a small set of core courses and experiencesthat define the “basics” of education in our field. This would allow students to have morelatitude with their electives in forming their graduate education to prepare them for 21stcentury jobs.

There is one aspect of our proposed changes that should be clarified. Obviously, wehave suggested several additions of courses and experiences. Concerning these various“add-ons,” we believe that programs should allow students to select subsets of these thatreflect their projected career trajectories. Our field has become far too large to absorb allof these topics at the predoctoral level. We believe that accreditation should allow stu-dents to acquire a base of knowledge, and then provide flexibility for more specializedcoursework. Beyond the matrix model and its four associated levels, we view our othersuggestions as content issues to be resolved via contracts between students and theirfaculties. In this process, creativity and flexibility will be crucial in defining the course-by-course curricula of our future students.

Our view is that the curricula and student evaluations of clinical psychology facultyat the predoctoral level are but a portion of the overall “checks and balances” that must besurpassed by future clinical psychologists. Namely, for students wanting an applied career,in most states they still would be required to have 2 years (or a comparable amount ofhours) of post-PhD supervised work. These applied clinical psychologists also wouldhave to meet the standards of state licensure boards, including a passing cut-off score ona national examination.

Finally, we suspect that our profession will be compelled to accommodate changesreflecting the real and substantive differences between programs that are grounded in ascientist–practitioner heritage, and those that have little investment and limited identityin this scholarly heritage. From our perspective, this scientific lineage demands a dynamicresponse to the expanding and evolving knowledge base. Programs that obviously areinvested in the maintenance of traditionally defined professional roles probably will bedisinclined to entertain our recommendations. More specifically, freestanding (not uni-versity affiliated) professional training programs (PhD or PsyD) will be concerned withadvocating for expanded and well-compensated roles for their graduates. The graduatesof these latter programs enter the work force with little interest in using science to addressthe larger issues of policy and service delivery. They also often may have high financialdebts incurred for their graduate educations.

Many of these programs have pecuniary interests in preserving therapeutic activitiesat the individual and interpersonal levels. Thus, they may oppose an empirical agendathat would include the use of low-cost, multidisciplinary, and efficacious services to meetthe pressing needs of our society. Furthermore, we do not see these programs preparingtheir graduates for scientist–practitioner roles at the higher levels of activity where exper-tise is required in program evaluation, empirically based resource allocation, and collab-oration with multidisciplinary teams in service delivery systems. Nor do we expectadvocates of these professional programs to be receptive to moving beyond a pathologically


oriented model of mental health so that future clinical psychologists can have balanced,theory-driven, and clinically practical views of human behavior. Our emphasis on sci-ence, empiricism, and theory probably will be antithetical to the thrust of many PsyDprograms. Perhaps the consequences and ramifications of a scientist–practitioner identityeventually will help to define different professions that are characterized by their relianceon scholarship and science, and others that are characterized by a set of service andtechnical skills. Accreditation procedures should recognize and acknowledge the distinc-tions between these different training models.

Concluding Thoughts

We firmly believe that the ideas presented in this article are doable, and that they arenecessary if we are to reach our potential as a scientific and applied profession. Notedresearcher Paul Baltes (Baltes, Gluck, & Kunzmann, 2002) has concluded that, as agroup, clinical psychologists manifest a sense of wisdom about human nature and humanexistence that is unmatched by any other professional group. We interpret this to meanthat clinical psychologists are facile at identifying key issues and finding good answersto chart more favorable futures. If indeed we are good at finding answers, the matrixmodel should help future clinical psychologists in training to apply their capacities tounderstand the strengths and weaknesses in working with people. As such, it is time tounleash the talents of clinical psychologists on the full spectrum of positive and nega-tive human actions.

Although clinical psychologists may be “filled with wisdom,” our entrepreneurialpropensities to apply this wisdom need improvement. On this point, many clinical psy-chologists are rather passive. Such passiveness may relate to our history of listening toothers, the luxury of having clients come to our offices, the intrapsychic roots of our field,etc. Whatever the reasons for this passivity, it is time to change our approach to clinicalpsychology. As is obvious in this article, we advocate greater involvement by clinicalpsychologists in various aspects of society. Educating and reinforcing clinical psycholo-gists for the widespread study and application of their knowledge at several levels for thebetterment of humankind would accomplish this.

Clinical psychology in America also needs to broaden its horizons to interact morewith the health professionals in other countries. Although the United States trains moreclinical psychologists than any other country, we still could greatly expand the number ofpeople from other countries who receive their educations in the United States. Moreover,we should be careful not to take a paternal or matriarchal perspective and conclude thatwe are the best place for the education of clinical psychologists. In this regard, we needto work with other countries so that they can increase the numbers of clinical psycholo-gists whom they train themselves.

The present suggestions, in part or whole, may elicit disagreements from our col-leagues. Some readers may stridently defend the status quo.Yet others may disagree becausethey have different visions for future education in clinical psychology. Whatever these objec-tions may be, they are for the good. An in-depth and extensive exchange of ideas is pre-cisely what our field needs right now. There should be no sacred or taboo topics as wecontemplate other paradigms for a “new” clinical psychology of the 21st century.

We salute our clinical psychology ancestors who implemented a workable educa-tional system for meeting the challenges of the 20th century. In considering the 21stcentury education of clinical psychologists, therefore, the central question is, “Will we beable to do the same?”


References

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders(4th ed.). Washington, DC: Author.

American Psychological Association. (1992, July). Report of the Ad Hoc Task Force on Psycho-pharmacology of the American Psychological Association. Washington, DC: Author.

American Association of Retired Persons. (1995). A profile of older Americans: 1995. Washington,DC: Author.

Baltes, P.B., Gluck, J., & Kunzmann, U. (2002). Wisdom: Its structure and function in regulatingsuccessful life span development. In C.R. Snyder & S. Lopez (Eds.), Handbook of positivepsychology (pp. 327–350). New York: Oxford University Press.

Barker, S.L., Funk, S.C., & Houston, B.K. (1988). Psychological treatment versus nonspecificfactors: A meta-analysis of conditions that engender comparable expectations for improve-ment. Clinical Psychology Review, 8, 579–594.

Baucom, D.H., Epstein, N., & Gordon, K.C. (2000). Marital therapy: Theory, practice, and empir-ical status. In C.R. Snyder & R.E. Ingram (Eds.), Handbook of psychological change: Psy-chotherapeutic processes and practices for the 21st century (pp. 280–308). New York: Wiley.

Blazer, D. (1989). The epidemiology of psychiatric disorders in late life. In E.W. Busse & D.G.Blazer (Eds.), Geriatric psychiatry (pp. 235–260). Washington, DC: American PsychiatricAssociation.

Bond, G.R., Resnick, S., Drake, R., Xie, H., McHugo, G., & Bebout, R. (2001). Does competitiveemployment improve nonvocational outcomes for people with severe mental illness? Journalof Consulting and Clinical Psychology, 69, 489–501.

Branstetter, S.A., & Handelsman, M.M. (2000). Graduate teaching assistants: Ethical training,beliefs, and practices. Ethics and Behavior, 10, 27–50.

Bronfenbrenner, U. (1979). The ecology of human development. Cambridge, MA: Harvard Uni-versity Press.

Buckingham, M., & Clifton, D. (2001). Now, discover your strengths. New York: Free Press.

Cheavens, J., & Gum, A. (2000). Gray power: Hope for the ages. In C.R. Snyder (Ed.), Handbookof hope: Theory, measures, and applications (pp. 201–221). San Diego, CA: Academic Press.

DeLeon, P.H., Hagglund, K., Ragusea, S., & Sammons, M. (2003). Expanding roles for psycholo-gists in the twenty-first century. In G. Stricker & T.A. Widiger (Vol. Eds.), Handbook ofpsychology: Vol. 8. Clinical psychology (pp. 551–568). New York: Wiley.

Drum, D.J., & Sekel, A. (2003). Health care marketplace in the United States. In G. Stricker & T.A.Widiger (Vol. Eds.), Handbook of psychology: Vol. 8. Clinical psychology (pp. 511–531).New York: Wiley.

Dryfoos, J.G. (1998). Safe passages: Making it though adolescence in a risky society. Oxford, UK:Oxford University Press.

Elliott, T. (2002). Defining our common ground to reach new horizons. Rehabilitation Psychology,47, 131–143.

Elliott, T., & Klapow, J. (1997). Training psychologists for a future in evolving health care deliverysystems: Building a better Boulder model. Journal of Clinical Psychology in Medical Settings,4, 255–267.

Elliott, T., & Shewchuk, R. (1996). Defining health and well being for the future of counselingpsychology. The Counseling Psychologist, 24, 743–750.

Elliott, T., & Shewchuk, R. (1999). Sponsored research in the counseling psychology literature.Counseling Psychology Quarterly, 12, 431– 446.

Etzioni, A. (1993). The spirit of community: Rights, responsibilities, and the communitarian agenda.New York: Crowne.

Fisher, S., & Greenberg, R.P. (Eds.). (1997). From placebo to panacea: Putting psychiatric drugs tothe test. New York: Wiley.


Forsyth, D.R. (1999). Group dynamics (3rd ed.). Pacific Grove, CA: Brooks/Cole.

Frank, R.G. (1997). Lessons from the great battle: Health care reform 1992–1994. Archives ofPhysical Medicine and Rehabilitation, 78, 120–124.

Frank, R.G., Farmer, J., & Klapow, J. (2003). The relevance of health policy to the future of clinicalhealth psychology. In S. Llewelyn & P. Kennedy (Eds.), Handbook of clinical health psychol-ogy (pp. 547–561). Oxford, UK: Wiley.

Gallagher-Thompson, D., McKibbbon, C., Koonce-Volwiler, D., Menendez, A., Stewart, D., &Thompson, L.W. (2000). Psychotherapy with older adults. In C.R. Snyder & R.E. Ingram(Eds.), Handbook of psychological change: Psychotherapy processes and practices for the21st century (pp. 614– 637). New York: Wiley.

Gallup Poll Organization. (1995). Disciplining children in America: Survey of attitude and behav-ior of parents (Project registration No. 104438). Princeton, NJ: Author.

Gottman, J.M. (1994). What predicts divorce? Hillsdale, NJ: Erlbaum.

Grant, J., Elliott, T., Weaver, M., Bartolucci, A., & Giger, J. (2002). A telephone intervention withfamily caregivers of stroke survivors after hospital discharge. Stroke, 33, 2060–2065.

Gray-Little, B., & Kaplan, D. (2000). Race and ethnicity in psychotherapy research. In C.R. Snyder& R.E. Ingram (Eds.), Handbook of psychological change: Psychotherapy processes and prac-tices for the 21st century (pp. 591– 613). New York: Wiley.

Haaga, D.A., & Stiles, W. (2000). Randomized clinical trials in psychotherapy research: Method-ology, design, and evaluation. In C.R. Snyder & R E. Ingram (Eds.), Handbook of psycholog-ical change: Psychotherapy processes and practices for the 21st century (pp. 14–39). NewYork: Wiley.

Handelsman, M.M., Knapp, S., & Gottlieb, M.C. (2002). The future of positive psychology. In C.R.Snyder & S. Lopez (Eds.), Handbook of positive psychology (pp. 731–744). New York: OxfordUniversity Press.

Hardin, G. (1968). The tragedy of the commons. Science, 162, 1243–1248.

Hayes, S.C. (1997). Technology, theory, and the alleviation of human suffering: We still have sucha long way to go. Behavior Therapy, 28, 517–525.

Horn, S.D. (1997). Clinical practice improvement methodology: Implementation and evaluation.New York: Faulkner & Gray.

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century.Washington, DC: National Academy Press.

Israel, B.A., Schulz, A.J., Parker, E.A., & Becker, A.B. (1998). Review of community-based research:Assessing partnership approaches to improve public health. Annual Review of Public Health,19, 173–202.

Ivey, S.L., Scheffler, R., & Zazzali, J. (1998). Supply dynamics of the mental health workforce:Implications for health policy. The Milbank Quarterly, 76, 25–58.

Kaplan, R.M. (1994). The Ziggy theorem: Toward an outcomes-focused health psychology. HealthPsychology, 13, 451– 460.

Kaplan, R.M. (2000). Two pathways to prevention. American Psychologist, 55, 382–396.

Keyes, K.L.M., & Haidt, J. (2002). Flourishing: Positive psychology and the life well-lived. Wash-ington, DC: American Psychological Association.

Lakdawalla, D.N., Bhattacharya, J., & Goldman, D. (2004). Are the young becoming more dis-abled? Health Affairs, 23(1), 168–176.

Levant, R. (2004). The empirically-validated treatment movement: A practitioner/educator per-spective. Clinical Psychology: Science & Practice, 11, 219–224.

Levant, R., Reed, G., Ragusea, S., Stout, C., DiCowden, M., Murphy, M., et al. (2001). Envisioningand accessing new roles for professional psychology. Professional Psychology: Research andPractice, 32, 79–87.

Leviton, L.C. (1996). Integrating psychology and public health: Challenges and opportunities.American Psychologist, 51, 42–51.


Lopez, S.J., & Snyder, C.R. (Eds.). (2003a). Positive psychological assessment: A handbook ofmodels and measures. Washington, DC: American Psychological Association.

Lopez, S.J., & Snyder, C.R. (2003b). The future of psychological assessment: Making a difference.In S.J. Lopez & C.R. Snyder (Eds.), Positive psychological assessment: A handbook of modelsand measures (pp. 461– 468). Washington, DC: American Psychological Association.

Lopez, S.J., Snyder, C.R., & Rasmussen, H.N. (2003). Striking a vital balance: Developing a com-plementary focus on human weakness and strength through positive psychological assess-ment. In S.J. Lopez & C.R. Snyder (Eds.), Positive psychological assessment: A handbook ofmodels and measures (pp. 3–20). Washington, DC: American Psychological Association.

Mahoney, M.J. (2003). Constructive psychotherapy: A practical guide. New York: Guilford Press.

McGinnis, J.M., Williams-Russo, P., & Knickman, J.R. (2002). The case for more active policyattention to health promotion. Health Affairs, 21(2), 78–93.

Mechanic D. (1998). Public trust and initiatives for new health care partnerships. The MilbankQuarterly, 76, 281–302.

Morgenstern, O. (1953). John von Neumann: The theory of games and economic behavior (3rded.). Princeton, NJ: Princeton University Press.

National Institutes of Health. (1994). NIH guidelines on the inclusion of women and minorities assubjects in clinical research. Federal Regulation 14508–14513 (Document No. 94–5435).Washington, DC: U.S. Department of Health and Human Services.

Neimeyer, R.A., & Mahoney, M. (Eds.). (1995). Constructivism in psychotherapy. Washington,DC: American Psychological Association.

Olkin, R., & Pledger, C. (2003). Can disability studies and psychology join hands? AmericanPsychologist, 58, 296–304.

Pargament, K.I., & Mahoney, A. (2002). Spirituality: Discovering and conserving the sacred. InC.R. Snyder & S.J. Lopez (Eds.), Handbook of positive psychology (pp. 646– 659). NewYork: Oxford University Press.

Peterson, C., & Seligman, M.E.P. (2004). Values in action (VIA) classification of strengths. NewYork: Oxford University Press.

Rimmer, J.H., & Braddock, D. (2002). Health promotion for people with physical, cognitive andsensory disabilities: An emerging national priority. American Journal of Health Promotion, 16,220–234.

Roberts, M.C. (1991). Overview to prevention research: Where’s the cat? Where’s the cradle? InJ.H. Johnson & S.B. Johnson (Eds.), Advances in child health psychology (pp. 95–107). Gaines-ville, FL: University of Florida Press.

Roberts, M.C. (1998). Innovations in specialty training: The clinical child psychology program atthe University of Kansas. Professional Psychology: Research and Practice, 29, 394–397.

Roberts, M.C., Brown, K.J., Johnson, R.J., & Reinke, J. (2002). Positive psychology in children:Development, prevention, and promotion. In C.R. Snyder & S. Lopez (Eds.), Handbook ofpositive psychology (pp. 663– 675). New York: Oxford University Press.

Roberts, M.C., Erickson, M.T., La Greca, A.M., Russ, S.W., Vargas, L.A., Carlson, C.I., et al.(1998). A model for training psychologists to provide services for children and adolescents.Professional Psychology: Research and Practice, 29, 293–299.

Roberts, M.C., & Steele, R. (2003). Predoctoral training in pediatric psychology at the Universityof Kansas clinical child psychology program. Journal of Pediatric Psychology, 28, 99–103.

Sagan, L.A. (1987). The health of nations: True causes of sickness and well-being. New York:Basic Books.

Schneiderman, N., & Speers, M.A. (2001). Behavioral science, social science, and public health inthe 21st century. In N. Schneiderman, M.S. Speers, J. Silva, H. Tomes, & J.H. Gentry (Eds.),Integrating behavioral and social sciences with public health (pp. 3–28). Washington, DC:American Psychological Association.


Schneller, E.S., & Ott, J.B. (1996). Contemporary models of change in the health professions.Hospital & Health Services Administration, 41, 121–136.

Seligman, M.E.P., & Csikszentmihalyi, M. (2000). Positive psychology: An introduction. Ameri-can Psychologist, 55, 5–14.

Seligman, M.E.P., & Levant, R. (1998). Managed care policies rely on inadequate science. Profes-sional Psychology: Research and Practice, 29, 211–212.

Snyder, C.R. (1994). The psychology of hope: You can get there from here. New York: FreePress.

Snyder, C.R. (2002a). Hope theory: Rainbows of the mind. Psychological Inquiry, 13, 249–275.

Snyder, C.R. (2002b). Part 1—The graduate school stages of preparing for a position in clinicalpsychology. The Clinical Psychologist, 55, 19–25.

Snyder, C.R. (2005). Teaching: The lessons of hope. Journal of Social and Clinical Psychology, 24,72–84.

Snyder, C.R., & Feldman, D. (2000). Hope for the many: An empowering social agenda. In C.R.Snyder (Ed.), Handbook of hope: Theory, measures, and applications (pp. 389– 412). SanDiego, CA: Academic Press.

Snyder, C.R., & Ingram, R.E. (1983). “Company motivates the miserable”: The impact of consen-sus information upon help-seeking for psychological problems. Journal of Personality andSocial Psychology, 45, 1118–1126.

Snyder, C.R., & Ingram, R.E. (2000). Psychotherapy: Questions for an evolving field. In C.R.Snyder & R.E. Ingram (Eds.), Handbook of psychological change: Psychotherapy processesand practices for the 21st century (pp. 707–726). New York: Wiley.

Snyder, C.R., & Lopez, S. (Eds.). (2002a). Handbook of positive psychology. New York: OxfordUniversity Press.

Snyder, C.R., & Lopez, S. (2002b). The future of positive psychology. In C.R. Snyder & S. Lopez(Eds.), Handbook of positive psychology (pp. 751–767). New York: Oxford University Press.

Snyder, C.R., Lopez, S.J., Edwards, L.M, Pedrotti, J.T., Prosser, E.C., Walton, S.L., et al. (2003).Measuring and labeling the positive and the negative. In S.J. Lopez & C.R. Snyder (Eds.),Positive psychological assessment: A handbook of models and measures (pp. 21– 40). Wash-ington, DC: American Psychological Association.

Snyder, C.R., & McCullough, M. (2000). A positive psychology field of dreams: “If you build it,they will come.” Journal of Social and Clinical Psychology, 19, 151–160.

Snyder, C.R., McDermott, D.S., Leibowitz, R.Q., & Cheavens, J. (2000). The roles of femaleclinical psychologists in changing the field of psychotherapy. In C.R. Snyder & R.E. Ingram(Eds.), Handbook of psychological change: Psychotherapy processes and practices for the21st century (pp. 640– 659). New York: Wiley.

Snyder, C.R., & Pulvers, K. (2001). Copers coping with stress: Two against one. In C.R. Snyder(Ed.), Coping with stress (pp. 285–301). New York: Oxford University Press.

Snyder, C.R., Rand, K., & Berg, C. (2004). Including human strengths and hope in interviews andpsychological reports. Unpublished manuscript, University of Kansas, Lawrence.

Snyder, C.R., Shorey, H., Cheavens, J., Pulvers, K.M., Adams III, V.H., & Wiklund, C. (2002).Hope and academic success in college. Journal of Educational Psychology, 94, 820–826.

Snyder, C.R., Tennen, H., Affleck, G., & Cheavens, J. (2000). Social, personality, clinical, andhealth psychology tributaries: The merging of a scholarly “river of dreams.” Personality andSocial Psychology Review, 4, 16–29.

Spruill, J., Kohout, J., & Gehlmann, S. (1997). Final report of the American Psychological Asso-ciation Working Group on the implications of changes in the health care delivery system forthe education, training and continuing professional education of psychologists. Washington,DC: American Psychological Association.

Strupp, H.H., & Hadley, S.W. (1977). A tripartite model of mental health and therapeutic outcomes.American Psychologist, 32, 187–196.


Tversky, A., & Kahneman, D. (1981). The framing of decisions and the psychology of choice.Science, 211, 453– 458.

Wagner, E.H., Austin, B.T., & Von Korff, M. (1996). Organizing care for patients with chronicillness. The Milbank Quarterly, 74, 511–544.

Weiss, J.A., & Weiss, C.H. (1996). Social scientists and decision makers look at the usefulness ofmental health research. In R.P. Lorion, P.H. DeLeon, & G.R. VandenBos (Eds.), Psychologyand public policy: Balancing public service and professional need (pp. 165–181). Washington,DC: American Psychological Association.

Wright, B.A. (1991). Labeling: The need for greater person-environment individuation. In C.R.Snyder & D.R. Forsyth (Eds.), Handbook of social and clinical psychology: The health per-spective (pp. 469– 487). Elmsford, NY: Pergamon.

Wright, B.A.,& Fletcher, B.L. (1982). Uncovering hidden resources: A challenge in assessment.Professional Psychology, 13, 229–235.

Wright, B.A., & Lopez, S.J. (2002). Widening the diagnostic focus: A case for including humanstrengths and environmental resources. In C.R. Snyder & S.J. Lopez (Eds.), Handbook ofpositive psychology (pp. 26– 44). New York: Oxford University Press.

Wright, R. (2001). Nonzero: The logic of human destiny. New York: Vintage.


Documents

No Job Nametelliott.education.tamu.edu/sites/telliott.education.tamu.edu/files/documents/snyder...educates our clinical psychology graduates for the contemporary marketplace (Spruill,