Training for prescriptions vs. prescriptions for training: Where are we now? Where should we be? How do we get there?

Training for Prescriptions vs. Prescriptions for Training:Where Are We Now? Where Should We Be?How Do We Get There?

�

Richard M. McFall

Indiana University—Bloomington

The proposal that state legislatures should grant prescription privileges topsychologists is examined critically, with particular attention to the pro-posal’s implications for the future education and training of clinical psy-chologists. First, the current status of clinical psychology is described.Then, an alternative to the prescription privilege proposal is presented; thisalternative prescribes a scientific approach to clinical psychology. Finally, aplan for achieving this alternative is outlined. © 2002 Wiley Periodicals,Inc. J Clin Psychol 58: 659–676, 2002.

Keywords: prescription privileges; doctoral training in clinical psychology;clinical science

Let me be clear, right from the start, about my aims in writing this piece. First, what I donot intend to do: I do not have any illusions that I will change many minds on the basicquestion of whether psychologists should be granted prescription privileges. Becausethere are not many “undecided” psychologists left out there, I do not expect my com-ments to affect the pollsters’ pie charts. My remarks really are not even aimed specifi-cally at psychologists on the pro side of the prescription privileges question, but areintended for like-minded colleagues, most of whom seem to be on the con side. If you are

Correspondence concerning this article should be addressed to: Richard M. McFall, Department of Psychology,Indiana University, Bloomington, IN 47405; e-mail: [email protected] thank Teresa A. Treat for her invaluable comments on this paper (and almost every other paper I’ve writtenover the past six years). I also am indebted to Bruce Thyer and Howard Garb for sharing their knowledge aboutrelevant resource materials, and to an anonymous reviewer for helpful comments on an earlier draft.

JOURNAL OF CLINICAL PSYCHOLOGY, Vol. 58(6), 659–676 (2002) © 2002 Wiley Periodicals, Inc.

Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jclp.10051

on the pro side, you are welcome to eavesdrop, if you like, but you might not be amember of my target audience. I will stipulate from the outset that most proponents ofprescription privileges and I disagree in our basic assumptions about clinical psychol-ogy. It is not my intention to arm wrestle over such matters; assumptions, after all, areassumptions! If you disagree with my postulates, you almost certainly will disagreewith the corollaries that I see flowing from them. There is not much I can do about suchbasic differences here, except to make my assumptions explicit. Nor do I have anyillusions that I have something new and different to say about the impact of prescriptionprivileges on the future of education and training in psychology. Smart people on bothsides already have covered this issue in detail (e.g., see the entire Current Issues sectionon prescription privileges in American Psychologist, 1996, with contributions by Hayes& Heiby; DeNelsky; Pachman; Klein; Lorion; DeLeon & Wiggins; Sammons, Sexton,& Meredith). I see little value in merely rearranging the same pieces of furniture onemore time. Finally, it is not my intention to make anyone angry. I’ve noticed, however,that challenges to the prescription privilege idea invariably upset some psychologists. Iwish this weren’t so.

Now, what I do intend to do: I intend to capitalize on the current debate about “pre-scription privilege for psychologists” (PPP). I see this as a golden opportunity for anin-depth reexamination of clinical psychology as a subdiscipline within psychology. Tome, the PPP debate is about whether clinical psychology should “reinvent” itself and, ifso, what the “new” clinical psychology should be. I intend to devote this piece to the threeself-examination questions that the PPP debate forces us to ask: “Where are we now?Where should we be? How do we get there?” Consistent with my assignment, I intend toconsider these questions within the realm of education and training; yet, education andtraining matters cannot be decided in isolation. Program philosophy, curriculum, admis-sions, accreditation, and continuing education are means to an end, not ends in them-selves, so of necessity, I will stray beyond the borders of my assigned area. Finally, Iintend to offer a vision of scientific clinical psychology that I find much more interestingthan the idea of granting psychologists prescription privileges. Clinical psychology is ata crossroads, seriously considering the path of prescription privileges. While we aremaking choices about future directions, I want to point out a different path, one that I seeas much more compelling and exalting.

As we consider the future of education and training in clinical psychology, we’relike children in a candy store. The possibilities are alluring, but our resources are lim-ited. Any choice will reduce our capital and limit all subsequent choices. Therefore,we had better consider our options carefully before plunking down our nickels. Weshould realize that buying into prescription privileges is only one of our options. Weshould not allow the money to burn a hole in our pocket. We should not think toonarrowly or decide too quickly. Instead, we should take the time to consider which ofour many options is the most judicious, beneficial, and satisfying way to spend ourfinite resources.

Where Are We Now?

The answer to this first question is, “It depends.” It is mythical to treat clinical psychol-ogy as though it were a homogeneous, unified field, standing all in one place, conve-niently marked by a “you are here” arrow. Focusing just on education and training, forexample, there are hundreds of APA-approved Ph.D. and Psy.D. training programs inclinical, counseling, and related areas of psychology, with numerous unaccredited

660 Journal of Clinical Psychology, June 2002

doctoral programs and masters programs in the wings. Each program has its own dis-tinctive training philosophy, goals, curriculum, faculty, resources, admissions criteria,graduation requirements, placement record, etc. Indeed, the Committee on Accredi-tation (CoA) of the American Psychological Association has given up all pretensesthat there is homogeneity in the training of clinical psychologists. The revised CoAguidelines require that each applicant program spell out its training model, within avery broad set of principles; the CoA then evaluates each program’s “truth inadvertising”—that is, how well each program lives up to its own stated goals. Viewedfrom such close range, there are almost as many answers to this first question as thereare programs.

If we focus on the professional activities of clinical psychologists, rather than ontraining programs, we find just as much diversity, if not more. Perusing the APA Monitor,one is struck by the diversity of theories, techniques, and professional stances advocatedby clinical psychologists. Up close, it is hard to see much order or coherence in all of this.If someone said, “Will the real clinical psychology please stand up?” the entire fieldwould rise to its feet. After all, each of us believes sincerely that our version is the realthing. But what would all of these standing clinical psychologists have in common asidefrom their label?

If we view the field from a greater distance (perhaps squinting a bit), some generaloutlines come into focus. I can identify six general features that I think most clinicalpsychologists probably could agree are fair descriptions of our current status:

1. Managed health care has arrived and, in the process, has changed the field inimportant ways. (There is disagreement about whether these changes are forbetter or for worse.) Among other things, managed care has affected the termi-nology (“behavioral health” is the new buzzword), the compensation system(“fee for service” is becoming obsolete), the reimbursement criteria (“cost-effectiveness” is the watchword), the list of treatable problems (DSM-IV diag-noses) and acceptable interventions (“medically necessary” conditions), the controlover case decisions (insurers pre-approve time-limited treatment plans), and thedegree to which providers are held accountable (insurers conduct “utilizationreviews” to ensure that providers match treatments to problems, measure change,and show positive results). Most critically, managed care is leading to standard-ization. For example, managed-care companies, in concert with consumer groups,government agencies, and representatives from all of the behavioral health-careprofessions, currently are developing industry-wide practice guidelines, or stan-dards of care (Hayes et al., 1995). Many psychologists fear that such guidelineswill favor time-limited, symptom-focused therapies—most likely with a biastoward pharmacological interventions—and that, as a result, psychologists mightbe excluded from full participation in the new behavioral health-care systemunless they were allowed to prescribe medications.

2. Under managed care, clinical psychologists working in private practice settingsincreasingly are finding it difficult (with a few exceptions) to sustain business asusual (Murphy, DeBernardo, & Shoemaker, 1998; Phelps, Eisman, & Kohout,1998; Rothbaum et al., 1998). The number of clients seeking treatment fromeach provider seems to be declining, even as the total number of available pro-viders is expanding, due in part to the volume of graduates coming fromprofessional-school programs. At the same time, insurers are approving fewertreatment sessions per client while paying providers less per session. Social

Training for Prescriptions vs. Prescriptions for Training 661

workers, who ostensibly deliver similar services for a lower cost, are competingwith psychologists for the available work.1

Essentially, the psychotherapy business is going through a period of restruc-turing and downsizing. For the first time since World War II (when clinicalpsychologists first took up psychotherapy in earnest), the average psychologistprovider is facing the prospect of a significant decline in future income. Practi-tioners naturally are responding to these market-driven changes in behavioralhealth care by looking for viable alternatives, or supplements, to their traditionalone-on-one, long-term, talk-therapy model. In part, the push to obtain prescrip-tion privileges for psychologists is a reflection of this search for ways to keepthe private practice model viable.

3. Psychologists working in institutional treatment settings (e.g., clinics, mentalhealth centers, managed care firms, hospitals, medical schools) are experiencingmany of these same pressures and uncertainties. “Billable hours” is the name ofthe game in such settings. Until recently, most clinical psychologists have paidtheir way and justified their existence by generating therapy revenue. Now, how-ever, psychologists are being squeezed. On the one side, administrators increas-ingly “are finding it more cost effective to hire MSW therapists than doctoral-level psychologists” (Thyer, 1999, p. 23); social workers cost less while generatingnearly as much revenue for the organization. On the other side, administratorssee psychiatrists as expensive but indispensable; they are the only mental-healthprofessionals who can write prescriptions. To remain viable, psychologists mustconvince administrators that they are making unique contributions that bringextra value to the organization. Clinical psychologists who make researchcontributions—especially those who bring in research dollars—are able to dothis most easily. Clinical psychologists without a research portfolio must findother ways to justify their existence. Many of them believe that if they wereallowed to write prescriptions, at a lower cost than psychiatrists, this might givethem a new lease on life.

4. Psychologists working in institutions devoted to the education and training ofclinical psychologists have experienced changes, as well. These have been moregradual, but no less significant. In the 1960s and 70s, graduate training in psy-chology, especially in clinical psychology, expanded dramatically. Psychology

1These developments have been chronicled with alarm by the APA Monitor, as illustrated by the following twoexcerpts:

“The pool of potential clients for the traditional psychologist in solo private practice is evaporating. . . .To reduce the costs of the corporate conglomerates that increasingly dominate the market, clients are being toldto seek out providers in panels that now include social workers and ‘licensed professional counselors’” (Fyfe,1995, p. 5).

“Social work . . . is booming. . . Visits to social workers have soared from 5 percent of total visits underfee for service to 56% under managed care. . . . Indeed, social workers now provide more than half of thenation’s mental health services. . . . Social workers are poised to be the winners in the mental health market ofthe future” (Clay, 1998, p. 21).

Some psychologists believe that this shift from clinical psychologists to social workers as the primaryproviders of mental health care will result in decreased accuracy in clinical judgments and decreased effective-ness in clinical interventions. However, there is almost no research comparing either the judgmental accuracy(Garb, 1998) or the therapeutic effectiveness (Kupfersmid, 1983) of psychologists and social workers. Accord-ing to Seligman and Levant (1998), the 1995 Consumer Reports survey of consumer satisfaction with mentalhealth services indicated that “social workers (presumably MSWs) did as well as doctoral-level providers”(p. 212). Furthermore, research examining the relationship between therapist training and treatment outcomeshas yielded few differences—even between professionals and paraprofessionals (Berman & Norton, 1985). Inshort, clinical psychologists’ presumed superiority over social workers remains to be demonstrated.


departments built new buildings, added new faculty members, admitted largerclasses of ever-brighter students, and chuckled at whimsical projections to theeffect that everybody in the U.S. would be a psychologist before long if the fieldcontinued to grow at the same rate. In the 1980s and 90s, however, this “bull-market” euphoria was dampened by three developments.

The first was the schism between those who, on the one hand, insisted thatall questions in clinical psychology be approached from a scientific perspective,and those who, on the other hand, felt that many questions in clinical psychologywere beyond scientific analysis and explication. Unfortunately, this schism toooften was misrepresented unidimensionally as a battle between science and prac-tice. A two-dimensional representation would have been more accurate (McFall,1991, 1996, 2000), with the vertical dimension anchored by “science” at the topand “nonscience” at the bottom, and the horizontal dimension anchored by “basic”questions on the left and “applied” questions on the right. Viewed in this two-dimensional way, the fundamental conflict was not about whether clinical psy-chology should address basic or applied questions; both are legitimate. The conflictwas about whether clinical psychology should address its central questions withina scientific framework. In the real world, of course, the two dimensions were notorthogonal. Clinical practitioners tended to be over-represented in the applied-nonscience quadrant; researchers tended to be over-represented in the basic-science quadrant; and the remaining two quadrants were underpopulated, but notempty. This correlation led to an unfortunate oversimplification, with the twodimensions collapsed into one—scientists versus practitioners. It is important tostress, however, that scientists in clinical psychology may work on questionsranging from basic to applied, and that some practitioners may be guided byscientific evidence, or make scientific contributions. The dispute over the role ofscience in clinical psychology eventually boiled over in 1988, with many research-oriented clinical psychologists leaving the American Psychological Associationand helping to found the American Psychological Society.

The second development was the schism between traditional, scientist–practitioner Ph.D. clinical training, as offered by main-line, university-basedclinical programs, on the one hand, and practitioner-oriented Psy.D./Ph.D. clin-ical training, as offered by the new breed of free-standing professional-schoolprograms, on the other hand. Both types of program were accredited by thesame agency, and graduates of both were identified as “clinical psychologists”and carried the same professional licenses. Although superficial external indi-cators implied an underlying equivalence, the two approaches to clinical train-ing actually differed dramatically on many dimensions. The most salientdifference, of course, was that students in professional-school programs weretrained exclusively for roles as service providers, with much less emphasis oncritical thinking or scientific methods, making them highly vulnerable to obso-lescence under changing market conditions, such as those ushered in by man-aged care, as described above.

The third development was an increasingly fierce competition for scarceresources within most universities and psychology departments. Resources in-creasingly were allocated to the various areas of psychological training—including clinical—based on their relative merit, as judged by standard criteriasuch as research productivity, grant funds, and scientific contributions. Thesecontingencies shaped the values and behaviors of the faculties and students inresearch-oriented clinical training programs, encouraging them to increase their


emphasis on scientific training and to strengthen their resistance to external“guild” pressures to reorient training more toward professional issues (e.g., ac-creditation and licensing). Historically, the Ph.D. in psychology has been aresearch degree. Thus, from the earliest days of clinical training, psychologistshad raised concerns about the potential corruptive effects of professional in-fluences on the integrity of the core scientific training (Woodworth, 1937).Over the years, many academic psychologists came to realize that these con-cerns were justified, and that clinical psychology’s future depended upon thequality of its science (Sechrest, 1992). It was difficult for these academics tofight the encroachments of professionalism during the heady times of abundantresources, but as resources became scarce, these academics became strongerand began to reassert their core scientific values. In 1995, for example, a groupof clinical programs joined together to form the Academy of PsychologicalClinical Science, an organization with the mission of reaffirming and reinforc-ing the scientific foundations of the field. Membership in the Academy hasgrown steadily, and in 1998, the Academy accepted into membership the firstgroup of internship training programs with a similar commitment to scientificvalues.

The convergence of these three developments eroded the Boulder Model’shalf-century reign over clinical training programs. According to the BoulderModel, the goal of clinical training was to produce “scientist–practitioners”who successfully integrated science with practice. Most clinical programs claimedto be Boulder Model programs, which fostered an illusion of unity among clin-ical training programs. In reality, the model provided an umbrella under whichprograms that varied widely in their commitment to integration and in theirrelative emphasis on scientific research and clinical practice were treated aslegitimate and equivalent. All illusions of unity were shattered, however, oncethe professional schools dared to offer practitioner-only training. (Actually, theUniversity of Illinois was the first to offer Psy.D. training, in a short-livedexperimental program.) Increasingly, university-based programs were forced totake sides in the unidimensional tug-of-war between training research scien-tists and training practitioners. The incentives within university-based psychol-ogy departments encouraged clinical programs to identify with the research-science side. In general, these three developments prepared the soil in whichthe PPP debate has taken root and grown.

5. Governmental support for training in clinical psychology has changed, as well.Following World War II, the federal government offered psychology depart-ments financial incentives to increase their production of clinical psychologists,with the aim of filling the country’s perceived need for more mental healthservice providers. In the mid-1960s, federal funding for clinical training grantsincreased, as the U.S. rushed to staff its new community mental health centersystem. By the beginning of the 1980s, however, the government no longerperceived a shortage of mental health providers. Federal grant support for prac-titioner training in clinical psychology was terminated. At the same time, grantsupport for training researchers in psychology was expanded. This shift in fed-eral priorities was reflected in the funding patterns of the Veterans Administra-tion. The VA had played a major role in the postwar expansion of trainingopportunities for clinical psychologists; however, as the number of veteransrequiring psychological services declined in the 1980s and 90s, so did the VA’s


support for psychological training. Indeed, the VA has moved toward cuttingstaff psychologist positions.2

Traditional Ph.D. training programs in clinical psychology—programs witha longstanding focus on research training—adjusted to these funding changeswithout undue stress by (a) decreasing their number of trainees, and (b) inten-sifying their commitment to training clinical scientists, as described above.Retrenchment and refocusing were not plausible adjustments, however, for pro-fessional schools and other programs modeled after medical schools, which trainedlarge numbers of students primarily for careers as practitioners. Students in suchprograms typically paid for the high cost of their own education, primarily bytaking out student loans. If these programs were to continue attracting applicantsand remain viable, they needed to assure prospective students that future employ-ment prospects were sufficiently good to justify a heavy loan burden. Such assur-ances were becoming unrealistic, however, in light of the changing labor marketfor clinical psychologists (Murray, 1999). The prospects for practitioner-focused training programs looked much brighter, however, if the graduates some-how could gain prescription privileges. Thus, it is not surprising that the facultiesat professional-school clinical training programs tend to support PPP, whereasthe faculties at most university-based clinical training programs (i.e., membersof the Council of University Directors of Clinical Programs) oppose PPP.3

6. Probably the most dramatic feature in the landscape of contemporary clinicalpsychology is the yawning epistemological chasm that now divides the field intotwo camps. On one side are the psychologists—typically clinical researchers—who are guided by a scientific epistemology. They are persuaded by the empir-ical evidence, for example, that many of the theories and methods that haveserved as clinical psychology’s stock-in-trade over the years are invalid andindefensible. On the other side are the psychologists—typically practitionerswith minimal scientific training—who are guided by a more intuitive, idio-graphic epistemology. Based on personal experiences and evidence from caseexamples, they honor the traditional clinical theories and methods. The gulfbetween these two epistemological camps may be unbridgeable, irreconcilable.Logically, both sides cannot be right. Nevertheless, both look at the same issuesthrough different lenses and come away convinced that their precepts are “thetruth.” For example, many practitioners believe in the predictive value of pro-jective tests, such as the Rorschach, and believe in the validity of their clinicaljudgments; in contrast, many researchers are convinced that projective tests haveno empirical justification, and are persuaded by the empirical evidence that clin-ical judgment is error prone and inferior to actuarial methods (see Grove &Meehl, 1996). Many practitioners employ clinical interventions that their per-

2 According to Sleek (1994), “. . . the VA is saying that other groups can perform the same function as psychol-ogists, and questioning whether it needs psychologists. . . . the VA’s Resource Planning Management Commit-tee had recommended eliminating 50% of VA psychologists and support-staff slots nationwide. Reports indicatedthat the VA was exploring the idea of hiring outside consultants—most likely lower-cost social workers—toreplace the psychologists” (p. 34).3 A majority of CUDCP representatives voted against endorsing PPP. A survey of directors of clinical trainingat APA-accredited programs (both Ph.D. and Psy.D) (Evans & Murphy, 1997) revealed that 62% of the respond-ing DCTs were equivocal (i.e., either negative or neutral) toward PPP. Interestingly, there was a significantnegative correlation (�.31) between a program’s research emphasis and its likelihood of adopting a PPP-relatedcurriculum. Other surveys focusing on practitioners have shown more positive support for PPP (see Gutierrez& Silk, 1998).


sonal experience tells them are effective, even though researchers have foundlittle or no empirical support for these interventions. Meanwhile, clinical research-ers have developed assessment and treatment methods that are supported byempirical evidence; yet, many practitioners dismiss these methods as too super-ficial, inflexible, and insensitive to be useful in their “real world” of individualpatients with complex problems. Indeed, some clinical psychologists have becomeincreasingly outspoken in their criticism of academic research as methodologi-cally rigorous, but clinically naive, simplistic, and irrelevant (Peterson, 1996).Over time, psychologists on both sides have persuaded themselves that theirepistemological approach to clinical psychology is the only legitimate one, andthat psychologists on the opposing side are untrustworthy and self-serving. Thispolarization is reflected (albeit imperfectly) in the battle lines separating the proand con sides of the PPP debate.

To summarize, I have described six features that stand out in the landscape of con-temporary clinical psychology: the impact of managed care; the declining viability ofprivate practice; the growing competitiveness and cost-consciousness within behavioralhealth-care systems; the evolving forces affecting educational institutions; the shiftingpatterns of funding in clinical training programs; and the epistemological gulf betweenmany research-oriented and practice-oriented clinical psychologists. Where possible, Ihave drawn connections between these features and the current PPP debate, and havesuggested reasons why some psychologists might see PPP as a solution to the problemsthat threaten to invalidate their professional existence.

The factor that has brought all issues to a head is managed care. Make no mistake,many practicing clinical psychologists view managed care as their enemy! Hostility isexpressed regularly in articles published in professional newsletters, such as the APAMonitor and The National Psychologist. Hostility was explicit in a March 1999 letter topsychologists from Bryant L. Welch, J.D., Ph.D. (formerly with APA’s Practice Director-ate; currently CEO of the Legal Center for Patient Protection) asking for donations “. . .to fight managed care” (boldface in original). The campaign’s ostensible mission is tofight “. . . the widespread abuses of the managed care industry” (boldface in original;abuses unspecified) and “. . . to hold managed-care companies accountable for the poorquality care provided in their networks.” I find it difficult to believe that this campaign ismotivated primarily by outrage over alleged patient abuses; I see no comparable outrageover patient abuses by psychologists working in the traditional “fee for service” system(e.g., psychologists who provide “poor quality care” by using unproven methods or byfailing to use the methods that empirical evidence supports as most effective). The oppo-sition to managed care seems to be driven as much by professional economic concerns asby ethical principles.

Meanwhile, many academic psychologists, who have the luxury of viewing managedcare as a distant abstraction, are ready to cheer its arrival as a welcome, long-overduereform. To practicing clinicians, of course, it is no mere abstraction, but an all-too-painfuleconomic reality that calls for survival responses. Academics should not be too judgmen-tal toward these reflexive survival responses, however. After all, academics’ oppositionto PPP could be construed as a survival response, too. Academics were slow to react toPPP proposals, but mobilized in earnest once it became clear that the proposals threat-ened their autonomy in the education and training of clinical psychologists. If state leg-islatures passed legislation granting prescription privileges to clinical psychologists,specifying the specific educational requirements for this privilege, this would have afar-reaching impact—devastating in the eyes of many academics—on the scientific train-


ing of clinical psychologists. Such legislation would threaten the very educational systemthat sustains and validates the research-oriented academic’s professional life.

An idea’s validity cannot be judged simply by examining the motives of its propo-nents or by assessing who stands to gain the most from it. Good ideas can arise fromquestionable sources, just as bad ideas can come from the pure-of-heart. Advocates andopponents of the PPP proposal naturally are interested in protecting and advancing theirown economic and professional positions. To judge the proposal’s merits, however, callsfor a set of principled evaluative criteria. One’s choice of criteria, of course, dependsupon one’s vision of where clinical psychology should be. The polarization among clin-ical psychologists over PPP tells us little about the merit of the idea, but it speaks vol-umes about the current status of clinical psychology.

So, “Where are we now?” We are a fractured field, fraught with contradictions,moving in incompatible directions simultaneously, all the while using one label (clinicalpsychology) to identify all of our disparate, conflicting parts. If we were to pick a clinicaltraining program or clinical psychologist at random, it would be difficult to predict indetail what we would find when we looked closely at this program or person. The mainproblem facing clinical psychology today is not the PPP debate; the debate is but areflection of other, more fundamental, longstanding structural problems. Our mainproblem is that we still have not resolved the questions of who we are and where we wantto be.

Where Should We Be?

It always is safer to talk about where we are than about where we should be. Shifting from“is” to “should” takes us from description to prescription. Nevertheless, it is time forclinical psychology to resolve its fundamental structural problems by making tough deci-sions about where it is headed. Even if clinical psychologists were to reach an accom-modation on the PPP question, the field still would be plagued by fractionation andinherent contradictions. How should these problems be resolved? Is it possible to putHumpty Dumpty the Clinical Psychologist back together again? Should this even be thegoal? I think not. Our current dilemma is a result, in large part, of allowing the definition,goals, and standards of clinical psychology to be compromised and diluted in the interestof growth and harmony. The field cannot be all things to all people. We should not beoverly inclusive, should not be hesitant to make sharp distinctions. We need a clear visionof where we want to end up before we can choose the best path to take us there.

Before we address these structural problems, we need to dispense with two red her-rings that have been tossed into the PPP debate:

First, the PPP debate is not about whether clinical psychologists should be allowed toacquire the credentials to prescribe medications. Clinical psychologists who wish to acquireprescription privileges already can do so through normal, existing channels! No newlegislation is required; under the existing laws in most states, any psychologist who wantsto prescribe medications may do so by earning an appropriate qualifying degree—such asan M.D., D.O., or nurse-practitioner degree—and by applying for a corresponding licenseto practice. No one would deny psychologists the right to pursue this normal course.Opponents of PPP are against new legislation that would allow psychologists to completea specified amount of additional psychopharmacological and biological training in clin-ical psychology and then to become eligible for a license to prescribe medications aspsychologists. Implicit in such legislation is a vision of clinical psychology’s identity,mission, training, and structure that many of us reject.


Second, contrary to PPP advocates’ claims, the changes that would be required inpre- and postdoctoral training to ensure that clinical psychologists actually are competentto prescribe psychotropic medications would not be minimal, inexpensive, or nonintru-sive. There is no such thing as a free lunch! If the added training requirements for PPPtruly were minimal in scope, then they could not possibly be adequate to ensure compe-tence. If they were extensive enough to ensure competence, then they could not possiblybe inexpensive. And if they were realistically extensive and costly, then they could notpossibly be nonintrusive. They obviously would steal scarce resources—time, money,energy, and space—from other, more fundamental training activities. Thus, the legislatedtraining requirements for PPP cannot be dismissed lightly. They inevitably would have amajor negative impact on both the substance and quality of scientific training in clinicalpsychology.4

Opponents of PPP legislation have provided a long list of reasons why this is a badidea (see American Psychologist, 1996; Hayes & Heiby, 1998). I agree with these rea-sons. However, the main thrust of my argument here is simply that the proposed PPPlegislation would move us farther away from where I think we should be, not closer. Thisis a straightforward, succinct argument. Whether you agree, of course, depends on whetheryou share the following vision of where clinical psychology should be.

1. Clinical psychology should be a science. This implies an uncompromising adher-ence to a scientific epistemology—a skeptical, challenging, evidence-basedapproach to deciding what is “known,” or choosing among competing “truths.”Everything clinical psychologists do should be guided by, consistent with, andcontributing to the advancement of this science. To the degree that clinical psy-chology knowingly allows its pursuit of “truth” to be diluted or compromised bynonscientific influences, it is not a science.

2. Clinical psychology can be distinguished from the rest of psychological scienceprimarily by its problem focus, or subject matter—namely, the assessment, pre-diction, explanation, prevention, and amelioration of deviant and distressing humanbehavior; the promotion of positive intra- and interpersonal relations; and theinvestigation of optimal human performance and achievement. Clinical psycholo-gy’s problem focus is not static, but is evolving and open to refinement. The keypoint here is that clinical science is a subdiscipline within psychological science,and aside from its distinctive focus, it should be an integral part of the largerdiscipline. This means that it should draw upon the best theories and methodsfrom all of psychology, as well as from other sciences, in seeking answers to itsquestions. The influences should be bidirectional, or reciprocal. Just as clinicalscience can be enhanced by its association with the larger discipline, advances inclinical science also should enrich the rest of psychology.

3. The primary mission of education and training in clinical psychology should be toprepare doctoral students for productive careers as clinical scientists. All students

4 The APA Task Force on Psychopharmacology (1992) proposed that training for prescription privileges consistof a predoctoral curriculum, totaling 26 credit hours, distributed as follows: biochemistry (3), mammalianphysiology (5), pharmacology (3), psychopharmacology (3), biological basis of behavior (3), behavioral psy-chopharmacology (3), clinical psychopharmacology and therapeutics (5), professional psychopharmacology(1). These courses would usurp nearly one-third of the credit-hour requirement in a typical doctoral program.Few faculties (free from outside pressures) would choose to devote this much doctoral training to these courses,at the sacrifice of other scholarly pursuits and empirical investigations. Clearly, a curriculum narrowly designedto train applied psychopharmacologists would undermine the quality and breadth of training in clinical science—claims by PPP proponents notwithstanding.


should be trained to function exclusively in the upper half (the science half ) of thetwo-dimensional representation of clinical psychology, presented earlier. Withinthat constraint, they would be free to address questions ranging from basic toapplied, and to work in any setting appropriate to their questions. All decisionsabout curriculum, student selection, and allocation of training resources should bemade in service of this mission. Secondary goals and external distractions, suchas preparation for licensing or other guild considerations, should not be allowedto conflict with or detract from this mission.

4. Consistent with its scientific epistemology and training mission, clinical psychol-ogy should promote a health-care system driven by evidence and focused onresults. For example, personnel decisions regarding who should deliver mentalhealth services must be driven by rational and empirical considerations, such astask competence and cost-effectiveness, rather than by professional consider-ations, such as discipline affiliation, status, or years of experience. Service-delivery roles should be filled by the individuals most capable of performing thetasks effectively, reliably, efficiently, and economically. (For a provocative dis-cussion of this point in the popular press, see Gawande, 1998.) There may bearguments about how best to measure such qualities, but there should be no argu-ments about these principles. Generally, clinical scientists should work to improvethe quality of life for others, not themselves, and should foster continuous qualityimprovements in the health-care system without regard for the consequent per-sonal or professional loss or gain.

5. Clinical psychologists should organize and coordinate their efforts for the pur-pose of advancing science. They should not participate knowingly in alliancesthat impede the progress or undermine the integrity of science.

6. Clinical psychologists should “give away” their science (Miller, 1969), openlyand accurately communicating with students, laypersons, scientists, and publicofficials about current scientific knowledge and its implications. They also shouldchallenge error, ignorance, and distortion wherever they encounter it, even if thiscontributes to tensions in the short run.

Other characteristics could be added to this short list, but if clinical psychologyaligned itself with these six characteristics, it would be a major stride toward resolvingthe current structural problems. Clearly, this vision of where clinical psychology shouldbe conflicts with the vision that many clinical psychologists would offer. My aim herewas to summarize the scientific vision succinctly, thereby sharpening, rather than level-ing, the differences that fractionate the field. Ironically, within this vision of clinicalpsychology, it is conceivable that the evidence might make a strong case someday forgranting prescription privileges to psychologists. This vision would not support such amove at this time, however, because the current PPP proposal is not based on a compel-ling scientific rational. Proponents have not provided convincing evidence that societywould benefit (or not be harmed) by increasing the number of mental-health providerswriting prescriptions; have not demonstrated that giving psychologists prescription priv-ileges is the most rational and cost-effective way to increase such numbers, if it werenecessary to do so; have not made a convincing case that the benefits of PPP wouldjustify this use of clinical science’s limited resources; have not demonstrated that phar-macological interventions are superior to psychological interventions for many clinicalproblems; and have not made a persuasive case that PPP would not undermine the pri-mary mission of education and training in clinical science. The history of clinical psy-


chology’s current structural problems should teach us to be cautious and skeptical whenconsidering such proposals. It is reasonable to worry that the PPP proposal, if passed bystate legislatures, would exacerbate existing problems and make it even more difficult forclinical psychology to become the science that many of us think it should be.

How Do We Get There?

Let’s assume for the moment that we agree that clinical psychology should be a science.The next issue is how best to achieve this goal. Obviously, a persistent, day-to-day invest-ment in rigorous, theory-driven research is the sine qua non of scientific advancement;yet this alone is not sufficient. Over the last several decades, we have seen major advancesin clinical theory and technique; however, the extent to which these advances have influ-enced the practice of clinical psychology has been disappointing. For substantive advancesto exert their full impact they must have a receptive audience, one with shared assump-tions, values, goals. The field of clinical psychology, as a whole, apparently is not yetcommitted to a scientific framework. In this section, I sketch a blueprint for a three-sidedplan of action aimed at building a receptive, supportive environment. Just as a triangle isa single, highly stable geometric form defined by its three sides, my blueprint describes aunified effort defined by three facets. Each facet represents a particular dimension, ordirection of action, aimed at enhancing and expanding the role of science in clinicalpsychology.

1. Differentiate. It is crucial that we dispel the uniformity myth. All of clinical psy-chology is not alike. Clinical psychology is deeply divided on many issues—not just thePPP proposal. To the degree that we allow fundamental differences to be obscured orpatched over for political or social reasons, we are allowing scientific clinical psychologyto be undermined. Skepticism and criticism are central to a scientific epistemology. Whenthey are stifled, scientific progress and integrity are compromised. If clinical psychologyis to develop as a science, we must take every opportunity to articulate and sharpen thefeatures that differentiate scientific clinical psychology from the alternative—on all lev-els. The aim of doing this, of course, is to advance science, not to tear down those withopposing views. Nevertheless, it is inevitable that comparisons, contrasts, and criticismswill create tensions and cause resentments. While trying to minimize animosities, wecannot be deterred by the threat of controversy.

On one hand, we must spotlight the theories, methods, and activities that are exem-plars of good clinical science, illuminating their strengths, their contributions to knowl-edge, and their implications. On the other hand, we must criticize vigorously the theories,methods, and activities that are exemplars of bad science, explaining clearly the episte-mological bases for our judgments and, where possible, suggesting ways to improve thescientific quality of future work. In science, criticism is valuable in its own right; we neednot be able to solve a problem before we can criticize others’ solutions. All aspects ofclinical psychology must be examined critically—from assessment tools to interventiontechniques; from nosological systems to methods of inference; from training models tohealth-care systems. Critical examination and evaluation is bound to stimulate internaldebate, even among participants who purport to be using the same “scientific” lenses toview the same evidence and the same problems. Science is not a “paint by the numbers”process, with rigid rules that can be applied in a rote, automated fashion; science is a setof abstract principles, or epistemological guidelines, that are subject to honest differencesof opinion when applied to concrete questions. Whereas honest differences among sci-entific clinical psychologists should be expected and even encouraged, these differences


must not be confused with the fundamental differences arising between those who areworking to make clinical psychology a science and those who are not. Currently, all ofclinical psychology is thrown together indiscriminately under a single label. Separatingclinical psychology into more meaningful, homogeneous groups through a process ofdifferentiation should reduce the confusion and foster scientific progress.

Some progress has been made in recent years toward increased differentiation, butmuch remains to be done. As noted earlier, the CoA’s revised accreditation guidelines nolonger employ a single “cookie-cutter” template to evaluate programs; the new guide-lines abandon the pretense of program uniformity by allowing each program to identifywith one of several training models. Unfortunately, distinctions among programs are notreflected in the CoA’s accreditation documents. This leaves the public uninformed aboutprogram differences and their implications (e.g., the orientations and competencies ofgraduates from different programs). State licensing laws also provide little useful infor-mation about meaningful distinctions, such as the educational background, theoreticalorientation, or technical competencies of licensees. Thus, service providers essentiallyare treated as equivalent and interchangeable, even though they are not. For instance, itwould be useful to have information regarding each provider’s track record in treatingspecific types of clinical populations and problems. These are examples of areas whereincreased differentiation is needed.

Because scientifically oriented clinical psychologists constitute a minority of all clin-ical psychologists, they have the most to gain and least to lose by differentiating them-selves from other clinical psychologists. By failing to draw clear distinctions, they areallowing themselves to be held hostage by the views and actions of the majority. Over theyears, scientifically oriented clinical psychologists have formed coalitions devoted topromoting their common interests. Often these organizations have focused narrowly onexchanging research information. In the 1990s, however, several organizations have broad-ened their focus to include the promotion of a scientific perspective within clinicalpsychology—with encouraging results. For example, during David Barlow’s term as pres-ident of Division 12 of APA, a task force was formed for the explicit purpose of differ-entiating between empirically supported psychotherapy methods and methods lackingsuch support (see Chambless et al., 1995, 1996). Some of the groups that have workedactively to promote differentiation within clinical psychology are the Society for a Sci-ence of Clinical Psychology, the Association for the Advancement of Applied and Pre-ventive Psychology, the Academy of Psychological Clinical Science, and the AmericanPsychological Society. Differentiation is not a one-shot affair; it is an ongoing effortrequiring vigilance and persistence. But it is an essential facet of transforming clinicalpsychology into a science.

2. Integrate. A second facet of this process is integration—at two levels. First, clin-ical scientists must integrate their own work across the full range of activities on thehorizontal axis of our two-dimensional model: from basic research to clinical applica-tions. In the past, too many clinical psychologists have led two incompatible lives, con-ducting rigorous research in the laboratory while employing untested, unsupported,unscientific practices in the clinic. This lack of integration across tasks and settings isantithetical to clinical science.

Second, even as clinical scientists are working to differentiate themselves from otherclinical psychologists and to make their own work more coherent, they also must work tobecome better integrated with the rest of psychological science—cognitive science, neuro-science, developmental, sensory, social, animal learning, etc. Clinical science has more incommon philosophically with these other areas of psychology than with much of clinical


psychology, as currently practiced. Strengthening ties with these areas will foster scien-tific progress by encouraging clinical scientists to draw from the best theories and meth-ods in all of psychology.

For example, cognitive-behavioral therapies currently enjoy strong empirical sup-port as effective interventions for a number of clinical problems. However, the cognitiveconstructs underlying these treatments often are not consistent with many of the con-structs in contemporary cognitive science (McFall, Treat, & Viken, 1998). Cognitive-behavioral theories and interventions might be improved if clinical scientists simply weremore knowledgeable about developments in cognitive science. Similar opportunities forcross-fertilization and improvement exist in other areas, as well. The general point is thatclinical scientists cannot afford to be isolated; they must work to break down the barriersthat have compartmentalized psychology in the past. One way to do this is to developresearch collaborations with nonclinical colleagues. An even better way is to expandone’s own competence and knowledge in other areas.

To promote the highest level of integration in the future, clinical students should betrained as broadly as possible. Ideally, clinical science training would be hybrid training.The training program at Indiana University, for instance, is committed to this ideal. Inincreasing numbers, our students are satisfying all requirements—including course work,research skills, and qualifying exams—for dual certification in clinical science and asecond area, such as cognitive science or neuroscience. This hybrid training program isfunded by a research training grant from NIMH. Indeed, NIMH has been advocatingprecisely this kind of integrative graduate training for clinical scientists in its announce-ments of funding opportunities and priorities.

Obviously, integrated training such as this is quite different from the narrow trainingproposed by the APA Task Force on Psychopharmacology (APA, 1992). Although mostclinical science students with hybrid training in neuroscience would take at least onecourse in psychopharmacology, they also would take a broad range of courses from suchareas as neuroanatomy, microbiology, neurochemistry, electrophysiology, learning andconditioning, development and neuroplasticity, behavioral genetics, neuropathology, andneural imaging, among other possibilities. Course work would not be dictated by legisla-tive fiat, nor would it be designed to prepare students for circumscribed careers as prescrip-tion writers. Instead, training would be individualized; choices would be dictated by eachstudent’s scholarly focus, and would be designed to prepare each student for a career inbasic and applied science. Program graduates would make original, substantive contribu-tions to knowledge concerning the role of biological, cognitive, and psychological factorsin the etiology of psychological disorders, and the assessment, treatment, and preventionof these disorders. I find this hybrid, integrated model of clinical science training much moreinspiring and promising than the narrow model envisioned in PPP proposals.

If PPP legislation were adopted, however, its required curriculum in psychopharma-cology would pose a serious threat to the integrative model of graduate training. Fewpsychology departments could afford to offer both; most would be forced to choose. ThePPP curriculum clearly would be more costly than the integrative curriculum, requiringsignificant additions in student credit hours, courses, faculty members, and facilities. ThePPP curriculum would serve a more limited objective: adding prescription-writing priv-ileges to the psychological practitioner’s toolbox. I doubt that this new tool, by itself, willsalvage the professional practices of struggling psychologists. The costs of pursuing suchan ephemeral goal seem too high, especially in light of the likely negative impact oncompeting models of graduate training. Clinical scientists must resist the costly and expe-dient proposals of PPP advocates, and insist that psychologists focus their resources onbuilding a genuinely integrative model of training.


3. Communicate. The third facet of the three-sided plan for advancing clinical sci-ence calls for a concerted effort to communicate more clearly and forcefully—to stu-dents, colleagues, consumers, policy makers, and the media—the key distinctions betweenscientific and nonscientific clinical psychology (across all settings and problems), whythese differences are important, and what steps are necessary for clinical psychology tobecome a science.

To some extent, the current fractionation of our field is a reflection of our pastfailures to imbue students with a scientific orientation toward clinical psychology that isdifferentiated and integrated. Sadly, many of the clinical psychologists who seem indif-ferent or hostile to the scientific approach are graduates of programs with an ostensibleresearch-training orientation. We must do a better job of articulating, modeling, instruct-ing, and reinforcing scientific values in our students.

We also must do a better job of communicating among ourselves. Too often we findourselves isolated in our work, feeling unable to effect change by ourselves at the locallevel. By communicating with like-minded colleagues, however, we can combine andcoordinate our efforts. We can make far more progress together than if we simply con-tinued to struggle alone.

Similarly, we must do a better job of communicating with our nonclinical psychol-ogy colleagues—many of whom hold biased, unflattering, misinformed views of ourwork We need to explain how our integrated scientific approach to clinical psychologydiffers from their preconceptions, and how it can contribute meaningfully to their goalsand to the advancement of psychological science generally. We need to convert our non-clinical colleagues into allies.

There is another important, but overlooked, opportunity for communication: Weneed to do a better job of communicating with clinical psychologists who currently do notshare our scientific views. In particular, clinical practitioners who are facing the uncer-tainties symbolized by managed care need to be informed about other ways to designtheir future, and need to acquire the knowledge, skills, and philosophical perspective thatwill allow them to make this transition. Essentially, clinical scientists must make a majorcommitment to a program of continuing education and retooling for clinical colleaguesaffected by the shift to empirically based standards of practice. Displaced practitionersshould be approached as potential allies, rather than as adversaries. Ironically, if theywere shown how to participate meaningfully as clinical scientists in the current behav-ioral health revolution, they would be less inclined to grasp for the straw of prescriptionprivileges.

Finally, consumers and policy makers must be educated about the public’s stake inmaking clinical psychology into a science. Currently, the public’s opinion of psychologyas a science, relative to other sciences, is very low (Janda et al., 1998), perhaps with goodreason. The media give us powerful tools for conveying our message vividly, accurately,and persuasively. We need to take full advantage of these tools. Part of our message, ofcourse, must focus on what is wrong with traditional approaches to clinical psychology;but the more important part of our message is why the science-based alternative is supe-rior, and why it is in the public interest for that alternative to prevail.

Summary

The PPP debate provides clinical scientists with an excellent opportunity for differenti-ating, integrating, and communicating their vision of clinical psychology as a science. Itwould be a mistake, in my view, if we allowed ourselves to be coerced by the PPP debateinto focusing narrowly on the isolated question of whether legislatures should grant clin-


ical psychologists the privilege of writing prescriptions. This question is not the mainproblem facing clinical psychologists; it merely is a reflection of more fundamental,long-standing, structural and epistemological divisions within clinical psychology. ThePPP debate raises three broader questions, however, that go to the heart of clinical psy-chology’s problems: “Where are we? Where should we be? How can we get there?” Ihave examined each of these questions, in turn.

There may be some consensus among psychologists about where we are and how wegot here. There surely are sharp differences, however, over where we should be headed.Any discussion of how best to reach one’s goals depends upon one’s choice of goals. Ihave presented one vision of where clinical psychology should be headed and how wecan get there. This vision can be summarized succinctly: Clinical psychology should be ascience, with all that this entails. To achieve this goal, clinical scientists must make atriangulated effort to differentiate, integrate, and communicate. This is most critical inthe arena of education and training. The faculties of predoctoral and postdoctoral train-ing programs must reexamine and reevaluate their program brochures and recruit-ment materials, their selection criteria and procedures, their curricula and pedagogicalmethods, their mentoring and evaluations systems, and their training outcomes andplacement records—all with an eye toward improving the effectiveness of training inclinical science. The effort to promote a scientific approach to clinical problems actuallyshould begin earlier in the education process—at the undergraduate and precollegelevels.

In the past 40 years, clinical scientists have made significant strides in their ability toassess, predict, treat, and understand psychological problems. These advances are testi-mony to the value of basic and applied scientific research in psychology. It would beironic if state legislatures were to embrace the PPP proposal now, at the very momentwhen clinical psychology, for the first time, can offer the public a wide range of empir-ically grounded psychological theories and techniques! It is easy to see why many clin-ical psychologists might find the PPP proposal attractive, given current uncertainties inthe field, but this is no time for clinical psychology to be “reinvented” as a prescription-writing profession. Now, more than ever, we must defend and extend the science ofclinical psychology.

References

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

Berman, J.S., & Norton, N.C. (1985). Does professional training make a therapist more effective?Psychological Bulletin, 98, 401– 407.

Chambless, D.L., Chair. Task Force on Promotion and Dissemination of Psychological Procedures(1995). Training in and dissemination of empirically-validated psychological treatments: Reportand recommendations. The Clinical Psychologist, 48, 3–23.

Chambless, D.L., Sanderson, W.C., Shoham, V., Johnson, S.B., Pope, K.S., Crits-Christoph, P.,Baker, M., Johnson, B., Woody, S.R., Sue, S., Beutler, L., Williams, D.A., & McCurry, S.(1996). An update on empirically validated therapies. The Clinical Psychologist, 49, 5–18.

Clay, R. (1998). Mental health professions vie for position in the next decade. APA Monitor, 29:Sep-tember, 20–21.

DeLeon, P.H., & Wiggins, J.G., Jr. (1996). Prescription privileges for psychologists. AmericanPsychologist, 51, 225–229.

DeNelsky, G.Y. (1996). The case against prescription privileges for psychologists. American Psy-chologist, 51, 207–212.


Evans, G.D., & Murphy, M.J. (1997). The practicality of predoctoral training for psychologists: Asurvey of directors of clinical training. Professional Psychology: Research and Practice, 28,113–117.

Fyfe, B. (1995, December). A field in transformation. APA Monitor, 26, 5.

Garb, H.N. (1998). Studying the clinician: Judgment research and psychological assessment. Wash-ington, DC: American Psychological Association.

Gawande, A. (1998). No mistake. The future of medical care: Machines that act like doctors, anddoctors who act like machines. Newsweek, March, 74–81.

Grove, W.M., & Meehl, P.E. (1996). Comparative efficiency of informal (subjective, impression-istic) and formal (mechanical, algorithmic) prediction procedures: The clinical-statistical con-troversy. Psychology, Public Policy, and Law, 2, 293–323.

Gutierrez, P.M., & Silk, K.R. (1998). Prescription privileges for psychologists: A review of thepsychological literature. Professional Psychology: Research and Practice, 29, 213–222.

Hayes, S.C., Follette, V.M., Dawes, R.M., & Grady, K.E. (Eds.) (1995). Scientific standards ofpsychological practice: Issues and recommendations. Reno, NV: Context Press.

Hayes, S.C., & Heiby, E.M. (1996). Psychology’s drug problem. American Psychologist, 51, 198–206.

Hayes, S.C., & Heiby, E.M. (Eds.) (1998). Prescription privileges for psychologists: A criticalappraisal. Reno, NV: Context Press.

Janda, L.H., England, K., Lovejoy, D., & Drury, K. (1998). Attitudes toward psychology relative toother disciplines. Professional Psychology: Research and Practice, 29, 140–143.

Klein, R.G. (1996). Comments on expanding the clinical role of psychologists. American Psychol-ogist, 51, 216–218.

Kupfersmid, J.H. (1983). The forum. Infighting in psychology: An in-house proposal. ProfessionalPsychology: Research and Practice, 14, 155–158.

Lorion, R.P. (1996). Applying our medicine to the psychopharmacology debate. American Psychol-ogist, 51, 219–224.

McFall, R.M. (1991). Manifesto for a science of clinical psychology. The Clinical Psychologist, 44,75–88.

McFall, R.M. (1996). Making psychology incorruptible. Applied & Preventive Psychology, 5, 9–15.

McFall, R.M. (2000). Elaborate reflections on a simple manifesto. Applied & Preventive Psychol-ogy, 9, 5–21.

McFall, R.M., Treat, T.A., & Viken, R.J. (1998). Contemporary cognitive approaches to studyingclinical problems. In D.K. Routh & R.J. DeRubeis (Eds.), The science of clinical psychology:Accomplishments and future directions (pp. 163–197). Washington, DC: American Psycho-logical Association.

Miller, G.A. (1969). Psychology as a means of promoting human welfare. American Psychologist,24, 1063–1075.

Murphy, M.J., DeBernardo, C.R., & Shoemaker, W.E. (1998). Impact of managed care on indepen-dent practice and professional ethics: A survey of independent practitioners. Professional Psy-chology: Research and Practice, 29, 43–51.

Murray, B. (1999). Some clinical psychology students’ growing debt burden triggers response fromtraining programs. APA Monitor, 30:February, 16.

Pachman, J.S. (1996). The dawn of a revolution in mental health. American Psychologist, 51,213–215.

Peterson, D.R. (1996). Making psychology indispensable.Applied & Preventive Psychology, 5, 1–8.

Phelps, R., Eisman, E.J., & Kohout, J. (1998). Psychological practice and managed care: Results ofthe CAPP practitioner survey. Professional Psychology: Research and Practice, 29, 31–36.

Rothbaum, P.A., Bernstein, D.M., Haller, O., Phelps, R., & Kohout, J. (1998). New Jersey psychol-ogists’ report on managed mental health care. Professional Psychology: Research and Prac-tice, 29, 37– 42.


Sammons, M.T., Sexton, J.L., & Meredith, J.M. (1996). Basic science training in psychopharma-cology: How much is enough? American Psychologist, 51, 230–234.

Sechrest, L. (1992). The past future of clinical psychology: A reflection on Woodworth (1937).Journal of Consulting and Clinical Psychology, 60, 18–23.

Seligman, M.E.P., & Levant, R.F. (1998). News from Washington, DC: Managed care policies relyon inadequate science. Professional Psychology: Research and Practice, 29, 211–212.

Sleek, S. (1994, May). Layoffs proposed by VA show public sector needs protection. APA Monitor,25, 34.

Thyer, B.A. (1999). Clinical behavior analysis and clinical social work: A mutually reinforcingrelationship. The Behavior Analyst, 22, 17–29.

Woodworth, R.S. (1937). The future of clinical psychology. Journal of Consulting Psychology, 1,4–5. (Reprinted in Journal of Consulting and Clinical Psychology, 1992, 60.)


Documents

Training for prescriptions vs. prescriptions for training: Where are we now? Where should we be? How do we get there?