Clinical and health psychology: Future directions.

Abstract

CPA Award for Distinguished Contribution to Psychology as a Profession (2000) - Prix de la SCP pour contribution remarquable iL la psychologie en tant que profession (2000) Abstract Whether clinical psychology continues to comprehensively serve the public and to benefit from enhanced future professional opportunities depends significantly on its ability to extend the professional identity and mainstream activities of clinical psychologists beyond the current nearly exclusive focus on mental health. Clinical psychology needs to embrace all areas of health with the same vigor and skill that has been applied to mental health. Tiis enhancement in professional role requires, in my opinion, significant change in the educational approach of many Canadian clinical psychology doctoral training programs. Such suggested change will undoubtedly provoke much resistance. Considerable leadership will be required of our professional associations and accreditation bodies to encourage mid guide the broadening of clinical psychology's educational and training programs. Suggestions for educational reform are presented here to stimulate discussion rather than to provide a blueprint for the re-conceptualization of clinical training. I believe that the single most important challenge facing clinical psychology today relates to its ability to significantly diversify its clinical and academic focus in order to incorporate a broader vision of health, which both includes but also extends beyond mental health. As the major clinical practice component of psychology related to health, clinical psychology must adopt a broad perspective which encompasses the whole area of health. While a certain degree of specialization in mental health issues is indeed desirable, this orientation should not continue to so dominate the clinical and academic activities of clinical psychology as is the case today. Academic psychology departments have done an excellent job in teaching sophisticated research skills to clinical psychology students and in inculcating a strong appreciation for the scientific method in approaching problems. They have also done a reasonably good job of imparting clinical skills in the area of mental health. They have, however, fallen far short in providing education and training in the vast majority of general health areas outside of mental health. Internship training, although still heavily focused on mental health, generally has provided a significantly broader training experience in general health areas. The career modifying impact of predoctoral internship training, however, has generally been significantly limited by its relatively brief duration and by the fact that it typically occurs late in the education and training process, well after the student's core professional identity has already been substantially formed. Clinical psychology appears to be one of the few health professional groups (aside from the medical specialty of psychiatry) which has maintained such a pronounced unidimensional focus on mental health. The professions of medicine, nursing, pharmacy, social work, occupational therapy, etc. have all, in general, followed a much broader and more diversified approach to health. While their professional and academic activities have included mental health, they have not been limited in a major way to this area. I would also suggest that partly as a result of their greater diversification, these fields have all grown in size and impact in the Canadian health care system much more over the last 25 years than has clinical psychology. I do not believe that these fields all have an inherently greater contribution to make to health than does clinical psychology. In my view, clinical psychology's long-standing lack of action in diversifying the education, training, and practice domains of the field has been the major contributing factor to its relatively limited impact so far. This situation has not only hurt the profession but it has also not served the public interest very well. …