Benefits to the clinical psychologist include reduced
liability insurance, increased status as a clinician or
expert witness, and increased ease of mobility if one
chooses to move to another state (Finch, Simon, &
Nezu, 2006).
National Register. In recent years, insurance
companies have increasingly extended their cover-
age to include mental health services. At the same
time, clinical psychologists have gained recognition
as competent providers of those services involving
prevention, assessment, and therapy. In 1975, the
firstNational Register of Health Service Providers in
Psychology was published. The Register (http://
http://www.nationalregister.org/)) is a kind of self-
certification, listing only those practitioners who
are licensed or certified in their own states and
who submit their names for inclusion and pay
to be listed. Along with the increasing numbers
of clinicians in private practice and their recogni-
tion as health care providers by insurance and
managed care companies, the Register is one
more indication of the growing professionalism of
clinical psychology.
Private Practice
Earlier, we observed that substantial numbers of
clinical psychologists work in private practice set-
tings. For some time, this seemed to be an ever-
increasing trend, mirroring the aspirations of many
students in clinical training. For some clinical psy-
chology graduate students, their goal is essentially to
open an office and hang out a shingle. This suggests
that the physician is now serving as a role model for
these aspiring clinicians—a model that does create
certain hazards.
In the recent past, for example, the medical
profession has experienced a great deal of criticism
and the loss of its Good Samaritan image because it
has appeared more concerned with economic
privileges than with the welfare of patients. Doctors
operate strong lobbies in Congress and in state
legislatures. They have gotten legislation passed
that not only restricts entry by others into what
they perceive as their professional arena but also
protects them and their vested interests. The Amer-
ican Medical Association is often perceived not as
the public’s guardian, but as the protector of the
rights and advantages of the physician.
What alarms many psychologists is that clinical
psychology seems to be moving in the same direc-
tion. The emphasis on restrictive legislation, diplo-
mas, and political activism and the de-emphasis on
research strike many as misguided (McFall, 2002,
2006). They fear that what began as an honest
and dedicated attempt to improve training, provide
continuing professional growth, protect the public,
and improve the common good will end in a selfish
posture of vested interest. Obviously, private practice
is not the only place such trends can develop, but the
danger exists. A larger social question is whether
training clinicians for private practice is an economi-
cal, efficient response to the nation’s mental health
needs. Nevertheless, private practice—with all its
concern about insurance coverage, professional
rivalry with psychiatry, and statutory regulation—
seems here to stay.
Traditional fee-for-service private practice is a
thing of the past (Baker et al., 2009; McFall, 2002,
2006); managed health care now dominates the
scene. Private practice psychologists have felt the
brunt of this change. However, training programs
must ensure that future clinical psychologists are not
sent out into the real world lacking the requisite
skills and knowledge demanded by managed health
care systems. Table 3-2 summarizes several sets of
recommendations for the training needs for future
practicing psychologists (e.g., see Baker et al., 2009;
Eby, Chin, Rollock, Schwartz, & Worrell, 2011;
McFall, 2006).
This economic squeeze on the private practi-
tioner has raised many concerns (Comas-Diaz,
2006). For example, how will changes in health
care coverage affect the viability of delivery of psy-
chological services? If managed care companies
endorse empirically supported treatments as standards
for psychological intervention, how will this impactCURRENT ISSUES IN CLINICAL PSYCHOLOGY 71