Clinical Psychology

training. In some instances, hypnosis may be used to
induce relaxation. More commonly, the patient
may be asked to imagine relaxing scenes and/or
breathing exercises are used to enhance relaxation.

The Anxiety Hierarchy. In discussions about

specific problems, the situations in which they

occur, and their development, the patient and the

therapist work together to construct a hierarchy.

For example, I structure teaching and supervision ses-

sions in the same way that I structure therapy. Also, I

have developed instruments for patients to evaluate

therapists and for supervisors to evaluate therapists

(and for therapists to evaluate supervisors).

I have coauthored a scale measuring personality-

related beliefs and am involved in developing self-

administered scales for children that assess symptoms

of depression, anxiety, anger, disordered conduct, and

low self-esteem.

What are the future trends you see for clinical

psychology?

One trend will be in devising and refining instruments

to diagnose patients and assess their symptoms more

accurately. Future scales will likely include more cogni-

tive items in addition to the traditional emotional,

behavioral, and biological symptoms. More scales will

be developed to identify and measure relevant beliefs

that underlie specific problems and diagnoses. Clinical

psychologists will increasingly focus on measuring out-

comes to assess efficacy of treatment.

I believe that master’s-level clinicians, social

workers, and primary care physicians will provide

treatment for straightforward cases of depression and

anxiety. Clinical psychologists, who are more highly

trained and have specific expertise, will be asked pri-

marily to care for patients with more complex prob-

lems, and they will increasingly utilize empirically

based treatments. Behavioral health care organizations

will ultimately ration care that psychologists provide

on a more rational basis that recognizes the severity

and comorbidity of various diagnoses.

What are some future trends you see in cognitive

therapy?

One trend is the application of cognitive therapy to a

wider variety of psychiatric disorders. Recent outcome

studies, for example, have demonstrated the efficacy of

cognitive therapy for substance abuse, eating disorders,

personality disorders, and as an adjunctive treatment for

bipolar disorder and schizophrenia, to name a few.

Cognitive therapy will also continue to be refined for the

treatment of a variety of medical illnesses: post-heart

attack patients who are depressed, diabetics who do

not follow their treatment regimen, patients with

stress-induced or stress-exacerbated conditions.

Clinicians will also continue to expand the delivery

of cognitive therapy to patients (and their families) in a

variety of settings: in inpatient and partial hospitaliza-

tion programs, outpatient clinics, in the offices of pri-

mary care providers and specialists, rehab centers,

nursing homes, and schools. Cognitive therapists who

are clinical psychologists will do more widespread

teaching of psychiatrists, psychiatric nurses, social work-

ers, counselors, primary care physicians, and other

adjunctive therapists whose efficacy can be enhanced by

incorporating cognitive techniques into their practice.

Finally, cognitive therapy teachers and supervisors

will refine methods to take advantage of evolving

technology for distance learning programs, dissemina-

tion of information, forums for discussion via the

Internet, and interactive multimedia computer

programs.

Judith S. Beck

Dr. Judith Beck, director of the Beck Institute for Cognitive Therapy & Research andclinical associate professor at University of PA. Medical School

PSYCHOTHERAPY: BEHAVIORAL AND COGNITIVE-BEHAVIORAL PERSPECTIVES 403