Clinical Psychology

(b) the development of the field of clinical psy-
chology itself (Hartlage, 1987). An important
development of the postwar period was the work
of Ward Halstead. By observing people with brain
damage in natural settings, Halstead was able to
identify certain specific characteristics of their

behavior. Next, he tried to assess these characteris-

tics by administering a variety of psychological tests

to these patients. Through factor analysis, he settled

on ten measures that ultimately comprised his test

battery. Later, Ralph Reitan, a graduate student of

Halstead’s, refined the battery by eliminating two

functioning, as being related to increased spiritual

transcendence.

What are the future trends you see for clinical

psychology?

It is always entertaining to project the future of psy-

chology, particularly given the potential growth

opportunities as well as stressors related to managed

care. On the positive side, clinical psychologists con-

tinue to expand their expertise into areas outside of

traditional mental health. At my current setting, clini-

cal psychologists have been primary investigators on

Robert Wood Johnson Foundation grants focusing on

(1) developing Medicaid managed care programs for

individuals with disabilities and (2) investigating the

impact of managed care on children with disabilities in

rural settings. Other psychologists in our department

have been primary investigators on grants investigat-

ing the use of telemedicine applications for individuals

with traumatic brain injury in rural settings, as well as

the PI for one of 17 national Spinal Cord Injury Model

Systems. In addition, many medical school psycholo-

gists are identifying numerous medical populations

that can benefit from psychological services (including

those with systemic illnesses, infectious diseases,

chronic pain, and cardiovascular diseases).

Managed care trends and current economic diffi-

culties have had positive effects in that they have

forced all health care professionals to better demon-

strate the effectiveness of our services. However,

because we have not demonstrated that psychologists

can provide superior and less expensive services than

social workers and licensed professional counselors,

there is a good chance that clinical positions for psy-

chologists will decrease in the future. As past president

of the Missouri Psychological Association, I have

learned that the future of clinical psychology rests on

our ability to advocate for our profession and demon-

strate our value to others. If we do not do it for our-

selves, no one else will.

What are some future trends you see in

neuropsychology?

I see the specialty of neuropsychology diverging in two

directions. The first will be toward an experimental

focus, with more research identifying specific brain–

behavior relationships such as the neuropsychological

processes associated with specific spiritual experiences.

Sophisticated neuroradiological techniques will allow

us to gain a much better understanding of how the

brain works. On the other hand, I foresee clinical

neuropsychology focusing on the development of

rehabilitation-based assessment and treatment. In the

future, most individuals who are referred for neuro-

psychology evaluations will have known etiologies for

their difficulties. Therefore, clinical neuropsychologists

will need to develop specific treatment recommenda-

tions to assist individuals in their daily functions, at

home, work, or school.

Brick Johnstone

Dr. Brick Johnstone, Dept. of Physical Medicine & Rehabilitation at Univ. ofMissouri Hospital

NEUROPSYCHOLOGY 517