It's year 2100. Where is clinical psychology?

[DrGachet]

If that's too far, go with 2050 or whatever. Regardless, where do you see the field headed? I see a greater influence of Eastern philosophies and religions as is already evidenced by the proliferation of mindfulness research and its incorporation into new forms of therapy. I see psychologists writing prescriptions all the time, perhaps even genetically "customized" meds. I see more paperwork, and greater use of technology such as email based psychotherapy, widely available computer simulations for phobias, EMDR type programs for PTSD for use at home at your convenience, sophisticated biofeedback programs, etc).

Psychologists would be behind the scenes working in labs and on computer programs, except for prescribing meds. Masters level therapists and social workers are the ones seeing clients and provide emotional support and encouragement. They would teach the clients how to use a computer program that teaches them CBT and report back every couple of months just to review their progress. In the meantime, they would do their homework and email it to the therapists.

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[erg923]

EMDR type programs for PTSD for use at home at your convenience

Excuse me, I just threw-up in my mouth a little bit...

 

[erg923]

Psychologists would be behind the scenes working in labs and on computer programs, except for prescribing meds. Masters level therapists and social workers are the ones seeing clients and provide emotional support and encouragement. They would teach the clients how to use a computer program that teaches them CBT and report back every couple of months just to review their progress. In the meantime, they would do their homework and email it to the therapists.

Throw-up, plus nightmares this time. When does Cyberdyne launch the nuclear missiles in your story?

In all seriousnes though, I didnt really go into this field to work on computers or sit in a lab all day. I doubt many others did either. This also assumes we have erradicted the minor problem of societal poverty, seeing as how everybody apparently has email access at their fingertips in this version.

 

[erg923]

Seeing as how the MMPI has been the dominant assessment tool for us for like 70 years now (20 of these years have been the within the age of technology, computers, and the human genome), Im not very confident psychology will change all that much in the next 50. The mental health paradigm may have shifted, and the Rx may indded have taken off, but frankly, I doubt psycholgists will have developed any revoluationary treatments.

I think what is really cool to think about however, is what we will know about schizophrenia 100 years from now. Now if you compare what we knew about schziophrenia in 1910 (even 1990) to what we know about it today...now THAT is really something.

 

[Jegg]

Open the pod bay doors HAL.

 

[deadmau5]

there are no more psychiatrists.

 

[edieb]

FROM THE SOUNDS OF THIS, which was posted on the Missouri Psychological Assn Listerv, I doubt psychology will exist:



Dear MOPA Friends, Because of apathy and lack of unity, we are now facing dire HMO rate rules. Do not think it will not happen to your part of the state. It is happening, because we were not unified in voice to combat it. We need to work on changing this in all of the state. EXAMPLES OF NEW HMO PAYMENT RATES: November 15th: HMO Medicaid Client from Bolivar, Missouri. 7 year old child, HMO Medicaid. My billing agent reported, "Please remember that Meritain will pay $55 for the evaluation no matter how long it takes." That is all they will pay...you get no more hours for testing...period. November 11, 2010: 10 year old child referral. Molina Health Care-Medicaid HMO Authorization is covered at $48 for evaluation. They want us first to do a one hour evaluation for $48 dollars, then send in request for more hours. That's right, two trips for the client, who is driving two hours. And if granted after the first session, we can see them for 2 or 3 more hours on a DIFFERENT DAY for a total of 3 x $48 dollars for the additional. That is four hours maximum testing at $192 dollars. That does not count the 1 to 4 hours you may have to spend chasing them and filling out multiple long forms, to try to get them to pay you anything. Friends, this is what is coming soon as insurance companies do not see the value of anything medical that takes more than 15 minutes. Mark Bradford

 

[BiopsychStudent]

As I was looking for schools I found a handful of PIs doing work in genetics, mostly related to substance abuse, BPD, and schizophrenia. It might be interesting to see how Bioinformatics is integrated into testing and treatment in the future, though.

But who needs a Psychologist when Dr. Wikipedia can tell you if you have Asperger's or ME?

 

[somedude14]

FROM THE SOUNDS OF THIS, which was posted on the Missouri Psychological Assn Listerv, I doubt psychology will exist:



Dear MOPA Friends, Because of apathy and lack of unity, we are now facing dire HMO rate rules. Do not think it will not happen to your part of the state. It is happening, because we were not unified in voice to combat it. We need to work on changing this in all of the state. EXAMPLES OF NEW HMO PAYMENT RATES: November 15th: HMO Medicaid Client from Bolivar, Missouri. 7 year old child, HMO Medicaid. My billing agent reported, "Please remember that Meritain will pay $55 for the evaluation no matter how long it takes." That is all they will pay...you get no more hours for testing...period. November 11, 2010: 10 year old child referral. Molina Health Care-Medicaid HMO Authorization is covered at $48 for evaluation. They want us first to do a one hour evaluation for $48 dollars, then send in request for more hours. That's right, two trips for the client, who is driving two hours. And if granted after the first session, we can see them for 2 or 3 more hours on a DIFFERENT DAY for a total of 3 x $48 dollars for the additional. That is four hours maximum testing at $192 dollars. That does not count the 1 to 4 hours you may have to spend chasing them and filling out multiple long forms, to try to get them to pay you anything. Friends, this is what is coming soon as insurance companies do not see the value of anything medical that takes more than 15 minutes. Mark Bradford

This is a huge problem for clinical psychology. The bottomline is always the money issue and if insurance companies don't think psychology is worth much it will start to fade.

I think there will be a lot more psychiatrists actually. (If psychoactive drugs continue to develop along with techniques like DBS, TMS) Clinical psychology will still be around but not much in demand. I only see health psychology really standing the test of time with its application in behavioral medicine. Neuropsychology might still be around if we neuroimaging tools are used cheaply and effectively in practice.

Social workers and masters level therapists will take over the psychotherapy realm as its much cheaper for the clients and insurance.

Just my two cents though, who knows what will happen. Humans could be extinct due a nuclear holocaust before the year 2100.

 

[stigmata]

All professional schools that cost money, because academia is a dinosaur. Medical school model that reflects integrated care ideas so out with all the BS, and in with more clinical medicine, real science and pharmacology. Psychologists and psychiatrists will be considered the same, but they will still fight each other, but probably have to do so in hindi. DSM12 will follow the plans of DSM5 and everything will be a spectrum with qualifiers, and hopefully the word client has died a peaceful death.

 

[Ollie123]

Yeahhh.....I felt a little sick reading the EMDR thing too....though sadly, it probably would boost our incomces (at least temporarily).

I think our role will be shifting more into that of background/administration then it is currently. I don't know that this is a bad thing. I actually think our role in science will expand. From what I understand of what is going on there, NIH thinks so too. We are on the cusp of several scientific revolutions. Genetics and neuroscience are doing quite well, but I think we are going to be the ones who need to tie it together.

I hold no doubt that psychology as a field will exist well beyond 2100, but it may (and probably will) evolve into something rather unrecognizable. I'm cautiously optimistic, but that may have to do with the fact that my career goals and interests are different from many here, and my financial needs and expectations are apparently lower.

 

[DrGachet]

Erg, we get it, you are easily nauseated...didn't need two posts to make that point.

As for your third post in a row, I don't think we'll know more about schizophrenia because schizophrenia--one of those catchall diagnostic labels that is constantly misused and carries so much stigma too--is not going to survive a more scientific clinical psychology. I think schizophrenia is made up of a dozen or two other psychotic disorders which can be delineated with more careful study, in particular by making use of genetics research.

Lastly, my reference to marriage of technology and clinical psychology is not about what I like to see but the direction lots of different fields are headed these days. Did anybody think they'd be paying their bills online or use an ATM instead of talk to a teller, fifty years ago? What about taking a course or doing a whole college degree online?

Of course I am merely speculating and things can be even worse. As a classmate once told me very confidently, "Clinical psychology never had an identity to begin with, and it won't be missed when it's gone...whatever it is or it was."

 

[erg923]

.

As for your third post in a row, I don't think we'll know more about schizophrenia because schizophrenia--one of those catchall diagnostic labels that is constantly misused and carries so much stigma too--is not going to survive a more scientific clinical psychology. I think schizophrenia is made up of a dozen or two other psychotic disorders which can be delineated with more careful study, in particular by making use of genetics research.

But if we can find irrefutable evidence of what those illnesses are and the genetic predispositions for them...then that will indeed be a HUGE step forward in understanding what we presently call "schizophrenia."

 

[stigmata]

but if we can find irrefutable evidence of this, what those illness are, and the genetic predispositions for them, then that will indeed be a huge step forward, in understand what we presently call "schizophrenia."

huh?

 

[erg923]

fixed typos. Should be readable now...

 

[loveoforganic]

Fingers crossed for big headway in neuroimaging as a diagnostic tool and widespread integration of health psych into the medical world.

 

[Existenz]

But if we can find irrefutable evidence of what those illnesses are and the genetic predispositions for them...then that will indeed be a HUGE step forward in understanding what we presently call "schizophrenia."

enjoy:
http://discovermagazine.com/2010/jun/03-the-insanity-virus/

 

[IT514]

In 2100, physicians will still need help with problem patients, parents will still need help raising their kids, and teachers will still need to know why johnny cant read and how to help him, as well as how to teach suzy who has symptoms of complex trauma. Also, neuroimaging is great, and a necessity, but it still will not be able to describe functional deficits and help families make good decisions for grandpa when he starts going downhill.

If you dont get my point let me be more explicit: lets continue to refine the areas where we have always done well. Plenty of problems cannot be solved by medication, period. Good therapy and psychometrics will always be in need, so lets continue to refine those things.

My crazy prediction is that "technology addiction" will be included in the DSM-12, after we discover how long-term exposure to texting differentially alters dopaminergic functioning in fronto-striatal systems and turns people into zombies. Perhaps "aspergers, secondary to years of pointless video games" will also be in the DSM...

 

[stigmata]

In 2100, physicians will still need help with problem patients, parents will still need help raising their kids, and teachers will still need to know why johnny cant read and how to help him, as well as how to teach suzy who has symptoms of complex trauma. Also, neuroimaging is great, and a necessity, but it still will not be able to describe functional deficits and help families make good decisions for grandpa when he starts going downhill.

If you dont get my point let me be more explicit: lets continue to refine the areas where we have always done well. Plenty of problems cannot be solved by medication, period. Good therapy and psychometrics will always be in need, so lets continue to refine those things.

My crazy prediction is that "technology addiction" will be included in the DSM-12, after we discover how long-term exposure to texting differentially alters dopaminergic functioning in fronto-striatal systems and turns people into zombies. Perhaps "aspergers, secondary to years of pointless video games" will also be in the DSM...

Good points!

 

[erg923]

The above point is spot-on.

I think much of the time we get so caught up in the sex-appeal of technology that we don't take the time to reflect on whether or not is really appropriate to utilize/apply it with our patients. I really see technology like the OP described NOT having that role in the next 50 years. I'd much prefer to improve on what we currently do and what we have been trying to do for the past century. Yes, we can bring the teletherapy and the emailed HW assignments in some too, but generally speaking, hold your horses. The human interaction that occurs during the therapeutic hour is a unique and intimate experience for both parties, and I don't think its going anywhere. At least I don't think it should. One of the biggest problems I see in my higher functioning patients (and its probably widespread in the normal population as well), is the inability to disconnect, relax and be "in the moment." I can't tell you how many times I offer the sage advice of "slow down." I guess I do harbor a mild bias towards turning my therapy into something that I think often impedes peoples ability to slow down, relax, and meaningfully reflect/interact with other human beings.

 

[FadedC]

I think in 50 years technology will have evolved to such an incredible degree that there is no possible way to predict what society will be like, let alone psychology. Think about what the world was like in the 1960s and how incomprehensible things like the internet, laptops and smart phones would be to them. Now try to imagine what the world will be like after what will mostly be an even more dramatic technological jump.

 

[KayJay85]

there are no more psychiatrists.

At the risk of getting my head bit off, I couldn't agree with you more.

 

[KayJay85]

fingers crossed for big headway in neuroimaging as a diagnostic tool and widespread integration of health psych into the medical world.

This makes me smile! If I had to put my money on it, this is where I see the field heading-- as well as harm reduction models for addiction.

 

[Schooled]

In 2100, I imagine graduate students saying "Wow, I can't believe anyone bought into cognitive behavioral theory. Maladaptive thinking and behaviors? Did they just make that up?!"

 

[Student4Life0]

This makes me smile! If I had to put my money on it, this is where I see the field heading-- as well as harm reduction models for addiction.

As far as that last part (harm reduction models)...I hope so! I am doing my practicum at a site that uses this model and I think we are ahead of the game. Much more realistic.

 

[Neuropsych2be]

I see clinical psychology evolving into a primary care profession in which psychologists work side by side with physicians in integrative care settings. Psychiatry will continue to wither away.

 

[Buzzwordsoldier]

In 100 years, Jung will be all the rage. The next big thing is interplanetary cultural psychology. And we'll have developed our sixth sense, well some will have more than others, so crystal balls and seances will be in direct competition with psychiatric meds. Lots of human factors research potential in these directions (will crystal balls work in zero-gravity?). What a beautiful world it will be...

 

[Buzzwordsoldier]

I see clinical psychology evolving into a primary care profession in which psychologists work side by side with physicians in integrative care settings. Psychiatry will continue to wither away.

Le Roi est mort, vive le Roi!

 

[edieb]

Le Roi est mort, vive le Roi!

uh, how is psychiatry withering away? Unllike psychology, the demand for them, and consequently, their salaries are increasing. the same can't be said for psychologists.

 

[Neuropsych2be]

uh, how is psychiatry withering away? Unllike psychology, the demand for them, and consequently, their salaries are increasing. the same can't be said for psychologists.

Demand for psychiatrists remains high (especially for child psychiatrists) but the supply is becoming ever smaller. Medical school students continue to gravitate to other specialties. The irony is that the enormous advances in neuroscience have not translated into interest on the part of physicians in training to consider psychiatry.

The gaps are being filled by foreign medical school graduates who are unable to be boarded in the specialty they trained in overseas so they become psychiatrists. Such persons may not be fluent enough in American English to do psychotherapy, and the cultural gap may be enormous, but they can prescribe psychotropics so they get hired into residency programs that are desperate to fill training slots.

I work in public mental health in the Appalachian South where even Yankees have trouble understanding the local culture and dialect. Imagine how effective a psychiatrist trained in another culture, with very different values, where English is not the native language would be in this region? I can't recall the last time I met a psychiatrist who was born and raised in North America with English as their native language who was initially trained as a psychiatrist rather than another medical specialty. Cultural familiarity and competency and linguistic proficiency are central to all medical practice but they are especially acutely needed in psychiatry. I recall a non-western psychiatrist being somewhat baffled as to why a woman who was beaten by her spouse would be depressed. In this person's patriarchal culture, this was regarded as normal.

 

[loveoforganic]

Pretty sure psychiatry is on an upward swing as far as competivity... And as a counter-anecdote, 4 of the 5 psychiatrists that I know of in my hometown are natives

 

[Jegg]

We will all have chips implanted in different areas of our brain to facilitate brain functioning. One of those chips will be a therapist chip (it will stimulate self-affirmation memories in the hippocampus), which will only kick in when the psychiatrist chip (the neuromodulator chip) malfunctions.

 

[Jegg]

In 100 years, Jung will be all the rage. The next big thing is interplanetary cultural psychology. And we'll have developed our sixth sense, well some will have more than others, so crystal balls and seances will be in direct competition with psychiatric meds. Lots of human factors research potential in these directions (will crystal balls work in zero-gravity?). What a beautiful world it will be...

Planalytic theory?

 

[deadmau5]

At the risk of getting my head bit off, I couldn't agree with you more.

I see clinical psychology evolving into a primary care profession in which psychologists work side by side with physicians in integrative care settings. Psychiatry will continue to wither away.

oooo... agreement! and this is not to say that I am against prescribing or that I'm 100% behind only psychotherapies. I am for prescription authority as long as there is a some sort of course and training involved for it. I just think that psychologists will continuously be taking over the jobs of psychiatrists and it only makes sense for this to be allowed to happen.

 

[LGPsychology]

EMDR has NOT been shown to be helpful AT ALL for PTSD.

 

[LGPsychology]

Or anything for that matter.

 

[somedude14]

Pretty sure psychiatry is on an upward swing as far as competivity... And as a counter-anecdote, 4 of the 5 psychiatrists that I know of in my hometown are natives

Yes, I would bet on psychiatry outlasting psychology overtime. People will continue to take tons of drugs and child medication will become common. Everyone will want to have their kid start off as perfect as possible and not have to worry about disciplining them.

 

[Buzzwordsoldier]

Planalytic theory?

Oooooh, SWEET......trademark that one, quicK!

 

[aequitasveritas]

The monad of irreducible choice will once again be introjected into the human condition and we will hold people accountable for their lives, for supporting themselves, and for upholding civility in social convention

 

[DrGachet]

I'm not sure if I need to start another thread but I like to hear your views on the future of clinical social work. In particular at the masters level. Presently clinical social work has many advantages over masters in clinical psychology but as things change and managed care takes over, there would more and more masters level clinicians providing therapy. I don't know what's in store for social work however.