Clinical psychology in early 21st century Aotearoa/New Zealand: Introduction to the special issue

New Zealand Journal of Psychology, Dec 2002 by Evans, Ian M

Clinical psychology is a thriving, rapidly evolving, professional and scientific discipline in Aotearoa/ New Zealand. There are 6 postgraduate clinical psychology training programmes conducted by the psychology departments of the major "older" universities of Otago, Canterbury, Victoria, Massey (Palmerston North, Albany, and Wellington campuses), Waikato, and Auckland. Each programme is highly selective, having many more applicants than can be accepted, and graduation rates are high. The academic staff of the university programmes and the many experienced clinicians involved in training as supervisors and mentors, together represent a pool of highly qualified scholarly talent (McMillan, Evans, Cowie, Lala, Williams, & O'Flaherty, 2001). As practitioners, clinical psychologists belong to either or both of the very active professional organisations: the New Zealand College of Clinical Psychologists, and the Institute of Clinical Psychology of the New Zealand Psychological Society. There remains, however, a serious shortage of qualified clinical psychologists to fill available posts throughout the country.

Clinical psychologists are employed in all areas of the mental health service, predominantly in outpatient clinics or specialty treatment programmes (for instance, eating disorders, or drug addiction), but also in hospital settings (psychiatric inpatient). Health contexts include programmes ranging from high-risk infants to the needs of the elderly, as well as in general medicine, such as pain and stress management, health maintenance, and disease prevention. Clinical psychologists play a vital role in the Department of Corrections (Psychological Service), contribute to assessment and treatment in the Department of Child, Youth and Family, work in Special Education (a group service now within the Ministry of Education) and in various organisations supporting people with developmental (intellectual) and other disabilities, especially rehabilitation for individuals with brain injuries and other neurological disorders. Clinical neuropsychology is a recognised specialty practice field in New Zealand. And, of course, there is a significant number of clinical psychologists in independent practice, who see clients with a wide range of interpersonal, family, and relationship problems.

The purpose of this Special Issue of the New Zealand Journal of Psychology is to provide something of a snapshot of the fascinating range of activities of clinical psychologists. The goal was to offer a picture of the kinds of work and concerns that currently engage the attention of clinical psychologists in this country. The original call for papers was an open invitation to talk about clinical work from a variety of perspectives, whether case studies, formal research, theory, or ethical and practical issues. I had little control over the material received and its representativeness, and as a result we have an eclectic mix of papers that does not comprehensively sample the variety of clinical work that is taking place. Nevertheless the following articles provide an interesting potpourri of positions and approaches that are shaping our discipline.

It is widely accepted in New Zealand that clinical training and practice must be evidence based and solidly grounded in the scientist-practitioner (or perhaps scholar-practitioner) paradigm. Our clinical students complete a major piece of research and will typically have a good background in measurement methodology and research design. The paper by Nick Wilson and myself, is an example of a basic research study that examines processes which may underlie a clinical disorder and thus has relevance to the design of innovative interventions. More and more students are opting to complete a PhD as part of their clinical training-across the country somewhere between a third and half of clinical trainees or very recent graduates are now pursuing this path. The University of Auckland has formalised the expectation of doctoral-level training by being the first programme to launch the Doctor of Clinical Psychology degree as a substitute for the traditional New Zealand qualification of the Master's plus the Postgraduate Diploma in Clinical Psychology.

Ideally, basic clinical research and evidence based practice inform each other. An assumption of the scientist-practitioner model is that by understanding underlying processes of psychopathology, such as reward dominance in children, interventions can be designed rationally and then evaluated. Sarah Calvert and Sue Lightfoot describe this process, calling it an Action Research approach to individual case study. They derive complex treatment strategies from the important developmental principles of attachment and "theory of mind". Sue Jackson, on the other hand, addresses issues confronting typical (not clinically referred) high school students, who nevertheless report a high incidence of highly distressing relationship experiences.

With clinical psychologists' broad training in research methods, there is excellent opportunity to contribute to the evaluation of programmes and services in which they are involved, or to develop new, evidence-based innovations. A good example of evaluating an on-going programme is provided by Kirsten Van Kessel, Ian Lambie, and Malcolm Stewart, who report the effectiveness of brief, planned hospital admission strategies in terms dear to any manager's heart; their dependent variable being reduction in hospitalisation usage.