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PubMed1978

The work of a clinical psychologist in primary care.

The data presented suggest that general practitioners would be likely to refer a large number of patients with diverse problems to clinical psychologists working in health centres. Compared with a centrally organized clinical psychology service, the work of the primary care psychologist is likely to offer the following advantages:1. Access to psychological help for patients with a need for such help, but who could not attend a central clinic owing to problems associated with travel, work, physical disability, or even a presenting problem such as agoraphobia.2. Greater continuity of care of patients.3. Increased communication between the psychologist and members of the primary care teams.4. Possibility of the psychologist seeing the patient earlier, before the problems have become entrenched.5. Less need for referral to other agencies.6. Reduced stigma for the patient.7. Development of new therapeutic approaches relevant to problems presenting in primary care.8. More flexible and more relevant therapy due to seeing the patients in their home setting.9. Greater therapeutic involvement of the patient's family.10. Reduced costs and inconvenience for the patient's family.11. Reduced administrative and ambulance service costs.While these points do not overcome the need for a formal evaluation of the work of psychologists in primary care, they do suggest that there are advantages in this type of service over the services which are currently available and that a full evaluation would be worth undertaking.

Adolescent↗

PubMed1979

Employment of master's-level psychologists.

Compared results from a survey of employment of Master's-level psychologists in the states of Michigan, Indiana, Ohio, and Kentucky to two previous studies recently published. It was found that results in all three studies are comparable; 87.6% of those mental health centers, state hospitals and other mental health organizations surveyed reported that they employ Master's-level psychologists. Duties of subdoctoral psychologists include testing, therapy, and community consultation. The finding that future Master's-level psychologists may find greater employment potential in towns with a population of less than 50,000 justifies future research in the area of Master's-level employment to consider demographic variables.

Community Mental Health Services↗

PubMed2006

Prescribing non-psychopharmacological agents: a new potential role for psychologists in primary care settings and specialty clinics.

At least 10 years have passed since the Department of Defense Psychopharmacology Demonstration Project graduated its first class of psychologists. All graduates of that program were credentialed to prescribe and the program received promising external reviews and audits. The profession has since moved well beyond the initial question, "Can and should psychologists prescribe?" posed over two decades ago. A number of professional schools and training institutions have implemented postdoctoral psychopharmacology training programs and over 20 states are actively pursuing legislative agendas. Given recent initiatives to provide health psychology services within the primary care arena, the authors introduce a new role in the scope of psychology's prescribing activities. They propose that psychopharmacological agents are not the only medications psychologists should be trained to prescribe and psychopharmacology training should include course work and supervision related to treatment within a primary care patient setting in addition to a traditional psychiatric one. The authors provide the rationale for primary care clinical health psychology training as the appropriate mechanism for psychopharmacology education and practice. Public health needs and epidemiological data provide the rationale for health psychologists additionally prescribing non-psychopharmacological agents.

Ambulatory Care↗

PubMed2004

A survey of psychologists' attitudes towards and utilization of exposure therapy for PTSD.

Although research supports the efficacy of exposure therapy for PTSD, some evidence suggests that exposure is under-utilized in general clinical practice. The purpose of this study was to assess licensed psychologists' use of imaginal exposure for PTSD and to investigate perceived barriers to its implementation. A total of 852 psychologists from three states were randomly selected and surveyed. An additional 50 members of a trauma special interest group of a national behavior therapy organization were also surveyed. The main survey results indicate that a large majority of licensed doctoral level psychologists do not report use of exposure therapy to treat patients with PTSD. Although approximately half of the main study sample reported that they were at least somewhat familiar with exposure for PTSD, only a small minority used it to treat PTSD in their clinical practice. Even among psychologists with strong interest and training in behavioral treatment for PTSD, exposure therapy is not completely accepted or widely used. Clinicians also appear to perceive a significant number of barriers to implementing exposure.

Attitude of Health Personnel↗

PubMed1989

Psychologists' involvement in cases of child maltreatment. Limits of role and expertise.

As psychologists have become increasingly involved in the investigatory and adjudicative phases of child maltreatment cases and as criminal prosecutions have become increasingly common in such cases, the ethical problems facing psychologists have become more acute. Psychologists involved in cases of child maltreatment should remember their primary duty to promote human dignity. In that regard, care must be taken to protect the rights of the various parties, assist the parties to make use of the legal process, and keep implicit or express promises, including those emanating from professional roles. Psychologists must be careful to avoid intruding into the province of legitimate decision-making authorities.

Child↗

PubMed1996

Comments on expanding the clinical role of psychologists.

The interest by psychologists in prescription privileges is welcome because it is a manifestation of the long overdue acknowledgement of the efficacy of medication for many mental disorders. The lack of national academic standards in psychology, however, poses a problem. Psychologists are certified in title only and are not licensed to perform any procedure, although there have been efforts to standardize the training of psychologists. Currently, states regulate the title, but no national educational standards exists. Therefore, psychologists are not able to claim they are a homogeneous patient care resource.

Curriculum↗

PubMed1997

Why psychologists should treat alcohol and drug problems.

Because of the prevalence of substance abuse in general clinical populations, it is important for psychologists to have knowledge and skill in this area. Psychologists also have special expertise to offer in the assessment and treatment of alcohol/drug problems. Current evidence indicates that (a) alcohol/drug problems generally obey ordinary behavioral principles and processes, (b) substance abuse frequently occurs within a broader cluster of psychological problems, (c) the treatment approaches most strongly supported by outcome research are fundamentally psychological in nature, (d) cognitive-behavioral principles are of demonstrable value in motivating change in alcohol/drug use, and (e) clinical skills and styles (e.g., empathy) commonly included in the training of psychologists are important determinants of favorable treatment outcomes with substance use disorders. These factors in the context of changing health care indicate that psychologists should play an increasing role in assessing and treating addictive behaviors.

Alcohol-Related Disorders↗

PubMed1992

Comparing the effectiveness of behavioral treatment for chemotherapy-induced nausea and vomiting when administered by oncologists, oncology nurses, and clinical psychologists.

Adequate control of side effects during medical treatment of cancer increases patient compliance and quality of life. Antiemetic drugs are not an effective treatment for the one in three cancer patients on chemotherapy who experience anticipatory nausea and vomiting (ANV); the behavioral treatment of systematic desensitization has been found effective for ANV when delivered by clinical psychologists. This study examined the effectiveness of systematic desensitization when delivered by medical personnel versus clinical psychologists. Seventy-two consecutive cancer patients with ANV were randomly assigned to no-treatment control or to systematic desensitization from 5 behaviorally trained clinical psychologists, 6 clinical oncologists, or 10 oncology nurses. The treatment was found effective in reducing anticipatory nausea, anticipatory vomiting, posttreatment nausea, and posttreatment vomiting compared to control patients, with no significant differences in effectiveness found between clinical psychologists and oncology staff. Although medical personnel should not engage patients in psychotherapy or other interventions that cannot be completed successfully, they can treat patients effectively with systematic desensitization and should be encouraged to learn and use this and other behavioral intervention techniques to benefit total patient care.

Behavior Therapy↗

PubMed1984

The physician perspective of health psychologists in medical settings.

In recent years psychology has defined for itself an expanding role in health care. Although more and more psychologists have gained entry into medical settings, evaluation efforts directed at assessing progress and obstacles have been extremely limited. The purpose of this study was to gather information from physicians regarding their level of knowledge, acceptance, and utilization of psychologists in hospital settings. Survey responses from 397 physicians to a 15 item paper and pencil questionnaire were analyzed according to medical specialty, type of practice, sex of physician, and number of years in practice. Overall, the findings were quite favorable toward psychologists though differences associated with physicians' age, sex, and specialty did emerge. Discussion of the findings included suggestions underlying the importance of evaluation efforts and methods of improving the future integration of health psychologists into health care organizations.

Adult↗

PubMed1994

Teaching psychologists and the new APA ethics code: do we fit in?

The new American Psychological Association (APA) ethics code (APA, 1992) creates dilemmas of both image and substance for teaching psychologists. Items specific to teaching psychologists reflect housekeeping matters of lesser importance and situations over which teaching psychologists have little control. Teachers of psychology are sometimes inappropriately grouped with other types of psychologists. Freedom of inquiry and communication are curtailed in ambiguous ways, and the standards expected of teachers in the academy are set a mediocre level. Although the new code contains some improvements over the previous code (APA, 1990)--especially in the areas of multiple relationships, prohibitions against sex with students, respect for differences among students, and authorship rights retained by students--numerous recommendations for future revision are strongly recommended.

Authorship↗

PubMed1987

A survey of psychologists' perspectives on catharsis.

A questionnaire assessing endorsement of the hostility catharsis hypothesis was developed and administered to 102 undergraduate students and 131 American and Canadian psychologists (randomly selected from 4 divisions of APA). Results indicated that students scored higher on endorsement of the catharsis hypothesis than did psychologists; females in general scored higher than males; psychologists not recently involved in research scored higher than psychologists who were so involved; and Freudian and Humanistic theorists scored higher than Behavioral theorists.

Abreaction↗

PubMed1999

Perceptions of the sport psychologist by female university athletes.

In this study we explored the existence of a favourable attitude towards sport psychologists by female athletes in relation to other sport-oriented and mental health professionals. Ninety female student athletes made judgements of similarity between 11 practitioner terms using the triad method. A rank-order task was also completed, where the 11 professionals were ranked on three expertise variables in sporting, mental and physical issues. The results were analysed using (1) the metric scaling procedure of correspondence analysis, (2) cultural consensus analysis and (3) PROperty FITting analysis. A two-dimensional solution provided the best interpretation of the similarity judgements. The correspondence analysis configuration positioned the sport psychologist centrally between a sport-oriented pair and the cluster of mental health professionals. Participants reported adequate consensus on all three expertise variables, which is consistent with the assumptions of Cultural Consensus Theory. Consistent with earlier research, the three variables were salient in the participants' similarity judgements of sport and mental health professionals. Our results suggest the existence of a more favourable perception of the sport psychologist and a distancing from a direct association with mental health practitioners. However, the centrality of the term may indicate a more cloudy distinction as to where the sport psychologist exists in relation to other professionals.

Adolescent↗

PubMed2003

Preparing psychologists to link systems of care in managing and preventing children's health problems.

OBJECTIVE: To describe the need for innovations in training to link health, educational, and family systems and to illustrate how this can be accomplished through child-oriented psychology training programs. METHODS: We describe multiple pathways for the preparation of child-oriented psychologists to link health, educational, and family systems, in keeping with the National Institute of Mental Health guidelines for preparing professionals in child and adolescent psychology. These pathways include training embedded in graduate programs specializing in clinical child, pediatric, school, community, and family psychology. This article highlights a training initiative for preparing child-oriented psychologists based in a school psychology program. RESULTS: A partnership between Lehigh University and The Children's Hospital of Philadelphia has been developed to prepare school psychologists to coordinate community-based systems of care to promote positive educational and health outcomes for children. This program emphasizes both intervention and prevention and provides a set of integrated experiences in both health care and educational settings. CONCLUSIONS: We highlight components of this program relevant to the preparation of pediatric psychologists. We identify and discuss potential challenges in establishing training programs for the preparation of professionals to link health, school, and family systems.

Child↗

PubMed2004

An investigation of inpatient referrals to a clinical psychologist in a hospice.

A clinical psychologist, in a new post in a hospice, developed an assessment, therapeutic and consultation role. A retrospective, diary-based audit was made of the inpatients referred during the first 2 years, allowing an examination of referral practices and changes over time as the psychologist's role developed. During the 2 years 11% of the hospice inpatients were referred, consistent with previous published work in this area. Referrals increased from 10% in year 1 to 12% in year 2. Referrals were not skewed in terms of patient gender or diagnosis but younger patients were referred more. Comparison with other studies suggests the psychologist's gender may influence referral rates of woman patients. Referrals for depression and anxiety increased in year 2 but decreased for pain. The number of patients seen with marital/family stresses also increased with time. Such patients required the most psychological input. Patients with problems of alcohol misuse or dementia were particularly challenging for the hospice team and specific training was developed. The psychologist's role is discussed in the light of these findings, particularly in enhancing the multidisciplinary team's holistic approach to the patient and their family, by emphasizing the patient's experience and the collaborative basis of care.

Adult↗

PubMed1994

Psychology, psychologists, and psychiatric epidemiology.

The purpose of this paper is to inquire into what interests psychologists might have in epidemiological approaches to the study of psychopathology, what psychologists have contributed in the past, and what they might be expected to contribute in the future. This inquiry starts with a consideration of epidemiological findings and issues that should command the interests of psychologists: differences between treated rates and untreated rates of psychiatric disorders, relations of psychiatric disorders to gender and socioeconomic status, and problems of case identification and diagnosis. My own experience with these issues and problems is discussed. An argument is made that there are important needs for the expertise of psychologists in psychiatric epidemiology and compelling reasons for them to enter the field in greater numbers than they have in the past.

Cross-Cultural Comparison↗

PubMed1992

Causal beliefs about depression in depressed patients, clinical psychologists and lay persons.

Non-depressed lay persons have been shown to have extensive and accurate knowledge about depression (Rippere, 1977, 1980 a, b, 1981 a) that is underpinned by a structure that resembles current academic theories of the disorder (Furnham & Kuyken, 1991). In this study a semi-structured interview schedule and a number of rating scales were used to determine and compare the nature and extent of depressed patients', clinical psychologists', and lay persons' beliefs about the causes of depression. We confirmed that depressed patients and non-depressed lay persons alike have relatively extensive beliefs about the causes of depression which are comparable to those held by clinical psychologists. However, depressed patients tend to endorse biological explanations of the causes of depression to a greater extent than clinical psychologists. In contrast, clinical psychologists assign a more important causal role to unconscious processes and childhood vulnerability factors than do either depressed patients or non-depressed lay controls.

Adjustment Disorders↗

PubMed2003

Inter-rater reliability of scales and tests used to measure mild cognitive impairment by general practitioners and psychologists.

BACKGROUND: This study was conducted to assess whether general practitioners (GPs) can be trained to use a simple battery of functional scales and neuropsychological tests to detect people likely to develop dementia as reliably as neuropsychologists in clinical practice. METHODS: Fifty GPs with medium-sized practices in the Bordeaux area of France were recruited by monitors and trained to use a battery of tests (Mini-Mental State Examination (MMSE), Isaacs Set Test (IST), Benton Visual Retention Test (BVRT) and Zazzo's Cancellation Test (ZCT)). Each GP was required to recruit one patient. The tests were administered first by the GP,and then by a trained psychologist. RESULTS: Overall, the GPs showed interest in participating in the study. They had no difficulty in recruiting patients according to the inclusion and exclusion criteria and none reported any difficulty in using the scales and tests battery. In total, 35 subjects were interviewed by both a trained GP and a psychologist. The scores obtained by the GPs and psychologists did not differ statistically for two of the four tests (IST, p = 0.6; BVRT, p = 0.7), but were statistically different for the other two tests (MMSE, p = 0.04; ZCT; p < 0.002). CONCLUSIONS: The results confirm the feasibility of conducting a study for detecting cognitive deficit in general practice. The GPs were interested and participated well, patient adherence was good, and the concordance correlation coefficients between the GPs' and psychologists' scores were satisfactory.

Activities of Daily Living↗

PubMed1985

Survey of the utilization of psychiatrists and psychologists for hospitalized children.

Although interest by psychiatrists and psychologists in consultation to pediatric settings has increased in the past few years, little is known about how frequently they have been involved in providing psychosocial services to hospitalized children. The authors distributed a 20-item questionnaire to 136 pediatricians and 12 head nurses, representing 22 hospitals throughout Washington State. The questionnaire was designed to assess the disciplines involved in providing psychosocial care, the availability of various personnel, teaching functions, funding of services, and perceived need for further services. The results showed that psychiatrists and psychologists were utilized least often in all settings. Respondents from 68% of the hospitals represented specifically requested more services from psychiatrists and psychologists trained in pediatric issues. The authors discuss possible reasons behind the underutilization of psychiatrists and psychologists.

Child↗