Tag: psychology

License to……

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Every two years around this time I am busy completing my Continuing Education Units (CEUs) so I can renew my license as a psychologist. I have done this every biennium since 1980, even though I retired from practice 17 years ago. In Florida, the license is both a practice and title act…to represent myself to the public as a psychologist, I need to be licensed. This was the first year I have even vaguely questioned why I continue to do so.

The decision to renew has usually been an easy one for me to make even though I do not practice and have no plan to return to work as a psychologist. I have a strong identification as a psychologist. I knew since early high school that I wanted a Ph.D. in clinical psychology; I always wanted to practice independently.

Even when we decided to relocate to central Florida and I took the opportunity to close my practice and work with SOS full time, I never considered dropping my license. After all, we have always told you that we provide software by psychologists for psychologists (and all other behavioral health providers). And anyway, who knows what time and politics will bring!

Usually my reading is a way to meet my CEU requirements and keep up with the clinical side of psychology. This year I was surprised; two of the articles I read this weekend were actually quite interesting to me; they were articles on personal or life coaching and Positive Psychology. Both of these areas have roots in the personal growth and Humanistic Psychology movements of the 1970’s, but are 21st century, mainstream ways of implementing growth-oriented interventions.

As the healthcare arena changes over the course of the next few years, it is highly likely that some organizations will seek to provide pure healthcare services. Others will choose to diversify their services in a variety of ways…and even to provide their services in unique fashion. Open Minds recently discussed both telehealth delivery of services and the use of virtual reality interventions to treat certain problems.

What new kinds of therapy has your organization considered? Do you continue to provide the same services you have always performed, or are you on the lookout for ways to diversify? What criteria do you use to decide if a particular service or technique should be added to your bag of tricks?

Please share your comments. We would love to know how you expand the services your organization provides. Just enter your comment in the box below. If you do not see a box, click on the title of the article and scroll down to the comment box. Thanks for reading!

The Day the Earth Stood Still: Humans & our planet

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Note: This article is my once-in-a-while exploration of human behavior and climate change. While it is in no way related to health care, it may be directly related to health.

Last weekend, we watched the critically unacclaimed remake of The Day the Earth Stood Still starring Keanu Reeves. While the movie left a great deal to be desired, it reminded me of the ongoing issue of human behavior and how we affect our world. This particular movie ends on a hopeful yet doubtful note that we will be able to change our behavior in time to keep climate change from destroying our species.

The American Psychological Association’s Climate Change Task Force Report has now been published in a nice booklet format. I am hopeful that the shorter, more attractive read will make the report accessible to more readers.

Section 2 of the report discusses the human behavioral contributions to climate change along with psychological and contextual components of the contributions. As is frequent in reports and studies by psychologists, ethical concerns are high on the list of issues to be considered. Since population growth and consumption of raw materials to manufacture those things which increase our perception of quality of life are two factors documented to contribute to the manner by which humans impact climate change, how we address population growth and consumption is crucial. Expecting developing nations to forego growth and consumption while the developed countries (like us) continue to consume is blatantly unjust. Many argue that expecting the developing world to forego growth is unjust even if we were to completely alter our own patterns of consumption.

Demographers have developed formulae to demonstrate the effect humans have on the environment. The basic

and widely known formula from the 1970s is I = PxAxT where I = Impact, P = Population, A = Affluence per capita and T = Technology. (APA Climate Change booklet, p 30, from Ehrlich & Holdren, 1971; Commoner, 1972; Holdren & Ehrlich, 1974)

Newer models take into account that countries with the highest per capita Gross Domestic Product plus intense consumption of goods and services requiring greenhouse gas production (environmental consumption) produce the most emissions and therefore the greatest environmental impact. These models are lovely ways to show in graphical form the impact of our reproductive and consumption choices. They do not, however, in any way address the variety of factors that contribute to growth in population (for example , individual and cultural religious beliefs; gender role beliefs; beliefs about individual vs. government control of reproduction; norms about when to start having children and how many to have; infant mortality; availability of food resources; and longevity. Population growth is a very complex phenomenon).

Consumption is an even more complex set of events and requires equally complex analysis. Each consumption behavior is multifactorially determined and requires analysis at different levels including institutional, sociocultural and physical environment context, individual factors such as demographics and psychological drivers, consumption of economic resources, consumption of environmental resources, greenhouse gases produced and emitted, and specific climate change.

The APA report discusses the need to separate consumption behaviors so we can determine which have the greatest impact on climate change. To spend significant resources researching behaviors with minimal impact will not be cost effective. To spend our time and energy learning about and affecting behaviors which have the most direct and largest impact on climate will be the best expenditure of psychological expertise.

While this report assesses what psychologists and the behavioral science community can do to impact climate change, the booklet is an articulate and readable explication of human behavior and climate change.

The question I have asked you before and will ask you again is the following: should we just sit helplessly by while the world (and our climate) changes around us, or should we learn what each of us can do in our individual and organizational lives to affect that change? What do you think?

Psychology & Climate change: Risk perception

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Note: This article is my once-in-a-while exploration of human behavior and climate change. While it is in no way related to health care, it may be directly related to health.

The cold temperatures across the nation this week have had some individuals scoffing at the notion of global warming. On the other hand, most scientists explain that extremes of weather are part of the whole pattern of global warming; these freezing temperatures are the other side of the extreme heat we experienced this summer and fall.

The American Psychological Association’s (APA) report on global climate change is a thorough examination of our current understanding of human attitudes, emotions and behavior relevant to climate change. Whether or not you have seen the movie “An Inconvenient Truth“, you might benefit from reading the introductory section (pages 24-30) of the APA report which does an excellent job of reviewing the background of the intersection of human systems and earth systems, and how human behavior impacts earth systems.

Section 1 of the report explores how people understand the risks presented by climate change. One of the primary challenges in changing behavior is to understand the perspective of the person whose behavior we are trying to change. Any psychotherapist worth his or her salt will tell you that a good assessment of the individual with whom one is proposing to work is essential to effective therapy. The nature of the assessment is less important than its outcome…an understanding of the experiences and motivations of the potential consumer of services, along with a sense of their strengths and limitations.  The beliefs and points of view of that person, about their problems and about their power to impact those problems, is crucial in designing a treatment plan.

So before we design a climate behavior treatment plan for our families, our neighbors and our communities, we must understand how they perceive the potential risks of global climate change. Psychological research leads us to believe that the impacts of distant or rare events tend to be underestimated. From pages 6 and 7 of the APA report, we learn that

…small probability events tend to be underestimated in decisions based on personal experience, unless they have recently occurred, in which case they are vastly overestimated. Many think of climate change risks (and thus of the benefits of mitigating them) as both considerably uncertain and also as being mostly in the future and geographically distant, all factors that lead people to discount them. The costs of mitigation, on the other hand, will be incurred with certainty in the present or near future…. Yet, emotional reactions to climate change risks are likely to be conflicted and muted because climate change can be seen as a natural process and global environmental systems perceived as beyond the control of individuals, communities, and quite possibly, science and technology.

Accordingly, when we communicate about the potential risks to humans of global climate change, we must recognize that different human responses will result based upon the individual’s perception of the risk to them and theirs posed by climate change. If the risk is seen as low and completely outside their control, no change to current behavior will occur. Even if the danger is seen as high, if it is seen as outside the ability of the individual to have an impact, there will still be no change in behavior.

Based on this understanding of how people behave in the face of risk, we must assure that our interventions allow people to experience a sense of efficacy and empowerment. We need to believe that the things we are doing to affect climate change can possibly have the effect we seek. Without such a belief, we will not likely take action.

For most of us, the source of information about climate change has been media reports of the observations of climate scientists. Few of us have personally seen melting glaciers or arctic ice. Psychological research on risk communication is important in this regard. What is the most effective way to communicate about climate change to inform individuals and communities and to empower them to take action? Just how should we be communicating the reports and projections of climate scientists to maximize change in human behavior? Will we be successful in enlisting the media as educators rather than as sensationalists or naysayers?

The summary of section 1 of the APA report (p 48-49) clearly states these issues.

Feeling (or not feeling) vulnerable and at risk in the face of climate change seems to be instrumental in moving (or not moving) people to action (see section 4), and thus the sources of these feelings are in need of further study. Research in cognitive psychology suggests that certain perceived characteristics of climate change (e.g., that it is “natural,” not new, and in principle controllable) may lead citizens as well as policy makers to underestimate the magnitude of the risks. Other psychological research provides additional hypotheses related to emotional reactions to climate change such that the absence of feeling at risk may be a psychodynamic reaction (see section 3), the result of psychic numbing or denial in the face of overwhelming and uncontrollable risk (see section 4 and 5). These explanations are not necessarily mutually exclusive, though sometimes contradictory in elements of their hypotheses (e.g., is climate change seen as a controllable or uncontrollable risk?). Such contradictions need to be resolved by empirical investigations.

The ability of different educational interventions in shaping perceptions, attitudes, and action related to climate change should also be a topic of empirical research (see section 6). Existing knowledge about the relative impact of direct personal experience vs. more abstract statistical information on the perceptions of risk in domains like financial decisions or with the relative effectiveness of emotional vs. analytic processes in prompting protective action can guide the design of different educational interventions about likely climate change scenarios and their repercussions and about the pros and cons of different courses of adaptation to climate change and/or mitigation of greenhouse gas emissions.

If you have not yet taken a look at the APA report, you should do so. Set aside some time to focus on the issues facing us as behavioral and psychological experts, then share your perspectives here. To enter your comments, just click on the title of this article and type in the box at the bottom of the post.

Evidence Based Treatment and Psychology

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As a psychologist trained 30 years ago in a Boulder-model scientist practitioner training program in clinical psychology, the ability to critically evaluate research and to determine its application to the treatment of my patients was an essential part of my practice and of my outlook on clinical psychology. That initial training fed my early interest in Cognitive Behavioral Therapy. I still have vivid recollection of attendance at my first two-day workshop conducted by Jeff Young (Jeffrey E. Young, Ph.D.) on Beck-style Cognitive Therapy of Depression, a workshop that had profound impact on the treatment I provided. Even my later identification as a Feminist Therapist and my questioning of programmed, patriarchal methods that elevated the therapist above the patient was always tempered by the need to use the scientific method in my practice and in my life. (I’ll credit George Kelly’s ‘man, the scientist’ and Franz Epting, Ph.D. for that.)

As I have mentioned previously, I have been retired from active practice since 1993. Imagine my surprise to learn this past November that clinical psychologists value their own experience and the guidance of their colleagues more than they do the dictates of science. In fact, according to the authors of Current Status and Future Prospects of Clinical Psychology: Toward a Scientifically Principled Approach to Mental and Behavioral Health Care by Timothy B. Baker, Richard M. McFall, and Varda Shoham, some clinical psychology training programs are downright anti-scientific. They believe the solution to this ‘problem’ is a new system of accreditation for training programs. NPR’s Science Friday aired an episode on this topic on December 4, 2009. The show, entitled The Science of Clinical Psychology, is a quick way to get a sense of the much longer paper.

This paper and the PR blitz surrounding it including an article in The Washington Post by the authors, has received strong reaction from practicing psychologists, directors of training programs in clinical psychology and divisions of the American Psychological Association (APA).

While some would describe the Baker, McFall, Shoham article as politically motivated and an attempt to wrest accreditation away from the APA, it seems to me that focusing in a defensive fashion on political motivations accomplishes little. Perpetuation of the ad hominem arguments used in the paper will not get us very far. Perhaps we should focus instead on the notion of scientific support for mental health and behavioral treatments, how clinical research might be encouraged, how evidence-based treatments (EBTs) might be most effectively promulgated, and whether psychologists are alone in their hesitance to adopt EBTs.

In his December editorial in Current Psychiatry Online, Henry A. Nasrallah, M.D. suggests that psychiatrists also could benefit from self-evaluation regarding their use of EBTs. Below is an excerpt from Dr. Nasrallah’s article:

PSYCHIATRISTS’ TRACK RECORD

 The Schizophrenia Patient Outcomes Research Team5 assessed how the treatment of 719 patients with schizophrenia conformed to 12 evidence-based treatment recommendations. Overall, <50% of treatments conformed to the recommendations, with higher conformance rates seen for rural than urban patients and for Caucasian patients than minorities.

A study using data from the National Comorbidity Survey6 found that only 40% of respondents with serious psychiatric disorders had received treatment in the previous 12 months, and only 15% received care considered at least minimally adequate. Four predictors of not receiving minimally adequate treatment included being a young adult or African-American, living in the South, suffering from a psychotic disorder, and being treated by physicians other than psychiatrists.

Finally, a recent survey of psychiatrists’ adherence to evidence-based antipsychotic treatment in schizophrenia7 showed: 1) mid-career psychiatrists more adherent than early or late-career counterparts; 2) male psychiatrists more adherent than female; 3) those carrying a large workload of schizophrenia patients more likely to adhere to scientific literature.

It would appear that psychologists and psychiatrists all need a stronger push toward use of EBTs.

In the world of community behavioral health, Medicaid and Medicare are pushing providers of care to the chronically mentally ill toward use of EBTs. SAMHSA has an entire section of its web site dedicated to EBTs. SAMHSA’s National Registry of Evidence-based Programs and Practices (NREPP) contains a searchable database of interventions for the prevention and treatment of mental and substance use disorders. The database currently contains 150 entries along with a method for submitting programs for review and inclusion in the database. The NREPP has the potential for becoming a clearinghouse for effective behavioral health treatment interventions.

How does your organization approach the issue of evidence-based treatments? What is your take on the current controversy in the field of clinical psychology? How do you imagine we ought to move forward in advancing scientifically-tested approaches to mental health treatment? Given the costs of health care, this seems like an extremely important issue for all providers of behavioral health services to address.

Please enter your comment by clicking on the title of the article and typing in the box at the bottom of the page.

APA & Climate Change: What psychology can do

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I sat down Monday morning to write this week’s blog post. I was intent upon writing about American Psychological Association’s (APA) recent report on climate change and what the psychology community can do about it. I had previously glanced at the executive summary of the report and was excited to learn what the entire report recommended. Unfortunately, I must have been a bit too tired when I started out in my reading. I was only on page three when my eyes glazed over.

I do have a history with APA; I have been a member for 30 years. I joined as soon as I was eligible after completing my Ph.D. In the early 1990’s I served on two different committees within APA—the Public Information Committee and the Committee for the Advancement of Professional Practice. I have read more than my share of scholarly papers and APA organizational documents. Since retiring from the practice of psychology in 1993 and moving to full-time involvement in the business of psychology billing and clinical record software, I have become more removed from scholarly work and more involved in the action orientation of the business world.

Psychology and Global Climate Change: Addressing a Multi-faceted Phenomenon and Set of Challenges, while perhaps intended to be a call to action, is actually a carefully written and documented organizational treatise on the psychological phenomena involved in this crisis, the psychological research and knowledge which are applicable to these events, and recommendations for the role APA as an organization and psychologists as professionals and individuals can and should play as this crisis unfolds. It is what I should have expected, but not what I hoped it would be.

In order to make this document useful, I believe it needs to be broken down into parts and digested in that fashion. Accordingly, over the next few months, I am going to take each section of the report and tell you about what is in that section. I hope this will have the result of helping us glean the recommendations of the APA and determining what constructive actions individual mental health professionals and behavioral health community organizations can take.

The APA Climate Change Task Force considered six questions:

  1. How do people understand the risks imposed by climate change?
  2. What are the human behavioral contributions to climate change and the psychological and contextual drivers of these contributions?
  3. What are the psychosocial impacts of climate change?
  4. How do people adapt to and cope with the perceived threat and unfolding impacts of climate change?
  5. Which psychological barriers limit climate change action?
  6. How can psychologists assist in limiting climate change?

In examining these questions, they reviewed the psychological literature to focus areas in which additional research might be useful and in which current data might enhance the work of climate scientists.  By way of this report, the task force attempted to create bridges between the climate science community and the psychological community.

It is also clear from these questions that the authors were considerably concerned about what the psychosocial effects of climate change might be. Since those of us who work with individuals, families and communities about various emotional and behavioral health concerns will undoubtedly need to address these impacts, it behooves us to be prepared…at least with knowledge.

Finally, the task force recommended that specialists in behavioral and psychological research adopt the following principles in an attempt to maximize the value and use of psychological principles in climate change work:

  1. Use the shared language and concepts of the climate research community where possible and explain differences in use of language between psychology and this community.
  2. Make connections to research and concepts from other social, engineering, and natural science fields.
  3. Present psychological insights in terms of missing pieces in climate change analysis.
  4. Present the contributions of psychology in relation [to] important challenges to climate change and climate response.
  5. Prioritize issues and behaviors recognized as important climate changes causes, consequences, or responses. 
  6. Be cognizant of the possibility that psychological phenomena are context dependent.
  7. Be explicit about whether psychological principles and best practices have been established in climate-relevant contexts.
  8. Be mindful of social disparities and ethical and justice issues that interface with climate change.

If climate change continues and has even some of the potential impacts that are predicted, mental health and behavioral specialists will be deluged with people caught in and reacting to those impacts. What can you and your organization do to prepare for addressing the fallout of some of these impacts? What would be the result of a Katrina-equivalent in your community? What knowledge and expertise do you need to gain?

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