Self-assessment in clinical health psychology: a model for ethical expansion of practice

Society expects autonomous professions to ensure the competency of it practitioners, and professions should facilitate the continuing education and training of its members. Given the shift from psychology as a mental health profession to that of a health profession, the authors propose a self-assessment model for the individual practitioner to gauge his or her readiness to provide professional service in expanded areas of practice. This model could also be useful to the American Psychological Association, state psychological associations, and other purveyors of continuing education programs in systematically developing postgraduate experiences. A template for self-assessment that reflects well-accepted core domains of knowledge and skills is presented.     

The assessment of competency for execution: An overview

Competency for execution is a legal competency that is an integral part of the capital punishment process in the United States. With the rapidly increasing population under death sentence, the issue of competency for execution is likely to be raised with increasing frequency in the coming years. This creates some compelling ethical issues for the mental health professions. The questions of whether mental health professionals should provide assessment of competency for execution and, if so, how the assessment should be performed, are issues of immediate urgency.     

Trainees with Competence Problems in the Professionalism Domain

Increasingly, professionalism has been recognized as a core competency for health service professionals and is the domain in which vexing competence problems are observed in trainees. We begin by describing manifestations of problems of professionalism in accord with the values that fall within the rubric of this multifaceted construct. We provide an approach for evaluating problems of professionalism and discuss intervention for trainees with mild, moderate, or severe problems in this domain. We propose implications for training focused on enhancing the culture of programs; bolstering the education, guidance, and mentoring provided related to professionalism; and encouraging best practices for addressing trainees with problems of professionalism. We conclude by sharing ideas about defining professionalism, identifying problems of professionalism, strengthening our approach to assessing professionalism and intervening when problems are evident, developing strategies for preventing professionalism problems, and ensuring that psychologists take seriously their responsibility to address professionalism concerns with colleagues.     

Towards a Confucian Virtue Bioethics: Reframing Chinese Medical Ethics in a Market Economy

This essay addresses a moral and cultural challenge facing health care in the People’s Republic of China: the need to create an understanding of medical professionalism that recognizes the new economic realities of China and that can maintain the integrity of the medical profession. It examines the rich Confucian resources for bioethics and health care policy by focusing on the Confucian tradition’s account of how virtue and human flourishing are compatible with the pursuit of profit. It offers the Confucian account of the division of labor and the financial inequalities this produces with special attention to China’s socialist project of creating the profession of barefoot doctors as egalitarian peasant physicians and why this project failed. It then further develops the Confucian acknowledgement of the unequal value of different services and products and how this conflicts with the current system of payment to physicians which has led to the corruption of medical professionalism through illegal supplementary payments. It further gives an account the oblique intentionality of Confucian moral psychology that shows how virtuous persons can pursue benevolent actions while both foreseeing profit and avoiding defining their character by greed. This account of Confucian virtue offers the basis for a medical professionalism that can function morally within a robustly profit-oriented market economy. The paper concludes with a summary of the characteristics of Confucian medical professionalism and of how it places the profit motive within its account of virtue ethics.     

Historicizing the Role of Psychologists in the U.S. Military: Introduction to Issue on Coercive Interrogations and the Mental Health Profession

This special issue addresses the disturbing events that emerged in the aftermath of 9/11 in the United States with regard to the role of mental health professionals in coercive interrogations of detainees held in detention centers and military “black sites.” While other professional associations condemned such practices, the American Psychological Association maintained a position of collaboration, despite activist members' protests.

These events will be examined in an effort to reconstitute our history as a profession through the actions of what Freud called “nachtraeglichkeit’, (deferred action) in which the unassimilated experiences of the past relationship between psychology and the military will be used to transform our perceptions and future directions. This introduction also summarizes the papers in this issue. These include a history of the interrogation practices and the controversy within the APA; a history of the long-standing relationship between the profession of psychology and government, military, and intelligence organizations; analyses of the psychology of torture and evidence of how this psychology is manifested in the consulting room; a comparison of psychological structures within the population and mental health professions in the United States today and Argentina during recent totalitarian regimes; and an interview with Robert Lifton, eminent psychohistorian, psychiatrist and political activist.     

The Credentialing of Professional Psychologists and Its Implication for the Other Mental Health Disciplines

Professional psychology was the first mental health profession to challenge the preeminence of psychiatry and in so doing blazed the trail for clinical social workers, mental health counselors, marriage and family therapists, and addiction counselors. Social work has followed one decade behind psychology's footsteps, and the other rapidly emerging mental health professions are not too far behind social work. This article reviews the lessons learned by professional psychology when it adopted the strategy of statutory regulation, freedom of choice, control of its own training and of its national organization, and future strategies for Medicare and eventually for the enactment of universal health care. These lessons are important to the professions following psychology.     

A psychology of the human brain–gut–microbiome axis

In recent years, we have seen increasing research within neuroscience and biopsychology on the interactions between the brain, the gastrointestinal tract, the bacteria within the gastrointestinal tract, and the bidirectional relationship between these systems: the brain–gut–microbiome axis. Although research has demonstrated that the gut microbiota can impact upon cognition and a variety of stress‐related behaviours, including those relevant to anxiety and depression, we still do not know how this occurs. A deeper understanding of how psychological development as well as social and cultural factors impact upon the brain–gut–microbiome axis will contextualise the role of the axis in humans and inform psychological interventions that improve health within the brain–gut–microbiome axis. Interventions ostensibly aimed at ameliorating disorders in one part of the brain–gut–microbiome axis (e.g., psychotherapy for depression) may nonetheless impact upon other parts of the axis (e.g., microbiome composition and function), and functional gastrointestinal disorders such as irritable bowel syndrome represent a disorder of the axis, rather than an isolated problem either of psychology or of gastrointestinal function. The discipline of psychology needs to be cognisant of these interactions and can help to inform the future research agenda in this emerging field of research. In this review, we outline the role psychology has to play in understanding the brain–gut–microbiome axis, with a focus on human psychology and the use of research in laboratory animals to model human psychology.     

Forming State Collaborations to Diversify the Nation’s Health Workforce: The Experience of the Sullivan Alliance to Transform the Health Professions

Diversifying the nation’s health professions is essential in order to maintain a vigorous health workforce, able to respond to the needs of all Americans. The inability of the health workforce to keep pace with the changing demographics of the nation is a major cause of the persistent inequities in access to quality health care for ethnic and racial minorities in the U.S. Ethnic and racial minorities have been underrepresented in the genetic counseling profession since its inception, despite vigorous professional initiatives to remedy this situation. Mittman and Downs published a critical review of these initiatives detailing recommendations for change in this journal in 2008. One of their major recommendations was the need to learn from, and join, efforts with other health professions in seeking to increase professional diversity in genetic counseling. This paper reviews new findings on issues impacting health workforce diversity in the nation, presents a case study of a national best practice to diversify the health workforce and illuminates actions that can be taken by the genetic counseling profession. The Sullivan Alliance to Diversify the Health Professions is a culmination of two historic initiatives for addressing the dearth of minority health professionals and is a national catalyst for increasing diversity within the health professions by forging state collaborations among institutions of higher education, health professions schools and other key stakeholders.     

Public Health Ethics Education in a Competency-Based Curriculum: A Method of Programmatic Assessment

Public health ethics began to emerge in the 1990s as a development within bioethics. Public health ethics education has been implemented in schools of public health in recent years, and specific professionalism and ethics competencies were included in the Master of Public Health (MPH) competency set developed nationally and adapted by individual schools of public health around the country. The University of Texas School of Public Health approved the present set of MPH competencies in 2005. After 4 years of experience, we now report information measuring the extent to which “Professionalism and Ethics” competencies and subcompetencies are being met in the MPH degree program. To this end we have audited the MPH “Professionalism and Ethics” competency forms for FY2009 MPH graduates (n = 61). Eight courses, including required MPH core courses plus the practicum and culminating experience, were found to have substantial professionalism and ethics content. Further, 67.2% of graduates met eight or more of the 13 competencies and subcompetencies, but only 36.1% met all thirteen, indicating a need to identify topic areas to be added to, or enhanced in, the MPH curriculum. In addition, these findings will inform ongoing efforts to enhance ethics education in our health science center. Assessment of these competencies and subcompetencies is an essential step in strengthening ethics education at our institutions and in better preparing our graduates for a challenging future. We report our efforts here to demonstrate one way of carrying out programmatic assessment of ethics education in a school of public health.     

The Problem of Integrating Behavioral Health in the Medical Home and the Questions It Leads to

Psychology and other behavioral health professions have amassed a broad empirical and clinical literature suggesting many medical presentations are best responded to with the addition of evidence based behavioral interventions. Despite this, psychology has not achieved a regular presence as part of medical practice. We suggest specific reasons for the current state of affairs including clinical, operational, societal labels, financial and training dimensions. Medical, psychological, administrative, and financial perspectives are reviewed. If the goals of health care system reform are to be reached then we must identify and challenge the current limitations of health care. This paper will identify the elements that need to be changed in order for psychology to be integrated into medicine rather than excluded from its policy, planning and operations.     

Federal Funds to Train Clinical Psychologists for Work with Underserved Populations: The Bureau of Health Professions Graduate Psychology Education Grants Program

This paper describes the Bureau of Health Professions (BHPr) Graduate Psychology Education program (GPE), which supports projects that train health service psychologists for work with underserved populations. BHPr history and funding criteria are discussed, as are those of BHPr's parent organization, the Health Resources Service Administration. BHPr objectives and methods for support of clinical psychology training parallel those that BHPr has used to support training in other heath professions. The paper also describes three psychology internship training programs in academic medical settings that competed successfully for BHPr GPE funding in 2002. The three training projects differ significantly in training rotation sites, target populations with which trainees work, and the other health care professions that partner with psychology in interdisciplinary training—but they are similar in that each project provides an example of a program that effectively satisfied BHPr criteria for expanding psychology's scope of practice with underserved populations.     

Assessment of competency for execution: professional guidelines and an evaluation checklist

The issue of whether mental health professionals should be involved in conducting evaluations of competency for execution is a topic that has elicited controversy and heated debate. This article picks up at a point beyond the controversy and addresses issues of professionalism and the objective assessment of competency for execution. Specifically, this article identifies professional standards for conducting competence for execution (CFE) evaluations, describes current practices in this area, and provides an interview checklist that can be used as an evaluation guide by involved professionals.     

Reviewing psychologists' qualifications for career development practice in Australia

Vocational psychology and the practice of career development are important dimensions of the psychology discipline and profession. This paper contains an overview of Australian career development practice in light of recent trends, particularly the formalisation of career development practice among professions other than psychologists. Given the advent of professional standards for Australian career development practitioners, a review of postgraduate degrees in organisational, developmental and educational, and counselling psychology was conducted to determine their correspondence with the competencies presented in the Standards. The review found significant consistency with generic competencies. Degrees in organisational psychology provided the broadest correspondence, while degrees in counselling, developmental and educational psychology had lower levels of correspondence on specific competencies. The implications of the review are discussed in light of the evolution of the career development industry and psychologists' standing in this field.     

“The Thing Happened as He Wished”: Recovering an American Indian Cultural Psychology

One of the chief questions confronting mental health professionals who serve American Indian communities is how best to offer genuinely helpful services that do not simultaneously and surreptitiously reproduce colonial power relations. To ensure that counselors and therapists do not engage in psy‐colonization, it is crucial to recognize the sometimes divergent cultural foundations of mental distress, disorder, and well‐being in “Indian Country.” In this article, I will consider four excerpts from a research interview undertaken among my own people, the Aaniiih Gros Ventres of north‐central Montana. At a superficial level, these excerpts seem to reinforce reigning sensibilities that are readily familiar within the mental health professions. And yet, closer analysis of these interview excerpts reveals several tantalizing facets of an indigenous cultural psychology that may well continue to shape life and experience among tribal members in this setting. I recover this distinctive cultural psychology through archival representations of cultural and community life, including analysis of an important tribal myth. This analysis makes possible an alterNative interpretation of these interview excerpts, grounded in an aboriginal cosmology, that yields important implications for conceiving a more inclusive knowledge base for psychology that only robust community engagement can reveal.     

Legal and psychological perspectives on children’s competence to testify in court

Young children are often called as witnesses to crimes they were victims of or observed. Because of their immaturity, child witnesses are sometimes more heavily scrutinized than adult witnesses before being allowed to testify in court, for example, through competency screening. This review discusses the psychology and US law relevant to decisions about children’s testimonial competency. Legally, a child is competent to provide in-court testimony if the presiding judge finds that the child can understand and answer basic interview questions, observe and recall pertinent events, understand the difference between truths and lies, and be affected by the moral obligation to tell the truth on the stand. We review the legal foundation and current practice of testimonial competence standards and discuss issues in the current system. We then review developmental psychology literature on children’s capabilities and individual differences in each domain of testimonial competency as well as the limited body of literature on competency exams. Finally, we make empirically-based recommendations and conclusions and highlight the need for further research and policy reforms related to children’s testimonial abilities.     

Practice Guidelines in school psychology: Issues and directions for evidence-based interventions in practice and training

Practice Guidelines have become increasingly popular at the national and international level. Practice Guidelines are a natural extension of the “evidence-based intervention” movement, and could be a mechanism to promote the use of evidence-based interventions within the field of school psychology practice and training. In this paper we review the use of Practice Guidelines in other fields and the promise and potential pitfalls associated with the development and application of Practice Guidelines within the field of school psychology. Recommendations for how to avert some of the difficulties faced by other disciplines in the development and application of Practice Guidelines are discussed. Suggestions for next steps in the profession and future research are noted.     

学校心理健康教育教师胜任力培养初探

学校中小学心理健康教育的效果与其教师的胜任力有关。心理健康教育教师胜任力特征可以概括为：职业理念与专业意识、职业人格特质、专业知识与技能等。要提高中小学校心理健康教育教师胜任力,应从胜任力特征分析角度出发,设计相关课程与活动传授心理健康知识与技能,并将内隐心理健康教育理念及其人格特质融合于其中。     

Empathy present and future

The empathy concept has central significance for social and personality psychology and in many other domains, including neuroscience, clinical/abnormal psychology, and the health professions. However, the current diversity in conceptual and operational definitions, and the promiscuous use of the term “empathy,” threaten the ability of researchers to advance the field. The present article provides a quantitative review and conceptual analysis of empathy definitions and usages by examining 393 studies published between 2001 and 2013, and 96 studies published in 2017. We document the prevalence and diversity of definitions, as well as inconsistencies between conceptual definitions and measurements employed. We discuss ways to refine the conceptualization and operationalization of the empathy construct, including for many purposes, bypassing the term empathy in favor of lower-level construct labels that more precisely describe what is actually being measured. In many cases we see no added theoretical or empirical value in applying the term empathy.