Psychoanalytic training experience and postgraduate professional development – Part II

This exploratory study looks at the training and postgraduate experience of the 2008–2014 graduates of the Chicago Institute for Psychoanalysis. It follows our former study of all living graduates through the year 2007 (Schneider et al., 2014). The survey developed and used in the first study, with a few additional questions added to increase our understanding of the training experience, was sent to 38 graduates with a return rate of 58%. As with the first survey, graduates were invited to assess, among other training experiences, their training analysis, classroom work, and supervision, and to tell of their post‐graduation involvement in teaching, supervising, study groups and other professional endeavors. They were also asked to rate their satisfaction with themselves as psychoanalysts and with their analytic career. The questions added to the previous survey related to the graduates’ theoretical orientation, the influence on their training experiences of the change in gender distribution, and of the diversity of professions now represented in the analytic training program. They were also encouraged to provide spontaneous narrative data. The data from our second survey showed important differences when compared with our first. In the first survey male respondents were in the majority; in the second, women held the majority. Of the professions represented in the training program, psychiatry was the majority in the first survey, psychology and social work held the majority in the second. Most respondents claimed an object‐relation theoretical orientation. Analytic immersion continues to decrease, with most respondents having two patients at the time of graduation and one at the time of the survey.     

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 new role for psychologists--hospital ethics committees

Over the past decade psychology has begun to appreciate that it represents more than "merely mental health care" and has become increasingly involved in the generic health care arena. The participation of psychologists in Hospital Ethics Committees (HECs) is presented as a professional activity for which psychologists are particularly well suited. The clinical mission of HECs, the historical importance of ethical considerations to psychology, and the field's specific training and psycho-social expertise suggest valuable contributions that psychologists can make in this particular area. Further, as psychology actively increases its participation in HECs, other professional disciplines outside of the mental health field will systematically have the opportunity to become more familiar with psychology and its clinical and research expertise.     

Challenges to professional psychology education in the 21st century: response to Peterson

Professional psychology education faces many critical challenges brought about by the major changes occurring in the health care arena. This article shows that professional schools and programs have a good record of responding to these challenges and of taking proactive steps sponding to prepare their graduates for new health care roles and delivery systems. Data on admissions to psychology doctoral training programs demonstrate little support for the toral concerns raised by Donald R. Peterson (2003, this issue) about the preparation of students for graduate training in professional programs. Although quality concerns are important to investigate, such examination best resides with portant the American Psychological Association's Committee on Accreditation, which has the promotion of quality and excellence in professional psychology education and training as its major goal and responsibility.     

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.     

Job Opportunities/Issues for Health Care Psychologists: The Coming of the Millennium

Job opportunities for psychology for the next decade are being influenced by ongoing shifts in our economic system and resultant general employment practices. As with many burgeoning fields, psychology is experiencing increasing diversification into subspecialities. Professionals in other fields are acquiring supplementary degrees in psychology to heighten their psychological knowledge and professional/organization skills. Thus, psychology is beginning to be viewed, like the MBA, as an important professional degree for many fields, not just mental health or teaching. Training programs are reflecting these diversification trends. Further, as professional applications at the doctoral level expand, there is increasing need for the master's-level technical competence to support the increasing specialities at the doctoral level. These changes represent the creative response of a young and vigorous profession to the challenges of changing market dynamics.     

Broadening Mental Health Services to Disadvantaged Communities in South Africa: Reflections on Establishing a Community Based Internship

The need to provide mental health services in disadvantaged communities remains a priority in South Africa. This paper illustrates how in consultation and partnership with the peri-urban community of Jamestown, a counselling psychology internship was established to provide a range of mental health services at a primary health clinic. We describe how the internship also became an important catalyst for other community interventions. We also illustrate how values of community psychology informed the establishment and foci of the internship. Tensions encountered in reconciling community needs and professional training requirements discussed include the lack of resources at the primary health care level, the bio-medical bias of the primary health setting, and addressing the needs articulated by the community for more direct interventions.     

Psychology in Medical Settings in Thailand

This article explores the development of psychology as a profession in Thailand, its challenges, and future trends. There are currently very few Thai psychologists who are active in the medical fields in comparison to other health care professions. Being held back by limited education and training, many psychologists see their future career as less than promising. The lack of professional licensing standards and dominance of psychiatry further limit their career advancement. However, tremendous opportunities await those who persevere to expand their roles beyond the traditional assessment, treatment, and research models. A small number of them have ventured out into unexplored territories such as behavioral medicine, AIDS counseling, health promotion, and prevention of mental health problems. There is a strong potential for Thai psychologists to make significant contributions in these areas. It is clear that higher standards of education and more rigorous training are needed if this goal is to be realized in the near future.     

Postdoctoral Internships: Potential Adverse Impacts on Internships, Dissertations, and Trainees

Increased consideration of transforming the predoctoral psychology internship into a postdoctoral training experience has resulted from changes in the training and reimbursement for psychology trainees, concerns about employment of recent graduates, and the perceived limited status of psychology interns within health care settings. Whether this fundamental shift in psychology's training paradigm could resolve any of the problems that have led to its deliberation is not known. The authors identify problems with a postdoctoral internship which may be as thorny as the problems it is intended to ameliorate. It may have unintended adverse effects (e.g., risk of reduced quality in training and dissertations, new pressures on internship programs and trainees, increased licensure quandaries). Until a highly detailed proposal is developed and its full range of potential consequences are analyzed and debated, it is premature for professional organizations to conclude whether such fundamental change should be pursued.     

Ethical issues in exercise psychology

Exercise psychology encompasses the disciplines of psychiatry, clinical and counseling psychology, health promotion, and the movement sciences. This emerging field involves diverse mental health issues, theories, and general information related to physical activity and exercise. Numerous research investigations across the past 20 years have shown both physical and psychological benefits from physical activity and exercise. Exercise psychology offers many opportunities for growth while positively influencing the mental and physical health of individuals, communities, and society. However, the exercise psychology literature has not addressed ethical issues or dilemmas faced by mental health professionals providing exercise psychology services. This initial discussion of ethical issues in exercise psychology is an important step in continuing to move the field forward. Specifically, this article will address the emergence of exercise psychology and current health behaviors and offer an overview of ethics and ethical issues, education/training and professional competency, cultural and ethnic diversity, multiple-role relationships and conflicts of interest, dependency issues, confidentiality and recording keeping, and advertisement and self-promotion.     

Counselling Older Adults Living in Residential Aged Care Settings: Four Illustrative Case Studies

The role of psychologists and other mental health professionals in long‐term care settings is undefined in Australia. Graduate psychology students receive little training in clinical geropsychology, and residential aged care providers do not routinely employ psychologists within such settings. Further, despite high rates of depression, neurocognitive problems, and other mental health problems, residents are rarely referred for evidence‐based psychological treatment. This article presents four case studies showing how psychology services may be employed in such settings within the context of a postgraduate psychology placement programme. These case studies emphasise the importance of engagement, the use of flexible and individualised treatment approaches, and the involvement of family and professional carers in the provision of psychological services. Psychology services in residential settings can have a positive impact on the care of older adults and their families.     

Pediatric Psychology: Child Psychological Health in the Next Century

The future of pediatric psychology is reviewed and placed in brief historical context in relation to children's psychological health care. Contemporary trends affecting the delivery of psychological services, research, and clinical training are highlighted, with suggestions for future development. Pediatric psychology is a child-based, developmentally-focused multidisciplinary practice directed toward psychosocial and neuropsychological issues of health and illness in children and youth. Pediatric psychologists need to develop strong professional identities as health care psychologists combined with a collegial and collaborative arrangement with physicians to ensure the future growth and development of pediatric psychology in the next century as a major vehicle to promote children's health care.     

The affirmation of the scientist-practitioner. A look back at Boulder

In the aftermath of World War II, several influences were paramount in forcing academic psychology to recognize, albeit reluctantly, the coming professionalization of psychology. The federal government, wishing to avoid a repeat of blunders following World War I that led to significant dissatisfaction among veterans, took proactive steps to ensure that mental health needs of the new veterans would be met. The USPHS and the VA were mandated to expand significantly the pool of mental health practitioners, a direction that led not only to the funding of the Boulder conference but also to the development of APA's accreditation program, funded practical and internship arrangements with the VA, and the USPHS grants to academic departments for clinical training. The GI Bill, amended to include payment for graduate education, created tremendous interest in graduate programs in psychology. As a result, psychology programs were inundated with funded applicants, most of whom were interested in the application of psychology to clinical and other applied fields. Graduate psychology departments were mixed in their views of this "blessing." The reality of a separate curriculum for professional training in psychology was a bitter pill for some academic psychologists to swallow. Graduate departments feared that control of their programs would be taken over by external forces and that they would lose their right to determine their own curriculum. Further, they feared the domination of clinical training within their own departments and the effects of such educational emphasis on their traditional experimental programs. The Boulder conference brought together these disparate needs and concerns, although one can argue about how well some points of view were represented with respect to others. It was a time of high anticipation and fear. The conference could easily have ended in failure, with such diverse interests being unable to reach any consensus. There are many letters in the correspondence of committee members that suggest disagreements serious enough to prevent the development of any single model of training. Instead, by most yardsticks that one could apply, the conference succeeded, perhaps beyond the dreams of many of those in attendance who were most invested in a model for professional training. In evaluating the legacy of Boulder, several points are apparent. First, the conference succeeded because 73 individuals were able to agree to some 70 resolutions in 15 days, creating the scientist-practitioner model of professional training. Such consensus was arguably a remarkable achievement. The endorsement of the model by academic units followed with little evident resistance, although it is clear that some Boulder-model programs were developed that bore little resemblance to the model's insistence on significant training in both research and practice. Second, as a response to social and political needs, the conference was clearly a success. The cooperation of the APA, the USPHS, and the VA benefited all three entities. Clinical psychology was given the financial support and backing to advance it as a profession, and the federal government was able to begin the process of securing the personnel needed to address the mental health needs of the nation. The architects of Boulder were clear that their vision of training for professional psychology should be viewed as dynamic and experimental rather than fixed and prescribed. Certainly there are several variants of professional training extant today, yet the overwhelming majority of currently accredited programs in psychology label themselves as "Boulder-model" programs or "scientist-practitioner" programs. Still, new national conferences on professional training in psychology occur with some regularity as participants seek to resolve many of the same concerns debated by those at Boulder. The grand experiment goes on.     

Religion,psychology, and mental health: The problems of partnership

While a current and increasingly popular trend is toward partnerships between religion and psychology in the area of mental health, and especially toward the use of psychological ideas and techniques by pastoral counselors, modern psychology and traditional religion are divided in significant ways over several normative issues. Too often these issues are minimized or overlooked. But unless these issues—which carry significant sociocultural implications as well as implications for our definitions of individual well-being—are acknowledged and subjected to critical considerations, partnerships between religion and psychology must be far more cautiously constructed and must be subjected to far more systematic thinking about the differences which separate the two.This article is based on a paper delivered at the Seventh Annual Clinical-Community Conference on Psychology and Religion at the University of Maryland in November, 1978.     

Counseling Military Populations: A Content Analysis of Counseling Journals From 1998 to 2018

Mental health scholarship of military populations is largely guided by researchers in psychiatry and psychology. Recent advocacy efforts have created increased opportunities for professional counselors to serve military clients, but the research within the profession has yet to be explored. A content analysis of 23 professional counseling journals from June 1998 to June 2018 was conducted to determine military population research trends. Findings indicated that counselors are researching topics similar to those of other mental health fields, such as posttraumatic stress, but are contributing to those topics conceptually rather than empirically. Topical areas in which counselors do produce more empirical studies include career counseling, and these studies relied on college student veteran populations. Suggestions for incorporating the philosophical principles of counseling into future research are provided to inform the trajectory of military scholarship in the profession.     

Practicing psychology in the era of managed care. Implications for practice and training

Beginning with the HMO Act of 1973, managed care, a system for controlling health care costs, rapidly expanded and gained influence as the main vehicle for health care delivery in the United States. Implementation of managed care principles in the mental health arena has generated much debate, particularly with respect to issues of quality of care. The authors briefly trace the development of managed care and evaluate its impact on the practice of psychology. The extant literature is reviewed with specific attention to issues of quality of care, confidentiality of patient information, and shifting practice patterns of clinicians. Finally, the future of professional psychology within the context of managed care is examined, and the implications of newly created mental health roles for practitioners, training programs, and organized psychology are discussed.     

The Practice of Integrity for Mental Health Professionals

Summary

The focus of this article revolves around accuracy and honesty in the mental health field. Integrity, both professional and personal, is the foundation of all mental health professionals' functioning. Honesty, fairness, and respect for others are necessary ingredients to professional behavior. Mental health professionals avoid misleading other individuals with regard to professional training and other areas of expertise. In professional roles, they clarify as early as feasible the nature of the expectations and activities in which they are engaged.     

Teaching Clinical Psychology Trainees about Weight Bias

Abstract

As an assistant professor who teaches clinical psychology trainees about social aspects of behavior, I devote one week to the topic of weight bias. In this class, I rely on the research literature to challenge common myths about “obesity,” demonstrate the pervasiveness and harm of weight bias, and offer recommendations to trainees to apply to their own professional and personal lives. I encourage trainees to shift focus from weight and weight loss to health and well-being and to engage in self-reflection on the role of weight bias in their interactions with others. Here, I describe my weight bias seminar and outline common questions and my responses to them (e.g., Do you actually believe that “obese” people can be healthy?). Weight bias is a neglected topic in most clinical psychology training programs. Weight bias must be addressed in clinical psychology programs to produce culturally competent graduates who are aware of diversity issues.