The Australian Psychology Workforce 4: An analysis of psychologists in private practice providing Medicare‐funded services

There have always been independent private psychology practitioners in Australia, yet in the past payment of their services was largely by a user‐pays model. The introduction of Medicare Benefits for patients, under the Enhanced Primary Care program in 1999, and Better Access in Mental Health Care in 2006, along with Government‐funded mental health initiatives such as Better Outcomes in Mental Health Care introduced in 2001, has provided an alternative funding model for independent private psychological services. Introduction of these and other Government‐funded programs has raised questions about the responsiveness of the psychology workforce to meet the changing demands for psychological services created by these reforms. This study aimed to profile the characteristics of 3,587 independent private psychologists who provide services to clients under these schemes by analysing their responses to the Australian Psychology Workforce Survey. Of the 44% of psychologists completing the survey who indicated that they had a Medicare Provider Number, only 61% were in private practice as their main job. The remainder conducted services for Medicare‐funded clients as part of a private practice in a second job. The demographic characteristics, work roles, client groups and income of psychologists with Medicare provider numbers are reported.     

The state of the psychology health service provider workforce

Numerous efforts to describe the health service provider or clinical workforce in psychology have been conducted during the past 30 years. The American Psychological Association (APA) has studied trends in the doctoral education pathway and the resultant effects on the broader psychology workforce. During this period, the creation and growth of the PsyD degree and the formalization of the predoctoral internship placement system (the APPIC Match) have been well noted, but efforts to gain a complete understanding of professional practice are lacking. Specifically, piecemeal research on the provider workforce has led to the study of specific subpopulations using varying approaches and definitions of those providing direct clinical service. Consequently, estimates of the supply and need for health service providers are distinctly divergent and generate protracted debate in organized psychology. The APA membership directory and the APA Doctorate Employment Surveys have traditionally been relied on for workforce analyses. Yet, these data have become characterized by limited generalizability in recent years because of declining survey response rates and the fact that APA member data may not be as representative of the entire psychology health service provider population as they were previously. The 2008 APA Survey of Psychology Health Service Providers targeted these limitations by including nonmember psychologists in the sampling frame. Results revealed emerging themes in the demographics, work settings, and delivery of health services of the psychology health service provider workforce. Future areas of research for APA and organized psychology to undertake in addressing need and demand are suggested.     

The Australian Psychology Workforce 3: A national profile of psychologists in salaried employment or in independent private practice

A detailed analysis of the different sectors of the psychology workforce was conducted as part of the National Psychology Workforce Survey: Independent Private Practice (IPP), Employed in Public Sector (EPuS) and Employed in Private Sector (EPrS). A total of 11,897 psychologists responded to the workforce survey, a response rate of 48%. Of these 8,086 were fully registered and currently working in a psychology role. Sectors were compared on a range of practice characteristics and differences were explored using a series of ANOVAs and post‐hoc analyses. Results of analyses revealed qualitative differences between the three sectors. Strategies for maintaining the employed workforce were also collected and are reported to be as much about increasing work satisfaction and support for professional and development opportunities as about salary.     

An Investigation of Psychology Staffing in Australian Metropolitan Acute Public Hospitals

Psychology is one component of the multidisciplinary services provided to patients in acute public hospitals, with research demonstrating that psychological intervention significantly enhances clinical outcomes for patients across a range of health issues. Despite the increasingly important role that psychologists play in Australian hospitals, there remains a lack of information available about staff levels, discipline structures, and clinical activity for psychological services within acute hospital settings. The most recent Australian data about hospital‐based psychology services was collected 20 years ago. The current study provides updated information from a survey of 15 Australian metropolitan, acute public hospitals: presenting and critically reviewing staffing configurations and models of service delivery. Results suggest that: (a) hospitals employ a highly skilled workforce at a rate of 0.16 full‐time equivalent psychology staff for every 10 hospital beds; (b) psychologists have a viable career pathway within the hospital‐based health sector; (c) role diversity is common, with the primary focus varying as a function of position level; (d) neuropsychology staffing requires urgent attention to address significant delays in access to services; and (e) public hospitals actively contribute to current and future workforce development through supervision, research, and training. The implications of these results for the future of psychological services in Australian healthcare are discussed.     

Development and current status of counselling psychology in Taiwan

This article details the three stages of counselling psychology’s development in Taiwan, including pre-legislation, legislation and post-legislation. In pre-legislation stage, a brief historical review of the growth of counselling and guidance is introduced, which is the root of the contemporary counselling psychology. The process of the Psychology Act’s legislation is described in legislation stage and the relationships between counselling teachers and clinical psychologist are also discussed. In the post-legislation stage, the licensure system, training programmes, main professional organizations, work settings, and the major opportunities and challenges for the counselling psychology field are presented. In addition, the article refers to data from a national survey of 124 counselling psychologists to provide a profile of the counselling psychologists in Taiwan.     

Employment Characteristics and Salaries of Psychologists in United States Medical Schools: Past and Current Trends

In 1997 the Research Office of the American Psychological Association (APA) collaborated with the Association of Medical School Psychologists (AMSP) to conduct a comprehensive employment and salary survey of psychologists employed in medical schools and academic health centers. Questionnaires were mailed to 3894 psychologists; postcard reminders and a follow-up mailing to nonresponders resulted in a final 50% response rate. The questionnaire addressed appointment characteristics, department and school characteristics, employment activities, salary information, demographics, and changes in the medical school work environment that have occurred as a result of managed care. This survey, the 1997 Employment Characteristics and Salaries of Medical School Psychologists, is the most comprehensive analysis to date of the practice of psychology in U.S. schools of medicine and academic health centers. This article reports the most salient findings from this survey.     

How international is psychology?

Psychology claims to be an international discipline. This claim has been based upon subjective estimates of attendance at international congresses, status reports from selected countries published within edited volumes, and a survey of the member countries of the International Union of Psychological Science (IUPsyS) (Rosenzweig, 1992). However, to be truly international, the work of psychologists in countries around the world must be internationally disseminated. Systematic examination of international congress presentations and abstracts of published psychological literature indexed on widely available electronic databases (e.g., PsycLIT) provides a more objective means of documenting the international presence of psychology. In this article, counts by country were made of research contributions reported within PsycLIT and on the programs of International Congresses of Applied Psychology over the five years in which the congresses were held from 1982 to 1998. Analyses of these data revealed PsycLIT to be more international in scope than previously assumed—45% of its entries were by authors from outside the US. Coverage of research from developing countries was even more limited within PsycLIT (4.67%), but proportionally greater within international congresses (10%). PsycLIT entries not in the English language were found noticeably to have declined from approximately 12–14% levels in the 1980s to only about 6% in the 1990s. An index of the presence of psychology in each country, based upon presentations at IAAP congresses, memberships in international associations, and the extent of PsycLIT entries over the previous three decades, provided an objective, empirically‐based answer to the question ‘How International is Psychology?' This index indicated that psychology has a significant presence in 47 countries, a presence in another 22 countries, but minimal or no presence in 82 other countries. The meaning of these data for the discipline and ways in which psychology's worldwide presence might be strengthened and extended were discussed.     

Psychologists' perspectives on the diagnostic classification of mental disorders: Results from the WHO‐IUPsyS Global Survey

This study examined psychologists' views and practices regarding diagnostic classification systems for mental and behavioral disorders so as to inform the development of the ICD‐11 by the World Health Organization (WHO). WHO and the International Union of Psychological Science (IUPsyS) conducted a multilingual survey of 2155 psychologists from 23 countries, recruited through their national psychological associations. Sixty percent of global psychologists routinely used a formal classification system, with ICD‐10 used most frequently by 51% and DSM‐IV by 44%. Psychologists viewed informing treatment decisions and facilitating communication as the most important purposes of classification, and preferred flexible diagnostic guidelines to strict criteria. Clinicians favorably evaluated most diagnostic categories, but identified a number of problematic diagnoses. Substantial percentages reported problems with crosscultural applicability and cultural bias, especially among psychologists outside the USA and Europe. Findings underscore the priority of clinical utility and professional and cultural differences in international psychology. Implications for ICD‐11 development and dissemination are discussed.     

The Australian Psychology Workforce 2: A national profile of psychologists' education,training, specialist qualifications and continuous professional development

Objective data on the training profiles of Australian psychologists is scarce, despite important reforms across the higher education sector. This study aimed to profile Australian psychological training leading to registration. Universities, Registration Boards and registrants were profiled during 2008. Results revealed that there were 1063 postgraduate places a year across 34 university postgraduate training programs, with two thirds of places in clinical psychology. However, half of psychologists do not undertake postgraduate training, but undertake four years of university psychology followed by a 2 year internship (4+2) to make up the minimum standard for registration of 6 years training. Those with over 6 years of university training tended to work more in clinical, university or specialised areas of practice, whereas those with 4+2 were more likely to work in schools and general counselling. One quarter of psychologists are College members and 13% have doctoral qualifications. Analysis revealed a workforce that is actively engaged in ongoing professional development, supervision and further training. The profession has grown steadily in size by 6.24% per annum over the past 8 years and this presents a challenge for increasing the supply of postgraduate training places.     

Addressing the Supply of Psychologists in the Workforce: Is Focusing Principally on Demand Sound Economics?

The growth of the psychologist workforce offers greater human capital for delivering psychological services. Workforce expansion also may contribute to excessive services or psychologists' employment concerns. Our survey revealed that interns and Internship Directors perceive the supply and demand workforce imbalance as one of the most important problems, and possibly the most challenging problem, facing professional psychology in the next decade. Organized psychology has predominantly focused on options for approaching workforce imbalances by exploring avenues for increasing the demand for psychologists' services and broadening the scope of their professional activities. Additional attention to moderating the supply of psychologists and current training levels is perceived as an important and potentially more successful means of addressing imbalances between the workforce supply and the demand for psychologists' services. Internship directors were pessimistic about the impact of most of the resolutions of the 1997 Supply and Demand Conference in addressing workforce imbalances.     

Family therapy and clinical psychology

The results of a survey of 111 clinical psychologists in the Republic of Ireland along with some comparable data from US and UK surveys were used to address a series of questions about the link between family therapy and clinical psychology. Family therapy was not a clearly identifiable sub-specialty within clinical psychology in Ireland. Family therapy theoretical models were used by more than a quarter of the Irish sample to conceptualize their work but by less than a tenth of US and UK respondents. In all three countries about a tenth of treatment time was devoted to the practice of family therapy. In Ireland, the use of family systems models, family assessment interviews and family therapy was more common within the child and family specialty than within the mental handicap or adult mental health clinical psychology specialties. The experience of live supervision and participation in family or couples therapy were important formative factors in the development of some clinical psychologists. Further training in systemic consultation, particularly in situations where an abuse of power has occurred, was identified in the survey as a priority area for continuing professional development. The evolving relationship between family therapy and clinical psychology is discussed in the light of these findings.     

Theorizing Safety Informed Settings: Supporting Staff at Youth Residential Facilities

Each year approximately 48,000 youth are incarcerated in residential placement facilities (YRFs) in the United States. The limited existing literature addressing the workforce in these settings paints a complicated picture. The YRF workforce is highly motivated to work with legal system involved youth. However, YRF staff report high rates of burnout, job fatigue, and work‐related stress. The current paper proposes solutions to persistent problems faced by staff in these settings by integrating literature from criminology, organizational psychology, trauma‐informed care, and community psychology. In doing so, we highlight previously overlooked aspects of intervention for trauma‐organized settings and respond to recent calls for community psychologists to take a more active role in the adaptation of trauma‐informed care in community settings. We conclude by advancing three recommendations, drawn from setting‐level theory and inspired by the principles of trauma‐informed care, to transform YRFs.     

A global portrait of counselling psychologists’ characteristics,perspectives, and professional behaviors

Counseling psychologists in eight countries (Australia, Canada, New Zealand, South Africa, South Korea, Taiwan, the United Kingdom, and the United States) responded to survey questions that focused on their demographics as well as their professional identities, roles, settings, and activities. As well, they were asked about satisfaction with the specialty and the extent to which they endorsed 10 core counseling psychology values. This article reports those results, focusing both on areas in which there were between-country similarities as well as on those for which there were differences. These data provide a snapshot of counseling psychology globally and establish a foundation for the other articles in this special issue of the journal.     

A comparison of the personal values and operative goals of school psychologists and school superintendents

A survey of 96 school psychologists and 75 school superintendents throughout the state of Ohio showed the two groups to have generally similar personal value systems and to be in overall agreement in their respective rankings of school psychology goals. Both groups held the traditional school psychologist's goal of conducting individual testing to be lower relevance than acting as an internal consultant or resource person. Of those differences identified, superintendents assigned greater relevance to values which were consistent with their administrative concerns, while psychologists held values preferring individualism as more relevant. Superintendents held goals associated with increased learning efficiency and interacting with community agencies as more relevant, while psychologists assigned higher relevance to goals associated with parent-psychologist interactions.     

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.     

Comment on “The Self‐Care of Psychologists and Mental Health Professionals” (Dattilio, 2015)

Professor Frank Dattilio's article “The Self‐care of Psychologists and Mental Health Professionals” provides an overview of stress and related mental health problems among psychologists, and a proposition that psychologists are not vigilant in regard to self‐care. Dattilio offers a range of self‐care strategies and recommendations, and highlights self‐care practices within various psychology frameworks, and concludes with some “healthy tips” for managing stress. In my commentary I underscore Dattilio's message that self‐care is of critical importance in psychology practice, given the responsibility of caring for others inherent in the work psychologists undertake. However, I raise additional points of consideration and suggest an alternative approach to addressing the self‐care needs of the profession. My commentary makes the following points: (a) the need to distinguish between psychology trainees and practising qualified psychologists when addressing stress and self‐care requirements in the profession; (b) the importance of developing a culture of self‐care among psychologists by providing self‐care instruction during training; (c) the need to temper research findings on stress and mental health among psychologists by the methodological weakness of the studies in this area; (d) adhering to the recent call from colleagues to shift from a focus on pathology and punishment to a positive acceptance, mindfulness, and values‐based approach for encouraging self‐care among psychologists; (e) the use of a systematic framework for organising the presentation of self‐care strategies that makes them more accessible; and (f) an appeal to professional bodies to take their responsibility in promoting self‐care in the profession.     

Counselling psychology in New Zealand

This article offers a brief overview of the history of counselling psychology in New Zealand. It describes current postgraduate study options and registration pathways as well as the institutions and organisations that provide legislative and professional membership and support to counselling psychologists in New Zealand. Data collected from a national survey in 2014 provide insight into the demographics of the profession in New Zealand, the theoretical frameworks that are utilised and employment opportunities that exist for counselling psychologists. The article also highlights the uniqueness of a cultural and contextual approach that aligns itself with New Zealand’s founding document, the Treaty of Waitangi/te Tiriti o Waitangi which is based on the principles of partnership, participation and protection. It concludes with the challenges the profession face as a new scope of practice. These challenges include establishing a professional identity in the mental health delivery system in New Zealand and responding to an ever increasing multicultural society.     

How special are the specialties? Workplace settings in counseling and clinical psychology in the United States

How special are the specialties? Although clinical and counseling psychology each have distinctive origins, past research suggests their potential convergence across time. In a survey of 5666 clinical and counseling psychologists, the similarities and differences between their workplace settings were examined during early-, mid-, and late-career phases to explore the distinctiveness of the two specialties. Overall, clinical and counseling psychologists reported markedly similar workplace settings. However, some significant differences remained; a greater proportion of counseling psychologists reported working in counseling centers, while a greater proportion of clinical psychologists reported working in medical settings. In addition, during late-career, substantially more counseling and clinical psychologists worked in independent practice contexts than in community mental health centers, medical settings, academia, or university counseling centers. Findings are discussed in relation to the ongoing distinctiveness of the two specialties and the implications of this for training and service in the field of professional psychology.     

Trauma‐Informed Care for Individuals with Serious Mental Illness: An Avenue for Community Psychology's Involvement in Community Mental Health

Individuals with serious mental illness are at particularly high risk for trauma; however, service environments with which they interact may not always be trauma‐informed. While community mental health and other human services settings are moving toward trauma‐informed care (TIC) service delivery, a variety of TIC frameworks exist without consensus regarding operationalization, thereby leading to challenges in implementation. TIC is principle‐driven and presents substantial overlap with community psychology values and competencies, including ecological frameworks, second‐order change, empowerment, and citizen participation. One way to address barriers to TIC implementation is to draw on the strengths of the field of community psychology. With a particular emphasis on the applicability of TIC to individuals with serious mental illness, this paper identifies key implementation issues and recommends future directions for community psychologists in clarifying the service framework, its adaptation to specific service contexts, and improving delivery through consultation and evaluation. Community psychologists may work with various disciplines involved in the TIC field to together promote a more conscious, actionable shift in service delivery.