Psychologists and Health Care Reform

Psychologists have been working in primary health care settings for over 30 years (McDaniel & LeRoux, 2007) providing assessments and treatment to patients and their families. Research shows that 24 % of patients who present themselves to primary care physicians suffer from a well-defined mental disorder, and 69 % of these patients present to physicians with physical symptoms and many of their mental health needs remain undetected (APA, 2010). According to a quote in the Monitor (January 2010) by Katherine Nordal, Ph.D. (Executive Director, APA Practice Directorate) “Psychologist are the leading experts…We have the skills to improve quality of life, reduce the level of disability associated with illness and at the same time dramatically reduce cost in our health-care system”.

Psychologists Role in Primary Health Care Settings (APA, 2010; Blount & Miller, 2009; McDaniel & LeRoux, 2007):

• Conduct cognitive, capacity, diagnostic, and personality assessments that differentiate typical behavior from pathology across the lifespan, side effects of medications, adjustment reactions, or combinations of these problems
• Offer behavioral health assessment and treatment that provide youth and adults with the skills necessary to effectively manage their chronic conditions
• Diagnose and treat mental and behavioral health problems (e.g. depression or suicide risk).
• Offer consultation and recommendations to family members, significant others, and other health care providers
• Contribute research expertise to the design, implementation, and evaluation of team care and patient outcomes
• Develop interventions that are responsive to specific individual and community characteristics that may impact the treatment plan

Want your voice to be heard? Take action and contact your locate state representative. Ask them to support The Mental Health Awareness and Improvement Act of 2013 

Copyright 2013 Erlanger A. Turner, Ph.D. 

Version previously published by Erlanger Turner, Ph.D. at http://www.apa.org/apags/programs/bulletin/2010/04/issue.pdf

Tips on Coping with Tragedy: In the wake of the Boston Marathon Explosion

On yesterday, we experienced another tragedy in Boston when an explosion occurred near the finish line at the Boston Marathon. According to the New York Times, almost 23,000 runners participated in the race and approximately three-quarters of the runners had crossed the finish line prior to the bomb exploding. President Obama made a statement following the explosion and stated “I'm supremely confident that Bostonians will pull together, take care of each other, and move forward as one proud city. And as they do, the American people will be with them every single step of the way.”

In the wake of another tragedy, below are some resources to help children and their families cope and process the event.

Evidence-Based Early Psychological Intervention for Victims/Survivors of Mass Violence  

Helping Children and Adolescents Cope with Violence and Disasters: What Rescue Workers Can Do

What Parents Can Do To Help Children

            Spanish version: Que Pueden Hacer los Padres

Tips of talking with children: A guide for teachers and parents

A Guide for Managing Stress in Crisis Response

  

Copyright 2013 Erlanger A. Turner, Ph.D.

Follow me on twitter @DrEarlTurner

References:

Image from the Boston Globe 

Therapy Effectiveness: Who gets the glory or the blame?

As a clinical psychologist who has been working in the field for years, I have provided therapy for children, adults, and couples. My philosophy has always been to meet clients at a middle ground and work towards mutually defined treatment goals. There are times when treatment progresses quickly over the course of several months, and there are times where it seems that no progress has been made. A recent New York Times (NYT) opinion article (http://fb.me/1rBrP2Nf5) titled: “In Therapy Forever: Enough Already” sparked my idea for this current post. Looking at these two sides of the coin, who gets the glory when therapy is a success and who gets the blame when it appears ineffective?

To summarize the NYT’s article, the author wrote that:

A patient recently told me that, after seeing her therapist for several years, she asked if he had any advice for her. The therapist said, “See you next week.” 

When I started practicing as a therapist 15 years ago, I thought complaints like this were anomalous. But I have come to a sobering conclusion over the years: ineffective therapy is disturbingly common.

So if “ineffective” therapy is common, who is to blame? Often in my clinical practice patients bestow gratitude upon their therapist when they note improvements in their lives and their symptoms decrease. Conversely, as noted in the NYT’s article, therapists hold the majority of the blame if progress is slow or nonexistent. According to the Society of Clinical Psychology (a division of the American Psychological Association) research indicates that on average 15 to 20 sessions are required for 50% of patients to recover as indicated by self-reported symptom measures. Clinical research also suggests that people with co-occurring conditions or certain personality difficulties may require longer treatment (e.g., 12-18 months) for therapy to be effective. Given the data, it’s possible that some of those patients who are in therapy for years may have complex conditions or may be working with therapist who is not using evidence based treatments. Anecdotally, I’ve worked with numerous patients over the years, and occasionally we make a decision to terminate if the patient or I feel no progress is being made for various reasons.

Research has also indicated that the following variable impact treatment progress (this list is not exhaustive):

·         Frequency of appointments (e.g., attend weekly versus monthly)

·         Levels of symptom distress (i.e., is the problem long standing)

·         Therapist and patient adherence

o   The therapist implements the treatment as designed

o   The patient complies with treatment recommendations and homework

In the effort of full disclosure, I believe it is the therapist duty to identify with the patient why treatment has been a success or non-effective. When I terminate with my patients I consistently discuss progress towards meeting goals as well as pitfalls towards success. In my view, both the therapist and the patient contribute to whether therapy is effective or ineffective. It’s not a one-way street.  

Written by Erlanger Turner, Ph.D.

© Copyright 2012 Erlanger A. Turner