Psychologists In Medical Settings Research Articles

Exploring The Impact of Acceptance and Commitment Based Cultural Humility Training on Standardized Patient Interactions: Revisiting the Measurement Process.

Recent findings in health sciences and medical education highlight the importance of training healthcare professionals to interact with their patients in a culturally humble manner (Nadal et al., in Journal of Counseling and Development 92: 57-66, 2014; Pascoe & Smart Richman, in Psychological Bulletin 135: 531, 2009; Sirois & Burg, in Behavior Modification 27: 83-102, 2003; Williams & Mohammed, in Journal of Behavioral Medicine 32: 20-47, 2009). An important piece in the progression of our ability to address training challenges is the assessment of cultural humility. As an extension of previous research (Lombardero et al., in Journal of Clinical Psychology in Medical Settings, 30: 261-273, 2023), this study implemented an evidence-based cultural humility intervention (based onAcceptance and Commitment Training) to improve medical students' interactions with standardized patients (SPs) which was assessed via direct behavioral observation. Specifically, the observational measurement system was focused on culturally humble responses to patients reporting microaggressions to the medical professional. A pre-post comparison of the results demonstrated statistically significant improvements pertaining to participants' culturally humble responses to SPs' reports of microaggressions for one of the measurement scales used (i.e., ARISE), but not the other (i.e., Responsiveness to Racial Challenges Scale). Further analyses, on the bottom quartile of performers, were conducted to assess a possible ceiling effect of the scale that did not demonstrate significant change. These results and implications for future research will be discussed.

Navigating Supervision and Interprofessional Relationships in Health Psychology.

Previous literature has focused on either individual models of supervision, developing trainees' interprofessional competencies, or on developing and maintaining interprofessional relationships outside of training. For psychologists in medical settings, these concepts are inextricably linked, and supervision must combine these professional practices to successfully meet the needs of psychology trainees, patients, and interprofessional colleagues, in an increasingly integrated healthcare landscape. This paper presents a model for advancing interprofessional collaborative practice competencies in supervision as health psychology trainees progress through the developmental stages of clinical competency, while supervising psychologists also maintain interprofessional relationships. The Interprofessional Collaboration Supervision Model (IPCSM)for Psychology describes trainee, patient, and interprofessional team factors for supervising psychologists to consider in supervision, as well as various interventions to deploy when these interrelated dynamics impact training. Case examples are provided along with discussion on how to implement this model in supervision.

Pratiquer la clinique en « milieu hostile » : quels possibles ?

ContextBy imposing techniques, reporting, efficiency, and profitability on hospital practices, New Public Management has considerably altered the role of psychologists in medical departments, as well as their relationship with teams and administrative staff. ObjectiveThe aim of this reflection is to highlight the positions that appear most appropriate for continuing to promote the activity of hospital clinical psychologists in this disrupted context. MethodThe author traces the evolution of the place of psychologists in medical settings, and draws on his own experience in the face of the disruptions encountered to examine what makes it possible to hold one's place as a clinical psychologist in a hospital institution. ResultsPositioning oneself as “carried by” an intention or a meaning, rather than “against” someone or a hierarchy, is necessary for one's clinical practice. By enabling us to continue questioning our subjectivities, the clinical approach has become an “authority” in relationships, transcending hierarchies. While accompanying the interlocutor, it naturally opens the way to joint elaboration. In addition to seminars, supervisions, and affiliations with psychoanalytic schools or groups, psychologists must also join psychologists’ collectives, such as colleges of psychologists or inter-colleges, in order to think about, discuss, and elaborate clinical possibilities. ConclusionThe work of clinical psychologists in hospitals is an act of resistance in itself. However, it is a natural outcome of our activity and should not become a goal in itself. It's about continuing to reflect on the complex situations we deal with, so that the obvious can emerge. Continually focusing on analyzing requests with tact allows us to modernize the authority inherent in the clinical approach itself, and to establish the autonomy of psychologists without them behaving like loose cannons, instead truly asserting their expertise. If valuable qualitative links are thus established with the interlocutors, the approach requires fully accepting the constraint of these links and of the debate which takes place throughout this analysis, whose finality is uncertain.

Training Psychology and Psychiatry Diversity Dialogue Facilitators.

This article describes a Diversity Dialogue Facilitator Training Program for Trainees, an innovative project that prepares psychology and psychiatry learners to facilitate diversity dialogues with healthcare professionals (i.e., clinical and research faculty, staff, and learners) in academic healthcare settings. Through participating in this program, trainees learn to facilitate discussions in which participants reflect upon oppression, discrimination, and disparities; explore their biases; connect and exchange views with colleagues regarding challenging societal events; and delineate action steps for advancing equity, inclusion, social responsivity, and justice in their professional and personal lives. After outlining contextual factors that informed project development, implementation, and dissemination, the iterative process of creating and implementing the training curriculum is detailed, with the aim of offering a model for other academic health center-based training programs interested in establishing a similar initiative. Lessons learned also are shared with the hope of contributing to future efforts to advance training in diversity dialogue facilitation and expand the role of psychologists in medical settings.

Motive Satisfaction Among Patients with Chronic Primary Pain: A Replication

We set out to replicate findings of significant (a) reductions in pain, psychological distress, and motivational incongruence (i.e., insufficient motive satisfaction) after interdisciplinary multimodal pain treatment and (b) associations between reductions in motivational incongruence (i.e., improved motive satisfaction) and decreases in psychological distress (Vincent et al., Journal of Clinical Psychology in Medical Settings 28:331–343, 2021). 475 Patients with chronic primary pain completed standardized self-reported questionnaires assessing motivational incongruence, psychological distress, pain intensity, and pain interference at intake and discharge from a tertiary psychosomatic university clinic. We used hierarchical linear models to analyze motivational incongruence’s effects on psychological distress. We partially replicated Vincent et al.’s findings. Significant reductions in pain, psychological distress, and motivational incongruence after treatment were found. Reductions in motivational incongruence were associated with reductions in psychological distress. Similarly, a better motive satisfaction mediated the relationship between pain interference and psychological distress. Our findings show that reducing motivational incongruence may be a key component of treating chronic primary pain; we recommend to assess and target motivational incongruence to improve interdisciplinary multimodal pain treatment.

Mentoring Journal Manuscript Reviewers Using a Competency-Based Approach: The Next Developmental Stage for the Journal of Clinical Psychology in Medical Settings.

Founded in 1994, The Journal of Clinical Psychology in Medical Settings (JCPMS) has paralleled the development of psychology's role in health care as well as contributing to its growth in science, services, and education in medical settings. JCPMS provides an essential, unique publishing outlet for health service psychology as represented by the recognized psychological specialties in those settings. At this point in its development, The Journal has turned its attention to generativity and contributing further to the field by helping prepare the next generation of journal manuscript reviewers and future psychological scientists. A brief developmental history of The Journal and its relationship to the evolution of health service psychology is offered followed by a description of a task-specific mentoring process for a new generation of manuscript reviewers. Building on work by other authors, a competency-based model is used to rearrange previously published guidance into categories of knowledge, skills, and attitudes required to become a competent manuscript reviewer. General competencies are described within each of those categories as well as specific behavioral anchors that a mentee must master in order to carry out a competent review.

ФЕНОМЕН БАТЬКІВСЬКОГО ВИГОРАННЯ ЯК ПРЕДМЕТ ПСИХОЛОГІЧНОГО ДОСЛІДЖЕННЯ

ФЕНОМЕН БАТЬКІВСЬКОГО ВИГОРАННЯ ЯК ПРЕДМЕТ ПСИХОЛОГІЧНОГО ДОСЛІДЖЕННЯ

Interdisciplinarity and Integration: An Introduction to the Special Issue on Psychopathology in Medical Settings.

As the world views, incredulously, the calamitous consequences of the COVID-19 pandemic, the inseparable connections between body and mind become more and more apparent, even for the heretics (i.e., biological determinists). Such realizations also bolster the understanding of the close link between medical conditions and psychopathology. Launched prior to the COVID-19 epidemic, this special issue sets out to illuminate the prevalence, course, etiology, and responses to a myriad of psychopathological conditions in medical conditions. The 13 articles in this special issue address a variety of medical conditions (chronic illness and chronic pain, Pica, cancer, acute delirium, factitious disorders, functional neurological symptoms, sleep disorders, fetal conditions), mental disorders (depression, anxiety, suicidality, eating disorders, personality disorders, PTSD), medical settings (primary care vs. specialty clinics), and developmental levels (children, adolescents, and adults). The overarching theme emanating from reading these articles is that clinical-health psychology, or clinical psychology in medical settings, is an ever-needed field of inquiry, epitomizing interdisciplinarity and science/practice integration.

Psychologists' Practices, Stressors, and Wellness in Academic Health Centers.

Burnout has been identified as widely prevalent in physicians and other health professions. However, relatively little has been written about burnout in psychologists. The current study reviews the literature investigating professional wellness, sources of stress, and burnout in practicing psychologists. Based on a survey of members of the Association for Psychologists in Academic Health Centers' (n = 93), stress levels, burnout, and work satisfaction in health service psychologists in academic health centers (AHCs) were examined. Respondents indicated some level of burnout ranging from having no symptoms (8%) to being occasionally stressed (59%), symptoms won't go away (12%), definitely burning out (18%), or being completely burned out (3%). Most respondents described working at high levels, including "at full capacity" (41%) or being "over-extended" (39%). Despite these concerns, most respondents indicated satisfaction with their positions (42% "very satisfied," 44% "somewhat satisfied") and recommended careers as psychologists in medical settings (50% strongly; 34% moderately). Most commonly perceived sources of stress included clinical load, salary, insufficient protected time for research, teaching, education, and supervision, insufficient psychologists to meet the need, and non-billable clinical activities. Consistent with the physician literature, workload was associated with burnout and burnout was associated with decreased professional satisfaction. The current study narrows the gap in the literature on the stress psychologists experience in AHCs and explores findings within the broader literature about health professional burnout. Greater understanding is needed about factors that affect burnout in health service psychologists, identification and modification of risk factors, and prevention strategies.

Evaluation and Management of Factitious Disorder Imposed on Another.

Munchausen by proxy refers to an individual who abusively and compulsively falsifies physical, psychiatric or developmental disorders in a child or adult victim in order to satisfy a psychological need. Factitious disorder imposed on another refers to the psychopathology in the abuser. Psychologists in medical settings may: (1) identify patients they come to suspect as being victims or perpetrators of MBP, (2) conduct or assist in clinical or forensic evaluations; (3) offer recommendations for clinical case management, and/or (4) provide treatment or referrals. The purpose of this paper is to provide guidance to psychologists and other mental health professionals in medical settings who may encounter individuals with this potentially lethal form of psychopathology.

The Emerging Role of Clinical Pharmacopsychology

Clinical pharmacopsychology is an area of clinical psychology that is concerned with the application of clinimetric methods to the assessment of psychotropic effects of drugs on psychological functioning, and the interaction of such drugs with specific or non-specific treatment ingredients. Clinical pharmacopsychology derives its data from observational and controlled studies on clinical populations and refers to the therapeutic use of medical drugs, not to the effects of substances used for other purposes. Domains and operational settings of clinical pharmacopsychology are illustrated. The domains of clinical pharmacopsychology extend over several areas of application which encompass the psychological effects of psychotropic drugs (with particular emphasis on subclinical changes), the characteristics that predict responsiveness to treatment, the vulnerabilities induced by treatment (i.e., side effects, behavioral toxicity, iatrogenic comorbidity), and the interactions between drug therapy and psychological variables. A service for clinical pharmacopsychology is here proposed as an example of the innovative role of clinical psychology in medical settings. Clinical pharmacopsychology offers a unifying framework for the understanding of clinical phenomena in medical and psychiatric settings. Its aim is to provide a comprehensive assessment of the clinical important changes that are concerned with wanted and expected treatment effects; treatment-induced unwanted side effects; and the patient's own personal experience of a change in terms of well-being and/or quality of life. It is now time to practice clinical pharmacopsychology, creating ad hoc services in Europe. Clinical pharmacopsychology assesses the effects of medications on psychological functioning Since clinical psychologists visit medicated patients, a comprehensive clinical evaluation is crucial Vulnerabilities induced by psychotropic drugs are an important area of application of clinical pharmacopsychology Clinical pharmacopsychology assesses the effects of medications on psychological functioning Since clinical psychologists visit medicated patients, a comprehensive clinical evaluation is crucial Vulnerabilities induced by psychotropic drugs are an important area of application of clinical pharmacopsychology

Children's Hospital Los Angeles integrates infant MH care into NICU

In the Early Childhood Mental Health Program at Children's Hospital Los Angeles (CHLA), clinical psychologists Marian Williams, Ph.D.; Patricia Lakatos, Ph.D.; and a team of infant‐family mental health specialists work toward greater mental health awareness in the NICU, Business Wire reported. Infants may not be the first age group that comes to mind in discussions of mental health. Yet, for babies in critical medical condition, Lakatos says an “infant mental health–informed perspective” could reduce stress and improve bonding with parents. This means focusing on not only the physical needs of the child but also the emotional and mental needs, not an easy task for newborn infants who cannot make their voices heard. In an article published in the Journal of Clinical Psychology in Medical Settings, Lakatos, Williams, and co‐authors Tamara Matic, M.D., and Melissa Carson, M.D., advocate for a third component of the NICU family — the relationship between baby and parents. “A lot of mental health work in NICUs currently focus[es] on either the mental health of parents or on the baby's development,” says Williams, who is also the director of the Stein Tikun Olam Infant‐Family Mental Health Initiative at CHLA. “We also want to focus on the relationship between babies and their parents.”

Measuring Emotional Intelligence Enhances the Psychological Evaluation of Chronic Pain.

The assessment of emotional factors, in addition to other psychosocial factors, has been recommended as a means of identifying individuals with chronic pain who may not respond to certain pain treatments. Systematic reviews of the evidence regarding the prediction of responsiveness to a treatment called the spinal cord stimulator (SCS) have yielded inconclusive results. Emotional intelligence is a term which refers to the ability to identify and manage emotions in oneself and others and has been shown to be inversely associated with emotional distress and acute pain. This study aims to investigate the relationship between emotional intelligence, chronic pain, and the more established psychosocial factors usually used for SCS evaluations by clinical psychologists in medical settings. A sample of 112 patients with chronic pain on an acute hospital waiting list for SCS procedures in a pain medicine service were recruited. Psychological measures were completed including: a novel measure of emotional intelligence; usual measures of emotional distress and catastrophizing; and a numerical rating scale designed to assess pain intensity, pain-related distress, and interference. As predicted, findings revealed significant associations between most of the measures analyzed and current pain intensity. When entered into a simultaneous regression analysis, emotional intelligence scores remained the only significant predictor of current pain intensity. There are potential clinical, ethical, and organizational implications of emotional intelligence processes partially predicting pain in patients on a waiting list for a medical procedure. These results may offer new insight, understanding, and evaluation targets for clinical psychologists in the field of pain management.

Managing Difficult Patients: Roles of Psychologists in the Age of Interdisciplinary Care.

Various problems can occur during encounters between health providers and patients. In some instances, clinicians attribute these problems to patients being "difficult." However, clinicians' perception of difficulties in the clinical encounter are also influenced by: clinicians' own attitudes, thoughts, and behavior; the specific setting in which patient and clinician interact; and properties of the healthcare organization in which they are embedded. This article explores how psychologists in medical settings can serve as a resource that: improves patient care for difficult patients; supports provider wellness; provides relevant education to clinical providers; and reduces the stress that difficult patients place on the healthcare system. The definition, scope, and impact of difficult patients in healthcare settings are reviewed, including an examination of patient, clinician, and systems factors that contribute to the etiology of difficult clinical encounters. Strategies are discussed that may prevent or limit the adverse impact of difficult patients in healthcare, with special emphasis on the roles of psychologists in interprofessional healthcare teams.

Jehovah's Witness parents' refusal of blood transfusions: Ethical considerations for psychologists.

Psychologists in medical settings may be confronted with Jehovah's Witness parents refusing blood transfusions for their children as an ethical dilemma. The purpose of this discussion is to help psychologists provide informed, ethical consultations and support by investigating the values of the Jehovah's Witness community and the origin of the blood transfusion taboo, how medical and legal professionals have approached this dilemma, exploring relevant ethical principles and standards for psychologists, and suggestions for how to move toward a better understanding of harm with Jehovah's Witness families.

Implications of Healthcare Payment Reform for Clinical Psychologists in Medical Settings

Health reform, post the passing of the Patient Protection and Affordable Care Act, has highlighted the need to better address critical issues such as primary care, behavioral health, and payment reform. Much of this need is subsequent to robust data showing the seemingly uncontrollable growth of healthcare costs, and the exacerbation of these costs for patients with comorbid behavioral health and medical conditions. There is increasing recognition that incorporating behavioral health in primary care leads to improved outcomes and better care. To address these problems, primary care will play critical roles across the healthcare system, especially in the delivery of behavioral health services. Psychologists are uniquely positioned to take advantage of this propitious moment and can help facilitate the integration of behavioral and primary care by developing competencies in integrated care, training a capable workforce, and advocating for integrated care as the status quo.

Introduction to the Second Section of the Special Issue: Invited Papers from the 2015 APAHC Conference.

This issue of the Journal of Clinical Psychology in Medical Settings includes a continuation of the special issue of Invited Papers based on presentations at the 2015 conference of the Association of Psychologists in Academic Health Centers (APAHC). The first installment of this special issue was published in December 2015. APAHC is an organization devoted to representing the interests and providing professional support and networking for psychologists working in Academic Health Centers (AHCs). Our biennial conference highlights the multiple aspects of our work in AHCs including clinical service, teaching, and research, as well as matters concerning the business of practice and professional identity for psychologists in these settings. The 2015 conference was held in Atlanta, Georgia in February with the theme, ‘‘Academic Health Centers in the Era of Interprofessionalism: Multifaceted Contributions of Psychology.’’ A complete overview of the conference is available in the introduction to the December special issue of JCPMS (Shaffer & Shahane, 2015). Because the APAHC conference tends to be fairly small relative to the estimated nearly 5000 psychologists practicing in academic health centers across the United States (Robiner, Dixon, Miner, & Hong, 2014), we followed the conference with these special issues of JCPMS to disseminate this highly pertinent information more broadly. Manuscripts published in the two sections of the special issue reflect themes related to expanding psychologists’ work through telehealth; capturing the value of psychologists’ clinical, administrative, and educational work; patient centered medical homes and integrated care; and professional development. The December 2015 section of the special issue included five manuscripts addressing psychologists’ roles in patient centered medical homes, measuring clinical and administrative outcomes, transformational leadership, and psychology licensure implications of telehealth. The current section has three manuscripts, one of which gives a broad overview of professional development issues and the other two of which address more specific administrative issues. In their article titled ‘‘Psychologists in Academic Health Centers: Being, Visible, Relevant, and Integral,’’ Barry Hong and William Robiner discuss how early and mid-career psychologist can thrive in AHCs. Eugene D’Angelo and Katie Gallagher’s article, ‘‘Capturing Psychologists’ Work in Academic Health Settings: The Role of the Educational Value Unit (EVU),’’ reviews how psychologists have been historically compensated, as well as alternative models that incorporate the many facets of psychologists’ work pertaining to education in AHCs. Last, Samuel Hubley and Benjamin Miller discuss the ‘‘Implications of Healthcare Payment Reform for Clinical Psychologists in Medical Settings’’ and give an overview of promising alternative payment models in integrated care. As the 2015 conference co-chairs and guest editors of the corresponding special issue of JCPMS, we are keenly aware of the power of the APAHC community and grateful to our many colleagues who had hands in the success of these ventures. First, we would like to thank our esteemed colleagues who contributed doubly by presenting in Atlanta and writing manuscripts for the special issue. & Laura A. Shaffer laura.shaffer@virginia.edu

Neuropsychological functioning and profile validity on the Personality Assessment Inventory (PAI): An investigation in multiple psychiatric settings.

Psychologists in medical settings are frequently tasked with providing comprehensive evaluations of patients with complex medical and psychiatric conditions. In order to achieve these aims, standardized measures of neurocognitive and psychological functioning are often employed to empirically assess a patient's level of functioning across an array of relevant clinical domains. However, less is known about the degree to which cognitive impairment affects a patient's ability to complete these more comprehensive assessments, raising questions about test validity. The current study sought to contribute to this growing body of literature by examining whether neurocognitive functioning is associated with profile validity on the Personality Assessment Inventory (PAI) in both outpatient (N = 321) and inpatient (N = 131) psychiatric settings. In Study 1, results indicate that while multiple cognitive domains are associated with overall profile validity in psychiatric outpatients, attentional impairment specifically was found to be a significant predictor of profile invalidity after accounting for the effects of overall intellectual functioning (accounting for 13% of the variance overall). The magnitude of attentional impairment specifically, and number of impaired cognitive domains more generally, were also found to be meaningfully associated with overall profile validity. Likewise, in Study 2, PAI profile validity was found to be meaningfully associated with gross cognitive impairment on the WMS-IV Brief Cognitive Status Examination (BCSE) in an inpatient psychiatric setting, with almost half of the patients in the most impaired group yielding invalid PAI profiles. The clinical implications of these findings are discussed.

Introduction to the Special Issue: Invited Papers from the 2015 APAHC Conference.

The 7th biennial National Conference of APAHC, the Association of Psychologists in Academic Health Centers, was held in Atlanta, Georgia, February 5-7, 2015. Speakers were invited to contribute manuscripts based on their conference presentations, and many submitted manuscripts for this special edition of the Journal of Clinical Psychology in Medical Settings. Some papers will appear in the December 2015 issue of JCPMS; others will appear in the March 2016 issue. All papers have undergone a rigorous peer review process. The Conference Co-Chairs, Drs. Laura Shaffer and Amit Shahane, are Guest Editors for the special issue. In this article, they provide an overview of the conference's major themes, and also discuss some aspects of conference planning.

Twenty Years of the Journal of Clinical Psychology in Medical Settings: We Hope You Will Enjoy the Show

The 20th anniversary of the Journal of Clinical Psychology in Medical Settings is celebrated by highlighting the scientist-practitioner philosophy on which it was founded. The goal of the Journal-to provide an outlet for evidence-based approaches to healthcare that underscore the important scientific and clinical contributions of psychology in medical settings-is discussed. The contemporary relevance of this approach is related to the current implementation of the Patient Protection and Affordable Care and its focus on accountability and the development of an interprofessional healthcare workforce; both of which have been foci of the Journal throughout its history and will continue to be so into the future. Several recommendations of future topic areas for the Journal to highlight regarding scientific, practice, policy, and education and training in professional health service psychology are offered. Successfully addressing these topics will support the growth of the field of psychology in the ever evolving healthcare system of the future and continue ensure that the Journal is a key source of professional information in health service psychology.