PSY 101 Homework #2
Glenn Booker 7/26/2012
The Belar article[i] gives an overview of the scope of practice and history of the field of clinical health psychology. As a field it first emerged via a seminal report to the American Psychological Association (APA) in 1969, and is now well established within mainstream psychology. To paraphrase the APA definition cited in Belar, clinical health psychology looks for interrelationships among psychological components (behavioral, emotional, cognitive, and social) and biological components of health and disease, in order to improve health, prevent and treat disease, cope with disability, and overall improve the healthcare system. As a clinical field it expects to work alongside physicians and other healthcare providers; to be an integral part of the healthcare system, and not just someplace you go when you’re feeling blue. Belar cites herself extensively in describing the history of clinical health psychology, so either she has played a significant role in its development, or she has an amazingly strong ego.
Clinical health psychology is a very broad field, since it addresses the integration of psychological and medical care throughout life, and supports people not directly affected by medical issues as well, such as providing support for the families of people with severe and/or chronic illnesses or traumas. As such, clinical health psychology professionals may work in private practice for individuals or groups, or a hospital setting, dental offices, emergency rooms, hospice or nursing home settings, and many others. The problems addressed by clinical health psychology include the psychological impact of disease on the patient and their loved ones, the interplay between medical and psychological conditions (e.g. chest pain and anxiety attack), psychological signs of medical conditions (e.g. brain injury, hypoglycemia), behavioral aspects of patient treatment (not taking medication, severe pain management), addressing risk factors for injury and disease, and finally addressing psychological issues of medical healthcare providers and the integration of healthcare services. In short, anything that connects medical and psychological issues for patients or those they interact with is fair game for clinical health psychology.
Traditional mental health treatment is viewed by the public in my opinion as two extremes; either ongoing counseling ala Dr. Frasier Crane, or treatment of severely disturbed people in a rubber room. Clinical health psychology seeks to integrate its practice into everyday medical treatment and recovery settings, producing a model that addresses the wide range of problems noted earlier, making clinical health psychology practitioners more a team member of medical healthcare rather than an isolated specialty focusing only on one’s grey matter. This also implies that practitioners would have a small amount of contact with a much larger number of patients, instead of lots of contact with few patients.
While some treatment (outlined by Belar as Assessment, Intervention, and Consultation services) is at the level of the individual patient and their family, practitioners also address issues with healthcare providers (e.g. burnout, stress management) and could consult on socio-cultural issues such as organ transplantation. In the latter sense, practitioners might be competing with medical ethics professionals (of which my brother is one), producing some possible turf battles among newly emerging healthcare professions.
Belar recognizes that the new field of clinical health psychology is so large no one can be expected to ‘be competent in every area of practice.’ She provides a self-assessment to see if the reader is aware of core knowledge and skills relevant to the field, and pitches getting board certification and ongoing training in the field.
I find Belar’s model to be utopian. Yes, it would be wonderful if there were a herd of wonderfully trained clinical health psychology practitioners to support every possible need of the healthcare system and its patients. But while she describes the certification and training areas needed for this to occur, she doesn’t address massively critical issues like … funding. Who is going to pay for this? The Social Security Advisory Board (2009)[ii] emphasized that “we believe that the rising cost of health care represents perhaps the most significant threat to the long-term economic security of workers and retirees.” Lack of economic security is a major source of stress, which could easily undo any benefits achieved from her model. In order to get support for funding her model, study and analysis would be needed to demonstrate its cost-effectiveness. Are the services provided by clinical health psychology practitioners cost-effective? Such studies would be very challenging to conduct, since the benefits associated with good mental health are often profoundly qualitative, making the case very hard to prove.
If implemented, I think that her model would be very effective. People have known for centuries that the mind and body are closely intertwined[iii]; only the metaphor of science tries to pry them apart to make analyses easier. I think implementing the model would meet some initial resistance by the public, since there is still a strong stigma associated with mental health services, as we discussed in class.
More generally I think that competition is the main issue facing clinical health psychology practitioners in the field. They are trying to establish a niche that doesn’t fully exist yet, so they are competing with other healthcare professionals and alternative medicine providers for time, money, and recognition by the consumer public that they are a desirable and meaningful contributor to the healthcare system.
[i] Belar, C. D. (2008). Clinical Health Psychology: A Health Care Specialty in Professional Psychology. Professional Psychology: Research and Practice 2008, Vol. 39, No. 2, 229–233.
[ii] Social Security Advisory Board. (2009). The Unsustainable Cost of Health Care. Retrieved from http://www.ssab.gov/documents/TheUnsustainableCostofHealthCare_508.pdf.
[iii] Mehling et al. (2011). Body Awareness: a phenomenological inquiry into the common ground of mind-body therapies. Philosophy, Ethics, and Humanities in Medicine. 6:6