sit-down with an experience psychologist recently and a very enlightening and expansive conversation ensued. The psychologist in question did request that her name and her practice be excluded from being named within this report, but there is a bevy of great information that was gleaned during the interview and will be shared in this report. She said she wanted to be very candid and felt she should not do so if her name (or the name of her practice) are in play. At the request of the professor, topics to be mentioned in this summary include how long the psychologist has been working in the field, what orientation the psychologist was trained for and the time splits that the psychologist allocates her time to, the assessment tools she uses and the associated training engaged in to be able to use those tools, the ethical dilemmas that the psychologist has encountered and how she reacted, where the field is doing and the type of training/licensing that was engaged within to attain their position. The student who wrote this report is asked to expand on what areas can be extended into by modern psychologists.
The particular psychologist interviewed for this report does therapy sessions for adults that suffer from certain psychiatric and/or behavioral disorders such as anxiety, obsessive-compulsive and depression. The psychologist does not see children as other psychologists and psychiatrists in the practice do that. The psychologist also only sees patients that willing seek help by reaching out to the practice for therapy and assistance. The psychologist does cash-only treatments but also processes with insurance for several different national and regional providers.
The bulk of the time spent by the psychologist is used for counseling but there is always at least an initial period whereby the psychologist has to decipher and determine what disorder(s) could be in play. Many times, the patient transitions from another psychologist but this psychologist always makes sure the right overall path seems to be underway so as to ensure that the right treatment plan is in place. She remarked that many disorders manifest themselves very similarly and this can lead to a feeling-out period, either initially or as time goes on, if certain treatments don't seem to be catching on. There is also a question of dosage (if medication is in play) and whether the person is actively trying their best to assist themselves as that is an important part of the equation for anyone seeking or getting treatment. The patient has to be willing to put in the work because medication is not a fix-all, although it certainly helps in many to most cases.
As is consistent with her field and general daily tasks, the bulk of her training is in the field of diagnosing and treating people with anxiety, depression and obsessive disorders. She said she chose to focus on all three collectively as they are very similar and often manifest themselves at the same time in the same patients. For example, very many people that have obsessive-compulsive disorder also have issues with anxiety, largely because one often feeds the other. A person that is OCD often has anxiety issues because the OCD symptoms and challenges cause the person to become agitated based on the prevalence and length of "spells" and symptoms. As such, she feels it's best for any patient treating any of those three classifications of disorder to at least be roughly familiar with all three as doing otherwise can lead to important flags and symptoms being missed.
Length of Experience in Field
The psychologist in question has been practicing roughly ten years and she started right after finishing school and getting licensed. She has served in a number of different practices in the geographical area she serves. She has always been the part of a larger practice that couples licensed therapists with psychiatrists in the same office. She says that is key for her because she cannot prescribe medication since she is not a medical doctor. If she were to a practice without a psychiatrist, whether it be because she was on her own or in a practice that was non-psychiatrists only, she would likely have to do a lot of referrals to specialists and she feels it is better to have a "one stop shop" for both therapy and medication management. She says that psychiatrists generally just do the latter and leave the former to people like herself. In short, including school and her actual time as a psychologist, she has been involved in the field approaching two decades.
The psychologist interviewed told the author of this paper that she, like many psychiatrists and other counseling professionals such as therapists, counselors, etc., she relies heavily on the DSM framework of diagnosing disorders and ruling others out. The DSM framework is heavily taught in the college environment for anyone that is involved in diagnosing and/or treating disorders and the framework also evolves post-college so all counseling/psychiatric professionals have to keep up on their training and on the latest news and updates from industry and trade organizations as well as the arbiters of the DSM framework itself.
The psychologist interviewed for this report is a PhD and is licensed by the state. She had to obtain three different degrees, those being a bachelor's, graduate (masters) and then a doctorate from a total of two different well-known colleges. She has also become licensed by the state so that she is allowed to provide counseling and therapy sessions in the state.
The psychologist in question perked up noticeably when this question was asked. She said that there are indeed a number of issues in her field that greatly involve ethics. One such major ethical issue is when to draw the line between something that should be reported to relevant authorities and when she should just stand pat and provide the counseling without an external reaction. She said that while many think that psychologists are never allowed to cross the line, they most certainly are if there are people in danger and this is especially true of children. Any admission of ongoing child abuse or other illegal activity generally has to be passed along to the authorities. While doctor/counselors are generally prohibited from broaching privacy laws, there are some situations and events that require it.
Another issue that comes up a lot with her, although not as much as it would with a psychiatrist, is the idea that people are being over-diagnosed and over-medicated vis-a-vis mood/psychiatric disorders. The psychologist is quick to point out that many other doctors and counseling professionals think the opposite is true. She says there is something to be said of people that overblow and over-dramatize their situation, there are plenty of people out there that are hurting and are not getting help, for whatever reason. A lot of the reason people don't get help often comes down to money and/or lack of insurance coverage. She said that while many health insurance policies allow for a certain number of mental health visits a year (whether it be for counseling and/or for psychiatry), many other policies make therapy and/or the medication behind it very cost-prohibitive. The same often goes for children/teens that need assistance but often forgo it because the parents simply cannot afford it.
She holds the view that the government and the industry can and should do more to address this issue because of the long-term implications it can and will have on society as well as the people themselves that suffer. However, she says it's a lot more difficult than it sometimes sounds due to the high-risting costs of health insurance and drugs in this country and there is only so much money to go around. She says one big problem in the equation is that some people over-use the system and this hurts people that truly need help. She says she has heard of more than one person who is obviously just trying to manipulate a psychiatrist to get drugs such as Xanax or the like. She notes that pill-popping is the new drug epidemic in this society and many people in her circle have to sometimes avoid drugs with patients because they are perceived to be trying to game the system.
She said that something else that doesn't involve her yet she discussed at great length with her fellow professionals is the practice of forcing people like inmates and vulnerable people (e.g. people who are suicidal or otherwise very imbalanced) to take medication when they don't want to. Some people struggle without taking medication but they can do OK in their daily lives despite that. However, some people can become very violent and/or very unstable. The ethical question comes in when the line that separates the two is not clear.
Something else that comes up from an ethical standpoint that directly involves her a lot more is when a spouse or family member pressures someone to…