Clinical psychology interview techniques and applications

¶ … 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.

Responsibilities

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.

Psychology Orientation

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.

Assessment Tools

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.

Training/Licensure Path

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.

Ethical Dilemmas

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 seek therapy and perhaps the other person is part of the problem or perhaps the whole problem. This can lead to a quandary when trying to talk to the person in therapy because it's more of a relationship issue and/or a problem the other person has rather than something that is wrong with the person in the office. Even so, she said that it's still possible to gently nudge someone in the seemingly right direction without giving the "that person is full of it" speech. It usually holds much better if the "patient" figures it out on their own.

The other ethical things she brought up were more general and were by no means specific to what she's seen or heard in her own practice. She does feel that no one should be forced (knowingly or unknowingly) to take medication without their consent. She also feels that people should not be forced to engage in therapy unless they truly wish to do so and/or it's court-ordered due to the actions/inactions of the person. For example, she's fine with a domestic violence criminal being mandated to get anger management because it's a disservice to the society to just let that go on. After all, the person can't be locked up forever and does need to address their problem since violence is never right. However, no therapy is going to go well or work out well if the person is not an active and willing participant of the therapy. This is even more true of medication. One can make a case for and against using animals, the whole guinea pig argument, but people should not be treated like lab rats in the opinion of the psychologist interviewed for this report.

Direction of Field of Psychology

One of the future directions the psychologist interviewed thinks is relevant has already been alluded to, that being the whole question of whether people across society are getting the quality and amount of care that is important and needed. As also noted above, there are divergent answers and viewpoints as to whether mental illness is over-played or too minimized in this country. The psychologist interviewed thinks it's certainly the latter and it's not even close. The two prior-mentioned issues of people seeking drugs they don't need and truly ill people not getting the help they need will both need to be addressed, each in their own way. The practice of people popping pills for sport needs to cracked down upon but the people that need medication should be given the opportunity to get the treatment they need at minimal expense.

On that note, she does feel that something will need to be done to address the cost of drugs and one big part of that are patents on name brand medications. Some name brand patents run for 25 years and this precludes generic iterations of very expensive drugs coming out. One example is the OCD drug Luvox. Luvox is a time-released version of another drug that has a generic, but no generic exists for Luvox and none will for at least ten years due to patent restrictions. One trivia note that the psychologist offered is that a different company makes the drug than originally did because of a lawsuit centering on the fact that one of the Columbine school shooters took the drug.

This leads to another topic the psychologist wanted to discuss, that being the litigious nature of people regarding their doctors and even therapists. This psychologist herself has not been sued but she has been made aware of ones that have been and it blows her mind that patients would do such a thing absent a clear amount of negligence or wanton disregard for the patient's safety. She said she thinks part of the problem is a lack of personal responsibility with some patients. They apparently think that doctors and/or therapists shoulder all of the responsibility for "righting the ship" and it is truly the other way around. The solutions and frameworks to get better are there but it is not the fault of the professionals that the people are sick and they cannot "put in the work" required of any suffering patient. Drugs and therapy can help but only if the patient takes the drug correctly and actually makes an effort both during and between therapy sessions.