Future challenges and professional psychology for special populations

Special Populations

Profession psychology

The future of professional psychology:

The influence of special populations on the field of professional psychology

According to the American Board of Professional Psychology: "It is expected that clinical psychologists will demonstrate sensitivity to and skills in dealing with multicultural/diverse populations....Individual and cultural diversity recognizes the broad scope of such factors as race, ethnicity, language, sexual orientation, gender, age, disability, class status, education, religion/spiritual orientation, and other cultural dimension" (Clinical psychology, 2012, ABPP). In other words, the special needs of specific population groups must be taken into consideration when offering care, to ensure that treatment is commensurate and sensitive to the population's needs. The reason for this emphasis on culturally-appropriate care reflects a greater awareness of how not all forms of treatment are appropriate for all population groups within the field, and the degree to which special population needs have and continues to shape the point-of-view of the discipline.

One population of great, recent concern in the field of psychology has been the rise in treating children with mental illness, particularly when done so with psychopharmacological means. Children used to be diagnosed with serious mental illnesses as bipolar disorder relatively rarely. Now the diagnosis has become common, as have drug treatments for the condition. "Many of the problems arise from disagreements on the most appropriate way to apply current diagnostic criteria, designed for use in adults, to children and adolescents" (Coghill 2003). Many of the psychotropic drugs have severe side effects, and their long-term impact upon the health of the children in question is unknown. Is the rise in diagnoses of childhood mental illness a result of under-diagnosis in the past? Are psychologists and physicians unconsciously copycatting one another? Is this due to the powerful influence of drug companies? "There is no evidence at all -- 'zero,' 'zip,' 'nil,' experts said -- that combining three or more drugs is appropriate or even effective in children or adults" but the practice of doing so is extremely common (Harris 206).

Today, "doctors routinely pair stimulants with antidepressants, antipsychotics and anticonvulsants, even though some of these medications can cause serious side effects, have few proven pediatric psychiatric benefits and lack clear evidence about how they interact or influence mental and physical development" (Harris 2006). Although these concerns specifically relate to children and children's special needs, the evident impact of the creation of drug treatments upon a rise in diagnosis has caused many to question the symbiotic relationship between the pharmaceutical industry and psychiatry, which is growing closer and closer than ever before. Reduced amounts of time frames for treatment have likewise driven more therapists to use medication rather than conventional talk therapy.

However, the special population group of children has additional concerns, because children's bodies and minds are still developing. It remains uncertain how the maturing of adolescence will affect children's brains and how drug treatment may permanently alter the child's character and experience of the world. Many of the drugs prescribed are for 'off label' use, such as using antipsychotic medication to treat children with bipolar disorder. And "most trials of antidepressants in depressed children, for instance, fail to show any beneficial effect," and some studies have even shown increased suicidal ideation (Harris 2006).

Children, in other words, are not miniature adults, nor should they be treated as such, although they very frequently are -- care must be tailored to their specific needs. This is also true of different cultures requiring mental health care. For example, "Asian-Americans make up 4% of the United States population, roughly 11 million people from China, India, Korea, the Philippines, Southeast Asia, and Vietnam. Despite the high risk for depression, language barriers, social stigma, and availability make mental health care virtually obsolete among this growing minority" (Asian-Americans need culturally competent mental health care, 2012, APA). Minority groups often frown upon the openness required between a therapist and patient, viewing it as a breach of privacy. Also, minority groups may face barriers of access to adequate care and language problems in accessing treatment. For example, "1 in 2 Asian-Americans suffering from mental illness will not seek help due to a language barrier; in 2002, only 2.3% of the 90,000 doctoral level psychologists were Asian; "and "Asian-Americans born in the United States are at higher risk for mental illness as a result of assimilating to American culture and its clashes with Asian values, usually enforced by elder family members" (Asian-Americans need culturally competent mental health care, 2012, APA).

Latino-Americans may face similar barriers because of the common cultural belief in the need to treat problems within the family, rather than through the field of psychiatry. The strong influence of religion on Latino culture can likewise be an important influence in reducing the tendency of the members of the population to seek treatment. "Mexican-Americans often perceive lives and health as being under the control of God" (Eggenberger, Grassley, & Restrepo 2006). Populations may view the 'locus of control' or the forces that affect their lives differently than those of other population groups. Latinos tend to view fate rather than self-empowerment as a force that shapes their lives, which can reduce their willingness to seek out assistance through the mental health profession.

Special populations thus force psychiatry to constantly reevaluate how it views patients, and the potential weaknesses of treatment, both in terms of the treatment's intrinsic nature and structural barriers to care. The extremity of children's problems taking antidepressants, as manifested in the high suicide rate of children taking antidepressants, highlights the questionable reliance upon antidepressants to the exclusion of conventional forms of talk therapy. The fact that many cultural groups do not talk about problems or engage in self-introspection in an individualistic manner way highlights the culturally-specific nature of psychiatric treatment. The development of family therapy, in which the family rather than the individual is the focus of treatment, has arisen partially in response to the need to provide more culturally-specific care. There have also been efforts to reinvent the use of diagnostic tools that had potential cultural biases, such as IQ tests and personality tests.