Who is a Clinical Psychologist? 

By Isha Malik and Wasim Kakroo

A Clinical Psychologist is a mental health professional who holds an M.Phil. degree in Clinical Psychology from an institute recognized by the Rehabilitation Council of India (RCI). During his or her training, the clinical psychologist trainee gets trained in  hospital settings and observes and works upon the cases related to various mental health issues while working shoulder to shoulder with the M.D psychiatry trainees. As per the RCI Act, a clinical psychologist can conduct independent psychological evaluation, testing, psychotherapy, psychoanalysis, hypnosis, biofeedback and behavioral modification for the purpose of prevention and treatment of mild to severe psychological conditions. Currently, the qualification of Ph.D in clinical Psychology is not recognized by RCI as a valid degree for practicing as a clinical psychologist as it is a research qualification and has little emphasis on clinical practice.

What does a clinical psychologist do?

Clinical psychologists meet with patients to identify problems—emotional, mental, and behavioral—in their lives. Through observation, interviews, and tests, the clinical psychologist will diagnose any existing or potential disorders. Then, together with the patient, they formulate a treatment plan according to the patient’s needs. Clinical psychologists also monitor the patient’s progress on a regular basis to ensure that their needs are met by the course of action and make adjustments if necessary.

Clinical Psychologists use scientific methods to study the factors that influence people’s thoughts, perceptions, emotions, and actions. They use evidence-based strategies and psychotherapeutic interventions to help people overcome challenges and cope with life issues such as various mental illnesses (including anxiety, depression, eating disorders, panic disorder and substance addiction etc.), relationship problems, parenting issues, challenges in adolescence, lifestyle effects on health etc.

Clinical psychologists do not prescribe medications to treat mental illnesses. Rather, they are specialized and trained in psychotherapies and use psychological techniques to treat mental health disorders. Clinical psychologists usually work in close collaboration with psychiatrists and other mental health professionals.

On the job, clinical psychologists:

• Identify and diagnose psychological, emotional or behavioral issues via observation, interviews and psychometric tests.
• Develop and implement non-pharmacological treatment plans. The treatment plans are tailored for each client, keeping their individual differences in consideration.
• Monitor patient progress through regular follow up sessions.
• Help patients define goals and plan action to achieve personal, social, educational, vocational development and adjustment and make positive changes in their lives.
• Provide psychological support to the caregivers of clients.
• Teach and supervise clinical psychology trainees.
• Meet and create a liaison with other medical and mental health professionals in order to facilitate referrals and provide them a second opinion or advice.
• Conduct applied research, adding to the evidence base of practice in context of different mental health conditions.
• Writing medico-legal reports, needed in case of legal proceedings (for e.g., in case of sexual offenders, juvenile delinquents, domestic violence, divorce/separation, claiming child custody, claiming disability benefits/rights.)

Behavioral medicine as a link between clinical psychology and various fields of medicine:

Clinical Psychologists work in collaboration with other mental health professionals such as Psychiatrists, Psychiatric social workers, special educators, rehabilitation psychologists etc. However, their role cannot be restricted only to the field of mental health. Their role needs to be understood in connection with many of the other fields of medicine including cardiology, pulmonology, dermatology, oncology etc. In order to understand this better, we first need to understand the sub specialization of clinical psychology known as behavioral medicine.

Behavioral Medicine is one of the most popular and fastest growing subspecialties of clinical psychology. Behavioral medicine is basically an interdisciplinary approach which utilizes knowledge from different fields of healthcare in order to integrate behavioral and biomedical information for the diagnosis, prevention, treatment and rehabilitation of both psychological as well as medical problems.

Clinical psychologists who by the nature of their training, understand the connection between mind and bodily functioning, can help people cope better with chronic medical illnesses such as chronic kidney disease(CKD), chronic pain,  asthma, COPD, cancer, dementia etc. as well as prevent potential illnesses (e.g. diabetes type 2, cardiovascular diseases, IBS etc.) from developing or worsening. One of the fundamental concepts on which this specialty is based is that psychosocial factors also affect the etiology and maintenance of diseases through alteration of various physiological functions. Certain diseases which were previously considered purely biological are now being studied through a bio-psycho-social approach.

The bio-psycho-social model views health as a product of various factors, which include biological factors (e.g. genetic predisposition), behavioral factors (e.g. lifestyle, stress levels, health beliefs, attitude towards seeking healthcare services) and social conditions (e.g. culture, family dynamics, socioeconomic background, ethnicity and social support). This conceptualization has many practical advantages. Firstly it reduces the risk of people developing certain health problems, secondly they receive more effective treatment and thirdly it makes treatment more cost-effective when they seek treatment from a multi-disciplinary team.

Role of clinical psychologist in the healthcare sector? 

Have you ever noticed that some people fall sick more frequently than others or take more time to recover as compared to others? We usually consider these differences as a result of various physiological factors but psychological and social factors also play a significant role. Clinical Psychologists are trained to understand the connection between the various physiological/biological factors, psychological factors and social factors in the emergence of various mental as well as physical illnesses. The main four ways in which clinical psychologists can contribute to the health care sector are:

1. To promote and advocate maintenance of health and well-being
2. To prevent and treat certain illnesses
3. To identify the causal factors and psychological correlates of health, illness, and related dysfunctions.
4. To analyze and improve the healthcare system and policies.

Major areas in which clinical psychologists can work in the healthcare sector are:

• Weight management/ lifestyle management
• Drug de-addiction
• Chronic Pain management
• Stress management
• Coping and adjustment to chronic lifelong diseases such as Diabetes, Cardio-Vascular Diseases, Cancer, Skin diseases etc.
• Management of the psychological correlates of some medical problems
• Improving treatment compliance and patient-doctor communication
• Palliative care
• Provision of psychological support to patients admitted in ICU
• Psychological support to long-term primary caregivers who are experiencing care-giver burnout.
• Psychological support before and after surgery or any intensive medical procedure.
• Disclosing critical diagnosis such as cancer, HIV etc and poor prognosis to the patient and family in a professional way so that they feel supported in times of distress.
• Help patients cope with the side effects of treatment such chemotherapy, radiotherapy, dialysis etc.

Different populations who can benefit from the services of clinical psychologists are:

• Healthy people-for promoting healthy behaviors and disease prevention
• People at high risk for a disease (for e.g. genetic carriers of a disease or people who engage in high-risk behaviors)
• People with complex healthcare needs or diagnosed with acute health problems
• People diagnosed with chronic illness

How a trained/certified clinical Psychologist can help people with various health conditions other than mental health disorders:

Example: Heart diseases/cardiovascular diseases:

The relationship between psychology and cardiovascular diseases is two way; psychosocial factors affect the heart and vascular system and cardiovascular diseases also affect the mental states of individuals. A clinical Psychologist can help an individual with genetic predisposition to develop various heart conditions to develop a healthy lifestyle so that he or she does not develop it. On the other hand, a person with any heart condition is helped by a trained clinical psychologist to reduce the stress related to the disease and help him make lifestyle changes so that his or her heart condition does not get worsened. Similarly, clinical psychologists have a significant role in the treatment and management of high blood pressure. A variety of behavioral and cognitive-behavioral methods can help in successfully lowering blood pressure. Some techniques that help achieve relaxation include biofeedback, progressive muscle relaxation, hypnosis and meditation, all of which reduce blood pressure via the induction of a state of low arousal. Deep breathing and guided imagery are often added to accomplish this task. Even giving patients feedback about exactly how their compliance efforts are can improve blood pressure. Other stress management techniques train people to identify their particular stressors and to develop plans for dealing with them. The programs include training in self-reinforcement, self-calming talk, goal setting and time-management. The fact that anger has been associated with hypertension suggests that teaching people how to manage their anger might also be useful.

Thus, through these examples we want to emphasize the fact that clinical psychologists have a significant role even beyond the identification, diagnosis, and management of mental illnesses.

Conclusion:

Public as well as administration needs to understand the role of clinical psychologists in the various fields of medicine beyond mental health care. They need to understand how clinical psychologists and medical doctors (from almost all fraternities) can work in collaboration and integrate their services, skills and knowledge in order to help in prevention, screening and early detection, etiology of diseases, management of disease, promotion and maintenance of health, factors for good prognosis of treatment, rehabilitation, post-recovery adjustment and quality of life etc. The role of clinical psychologists in the treatment of common medical conditions needs to be highlighted in order to help other medical professionals understand when to refer patients for psychological evaluation and intervention. By acknowledging and accepting the role of clinical psychologists in the health sector we can improve healthcare services and formulation of health policies and help humanity to prosper with a sound body and sound mind.

• Isha Malik is a Clinical Psychologist at GB Panth Hospital and Wasim Kakroo is a Clinical Psychologist at IMHANS. For feedback: [email protected]  [email protected] 

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