Monday, December 03, 2007

What Good Are Psychologists?

So this morning I'm scheduled to see eleven people and an officer catches me at the door, before I even have my coat off, to tell me that one of my patients is down and waiting to see me. I get to the clinic and see two of our institutional psychologists sitting in an office, chatting. I don't think too much of this---it's the usual morning start, they've made the morning coffee---until I happen to see the morning clinic schedule for the psychologists.

Four fulltime psychologists are scheduled to see a total of six patients today.

The thought flitted through my head: "What good are these people?"

The unvarnished truth is that a single correctional psychiatrist will see as many patients in a given year as three fulltime psychologists. This is pretty consistent from what I've learned from talking to correctional psychiatrists in other states. And this makes sense---the vast majority of referrals are medication issues and they can't do anything about that so the referrals get routed directly to me. I also get the diagnostic dilemmas, the unexplained mental status changes that you need medical training to sort out. (Heaven help me if I see another inmate in alcohol withdrawal diagnosed with schizophrenia.) Psychiatrists see more people because they are trained to do things that psychologists can't do, and psychiatric issues come up much more frequently than psychological issues.

That being said, the psychologists I work with are wonderful. They have great senses of humor, they help me keep up my morale and they don't hesitate to step up to the plate to help with what they can help with. They handle the emergency referrals that come up during my clinic. When the secretary is off or out sick (I don't have a clerk of my own, I have to borrow help from the psychology department secretary), the psychologists help traige referrals, set up my clinic schedule and pull charts.

They have their own specific professional duties, of course. They give input into classification decisions (where an inmate is assigned to do his time, what security level he needs) as well as input into program eligibility. When requested they'll do parole assessments and respond to staff needs in case of crisis (suicide response debriefing, mass disturbance debriefing, etc). They provide crisis intervention counselling, substance abuse groups, sex offender therapy and set up behavior plans for inmates who require them.

So this is what psychologists are good for in prison, in case you were curious.


Midwife with a Knife said...

Do the psychologists in jail do psychotherapy? Just curious....

Anonymous said...

I wouldn't want my psychotherapy done by any psychologist who was in jail unless it was for a parking infraction or something like that.

Gerbil said...

Clink, I'm not sure whether I'm reading between the lines correctly (or whether I might be reading between lines that don't even exist) but this post makes it sound like professional worth is ultimately based on how many patients you see in a period of time, not what you do with/for them.

Incidentally, this is one reason why we psychologists feel looked down upon by psychiatrists. No, most of us can't prescribe medications; and yes, a psychiatrist could do three med checks for every hour-long therapy session we do. But we also can do things that most psychiatrists cannot--like administering and interpreting psychological tests. In my experience (none of which has been in a forensic setting) it's the psychiatrists who request differential diagnosis from the psychologists, not vice versa.

A friend of mine is a psychologist at a very large prison, where she does all sorts of things, including therapy (to answer MWAK's question), testing, and making sure that inmates actually get to see the psychiatrist before their medications run out. In reality, she says, inmates' medications run out weeks before the psychiatrist can see them for a refill. But this is California, where everything (not just the prison) is overcrowded and understaffed.

Anyway, I'm hoping you weren't intending to diss the psychologists. Just wanted to provide some perspective from the other side.

Anonymous said...

slow news day

Loo said...

" Psychiatrists see more people because they are trained to do things that psychologists can't do,"

By the same token, can't it be argued that psychologists see fewer patients because they are trained to do things psychiatrists can't do? (I am neither, by the way)

HP said...

Gerbil voiced my thoughts on reading this post perfectly.

I can't talk from a correctional perspective but the roles are, and should be, different.

I guess your post stems from frustration at being overstretched while your psychological colleagues seem comparatively idle. Quite understandable. Most of us cannot even begin to imagine the kind of environment you work in. However, even though you ultimately say appreciative things about your colleagues, your post reflects perfectly the dismissive attitude sometimes modelled by psychiatrists in respect of psychologists.

HP said...

Or, on reflection, maybe it was just that title..? :)

Anonymous said...

uh yeah, if they are running groups then it seems that if you add it up they see more pts per day than you are. so you are saying that this is less important than what you do and that they are really great at pulling files for you. it would be interesting to get a better picture of the dif btw psychiatric and psychological issues because it sounds like you are saying that anything psychiatric is by defintion not psychological and by extension, a biological meds based approach is the answer so who is making that mind body distinction here?

Dinah said...

I thought the disparaging tone was related to the psychologists' light schedule, four psychologists, 6 patients in a morning. You'd think they'd be busier in jail.

It's not the number of contacts, it's the idea that one professional is so over-utilized while another is so under-utilized and it sounds like they do pitch in and help out.

You're a trooper. I work one morning in a clinic-- I feel like I've had a lot if I see 7 patients in that morning. The rest of my life is part time and mostly 50 minute sessions, so 8 patients is a long day. My all-time record is probably 15 patients in a day. You are a trooper and I am a wimp.

Anonymous said...

What's fantastic? New Mexico and Louisiana. Why? Because they've given PhD/PsyD Psychologists script rights and many other states have legislation in process to extend prescription rights to psychologists with a 2 year post doc specialization. What does this mean? The MD/DO ego of the psychiatrists will soon be obsolete, as will they.

Anonymous said...

what will happen to their ids and superegos??

Jodie Brown said...

Yes maybe psychiatrists can administer medschool but psychologists talk and get to know people on a deeper level it's not about how many patients they see it's about making use of the time they do have when they see patients!