t h e j o u rn a l o f t h e b c psych o l o g i c a l a s s o ciati o n
Vo lu m e 3 • Is su e 4 • fa l l 2014 • fu t u re o f psych o l o gy
BC PsyChologist
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Board of Directors (from left to right: Michael Mandrusiak, Psy.D., R. Psych.,
Marilyn Chotem, Ed.D., R. Psych., Don Hutcheon, Ed.D., R. Psych., Ted Altar, Ph.D.,
R. Psych., Yuk Shuen (Sandra) Wong, Ph.D., R. Psych., Douglas Cave, MSW, RSW,
Ph.D., R. Psych., MA, AMP, MCFP. & Murray Ferguson, Psych.D., R. Psych.)
EDITOR IN CHIEF
Ted Altar, Ph.D., R. Psych.
Assistant Editor
Marian Scholtmeijer, Ph.D.
PUBLISHER
Rick Gambrel, B.Comm., LLB.
BOARD OF DIRECTORS
PRESIDENT
Ted Altar, Ph.D., R. Psych.
VICE-PRESIDENT
Don Hutcheon, Ed.D., R. Psych.
TREASURER
Marilyn Chotem, Ed.D., R. Psych.
ART DIRECTOR
Inkyung (Inky) Kang
executive director
Rick Gambrel, B.Comm., LLB.
administrative director
Eric Chu
EXECUTIVE ASSISTANT
Rukshana Hassanali
DIRECTORS
Michael Mandrusiak, Psy.D., R. Psych.
Douglas Cave, MSW, RSW, Ph.D.,
R. Psych., MA, AMP, MCFP.
Yuk Shuen (Sandra) Wong, Ph.D., R. Psych.
Murray Ferguson, Psych.D., R. Psych.
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ASSOCIATION
Table of Contents
4
Letter from the President
5
Letter from the Executive Director
6
APA Council of Representatives Report — August 2014
8
BCPA News & Events
9
Board Statements 2014
10
BCPA Constitutional Amendments
11
The RCMP: A Corporate Culture Out of Step
Mike Webster, Ed. D., R. Psych.
14
Hopeful Prognosis for Psychodiagnosis
Noah Susswein, Ph.D.
18
Self-Compassion: The Future of Self-Care?
Dawn Johnston, Ph.D., R. Psych.
20
Meeting the Needs of the Community:
A Training Model Addressing Psychologists’ Competencies
Michael Mandrusiak, Psy.D., R. Psych., Vaneeta Sandhu, Psy.D.,
R. Psych. & Angie Ji, M.Ed., CCC., MTA.
23
Current Status, Challenges & Future Directions of Telepsychology
Jaye Wald, Ph.D., R. Psych.
26
Primary Care Psychology – Increasing Capacity & Decreasing
Barriers to Psychological Services Through Integrated Care
Joachim Sehrbrock, Ph.D., R. Psych. & Theo DeGagne, Ph.D.,
R. Psych. (Vancouver Coastal Health)
29
Sleep Management Workshop & BCPA AGM Registration
Letter from the President
t e d a lta r, Ph . D. , r. psych .
The President of the BC Psychological Association.
Contact for the Board of Directors at [email protected]
D e a r Co l l e ag u e s a n d Frie n ds ,
This will be my last letter as it is time for me to retire
from BCPA. I will have completed my last 3 year-term
this November and since I will now be 65, I now need to
step aside for new and younger Psychologists to move
BCPA forward. I want to thank everyone for their support
during my terms as a Director since 2006 and as your
President for the last three years. All should be pleased
with the diversity of directors volunteering their time for
BCPA which our progressive membership elected. I myself
have appreciated being accepted as an unusual Board
member due to being an ethical vegan, a visible minority,
short in height, and a rural psychologist from Northern
BC whose clients are predominantly First Nations. I
believe that the diversity of experience that I and others
have brought to BCPA has served it well.
During my term as President, BCPA had to
address some difficult issues of restructuring, which was
definitely needed and was onerous to undertake. This
was a difficult time for all of the directors and through
it all, notwithstanding any disagreements, we remained
steadfast, magnanimous, respectful and caring of each
other as we addressed the difficult problems at hand
and established a more solid organizational foundation
for BCPA. This will benefit all future directors and has
allowed BCPA to become more efficient and responsive
to its members. Again, I humbly thank you all and give
my fondest kudos to the current board, to all past board
directors, and to all of our volunteers for their generosity
in giving the best of themselves over the years of BCPA’s
life.
We have a new and dynamic Executive Director
with both legal and political experience. We have
maintained the Journal and improved its professional
appearance. We have effected an organizational review,
improved staff working conditions, cut office costs and
improved operational efficiency. We have updated and
effected some good Constitutional changes. The Board has
completed briefs for MSP/Collaborative care and limited
Prescription Privileges for BC Psychologists. With patience
and persistence, I am confident that we will eventually
succeed in advancing our profession in BC by both
increasing our availability to citizens and expanding our
services into new areas. We cannot rest content with past
achievements as the world around us all is rapidly changing
and our best opportunities are to be found in adapting to
circumstances and innovating salutary changes where we
can and must.
There is the old joke of the intoxicated man
who was looking for his car keys which he had dropped
somewhere in a parking lot, but he was only looking around
a street light. When asked why he continued looking in the
one area where it was obvious that his keys were not there,
he replied that that is where the light is best. In contrast, our
noble and great profession of Psychology shines light where
light is needed and does so with a sober and intelligent
mind and compassionate heart. As Psychologists we bring
light and hope for individuals in distress, and our discipline
shines a penetrating light to advance our knowledge for the
betterment of all. It has indeed been a privilege and honor
to have been a Psychologist and to have been your President
of your voluntary association of colleagues. With gratitude
and good memories, I wish you all the very best.
Sincerely,
Dr. Ted Altar
4
fall 2014
Letter from the Executive Director
ri ck ga m b re l , b . Co m m . , LLB .
The Executive Director of the BC Psychological Association. Contact: [email protected]
T his is su e o f t h e BC Psych o l o g is t
is a b o u t t h e Fu t u re o f Psych o l o gy.
And for
BCPA the future looks bright indeed.
We finished our membership year on August 31st
with 740 members — the largest number of members in
this association’s history. Membership renewals for this
year continue at a brisk pace. If you are one of the few
who have not yet renewed, please do so now to ensure the
continuation of all of the benefits of BCPA membership:
• Discounts on BCPA-sponsored Continuing Education
events, such as the very successful workshop on ethics
Stephen Behnke just held in both Vancouver and
Victoria;
• A free yearly subscription to our journal the BC
Psychologist;
• Professional development and networking
opportunities;
• Access to our job board;
• Discounts on liability insurance, with average savings of
77% (over $1100.00)over non-discounted rates;
• Discounts on property insurance plans;
• Access to Association health, dental and disability
insurance;
• Access to the e-mail forum, which allows you to converse
with, and learn from, other psychologists;
• The satisfaction of knowing that you are supporting the
advocacy efforts of BCPA.
BCPA has worked hard to schedule more quality workshops
this year, the next being on November 28th, in conjunction
with our Annual General Meeting — Integrating Sleep
Management into Clinical Practice: Cognitive Behavioral
Treatment for Children, Adolescents & Adults, by Catherine
Schuman, Ph.D. In the new year we have two more
workshops scheduled — Friday March 27 th, 2015 — FitnessFor-Duty & Professional Practice Evaluations: Ethics &
Assessment Techniques at Park Inn & Suites (OAK Room),
presented by Dr. Mark Zelig and Friday April 24th, 2015
Impact Therapy: A Multisensory Approach to Therapy
(What Advertisers Know that Therapists should Know) at
University Golf Club presented by Dr. Ed Jacobs & Dr. Nina
Spadaro.
It was wonderful to see and meet so many of you at
our workshop presented by Dr. Behnke. We were especially
glad to be able to present the workshop in Victoria,
bringing BCPA educational programs to those of you on
the island. We hope to do that again soon.
I encourage you to come out to our AGM on
November 28th and the associated workshop. Any BCPA
member in good standing is entitled to attend. Come
and hear about the business of your association and
contribute to the discussion at the AGM. In this issue
of the BC Psychologist you will also find a ballot for an
amendment to our Bylaws. Please read it and submit
your vote by mail or in person at the AGM.
Since our last issue, it has been a busy time
at BCPA. In addition to preparing for our September
workshop and producing this publication, the staff,
board and committees have been engaged in preparing
submissions to government on youth mental health and
reviewing proposed changes to the BC Supreme Court
rules. Our very successful Piece of Mind Art Exhibition
is expanding this Winter to UBC, from October 27th
to November 7th, with an opening event on Saturday
November 1st at 2:00 p.m. Please come out and see
how artists answer the question, “What does good
psychological health mean to you?”
BCPA is always looking for member volunteers
to serve on committees, help with Piece of Mind, or
give a talk during February — Psychology Month. Ask
a colleague that volunteers about how satisfying giving
back to the profession really is.
I also wanted to recognize our two interns who
assist us in the office every week — Chelsea Light from
SFU and Vanessa Hazell from the Psy. D. Program at the
Adler School.
I want to close by thanking the Board and
members for their continued support of me and the
BCPA staff. And a special thanks to the best psychological
association staff in North America — Eric Chu, Inky
Kang, and Rukshana Hassanali — your BCPA staff.
BC Psychologist
5
APA (American Psychological Association)
Council of Representatives Report — August 2014
J e a n n e L e B l a n c . Ph . D. ,
ABPP, R. Psych .
The BC Representative to the APA’s
Council of Representatives. Contact:
[email protected]
T his y e a r at APA’s su m m e r co u n cil m e e tin g , a
number of issues were discussed. One area on which the most amount of
time was spent was in respect to how amending APA governance could
assist APA becoming more “nimble” and quicker to respond to changing
needs of the membership and the community in general. Of relevance
to British Columbia, there remains a smaller group of individuals who
are advocating with doing away with State, Provincial, Territorial
representation, in favor of either having regional representatives, or doing
away with them all together (and have members represented primarily
by divisions or areas of expertise (i.e., academic, scientific, etc.). BC —
along with representatives in other Provinces, Territories, and smaller
states, continue to work together to promote inclusion of voices from
SPTA membership. We are also moving towards the likely inclusion of a
Canadian representative on the SPTA caucus, to assist with continued
efforts to lobby for our input as changes in governance are discussed.
Furthermore, BC representation continues to support members
of APA Council who are striving to have APA endorse a more explicit
stance against psychologists being involved in torture. While a number
of members feel that APA has already made strong enough statements, a
number of us disagree. At this meeting, additional support from some
divisions was given to the motion to revisit this issue.
O t h e r u pdat e s in clu d e t h e f o l l owin g :
1. There is an ongoing discussion regarding APA membership. APA
membership is down across all categories except ‘lifetime’ (which
is up 41% over 5 years). In response, APA is planning to undertake a
member survey to inquire about the motivation behind joining APA,
and how APA is (or is not) meeting people’s expectations. One finding
thus far is that only 40% of graduate students have joined, generating
a discussion of the importance of professors’ and academic mentors’
introducing students to APA. Another finding of note is that many
divisions’ membership is by those who are not members of APA.
2. APA approved policy on the interrogation of criminal suspects.
American Psychological Association recommends:
a. that all custodial interviews and interrogations of felony suspects
be video recorded in their entirety and with a “neutral” camera
angle that focuses equally on the suspect and interrogator;
b. recognizing that the risk of false confession is increased with
extended interrogation times, that law enforcement agencies
consider placing limits on the length of time that suspects are
interrogated, with these limits only being exceeded with special
authorization;
6
fall 2014
c. that law enforcement agencies, prosecutors, and the
courts recognize the risks posed to innocent suspects by
interrogations that involve the presentation of false evidence;
d. that police, prosecutors, and the courts recognize the risks
posed to innocent suspects by interrogations that involve
minimization “themes” that communicate promises of leniency;
e. that particularly vulnerable suspect populations be provided
with special protection during interrogations in the form of
the mandatory presence of either an attorney or professional
advocate,
f. that those who conduct interrogations receive special training
regarding the risk of eliciting false confessions from individuals
who are young, cognitively impaired, psychologically
disordered, or in other ways vulnerable to manipulation.
3. APA approved policy that an Early Career Psychologist seat be on
Boards and Committees, as well as approving the need to engage
new talent in APA governance.
4. APA approved endorsing the UN Convention on the Rights and
Dignity of Persons with Disabilities, encouraging the use of
psychological research and education to heighten awareness of the
impact of stigma and discrimination on persons with disabilities,
and the ways in which disability intersects with other minority
statuses throughout the global community; encouraging the
inclusion and involvement of persons with disabilities in research,
information and technology, public policy, and advocacy; and
advocating for public policies that support global change toward
egalitarian relationships and the elimination of practices and
conditions oppressive to persons with disabilities.
5. APA continues to review and consider methods of improving
the nimbleness and efficacy of APA governance. At this time, the
majority of the council are indicating that all States, Provinces and
Territories, as well as Divisions have at least one seat on Council.
There is still much discussion of what that would look like, whether
larger Divisions and States/Territories/Provinces should have ways
of increasing their representation, and how to adequately represent
members who are not involved in any Divisions and/or the State,
Provincial, Territorial associations (which is estimated to be about
40% of membership).
Regards,
Dr. Jeanne LeBlanc, ABPP, R. Psych.
Council of Representatives, British Columbia
BC Psychologist
7
BCPA News & Events
T o ke e p re ce ivin g n o ti ce s & u pdat e s fr o m us ,
please add [email protected] to your address book.
•
upcoming workshops
•
correction
In t e g r atin g S l e e p M a n ag e m e n t in t o
pl e a s e acce p t o u r a p o l o gy f o r
Clini c a l Pr ac ti ce Wo rk s h o p & BCPA AGM
mis prin tin g the bio of the writers, Dr. Carla Fry
and Dr. Lisa Ferrari, on page 13 of the Summer issue
of the BC Psychologist. Although, it was too late to fix
the problem in print, we changed it on our electronic
versions. Thank you very much for understanding.
Presented by Dr. Catherine Schuman
9:00am – 4:00pm Friday November 28th, 2014
@ University Golf Club
Please see page 29 or visit www.psychologists.bc.ca
for more information and registration.
•
submit articles
Fit n e s s - f o r - d u t y & Pr o fe s si o n a l
Pr ac ti ce Eva luati o ns: E t hi c s a n d
A s se s sm e n t T e ch ni q u e s
Presented by Dr. Mark Zelig
9:30am – 4:30pm Friday March 27th, 2015
@ Park Inn & Suites on Broadway
We are always looking
for writers for the BC Psychologist or the BCPA blog. The
theme for the upcoming Winter 2015 issue is: Depression.
For further details, contact us at: communications@
psychologists.bc.ca
Wa n t t o w rit e f o r us?
regarding retirement,
awards, and deaths of members. Please keep us informed
about your career and life milestones. If you want a
notice to be included in the publication (approximately
100 words) contact us at: [email protected]
W e pu b lis h n o ti ce s
Im pac t t h e r a py: A M u ltis e ns o ry
A ppr oach t o T h e r a py (w h at Adv e r tis e rs
Kn ow t h at T h e r a pis t s s h o u l d Kn ow)
Presented by Dr. Ed Jacobs & Dr. Nina Spadaro
9:00am – 4:00pm Friday April 24th, 2015
@ University Golf Club
•
piece of mind @ UBC
J o in us f o r O pe nin g e v e n t!
2:00pm – 4:00pm Saturday November 1st, 2014
@ AMS Art Gallery (UBC) 6138 Student Union Boulevard
Opening Remarks and Panel Discussion begins at 3pm.
Exhibit runs from October 27th to November 7th, 2014.
8
fall 2014
•
social media
J o in us O n lin E!
www.psychologists.bc.ca/blog
www.youtube.com/bcpsychologists
www.twitter.com/bcpsychologists
www.facebook.com/bcpsychologists
Board Statements 2014
we had four positions opening on the Board of Directors of the BC
Psychological Association (BCPA). We have 1 new and 3 returning Board Members.
WE WANT TO CONGRATULATE the following candidates who have been
elected to the BCPA Board by acclamation. We also thank our returning Board
Members for their continuing commitment.
T his y e a r,
D OUGLAS CAV E , MSW. RSW.
D ONAL D "D ON" HUTCHEON , E D. D. ,
PH . D. , R. PSYCH . , MA , AMP, MCFP.
C . PSYCHOL . (UK). , R. PSYCH .
My MSW and PhD in Counselling Psychology were
granted by UBC. My Post-Doctoral Master’s Degree
in Clinical Psychopharmacology is from New Mexico
State University. I am an Assistant Professor and Lead
Faculty for Behavioural Medicine in the Faculty of
Medicine at UBC. My clinical work is at the Centre for
Practitioner Renewal at Providence Health Care where
I provide care to healthcare providers. Previously, I
worked in the areas of addictions, sex-related and LGBT
concerns, trauma among peacekeepers and forensics.
Some of the things that are important to me regarding
psychology in BC are: enhancing the relationship
between medicine and psychology, developing healthy
and resilience enhancing workplaces, fostering an
expansion of psychological services, and examining
psychologists’ ability to bill to MSP.
Please review my candidacy for the BCPA Board using
the following information as a guideline. I have most
recently sat on the Prescription Privileges committee
(2009 – 2011). Previously and prior to commencing BCPA
Board membership I was a member of the BCPA Referral
Subcommitee (2003 – 2004) and subsequently nominated
to the Board, initially in the role of Vice President and
subsequently as Treasurer of the organization (2005 –
2008). Currently, I look forward to greater empowerment
of psychologists in the following areas: developing a
training curriculum for prescription privileges; assisting
foreign psychologists currently awaiting professional
equivalency status; increasing numbers of internships
in the Province; and, investigating “third party” billing
for psychologists. Thank you for your attention in this
matter and I look forward to seeing you at the AGM.
MARILYN CHOTEM , E D. D. , R. PSYCH .
PAUL G . SWINGLE , PH . D. , R. PSYCH . ,
Having just completed a three-year term on the Board
of Directors as Treasurer and Chair of the Advocacy
Committee, it is my desire to build on projects already
started and another three-year term would allow
me to accomplish this. For example, we are now in
a position to promote the Access to Psychologists in
Primary Health Care proposal. Also, we hope to market
the brochure, Psychologists Make Business Sense,
which promotes a mental health budget and the BCPA
referral service for employees of small businesses as an
alternative to costly employee assistance programs.
Having just celebrated the 50 year mark as a Ph.D.
level psychologist I was mindful not only of how far
we have progressed as a profession but also of the need
for facilitating public awareness of the very special
skills we have for remedying a very broad spectrum of
conditions. Psychologists who are truly talented make it
look easy so we have a myriad of me-tooers who purport,
and apparently believe, that they are in our league. My
motivation for accepting nomination is that I would
like to help bring clarity to public understanding of our
profession.
BC Psychologist
9

BCPA Constitutional Amendments
T his y e a r BCPA s e e k s t o a m e n d
t h e pr o ce s s by w hi ch it s
Currently,
the members elect the Board members
and they, each year, elect the officers —
the Secretary, Treasurer, Vice President
and President. Under the amendment, the
board will elect the officers as in the past,
with the following exceptions:
pre sid e n t is e l e c t e d.
• A Vice president will be elected for
one year, and the following year, the
Vice President will assume the office
of President. The year after serving as
President, that person will continue
on the board as Past President.
• The change is designed to provide an
opportunity for the Vice President
to learn about the office of President
before serving in that office, and for
the past President to continue on
the board, if they wish, for another
year, to provide some continuity of
knowledge and act as a source of
advice for the new President.
S e c ti o n 24(1) o f t h e by l aws s h a l l b e
“The President, Vice President,
Secretary, Treasurer, past President and one or more
other persons shall be the directors of the society.”
a m e n d e d t o re a d :
S e c ti o n 2 5 (3) is re n u m b e re d s e c ti o n
2 5(7) a n d is a m e n d e d t o re a d : “An election
may be by acclamation; otherwise it shall be by ballot.”
A n e w S e c ti o n 2 5(3) is a dd e d a s
“The Vice President shall take office as
President at the conclusion of the Annual General
Meeting of the year following his/her election.”
f o l l ows:
A n e w s e c ti o n 2 5(4) is a dd e d a s
f o l l ows: “In order to be eligible to be elected as
Vice President or President a person must have served
at least one year as a director before being elected.”
A n e w s e c ti o n 2 5(5) is a dd e d a s f o l l ows:
“In the event that the President shall not serve out a
term for any reason, the Vice President shall succeed to
the unexpired remainder thereof and continue through
his/her own term. In the event that the Vice President
shall not be able to serve out a term, both a President
and a Vice President shall be elected by the directors of
the society and shall assume office immediately.”
Agree
Do Not Agree
f o l l ows: “The past President shall be the most
recently retired President and will serve a term of one
year. The past President shall not be eligible to appear
as a candidate on the Vice President election ballot.”

q
q
A n e w s e c ti o n 2 5(6) is a dd e d a s
The RCMP: A Corporate Culture Out of Step
Mike W e b s t e r, Ed. D. , R. Psych .
Dr. Webster has practiced as a police psychologist for over 35 years. He specializes in Crisis Management and
works with law enforcement agencies both domestically and internationally. He has consulted on a number of
high profile crises including Waco Texas, Jordan Montana, Lima Peru, and Gustafsen Lake British Columbia.
I would like to examine the
culture of a large government bureaucracy, the Royal
Canadian Mounted Police (RCMP). For the purposes
of this piece I will define corporate culture as simply,
“the way we do things around here”. The RCMP, to my
knowledge, is the only major Canadian police service
without a union/association. (An in-house Division Staff
Relations Representative Program was imposed upon
the members in 1974 by the Commissioner of the day). In
2007 a group of RCMP members, largely from Ontario,
Quebec, and British Columbia challenged the legality of
a union ban dating back to 1919. In that application to the
Ontario Superior Court, the members’ counsel outlined a
workplace characterized by dysfunction, high levels of stress,
harassment, bullying, a culture of fear and an absence of
independent representation (Canadian HR Reporter, 2007).
The RCMP’s continued resistance to the union initiative
calls into question the organization’s genuine commitment
to cultural change. In 2006 the senior executive of the
above noted in-house staff relations program dipped into
the membership’s legal fund to pay a lobbyist (Summa
Strategies) to dissuade federal members of parliament from
supporting the creation of an RCMP members’ association.
This misuse of funds was mostly unknown; however among
those members who were aware of what their staff relations
representatives had done, it was considered a betrayal by
those who claim to put “members first”. Leading up to the
constitutional challenge, approximately two dozen serving
and retired RCMP members filed affidavits in support of the
motion. The affidavits asserted a “disturbing tolerance for
bad and sometimes borderline criminal behaviour within
the force”. (Gatehouse & Gillis, 2007).
In a recent Ipsos Reid poll (2013) only 33% of British
Columbians thought that the RCMP leadership was doing
a good job; only 39% thought the Force treated its own
employees fairly; and only 45% thought the organization
would be able to stop the harassment of female members.
There is, currently, a landslide of female members alleging
harassment in the RCMP workplace including: Catherine
Galliford; Janet Merlo; Karen Katz; and nearly 300
In t his a r ti cl e
individuals in a pending class action lawsuit. Historically,
the record reveals both male and female members alleging
harassment, discrimination, physical abuse, sexual
assault, bullying, and intimidation (see for example,
Mariga, 2006; Gatehouse & Gillis, 2007; Humphrey, 2006).
Further insight into the dysfunctional culture
of the RCMP is provided by scholarly organizational/
management reviews (e.g. Brown Report, 2007; Duxbury
Report, 2007) and employee surveys. One such survey
undertaken in the RCMP’s “C” Division in 2008 indicated
“that the Quebec division... is a mess of bad management,
poor employee communications, and rotten promotion
procedures that reward cronyism and sycophants while
keeping good officers down” (Marsden, 2009). These
failures are thought to be reflective of a corporate culture
characterized by a rigid hierarchical structure replete with
impermeable para-militaristic barriers between leaders
and those led. The report, based upon 688 interviews,
went on to assert that it is not uncommon for RCMP
managers/executives to ignore “mediocre performance,
incompetence, and... reprehensible actions when it suits
them” (Marsden, 2009). Another more recent internal
RCMP report (2012) based upon survey responses from
426 respondents found “that female members do not trust
the force’s system to deal with harassment complaints
and frequently avoid reporting instances of perceived
wrongdoing” (Leblanc, 2012).
The examples provided above suggest that
contrary to RCMP spin, the problems are systemic and not
just the occasional example of “dark-hearted behaviour”.
It is well to remember that while there have been several
high profile reports of harassment there are likely many
that go unreported, as the common perception among
RCMP members is that “the harasser will simply be moved
to another unit or promoted” and the complainant will
become a target (Leblanc, 2012). Amidst much fanfare,
and following the reporting of the above noted survey
of female members, a senior executive of the Force’s
British Columbia Division announced that “a number of
initiatives” were “about to be rolled out” (Kellar, 2012). In
BC Psychologist
11
fact, the RCMP has had in-house harassment and antidiscrimination training in place since 2001. Moreover,
prior to the previously mentioned senior executive’s
announcement of newly minted “respectful workplace
advisors” and her boss’ announcement of one hundred
specially trained harassment investigators, the Force
already had an anti-harassment policy and harassment
prevention coordinators (Mariga, 2006). A reasonable
person might tend to wonder whether these policies and
programs were merely window dressing. A background
investigation undertaken for the Brown Report (2007)
suggested that within the RCMP’s corporate culture there
existed “an ethos that permitted the authoritarianism
and intimidation by a few to override the principles of
the many, and a culture of fear to prevent any effective
challenge by subordinates of abusive behaviour by
superiors”. (Paquet, 2007).
As suggested above, following several high
profile allegations of sexual harassment, a class action
suit with nearly 300 cases, task force investigations,
management studies and employee surveys, it is
somewhat uncontroversial that the RCMP has a workplace
harassment problem. In my opinion, the corporate culture
can be held not only responsible for this state of affairs but
also for the organization’s inability to “get out in front of
the story”. In the law enforcement universe the unspoken
expectation is that police persons have to be tough to deal
with the “bad guys”; so why would an off colour remark, a
nasty word, or a pat on the “bum” be such a problem? The
answer lies within the fabric of traditional police culture.
The latter is woven out of several fundamental values
including solidarity, authoritarianism, conservatism,
prejudice, cynicism, suspicion, and a well rooted blue
collar ethic (Murphy & McKenna, 2007). The combination
of solidarity and authoritarianism act to dissuade police
persons from coming forward to complain about abusive
behaviour. Recent support for this hypothesis can be
found in the Brown Report (2007). The chair of the
taskforce criticized a former Commissioner of the RCMP
for his autocratic leadership style and for his obvious
punishment of whistleblowers (Clark, 2007). More recently,
a senior non-commissioned officer registered a thoughtful
complaint with the present Commissioner by suggesting
“Trust has become an essential element missing from
the relationship between senior executive/management
and the membership in the RCMP’s leadership crisis”
(CBC News, 2012). The Commissioner responded to this
member in what many thought was a demeaning and
authoritarian manner by saying, “You are living under
a rock... Your words reveal an ill-informed arrogance...
12
fall 2014
You are a Staff Sergeant in the Mounted Police writing
the Commissioner... You have done yourself a disservice”
(CBC News, 2012). Many believe that these examples of
Commissioners leading by intimidation, reflect the core
values of an oppressive corporate culture that seems out of
step with the times and impervious to change.
The example of (organizational) culture that I have
presented is widely considered to be badly in need of change.
The organizational design of military and para-military
(i.e., police) organizations is one of hierarchy. I have long
been a proponent of transformational change for the RCMP.
Even if my wish came true and the organization was to
become a separate status employer, de-militarized, downsized, tasks put in check with resources, and focused only
on federal statutes the hierarchical design would remain.
Providing more training for those in leadership positions is
not likely to improve their leadership capabilities (it hasn’t
yet!). Tinkering with policies and training more “harassment
coordinators” or “respectful workplace advisors” is not likely
to meet with success (it hasn’t yet!). Moreover, it appears that
due to hiring shortages junior members will be promoted
into positions of leadership without adequate experience.
If the RCMP is serious about getting a handle on
workplace bullying, they must address their dysfunctional
corporate culture. The keystones of the culture, solidarity
and authoritarianism, must be remediated. In my opinion,
this moves the contentious issue of a union out of the
shadows and into the spot light. If the RCMP wishes to
function in the 21st Century, they must provide a mechanism
to address the inequities in the hierarchical design. An
independent Mounted Police Professional Association would
be an autonomous entity that would move its members
“along the continuum of power ensuring a voice for those of
less power in the lower ranks of the hierarchy” (Clark, 2007).
This would finally rein in an RCMP executive/management
that has been tripping over its corporate culture and
worshipping anachronistic “sacred cows” for decades.
references
Canadian HR Reporter. (2007). Mounties want to get their union. Vol 20 (3).
Gatehouse, J. & Gillis, C. (2007). What’s really killing the Mounties. MacLean’s Vol. 120 (46).
Mariga, V. (2006). RCMP officer launches lawsuit citing harassment. OH&S Canada, Vol. 22 (8), p. 23.
Humphrey, B. (2006). Employee Awarded $1Million Damages: Mental Health Ruined by Supervisor’s Treatment. Stinger Brisbin Humphrey,
February 20.
Task Force on Governance and Cultural Change in the RCMP (RCMP Task Force, 2007). Government of Canada, December 2007.
Duxbury, L. (2007). The RCMP Yesterday, Today, and Tomorrow: An Independent Report Concerning Workplace Issues At The Royal Canadian
Mounted Police. Government of Canada, November 2007.
Marsden, W. (2009). Quebec RCMP a managerial mess: internal poll. Ottawa Citizen, Jan. 8, 2009, P.A.5.
Leblanc, D. (2012). Female Mounties fear backlash over reporting harassment, report shows. Globe and Mail, Sept. 17.
Kellar, J. (2012). Workplace advisors and online tool to help RCMP members report harassment. The Canadian Press, September 24.
Paquet, G. (2007). Background paper prepared for the Task Force on Governance and Cultural Change in the RCMP. November.
http://www.publicsafety.gc.ca/rcmp-grc/fl/eng/backgroundpaper
Murphy, C. & McKenna, P. (2007). Re-thinking Police Governance, Culture, & Management: A Summary Review of the Literature. Public Safety
Canada.
Clark, C. (2007). Closed-door task force announced for RCMP as calls for inquiry persist. The Globe and Mail, June 19, P.A. 8.
CBC News (2012). RCMP emails reveal tensions as force faces changes. cbc.ca/news/Canada/story/2012/08/09
British Columbia School of Professional Psychology
406-1168 Hamilton Street • Vancouver, B.C. • V6B 2S2 • (604)682-1909 • Fax (604) 682-8262 • email: [email protected]
The British Columbia School of Professional Psychology is presenting Basic Training in Eye Movement Desensitization and Reprocessing
(EMDR). This course is approved by the Eye Movement Desensitization and Reprocessing International Association (EMDRIA).
Participants will learn to use EMDR appropriately and effectively in a variety of applications. Such use is based on understanding the
theoretical basis of EMDR, safety issues, integration with a treatment plan, and supervised practice. Part One / Level I EMDR training is
usually sufficient for work with uncomplicated Posttraumatic Stress Disorder in most clients. Part two / Level II is necessary for working
effectively with more complex cases, special populations and more severe, longstanding or complicated psychopathology.
Qualified applicants will have a minimum of Masters level training in a mental health discipline and must belong to a professional
organization with a code of ethics or be a Graduate student in practicum/internship with appropriate supervision.
Instructor: Marshall Wilensky, Ph.D., R. Psych., EMDRIA Approved Instructor
Format: Lecture, discussion, demonstration, video – 20 hours
Supervised practice (during training weekends) – 20 hours
Consultation by group meetings or online discussion forum – 10 hours
Dates: Part One November 28 – 30, 2014; Part Two February 27 – March 1, 2015
Times: Friday 9:00 a.m. – 5:00 p.m.; Saturday and Sunday 9:00 a.m. – 4:30 p.m.
Consultations: Mondays, December 15, 2014, January 19 & March 23, 2015 - 6:30 p.m. – 9:30 p.m.
Location: Peretz Centre (6184 Ash St., Vancouver)
Tuition: Full Course: $1,850 (before October 17, 2014) $1,950 (after October 17, 2014)
Previously trained EMDR clinicians can get updated for half price
Registration: Online at www.emdrtraining.com (>>Basic Training >>Vancouver page)
Approved for Continuing Education Units by Canadian Counselling and Psychotherapy Association
For more information please contact: Alivia Maric, Ph.D., R. Psych. 604 251-7275 [email protected]
Prognosis for Psychodiagnosis
N oa h Sus sw e in , Ph . D.
Noah Susswein works at private practices in
West Vancouver and South Surrey, and for BC’s
provincial Child and Youth Mental Health program.
W h e n I t hin k o f t h e fu t u re o f
I also think of its past, in particular,
of historical developments leading up to what has been
described as a crisis, but which also might be seen as an
opportunity. In his Book of Woe, author Gary Greenberg
(2012) uses the well-publicized controversy over the
construction of the DSM-5 (American Psychiatric
Association, 2013) as a platform for investigating
longstanding debates regarding psychodiagnosis.
Greenberg’s book documents the influence of nonscientific, market forces in shaping the most recent
DSM. I take it for granted that we all agree that conflicts
of interest can compromise scientific integrity, whether
or not one believes that the construction of the DSM-5
in particular suffered from this problem. But one thing
that field cannot seem to agree on is how to answer
the seemingly basic question, What are psychological
disorders?
Many readers will recall, at least vaguely, that
Thomas Szasz (1960) once railed against the Myth
of Mental Illness and related research demonstrating
how psychodiagnoses can be inadvertently used as
instruments of social control, (e.g. Rosenhan, 1973).
The controversy regarding psychodiagnosis has often
been described in black-and-white terms as a polarized
debate between the extremes of an anti-psychiatry, and
thereby anti-diagnosis, movement (e.g., Cooper, 1967)
and orthodox defenders of the status quo. Thankfully,
our times seem to be less polemical. Even those who
“recall shuddering when [Szasz] spoke” readily concede
that “[a]lthough irritating, antipsychiatry helps keep us
honest and rigorous” (Nasarallah, 2011, p. 53). It is widely
appreciated that the problems of psychodiagnosis are
subtler than the question as to whether mental illnesses
are real or made-up. The question is whether or not the
forms of suffering that have been called ‘mental illnesses’
are understandable and treatable on the model of medical
illnesses. In which cases are the problems that lead people
psych o l o gy,
14
fall 2014
to seek mental health treatment reflective of dysfunction,
infection, or disease?
As I understand it, science has ruled out an illnessor disease-model for mental health problems in general.
But, if we want to drain this disease-model bathwater
without throwing out our babies, we need to make a sharp
distinction between a disease model of psychopathology
and a scientific understanding of it. On the one hand, there
is believing, on the basis of evidence, that a particular
condition or symptom is correlated with a particular
physiological phenomenon. On the other hand, there is
assuming that psychopathological problems in living always
indicate a neurological dysfunction or infection, that if a
condition is worth treating, then it must correspond to a
disease. The disease assumption appears to be false, and
we should expect that few to none of our core diagnostic
categories and/or concepts (e.g., “anxiety,” “inattention,”
“trauma”) will be correlated with brain diseases: “The study
and treatment of psychiatric disorders is made difficult by
the fact that patients with identical symptoms often differ
markedly in their clinical features and presumably in their
etiology… [and this] heterogeneity undermines the value of
psychiatric diagnosis” (Mill et. al., 2006, p. 462). So, to know
that a person meets criteria for, say ADHD, is less specific
and informative than knowing that they have, say, Type 2
Diabetes.
An intimidating word for this is ‘equifinality’
— many distinct developmental pathways can lead to a
common maladaptive outcome. This leads to a taxonomic
predicament — there is a great degree of phenotypic
variability within most diagnostic and clinical categories.
So, although medical practitioners and researchers are
obviously essential allies to mental health specialists, it
appears that the symptom clusters which define familiar
diagnostic concepts (e.g. “anxiety,” “depression,” “trauma”)
will not be explainable in terms of a common, underlying
pathology in the way that, say, diabetes symptoms are
explainable in terms of blood-sugar regulation mechanisms.
Developmental psychopathologists have bemoaned
the “unhelpful reification of diagnostic categories” (Rutter &
Sroufe, 2000, p. 267) criticizing the “classic disease model...
with its emphasis on diagnostic entities that are used to
both describe and explain maladaptive behavior” (Shirk,
Talmi, & Olds, 2000, p. 836). To reify is to mistakenly treat
something abstract as if it were a concrete, material entity,
like confusing the note ‘middle C’ with a particular key on
a particular keyboard, or supposing that Conduct Disorder
meaning of particular symptoms depends upon clients’
causes persons diagnosed with Conduct Disorder to behave
personal histories as well as on what they themselves
in Conduct-Disordered ways. It is clear that Conduct
understand their symptoms to mean. We have a rich
Disordered behavior is a problem, but there is no reason to
vocabulary of clinical concepts inherited from a variety
suppose that Conduct Disorder is correlated with a disease.
of therapeutic and research traditions, none of which
The potential for reification extends beyond the particular
require the assumption of underlying diseases.
diagnostic categories that happen to exist in any particular
Wouldn’t it be great if we had a diagnostic
edition of the DSM, however.For example, the vocabulary
system that was consistent with our science and
of attachment theory is an invaluable clinical resource, but
not because, say, describing a client as ‘insecure-dismissing’ standards of practice? As I see it, the failure of the
disease model of psychopathology is an opportunity for
involves a causal explanation of their tendency to devalue
conceptual innovation. The broad base of knowledge
relationship. We undermine our professional integrity and
— regarding social, cognitive, and neurological
credibility when we speak as if such diagnostic and clinical
development, of group behavior, family dynamics,
concepts refer to causes underlying behavior.
and cross-cultural variation — that is particularly
The issue of diagnostic validity is, on the one
characteristic of psychologists potentially lays the
hand, technical and scientific, but it is also an issue with
personal, political and ethical implications. Our ideas of how groundwork for developing a diagnostic framework that
best fits the clinical facts. The field is hardly short on
we should respond to our own and each other’s suffering
depend on what we think that suffering means. To my mind, good ideas; for example, some authors have considered
the possibility of a developmentally-based classification
the widely-accepted biopsychosocial perspective on mental
system (e.g., Beauchaine, 2003) while positive
health requires that we see multiple meanings in it, and
psychologists turn traditional clinical concerns upside
treat clients on the basis of an integrated understanding
down and look for sources of well-being that cut across
of the relevant variables. From what I can tell, this is what
clinical and non-clinical populations (Duckworth, Steen,
many if not most clinicians already aspire toward. The
and Seligman, 2005). Where might psychodiagnosis
disease model’s most famous critic, Thomas Szasz (1960)
be led if it were framed in terms of developmental
wrote that he was “concerned with problems in living
pathways and well-being as opposed to disease and
(and not with diseases of the brain, which are problems
symptom reduction? I don’t pretend to know the answer
for neurology).” Szasz argued that “[p]roblems in human
to this question, and neither am I sure that it is the best
relations can be analyzed, interpreted, and given meaning
particular question to ask. But I think that engaging
only within given social and ethical contexts” (p. 116). More
with this sort of back-to-the-drawing-board conceptual
than fifty years later, it appears that this once-controversial
work would make for a very rich future clinical
point of view is commonplace. We take it for granted that
clients must be assessed and treated in light of their cultural psychology. It is easy to appreciate why Greenberg
(2012) chose the clever title Book of Woe, but the story of
and individual expectations and preferences, and that the
psychodiagnosis also begs for this positive reframe.
references
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric
Publishing
Beauchaine, T. P (2003). Development and toxometrics. Development and Psychopathology, 1, 3, 501–527.
Cooper DG. (1967). Psychiatry and antipsychiatry. London, United Kingdom: Tavistock Publications.
Duckworth, A.L., Steen, T.A. & Seligman, M.E.P. (2005). Positive psychology in clinical practice. Annual Review of Clinical Psychology, 1, 1, pp.
629–651
Mill, J., Caspi, A., Williams, B.S., Craig, I; Taylor, A., Polo-Tomas, M., C., Berridge, C.W., Poulton, R., Moffitt, T.E. (2006). Prediction of
Heterogeneity in Intelligence and Adult Prognosis by Genetic Polymorphisms in the Dopamine System Among Children With Attention-Deficit/
Hyperactivity Disorder. Archives of General Psychiatry, 63, 462–469.
Greenberg, G. (2012). Book of Woe: The DSM and the Unmaking of Psychiatry. New York: The Penguin Group.
Nasrallah, H.A. (2011). The antipsychiatry movement: Who and why. Current Psychiatry, 10, 12, 6–53.
Rosenhan, D.L. (1973). Being Sane in Insane Places, Science, 179, 250–258.
Rutter, M., & Sroufe, L. A. (2000). Developmental psychopathology: Concepts and challenges. Development and Psychopathology, 12, 265–296.
Shirk, S. R., Talmi, A., Olds, D. L. (2000). A developmental psychopathology perspective on child and adolescent intervention policy. Development
and Psychopathology, 12, 835–855.
Szasz, T.S. (1960). The Myth of Mental Illness. American Psychologist, 15, 113–118.
BC Psychologist
15
KPU Continuing & Professional Studies
Prevention & Reco
Eating Disorders a
Disordered Eating
Students may register at anytime and will be given
six months to complete.
online course
$1996 + GST
*This course is recognized by the Royal College of Physicians and Sur
Canadian Nurses Association and the Canadian Counselling & Psyc
Improve your Relationships:
A new group for adults
Does your client have difficulty seeing how they come across to
others? Does your client want to try out new interpersonal skills
in a safe environment?
If so, this new Yalom-style group in Langley could be a
transformative next step in your client’s growth.
Starting November 18, 2014.
This is an ongoing group. People can join the group as there are
openings and can stay in the group until their work is finished.
When: Every Tuesday, 6:30-8:00 pm
Where: TLC Medical Centre,
near Langley Memorial Hospital in Langley, BC
Cost: $165 for individual session to discuss treatment goals;
$50 per group session, billed monthly
Therapist: Colleen Wilkie, PhD, RPsych (#1180). I have
over 20 years clinical experience including additional training in
group therapy; I provide consultation, supervision and continuing
education to clinicians offering group therapy; and I have a long
commitment to the Canadian Group Psychotherapy Association
where I’m currently on the Board of Directors.
For more information: Visit my website at: www.drwilkie.ca.
Also, feel free to call me if you’d like to talk about how this group
could be helpful for your client: 604-525-9214
BC Psychologist
Upcoming themes
•
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Win t e r 2015
S prin g 2015
Depression
Law & Psychology
Advertising Inquries
Co n n e c t wit h b c psych o l o g is t s!
• print (BC Psychologist)
• web posting (30 days)
• e–blast (every friday)
Contact Info.
604.730.0501 | Fa x 604.730.0502
[email protected]
Ph o n e
E m ail
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DR. BIRMINGHAM has treated people with
eating disorders for over 35 years and has
pioneered several new internationally
recognized treatments for eating disorders.
Dr. Birmingham’s lectures and presentations
are tailored to meet the needs of individual
professional disciplines or public groups.
His KPU eating disorder course has
separate tracks for: family doctors, nurses,
psychiatrists, psychologists, counsellors,
mental health workers, dieticians and chefs,
physiotherapists and kinesiologists, pastors,
and researchers and the public.
To register, please go to
rgeons of Canada, the
chotherapy Association
Two Brand New Psychology
Ofﬁces for rent in new clinic
located in South Surrey
http://www.croydonofﬁce.com
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Sponsorship Opportunities
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• Exhibit at the BCPA workshop
• Advertise in workshop booklet
604.730.0501 | Fa x 604.730.0502
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Ph o n e
E m ail
Professional soundprooﬁng, kitchenette, waiting
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ROUND LAKE
DRUG & ALCOHOL
TREATMENT SOCIETY
is seeking a REGISTERED PSYCHOLOGIST to provide
contracted services to clients of Round Lake Treatment Centre
(www.roundlaketreatmentcentre.ca) who are at risk. For a
PDF copy of the Request for Expression of Interest, please
email [email protected] or call 250–546–3077.
The Future of Self-Care?
Daw n J o h n s t o n , Ph . D. , R. Psych .
Dr. Dawn Johnston is a registered
psychologist providing psychotherapy to
adolescents, young adults, individuals,
families and couples. She is in private
practice in White Rock/South Surrey, as
well as in Vancouver.
H av e yo u e v e r s t ru g g l e d in a s e s si o n , and then
gotten frustrated with yourself for your emotional reaction, or not
known what to do or how to respond? When I first registered for Kristin
Neff’s two-day workshop on Mindful Self-Compassion I thought I was
registering for training on how to integrate self-compassion into my work
with clients, for their benefit. While this was partly true, I quickly learned
that the focus was actually on self-compassion for the caregiver.
Self-compassion is a rather ‘newish’ buzzword in psychology, but
what exactly is it, and how does it work? The purpose of this article is
to provide an introduction to self-compassion in therapy, from my own
readings, from participating in Kristin Neff’s workshop, as well as from
my own clinical experiences.
W h at is s e l f - co m pa s si o n?
For someone to develop genuine compassion towards others, first he or she
must have a basis upon which to cultivate compassion, and that basis
is the ability to connect to one’s own feelings and to care for one’s own
welfare… Caring for others requires caring for oneself.
— Tenzin Gyatso, the 14th Dalai Lama
When a colleague learned about my workshop in self-compassion,
he half-jokingly asked, “Wouldn’t that be like taking a course in
narcissism?” While we laughed at the prospect of learning to love
ourselves more, I found myself asking, does having compassion for oneself
have to be equated with self-righteousness or self-indulgence? According
to Kristin Neff (2003) the constructs are quite different. She defines selfcompassion as being comprised of three components:
1. Being kind to oneself and not judging ourselves harshly. This requires
treating oneself with care and actively working to comfort and soothe
oneself, as opposed to treating oneself critically or unkindly.
2. Seeing the common humanity in our experiences, rather than
perceiving them as abnormal or isolating. Basically this means that
we recognize that we are not the only ones who experience suffering
and that suffering is a part of life.
3. Lastly, self-compassion calls us to “be” with our suffering and difficult
feelings, without feeling the need to supress them or get caught up in
them. This is not an easy task.
H ow t o b e s e l f - co m pa s si o n at e :
Neff (2012) discusses the role of soothing touch releasing oxytocin in
the body, which provides positive feelings of safety, and connectedness,
thereby facilitating feelings of warmth and compassion toward ourselves.
She states that when we offer ourselves a soothing touch like rubbing our
arm, placing our hand on our heart, or giving ourselves a light hug, our
body releases oxytocin in the same way as if we were touched by someone
else.
18
fall 2014
In her book, Self-Compassion: Stop beating yourself
up and leave insecurity behind, Neff (2011), provides practical
self-compassionate exercises we can use with clients and
ourselves. Exercises include using self-compassionate
imagery, developing a practice of gratitude, and repeating
self-affirming statements.
S e l f - co m pa s si o n in pr ac ti ce :
“The research of Dr. Kristin Neff and other leading
psychologists indicates that people who are compassionate
toward their failings and imperfections experience greater
well-being than those who repeatedly judge themselves”
(Neff, 2012, inside cover).
As therapists, we likely engage in self-care
activities after work and when we “have time.” However,
self-compassion is something that we can employ in
session, during the moment of struggle, when we need it
most. Self-compassion occurs when we can recognize our
struggle without judging it, recognizing that all therapists
experience struggles in session and being able to accept
it, without needing to avoid it, quickly fix it, or get stuck in
it (Neff, 2003). This of course is not something that can be
readily done, but similar to developing any new skill, like a
practice of mindfulness, or even weight lifting or running,
self-compassion needs to be practiced regularly and with
intention.
Since I took this training and integrated selfcompassion into my clinical work, several clients have
reported practicing self-compassion as a new and
provocative experience. For one young woman with body
image issues, a self-compassionate body scan provided her
with a new and appreciative perspective on her body and
all that it does for her on any given day. Another client with
PTSD expressed with gratitude that through a focus on
self-compassion, she was able to find self-care and selfforgiveness. Yet another adult client, struggling with
affect regulation, reported that repeating self-affirming
phrases through a self-compassion exercise, provided
him with a sense of “comfort” and “reassurance,” — two
experiences that he had yearned for, but not received as a
child.
Similar to my clients and supervisees, I struggle
with hushing my inner critic and accepting when I
am not “perfect”, Alongside my clients I have also
experienced benefit from integrating a focus of selfcompassion into my clinical work. Now when sitting with
the challenging situations that arise in my work with
clients and supervisees, I can more readily recognize and
acknowledge my feelings, and be OK with them without
judging myself for not having the “best” answer for this
particular predicament.
My practice of self-compassion is just that, a
practice that I continue to engage in as I strive to come
by it more readily. By allowing myself to accept my
humanness, complete with my imperfections, I believe
that I more readily create a space where my clients and
supervisees feel permission to more freely do the same.
Our clients increasingly report experiencing
greater levels of stress, something that we as psychologists
are not immune to experiencing ourselves. If we want to
be consistent with the strategies that we offer our clients,
we also need to learn to be forward thinking rather than
reactive to life’s stressors. I believe that self-compassion
offers a way to manage the future of psychology better by
re-conceptualizing self-care, and offering us a tool that we
can use in the moment of stress, before it can take its toll.
references
Neff, K. (2003). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and identity, 2(2), 85 – 101.
Neff, K. (2011). Self-compassion: The Proven Power of Being Kind to Yourself. New York, NY: Harper Collins Publishers.
Neff, K. (May 2012). Why caregivers need self-compassion. Huffington Post.
Retrieved from http://www.huffingtonpost.com/kristin-neff/caregivers_b_1503545.html
BC Psychologist
19
Meeting the Needs of the Community:
A Training Model Addressing Psychologists’ Competencies
In t r o d u c ti o n
Mi ch a e l M a n d rusia k ,
Psy. D. , R. Psych .
Michael Mandrusiak, Psy.D., is a
Registered Psychologist (CPBC #1803)
and is the Director of Training at
the Adler School of Professional
Psychology, Vancouver Campus, where
he also serves as Core Faculty for the
Psy.D. in Clinical Psychology program.
Michael has been actively involved in
the BCPA, at the board and committee
level, where he chairs the Community
Engagement Committee and serves as
the Public Education Coordinator.
Va n e e ta Sa n d h u,
Psy. D. , R. Psych .
Vaneeta Sandhu, Psy.D., is a Registered
Psychologist (CBPC #2120) and is Core
Faculty and Training Coordinator
at the Adler School of Professional
Psychology, Vancouver Campus, for the
Psy.D. in Clinical Psychology program.
She is currently on the Early Career
Professionals Council for Division 38
(Health Psychology) of APA.
A n g ie Ji , M . Ed. , CCC , MTA
Angie Ji, M.S.W., is a second year
student in the Psy.D. in the Clinical
Psychology program at the Adler
School of Professional Psychology,
Vancouver Campus.
20
fall 2014
In considering the future of professional psychology, this article examines
how the competencies or skills that are part of optimal training in
professional psychology meet the needs that exist in our communities.
This approach is based on the assumption that the future success of our
profession depends on our ability to meet the needs of society. Recent and
emerging competency benchmark literature will first be briefly reviewed,
before examining how doctoral training programs can integrate these
competencies in order to diversify the future roles of psychologists and
more effectively meet the needs of the community. The Community
Service Practicum is an innovative training experience that will receive
particular focus for its ability to broaden particular competencies.
Co m pe t e n cie s f o r E xpa n d in g R o l e s
The traditional skill sets of psychologists consist of psychological
assessment and psychotherapy. However, the promising future of
professional psychology depends, in part, on psychologists successfully
embracing expanding skill sets and roles. This expansion has been
widely recognized in benchmark competency literature (Fouad et al.,
2009; Rodolfa et al., 2013; Hatcher et al., 2013). In addition to assessment
and intervention, psychologists are expected to obtain competence in
supervision, teaching, consultation, research, evaluation, management,
administration, and advocacy (Hatcher et al., 2013). The competence to
engage in critical reasoning and evidence-based decision making (Rodolfa
et al., 2013) is seen as one which defines psychologists and has broad
application for program and policy development, as well as operational
and organizational decision making. As professionals possessing a
valuable and diverse set of competencies, psychologists have the potential
to take on more leadership, consultation, and program and policy
development roles.
Available data suggest that much of this potential for expansion
in roles and utilization of competencies remains untapped. For example,
a survey of Canadian psychological practitioners by Hunsley, Ronson,
and Cohen (2012) showed that approximately 70% of respondents’ time
was devoted to intervention and assessment, compared to 13.3% for
consultation, 5.9% for teaching, 5.5% for research, and 5.6% for other
activities. While reimbursement is likely a primary driver of the continued
emphasis on provision of assessment and intervention, training may
well be another factor. A survey of US graduate students in professional
psychology programs found that only 14% of students expressed interest
in an administrative career (Cassin, Dobson, Singer, & Altmaier, 2007).
This finding stands in contrast to 85.3% expressing interest in a career in
a clinical/hospital setting, 61% expressing interest in a private practice
setting, and 50.4% expressing interest in an academic setting. Limitations
in the survey design itself prevent differentiation of consultation focused
practices and roles and activities within organizations
that are focused on program and/or policy development.
However, the results suggest that the future practitioners of
our profession continue to think of their roles in traditional
ways (i.e., intervention and assessment; clinical and
academic work). One implication of these results is that an
opportunity exists for training programs to help future
graduates broaden their career interests, demonstrate the
value of the profession, and understand the multitude of
potential roles they may undertake.
helping to cultivate and develop these competencies, and
to encourage future practitioners to assume a diversity of
leadership and policy-related roles.
T h e Co m m u nit y S e rvi ce Pr ac ti cu m
One doctoral program in professional psychology in
British Columbia requires that students complete a
Community Service Practicum (CSP) in conjunction
with their first year of study. The CSP draws upon service
learning principles, which have been shown to deepen
students’ understanding of complex social issues and
to foster critical thinking skills (Hurd, 2006). Specific
S e rvin g D iv e rse a n d D isa dva n tag e d
to psychological competencies as developed by Hatcher
P o pu l ati o ns
With a diversifying Canadian population and strong support et al. (2013), the CSP has the explicit aim of building
competencies related to professionalism (including values
for multicultural competence as a benchmark competency,
and attitudes, reflective practice, ethics, and individual
this domain is critical to the future of psychology. Jones,
and cultural diversity), relational skills (including how to
Sander, and Booker (2013) suggest that the abstract nature
build and maintain various professional and therapeutic
of multicultural competence has presented challenges to
relationships), science (including methodology, research,
training programs. They advocate for cultural competency
to be integrated across the curriculum rather than relegated and evaluation), application (including initiative,
leadership, and implementation), and systems thinking
to specific courses. In addition, they add a much-needed
(including advocacy, management, and administration).
dimension to cultural competence, advocacy and action,
While some literature has addressed the integration of
suggesting that psychologists will often find themselves
social justice training into clinical practicum experiences
in leadership roles within systems and will have the
(Lewis, 2010; Burnes & Singh, 2010), clinical training
responsibility to advocate for those with less power.
This dimension of cultural competence proposed by inevitably places the trainee in the role of assessor or
Jones, Sander, and Booker (2013) is congruent with the social psychotherapist and is less suited for training in some
of the other roles (e.g., consultant, program developer,
justice paradigm. The social justice perspective focuses on
program evaluator, grant writer, administrator, advocate)
how distributive, procedural, and interactional injustices
that psychologists are increasingly in demand to
are involved in mental health disparities, where distributive
fulfill. The CSP is therefore ideally suited to supplement
justice refers to equitable distribution of resources,
traditional training experiences and will be explained
procedural justice refers to fairness of decision making
further below.
processes, and interactional justice refers to fair treatment
The non-clinical Community Service Practicum
in relational exchanges involving power differences
involves students integrating themselves at a community
(Lewis, 2010). From a social justice perspective, the role of
agency or organization; for example, training contexts
practitioners is to use their own position of authority in
may include social profit organizations, government
order to help marginalized groups gain a greater voice in
programs, consumer advocacy organizations, and
decision making (Goodman, 2004).
professional organizations. Through service learning,
Crethar, Torres-Rivera, and Nash (2008) argue that
students acquire knowledge about community issues
multicultural, social justice, and feminist paradigms share
and the range of programs and services designed to
two conceptual links:
address these problems (i.e., public health approaches,
i) that clients exist within environmental contexts that
and policy development and implementation). Engaging
impact them; and
in systems thinking allows students to begin the
ii) that helping professionals must remain aware of and
processes of reflective practice and role definition —
responsive to issues of power, oppression, and privilege
skills that are essential to cultivate as they progress
that are detrimental to the client’s quality of life and
to clinical practicums and, ultimately, professional
mental health.
practice. Although students are not engaging in direct
To highlight the reviewed psychologist competencies in
psychological services, they fulfill significant roles related
meeting the needs of the community in the future, we will
to research initiatives to inform policies and procedures,
examine one particularly promising training experience for
BC Psychologist
21
conducting needs assessments, evaluating programs to
increase effectiveness or make administrative decisions,
assisting in program delivery or implementation, and
providing psychoeducation, training, or devising
strategies to promote well-being as part of community
outreach and education.
The third author completed a six-month
Community Service Practicum at the Mood Disorders
Association of British Columbia (MDABC) as a
requirement of the Psy.D. in Clinical Psychology
program in which she is enrolled. MDABC is a non-profit
organization that provides psychiatric treatment and
therapeutic support to individuals living with a mood
disorder and has facilitated development of more than
40 support groups across British Columbia. Additionally,
MDABC manages a Psychiatric Urgent Care Program and
a Mental Health Wellness Centre where individuals can
access both psychiatric treatment and complementary
therapeutic services, like group cognitive-behavioural
therapy. This author’s role at MDABC was to support
identification and recruitment of professional service
providers to facilitate group therapy, lead group
orientation sessions introducing patients to programs and
services, and engage with the MDABC team to support
development of organizational policies.
Through the CSP experience, this author learned
that meaningful relationships with others strengthen a
sense of mutual community responsibility in working
together to serve disadvantaged populations. She also
learned to assume less of an expert role, and more of
an allied, egalitarian relationship to individuals living
with mental illness. She attended MDABC staff team
meetings to discuss policy and program development.
Inextricably linked to these discussions were dialogues
related to social justice issues, including accessibility
of services, and challenges and barriers MDABC faces
and creates (or not) for patients trying to access mental
health treatment and support. Challenging questions
about privilege, poverty, and mental health services were
raised. These discussions encouraged critical thinking
and increased this author’s appreciation for the difficult
administrative and managerial decisions, given that the
resultant effects have the power to systemically impact
all members of an organization and, most importantly,
the patients who access mental health services.
When considering the future of psychology,
community needs must be addressed as we strategize
how to train new psychologists. Developing new skill sets
will facilitate the process of psychologists undertaking
new roles and establishing the success of our profession.
references
Burnes, T.R. & Singh, A.A. (2010). Integrating social justice training into the practicum experience for psychology trainees: Starting earlier.
Training and Education in Professional Psychology, 4(3), 153–162. doi: 10.1037/a0019385
Cassin, S.E., Singer, A.R., Dobson, K.S., & Altmaier, E.M. (2007). Professional interests and career aspirations of graduate students in
professional psychology: An exploratory survey. Training and Education in Professional Psychology, 1(1), 26–37. doi: 10.1037/1931-3918.1.1.26
Crethar, H.C., Torres Rivera,. E., & Nash, S. (2008). In search of common threads: Linking multicultural, feminist, and social justice counseling
paradigms. Journal of Counseling & Development, 86(3), 269–278. doi: 10.1002/j.1556-6678.2008.tb00509.x
Fouad, N.A., Grus, C.L., Hatcher, R.L., Kaslow, N.J., Hutchings, P.S., Madson, M.B., … Crossman, R.E. (2009). Competency benchmarks: A model
for understanding and measuring competence in professional psychology across training levels. Training and Education in Professional Psychology,
3(4), S5–S26. doi: 10.1037/a0015832
Hatcher, R.L., Fouad, N.A., Grus, C.L., Campbell, L.F., McCutcheon, S.R., & Leahy, K.L. (2013). Competency benchmarks: Practical steps toward a
culture of competence. Training and Education in Professional Psychology, 7(2), 84–91. doi: 10.1037/a0029401
Hunsley, J., Ronson, A., & Cohen, K.R. (2013). Professional psychology in Canada: A survey of demographic and practice characteristics.
Professional Psychology: Research and Practice, 44(2), 118–126. doi: 10.1037/a0029672
Hurd, C.A. (2006). Is service learning effective?: A look at the current research.
Retrieved from https://mail.csuchico.edu/civic/documents/Is%20Service%20Learning%20Effective.pdf
Jones, J.M., Sander, J.B., & Booker, K.W. (2013). Multicultural competency building: Practical solutions for training and evaluating student
progress. Training and Education in Professional Psychology, 7(1), 12–22. doi: 10.1037/a0030880
Lewis, B.L. (2010). Social justice in practicum training: Competencies and developmental implications. Training and Education in Professional
Psychology, 4(3), 145–152. doi: 10.1037/a0017383
Rodolfa, E., Greenberg, S., Hunsle, J., Smith-Zoeller, M., Cox, D., Sammons, M., …Spivak, H. (2013). Competency model for the practice of
psychology. Training and Education in Professional Psychology, 7(2), 71–83. doi: 10.1037/a0032415
22
fall 2014
Current Status, Challenges, and
Future Directions of
•
Jay e Wa l d, Ph . D. , R. Psych .
Dr. Jaye Wald started her career as a psychologist
in research/academia at the University of British
Columbia and then moved into the private sector to
pursue her clinical interests in work disability and
rehabilitation. Questions and comments on this
topic can be emailed to [email protected].
In t his pa pe r 1 , I provide an overview of the
current practice and research of telepsychology, discuss
its unique clinical, ethical, and technological challenges,
and highlight strategies for improving service delivery
as suggested by the literature. I hope it serves as a useful
reference tool for psychologists using, or considering these
innovative and emerging services as part of their practice.
CURRENT PRACTICE AN D RESEARCH
Telepsychology involves the use of telecommunication
technologies in the delivery of psychological services and
includes all electronic forms and mediums (telephone,
mobile devices, videoconferencing, email, texting, Internetbased applications, and social media; Joint Task Force for
The Development of Technology Guidelines for Psychologists,
2013). Telepsychology services are becoming more widely
used and accessible, and can offer many potential benefits
(see review articles by Backaus et al., 2012; Brenes, Ingram,
& Danhauer, 2011; Richardson et al., 2009; Yuen et al., 2012),
such as the following:
• Increased treatment access for clients who live in rural
and remote locations (including geographical areas
where treatment would otherwise be unavailable)
• More cost-effective and timely services, including
reduced wait-lists, and possibly reducing transportation
and related expenses
• Improved convenience related to reduced travel time
and increased flexibility in scheduling appointments
• Increased treatment access for clients who are
reluctant (or unable) to seek in-person treatment due
to psychological factors (e.g., severe anxiety), persons
who have mobility and transportation barriers, as well
individuals who are reluctant to attend an office or
clinic due to privacy concerns.
1
In this article, I primarily focus on the provision of treatment
services using telephone-based and videoconferencing. Please see
the references for additional reading in other telecommunication
applications.
Enhanced engagement and facilitation of certain
techniques such as exposure therapy (see Yuen et
al., 2013 for further discussion of “remote exposure
therapy”).
There is also a growing evidence base for
telepsychology in the empirical literature, especially for
telephone-based and videoconferencing therapy using
Cognitive Behaviour Therapy (CBT) protocols. Overall,
research has shown positive treatment outcomes and
good client and therapist satisfaction across a range of
populations and settings (Backaus et al., 2012; Brenes
et al., 2011; Richardson et al., 2009; Yuen et al. 2012).
However, these review articles caution that research to
date has largely been based upon small sample sizes and
uncontrolled research designs. Only a small number of
randomized controlled trials have been conducted with
most looking at the efficacy of results, quality of the
therapeutic relationship, and therapist fidelity ratings
between videoconferencing and in-person treatment
groups.
CLINICAL , ETHICAL , AN D TECHNOLOGICAL
CHALLENGES
Despite the promising treatment efficacy and
effectiveness of telepsychology, these constantly evolving
applications also present an array of clinical, ethical, and
technological challenges for psychologists. Frequently
identified clinical challenges include the following
(Backaus et al., 2012; Brenes et al., 2011; Richardson et al.,
2009; Yuen et al., 2012):
• There is a loss of control over the therapeutic
environment as compared to in-person treatment (e.g.,
client being disrupted in their home during a session).
• There can be a greater potential for
miscommunication and misunderstandings between
the psychologist and client due to the loss of visual
and non-verbal cues, particularly when conducted by
telephone-based therapy but also to some degree in
video-conferencing depending on the quality of the
technology being used.
• It may be more challenging to implement and
practice certain types of interventions (particularly
without visual cues or the inability to demonstrate
and observe the practice of techniques, which is a
limitation of telephone-based therapy).
• Certain types of clinical issues may be less or
inappropriate for these services (e.g., clients who
BC Psychologist
23
RECOMMEN DATIONS AN D STRATEGIES FOR
are suicidal, or those presenting other severe
IMPROVING SERVICE D ELIV ERY
symptoms, such as substance abuse, dissociative or
With
no recognized training standards for the provision
psychotic features), and it can be difficult to deal with
of telepsychology services, the onus falls on psychologists
emergency situations especially when the service is
to
obtain sufficient competency for addressing the clinical,
conducted remotely
ethical, and technological issues relevant to the technology
• Professional boundaries can become blurred
being
used. Psychologists are also expected to have the
particularly given the availability of email and online
knowledge and skills to assess each client’s suitability, needs,
communication. Furthermore, clients may disclose
and
other relevant factors (e.g., the client’s knowledge of and
personal information (including suicidal thoughts)
skill with the technology, geographical location, alternative
by email or through other on-line mediums between
services, and other available support) and to develop
sessions.
treatment plans accordingly in collaboration with the
• With telephone-based treatment (and even more so
client, based upon ethical decision-making, and the current
with other Internet-based applications) it may be may
research literature. In recent years, there has been an
be difficult (or impossible) to verify the identity of
emerging literature of practice recommendations to educate
clients who are at a distance.
and guide psychologists using these services, some of which
Many of these clinical issues also intersect
are described below.
with, and raise other ethical challenges in the provision
• The Guidelines for Psychologists Providing Psychological
of telepsychology services related to competency,
Services via Electronic Media (Canadian Psychological
informed consent, confidentiality, privacy and
Association, 2006) provides a description of information
security, documentation and record keeping, integrity
that should be included in the informed consent. This
of relationships (e.g., professional boundaries), duty to
information ideally is provided to clients in writing in
care (e.g., responding to emergency situations), and
advance of the service, and then discussed, and agreed
legal, insurance, and jurisdictional requirements (Baker
upon. For example, as part of the consent, clients
& Bufka, 2011; Nicholson, 2011; Richardson et al., 2009;
need to be informed of potential privacy and security
Shore, 2013; Yuen et al. 2012). In response, various ethical
breaches of the technology being used (e.g., informing
guidelines for telepsychology have been developed (e.g.,
clients that confidentiality cannot be guaranteed when
Joint Task Force for The Development of Technology Guidelines
transmitting information electronically).
for Psychologists, 2013).2 There has also been growing
A
growing recommendation for psychologists who
•
recognition of the importance of establishing enforceable
use telepsychology services is having an Electronic
standards and codes, as reflected in the Code of Conduct
Communication and Security Policy (as well as a Social
(Revised September 2014) by the College of Psychologists of
Media Policy), which can then be made available to
British Columbia (CPBC), which includes a new section on
clients prior to initiating the service (see American
the use of telepsychology.
Psychological Association Practice Organization, 2012
A range of technological challenges can also
and Standards for the Use of Technology in Counselling,
interfere with the delivery of telepsychology services, and
British Columbia Association of Clinical Counsellors,
this is particularly evident with video-conferencing, such
201l). This information can also help to clarify the
as poor sound, video, or equipment quality (e.g., headsets,
professional boundaries of the services, such as
Web-cam) as well as disrupted transmission using mobile
indicating when the psychologist will respond to
phones and Internet connections (Shore, 2013; Richardson
electronic messages.
et al., 2009; Yuen et al., 2012). Some clients may not have
Before
providing telepsychology services, it is also
•
the necessary equipment needed for the service (more so
important for psychologists to develop procedures
with video-conferencing) or have difficulty setting it up.
for
dealing with emergency situations, which is also
Furthermore, some research has found that treatment
communicated to clients at the outset of service delivery.
outcome can be impacted by the level of knowledge and
The
CPA Guidelines (2006) and others (e.g., Shore, 2013)
comfort with using technology (see reviews by Richardson
suggest having the contact number of the client’s family
et al., 2009; Yuen et al., 2012).
physician and another emergency contact (family
member or friend), local crisis hotline numbers, and
2
It is also interesting to look at other allied mental
emergency contact numbers (e.g., nearest hospital).
health professional associations and organizations who have also
Advance knowledge of the distance between the client’s
established detailed telepsychology guidelines, such as the British
location and emergency response location (e.g., nearest
Columbia Association of Clinical Counsellors. A list of other relevant
hospital) and other community resources can also be
ethical and practice guidelines are provided at the end of this article.
24
fall 2014
•
•
•
psychologist for a telephone session in lieu of a
helpful in emergency decision-making. This information
videoconferencing if the Internet connection
should always be readily available each session.
is disrupted). Clients should also be regularly
For documentation and maintaining client records,
encouraged to report any technological problems
it is important to remember that this includes all
during a session.
forms of electronic communications (e.g., email
correspondence). It is also a good practice to document
• Psychologists are required to be informed of the
additional information about the service delivery,
unique jurisdictional requirements of providing
such as the location of the client, the type of electronic
telepsychology services (e.g., to clients who are
medium used, technology problems that occurred (and
visiting or living in other jurisdictions), and ensure
procedures taken) during the provision of service, and
liability insurance coverage (see Baker & Bufka,
who was present during the session.
2011 as well as the CPBC Code of Conduct, 2014).
When using videoconferencing, it can be helpful to have
a pre-treatment training session with clients to help
SUMMARY AN D FUTURE D IRECTIONS
them set up the technology and equipment (e.g., such
In conclusion, telepsychology offers a promising
as the positioning of the webcam and lighting issues).
current and emerging innovative approach to improve
The provision of written step-by-step instructions at
and expand the provision of psychological services. In
the training session could also facilitate this process.
our rapidly changing digital age, telecommunication
See Shore (2013) for additional recommendations for
applications will inevitably continue to evolve and
optimal room configurations and Yuen et al. (2012) for
become more available in society. As technology
other suggestions for improving the quality of videobecomes more integrated into our day-to-day life, we
conferencing services.
are also likely going to see a greater demand for these
It is also helpful to establish procedures on how
services in the future. Along with these developments,
there will be a need for larger scale controlled research,
psychologists will address technology problems that
and ethical guidelines and standards will also
might occur during a session (e.g., poor or disrupted
continue to be developed and refined. As psychologists,
transmission). This information should also be
we will also need to be adequately equipped to respond.
communicated to the client at the outset of service
(possibly including it in the informed consent form). For It will be our responsibility to seek competency and
professional development to be able to navigate the
these situations, alternative arrangements should be
technological advances in the context of our clinical
established (e.g., such as rescheduling the appointment
and ethical responsibilities and the empirical evidence.
or using an alternate technology, such as calling the
references
Backhaus, A. et al. (2012). Videoconferencing psychotherapy: A systematic review. Psychological Services, 9 (2), 111–31.
Baker, D. & Bufka, L. (2011). Preparing for the telehealth world: Navigating legal, regulatory, reimbursement, and ethical issues in an electronic
age. Professional Psychology: Research and Practice, 42 (6), 405–11.
Brenes, G. A., Ingram, C. W., Danhauer, S. C. (2011). Benefits and challenges of conducting psychotherapy by telephone. Professional Psychology
Research and Practice, 42 (6), 543–549.
Canadian Psychological Association (2006). Guidelines for Psychologists Providing Psychological Services via Electronic Media.
College of Psychologists of British Columbia (September 2014). Code of Conduct.
Joint Task Force for the Development of Telepsychology Guidelines for Psychologists (2013). Guidelines for the Practice of Telepsychology.
American Psychologist, 68 (9), 791–800.
Nicholson, I R. (2011). New technology, old issues: Demonstrating the relevance of the Canadian Code of Ethics for Psychologists to the ever
sharper cutting edge of technology. Canadian Psychology, 52 (3), 215–224.
Richardson, L. K. et al. (2009). Current directions in videoconferencing tele-mental health research. Clinical Psychology, 6 (3), 232–338.
Shore, J. (2013). Telepsychiatry: Videoconferencing in the delivery of psychiatric care. American Journal of Psychiatry, 170, 256–262.
Yuen, E. K. et al. (2012). Challenges and opportunities in Internet-mediated telemental health. Professional Psychology: Research and Practice. 43 (1),
1–8.
OTHER RELEVANT ETHICAL AND PRACTICE GUIDELINES AND REFERENCE MATERIAL
American Telemedicine Association. (2013). Practice Guidelines for Video-Based Online Mental Health Services.
American Psychological Association Practice Organization. (2012, Spring/Summer). Social media: What’s your policy? Good Practice, pp. 10–18.
Anthony, K., Merz Nagel, D., and Goss, S. eds. (2010). The Use of Technology in Mental Health: Applications, ethics and practice. Springfield: Charles C.
Thomas.
British Columbia Association of Clinical Counsellors (2011). Standards for the Use of Technology in Counselling.
International Society for Mental Health Online (2000). Suggested Principles for the Online Provision of Mental Health Services.
Ohio Psychological Association. (2010). Telepsychology Guidelines.
New Zealand Psychologists Board. (2011). Draft guidelines: Psychology Services Delivered via the Internet and Other Electronic Media.
BC Psychologist
25
Primary Care Psychology — Increasing Capacity & Decreasing
Barriers to Psychological Services Through Integrated Care
T h e BHC M o d e l
Access to psychological services has recently changed in one
Vancouver family practice, which adopted an integrated
(Va n co u v e r Coa s ta l H e a lt h)
care model this year, making the services of a psychologist
Dr. Joachim Sehrbrock, R.Psych. is a Behavioural Health
available right in the clinic. This Behavioural Health
Consultant and the Behavioural Health Consultation
Consultation Program (BHCP) is a collaborative project
(BHC) coordinator of clinical programming. He also
between Vancouver Coastal Health (VCH), the Vancouver
works in private practice and is Adjunct Professor in the
Division of Family Practice and in particular, local primary
Department of Psychology at UBC and Clinical Associate
care offices. In this integrated model a behavioural health
in the Department of Psychology at SFU.
consultant (BHC) is placed within the primary care team
providing brief, highly accessible consultative services to
physicians and patients aimed at detecting and addressing
T h e o D e Gag n e , Ph . D. , R. Psych .
a wide range of behavioural health and mental health
(Va n co u v e r Coa s ta l H e a lt h)
concerns with the goals of early identification, quick
Dr. Theo De Gagne, R.Psych. is the Regional Psychology
resolution, long-term prevention, and general wellness.
Practice Leader and Director of Clinical Training for
As a Psychologist in the BHC program, I (JS)
Vancouver Coastal Health Authority (VCHA). He is on the
support physicians in helping patients better cope with life’s
Executive Committee for Online E-Mental Health VCHA;
challenges. In the aforementioned scenario, typical for a
Member at Large, Psychologists in Hospitals and Health
family practice, the physician would simply walk his patient
Centres, CPA Section; Adjunct Professor, Department
down the hall to my office for an introduction (we call this a
of Psychology, University of British Columbia; Clinical
“warm handoff”) and a brief assessment. Sarah and I would
Instructor; Department of Psychiatry, University of British meet for 30 minutes and collaboratively developed several
Columbia; and a founding member of the Canadian
strategies for Sarah to better cope with her depressive
Association of Cogntive and Behavioural Therapies.
symptoms and explore how to be more assertive about her
needs as a new mom. Subsequently, we may meet for three
30-minute follow-up sessions to review homework and
related interventions.
During a recent consultation, one of the physicians
Sa r a h ’s S t o ry
in the clinic, Dr. Bregman (personal communication, August
Sarah1 is a young new mother, who presented
21, 2014) said that many of his patients seem reluctant to
to her family physician with difficulties
access mental health treatment because of stigma, lack
breastfeeding. During his assessment, her
of financial resources, socio-cultural factors, and other
physician also found that Sarah showed
barriers. He noted that having a psychologist directly in the
symptoms of post-partum depression and
practice, the patient’s familiarity with the office, and the
significant levels of chronic stress, which
physician’s endorsement of a colleague in the same practice
were likely linked to the adjustment of
seem to be critical factors to enable patients to seek out
having a newborn and long-standing
mental health support.
marital challenges. In subsequent
The BHC Program provides consultation to patients
consultations, her physician recommended
and physicians utilizing a stepped care approach with an
post-partum depression support groups
emphasis on early intervention. While not intended to
numerous times, but Sarah seemed
replace other psychotherapeutic practices, the program
reluctant to seek out mental health services.
provides an early entry point for intervention. In some
cases, patients are referred for longer term or specialized
1
For the purpose of this vignette, any potential identifying
services that can include partnering with psychologists,
information has been changed. The vignette serves to model a
psychiatrists, registered social workers, dieticians, etc.
Behavioral Health Consultation in a primary care office. Permission
When
a BHC clinical intervention is deemed appropriate,
to discuss physician experiences has been obtained.
J oachim Se h rb r o ck , Ph . d. , R. Psych .
26
fall 2014
the consultations are based on an accelerated short-term
therapy model (usually up to four sessions), emphasizing
patient self-management, the acquisition of coping skills,
and increasing patient’s functional capacities (Hunter,
Goodie, Oordt, & Dobmeyer, 2012; Robinson & Reiter,
2007). BHCs document their evaluation, consultation and
recommendations directly in physicians’ electronic charting
systems and provide “in house” immediate consultation
and education to physicians about clinical mental health
assessment and treatment issues. Physicians report that
immediate feedback enhances their care of patients and
assists is ongoing treatment planning.
F o l l owin g t h e C a l l f o r In t e g r at e d C a re
Models
It is estimated that about 1 in 5 Canadians are affected
annually by mental illness (Smetanin et al., 2011) and that
only about 1 in 3 of those who are adults (Statistics Canada,
2013) — and 1 in 4 children and youth (Waddell, McEwan,
Shepherd, Offord, & Hua, 2005) — seek or receive mental
health treatment. Many people don’t seek mental health
services directly from psychologists or other mental health
specialists, and initially seek assistance from their family
physicians (Vasiliadis, Tempier, Lesage, & Kates, 2009).
About 50% of all individuals with mental disorders in
Canada receive care only through primary care, such as
their family physician (Lin, Goering, Offord, Campbell, &
Boyle, 1996). This not only places a tremendous burden
on primary care physicians, but also limits options to
collaborate with professionals specifically trained to provide
evidence-based psychotherapy, such as psychologists.
Former president of the American Psychological
Association (APA), Dr. James Bray (2009) called primary care
psychology an important principle in guiding the “future of
psychology health service practice” (p. 5). He pointed out that
because psychology is still not regarded as an essential part
of health care teams, psychologists are often not involved in
the prevention of mental health challenges, despite the fact
that psychology is the profession that “knows the most about
human behavior and how to change it” (ibid.).
There have been numerous initiatives across
Canada as well as in British Columbia on a regulatory
level to modify the delivery of primary care to include the
integration of psychologists. For example, in 2007 the BC
government released the “Primary Health Care Charter”
signaling its support for integrated health care that includes
psychology. Healthy Minds, Healthy People: A Ten Year Plan
to Address Mental Health and Substance Use in B.C. (Ministry
of Health, 2010) recognized the role of non-medication
therapeutic approaches to the treatment of mental health
and substance use problems. The BHC program is aligned
with this plan by increasing capacity for evidence-based
psychotherapies for people with mental health and
substance use problems in primary care.
The College of Psychologists of BC (College
of Psychologists of BC, 2011) has expressed its support
for the integration of psychology into primary care,
providing information to its registrants about the benefits
and research evidence on integrated care. In 2012, a
joint presentation by Psychology Services at Vancouver
Coastal Health, The Alberta Health Services Shared Care
Program, The College of Psychologists of BC and The
British Columbia Psychology Association introduced the
BCH model to Division of Family Practice and regional
corporate health authority representatives. In 2013 the
Canadian Psychological Association issued a report
(Peachey, Hicks, & Adams, 2013) pointing to significant
problems with accessibility to psychological services and
recommended, among other things, the integration of
psychologists in primary care settings. Several provincial
psychological associations are actively supporting this
integration of psychological services in primary care,
including Alberta, Manitoba, and Nova Scotia (Canadian
Psychological Association, 2013).
Following the call of these initiatives, the BHC
Program at Vancouver Coastal Health began in March
2014 as an integrated care demonstration project. This
program was implemented in consultation with the
Calgary BHC Service, which has been an integral part of
Alberta Health Services since 2007. The Calgary program
is now the fastest growing mental health service in
Alberta with 48 Behavioural Health Consultants working
with 700 family physicians in Calgary, 32 of whom are
psychologists with the remainder being regulated mental
health practitioners who report to psychologist leads in
the program. Alberta Health Services estimates that more
than 70 BHCs will be employed in Calgary by the end of
2014.
Prim a ry C a re Psych o l o gy a n d t h e Fu t u re
o f Psych o l o gy
There is an increasing body of Canadian and international
research supporting the effectiveness of integrated
care models (e.g., Craven & Bland, 2006). Some models
(Kates et al., 2011) have shown to facilitate symptom and
functional improvements, an increase in quality-adjusted
life years, medication compliance, a greater likelihood of
return to the workplace, as well as reductions in health
care costs and an increase in efficient use of existing
resources. Integrated models like the BHC Program
BC Psychologist
27
demonstrate innovative ways in which psychology can
have a significant positive impact on consumers of health
and mental health services.
Programs like these provide a number of benefits
that include increased access to psychological care with
early interventions (especially for those who are less likely
to seek behavioural health or mental health treatment
in non-medical settings), providing the right provider
with the right intervention at the right time; improved
collaboration in the management of Mental Health
and Addictions presentations; reduction in overall GP
visits for persons in the program; potential reduction in
hospitalizations for persons in the program; reduction in
symptom severity and duration of symptoms; improved
management of persons with mental illness overall in
the primary care clinic; and opportunities to support
physicians to establish individual care plans for patients
with mental health and/or substance use problems.
Approximately 3% of persons in BC report they are
currently looking for a family doctor; 80% of individuals
who have a family doctor report getting help from their
doctor in coordinating care from others; 1 in 2 patients
feel their doctor spends enough time with them (Health
Council of Canada, 2013). An integrated care approach
that includes psychologists will allow family physicians
to more effectively and appropriately allocate their time
to providing medical assessment and treatment. It will
facilitate more immediate referrals to evidence-based
non-pharmacological treatments for patients with mental
and behavioural health problems, which in turn will improve
health outcomes and reduce overall health care costs.
Psychologists in primary care can contribute to
improving population health by filling important gaps in
(mental) health care services. They also have the potential to
• Increase recognition of the value of psychology as a
contributor in health care,
• Confirm that psychologists are essential elements of the
Canadian health care system,
• Strengthen collaborative relationships with other
disciplines (especially general medical practice),
• Decrease barriers to psychological services, such as
stigma and financial constraints, by making these
services available in primary care settings,
• Provide early entry points to mental health care with
informed referrals to appropriate alternative services as
needed,
• Create possibilities for psychologists to do what they do
best; providing the right intervention, at the right time,
to the right person,
• Relieve pressure on the primary care system, and
• Contribute to health system cost savings.
For more information, please contact Dr. Sehrbrock
at [email protected] or Dr. DeGagne, Psychology
Practice Leader at Vancouver Coastal Health at theo.
[email protected].
references
Bray, J. (2009). Vision for the future of psychology practice. Monitor on Psychology, 40(2), 5.
Canadian Psychological Association. (2013). Provincial and territorial initiatives and campaigns. Retrieved August 12, 2014, from
http://www.cpa.ca/practitioners/practicedirectorate/provincial/
College of Psychologists of BC. (2011). Integrating psychology into primary care: Regulatory challenges. Chronicle, 12(4), 2.
Craven, Marilyn A., & Bland, Roger. (2006). Better practices in collaborative mental health care: an analysis of the evidence base.
Canadian Journal Of Psychiatry. Revue Canadienne De Psychiatrie, 51(6 Suppl 1), 7S-72S.
Health Council of Canada, 2013. Where you live matters: Canadian views on health care quality. Results from the 2014 Commonwealth Fund
International Health Policy Survey of the General Public.
Hunter, C., Goodie, J., Oordt, M., & Dobmeyer, A. (2012). Integrated behavioral health in primary care: Step-by-step guidance for assessment and
intervention. Washington, DC: APA.
Kates, N., Mazowita, G., Lemire, F., Jayabarathan, A., Bland, R., Selby, P., ... Gervais, M. (2011). The evolution of collaborative mental health care
in Canada: A shared vision for the future. Canadian Journal Of Psychiatry. Revue Canadienne De Psychiatrie, 56(5), 1–11.
Lin, E., Goering, P., Offord, D. R., Campbell, D., & Boyle, M. (1996). The use of mental health services in Ontario: Epidemiologic findings.
Canadian Journal Of Psychiatry. Revue Canadienne De Psychiatrie, 41, 572–577.
Peachey, D., Hicks, V., & Adams, O. (2013). An imperative for change: Access to psychological services for Canada. Ottawa, ON: Canadian
Psychological Association.
Robinson, P., & Reiter, J. (2007). Behavioral consultation and primary care: A guide to integrating services: Springer.
Smetanin, P., Stiff, D., Briante, C., Adair, C. E., Ahmad, S., & Khan, M. (2011). The life and economic impact of major mental illness in Canada: 2011 to
2041. Risk Analytica: on behalf of the Mental Health Commission of Canada.
Statistics Canada. (2013). Canadian community health survey: Mental Health. The Daily, September 18, 2013.
Vasiliadis, H., Tempier, R., Lesage, A., & Kates, N. (2009). General practice and mental health care: Determinants of outpatient service use.
Canadian Journal Of Psychiatry. Revue Canadienne De Psychiatrie, 54(7), 468–476.
Waddell, C., McEwan, K., Shepherd, C. A., Offord, D. R., & Hua, J. M. (2005). A public health strategy to improve the mental health of Canadian
children. Canadian Journal Of Psychiatry. Revue Canadienne De Psychiatrie, 50(4), 226–233.
28
fall 2014

Integrating Sleep Management into Clinical
Practice: Cognitive Behavioral Treatment
for Children, Adolescents & Adults
(in conjunction with the BCPA Annual General Meeting 2014)
Pre sented by D r. Cathe rine Sch u man
F riday N ov e m b e r 28 t h , 2014
@ University Golf Club
5185 University Blvd. Vancouver, BC V6T 1X5
9 : 00 PM – 4 : 00 PM
Co n tin u in g E d u c at i o n Cr e d it s : 6
A b o u t t h e Wo r k s h o p
Sleep affects every aspect of health, daily functioning
and well-being. The purpose of this presentation is to
provide practitioners with up-to-date information about
sleep as well as the etiology, clinical assessment tools and
management of two or more sleep disorders for children,
adolescents and adults.
several book chapters and peer reviewed articles about
the integration of sleep management into clinical practice
and the relationship between stress, physical disease, and
psychological well-being and impact of health disparities.
She is currently working on the third edition of the book
she co-edited, Clinical Handbook of Insomnia. Most
recently she published the article, Integrating Sleep
Management in to Clinical Practice in the Journal of
Clinical Psychology in Medical Settings. She is also the
President-Elect for the Association of Psychologist in
Academic Health Centers.
Register early to
get $24 discounts!
L e a r nin g O b j e c t iv e s
1. Participants will better understand normal sleep versus
problematic sleep in children, adolescents and adults.
2. Participants will be able to identity three common child,
adolescent and adult sleep disorders.
3. Participants will have knowledge of cognitive-behavioral
treatments and their empirical support for treating
three common child, adolescent and adult sleep
disorders.
A b o u t t h e Pr e s e n t e r : D r. Sch u m a n

Catherine Schuman, Ph.D. recently joined Geisinger Health
System in Pennsylvania in a leadership position aimed at
integrating behavioral health services into primary care
on a comprehensive level across the state of Pennsylvania.
Previously she has held positions as the Director of
Behavioral Medicine and Behavioral Medicine Training at
Cambridge Health Alliance and Harvard Medical School as
well as the Director of Sleep Psychology at the University
of Vermont College of Medicine and Fletcher Allen Health
Care. She divides her time between three passions, treating
individuals to better cope with their medical conditions,
research and teaching. Dr. Schuman has published a book,
H ow t o r e g is t e r f o r t his wo r k s h o p
•
•
•
•
Mail this form to: BC Psychological Association
402 – 1177 West Broadway Vancouver BC V6H 1G3
Fax this form to 604 – 730 – 0502
Call if you have questions at 604 – 730 – 0501
Go online: http://www.psychologists.bc.ca
C a nce ll at i o n P o li cy:
C a nce ll at i o n s m u s t b e r e ce iv e d in
w rit in g by M o n day N ov e m b e r 17 t h , 2014 .
A 20 % a d m in is t r at i o n f e e will b e
d e d u c t e d f r o m a ll r e f u n d s . N o r e f u n d s
will b e g iv e n a f t e r N ov e m b e r 17 t h , 2014 .
Free Parking is Available.
Go Green: http://tripplanning.translink.ca/

workshop & agm
registration form
E a r ly B ir d R e g i s t r at i o n
q
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BCPA Members and Affiliates
R e g u l a r R e g is t r at i o n
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(Un t il Oc t 10 t h , 2014)
$246.75 (incl. GST)
$173.25 (incl. GST)
(O C T 11 t h – N ov 2 4 t h , 2014)
Regular (Non-Members)
BCPA Members and Affiliates
$270.90 (incl. GST)
$197.40 (incl. GST)
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FUTURE (2015)
WORKSHOPS:
I ag r e e t o t h e C a nce ll at i o n P o li cy (r e q u ir e d)
Fit n e s s - f o r - d u t y &
Name:
Pr o fe s si o n a l Pr ac ti ce
Eva luati o n s: E t hi c s a n d
A s s e s s m e n t T e ch ni q u e s
Address:
Presented by Dr. Mark Zelig
9:30am – 4:30pm Friday March 27th, 2015
@ Park Inn & Suites on Broadway
City:
Im pac t t h e r a py:
A M u ltis e n s o ry A ppr oach t o
T h e r a py (w h at Adv e r tis e rs
Postal Code:
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Phone:
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Presented by
Dr. Ed Jacobs & Dr. Nina Spadaro
9:00am – 4:00pm Friday April 24th, 2015
@ University Golf Club

GST # 899967350. All prices are in CDN funds.
Please include a cheque for the correct amont, not post-dated, and made out to “BCPA” or “BC Psychological Association”.
If you prefer paying by credit card, please register online. Workshop fee includes handouts, morning & afternoon coffee,
and lunch. Free parking is available. Participant information is protected under the BC Personal Information Act.
BC Psychologist
L o o kin g f o r a n a r ti cl e yo u o n ce
re a d o r w r o t e in a n o l d is su e o f
t h e B C Psych o lo g ist ?
You can find PDF and online copies dating back
to Summer 2007 at: www.psychologists.bc.ca
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BC Psychological Association
Since 1938, the BC Psychological Association (BCPA) has
represented psychologists in British Columbia. It is a
voluntary body and is committed to advancing psychology
and the psychological well-being of all British Columbians.
BCPA A D MINISTRATIV E OFFICE
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