THE ROLE OF PSYCHOLOGISTS IN HEALTH CARE DELIVERY

Saeed H. Wahass, PhD, CPsychol., AFBPsS.

Department of Psychiatry, College of Medicine, King Faisal University, Dammam, Saudi
Arabia
______________________________________________________________________________

‫ ﺃﻥ ﺍﻟﺘﻘﺪﻡ ﺍﻟﻌﻠﻤﻲ ﻓﻲ ﻣﺠﺎﻝ ﺍﻟﻌﻠﻮﻡ ﺍﻟﺤﻴﻮﻳﺔ ﺍﻟﻄﺒﻴﺔ ﻭﺍﻟﻌﻠﻮﻡ ﺍﻟﺴ�ﻠﻮﻛﻴﺔ ﻣﻬ�ﺪ ﺍﻟﻄﺮﻳ�ﻖ ﻟﻤﺰﻳ�ﺪ ﻣ�ﻦ ﺍﻟ�ﺘﻼﺣﻢ ﺑ�ﻴﻦ ﻫ�ﺬﻳﻦ‬:‫ﻣﻘﺪﻣﺔ‬
‫ ﻭﻋﻠﻴﻪ ﻓ�ﺈﻥ ﺍﻟﺘﻌﺎﻣ�ﻞ ﻣ�ﻊ‬.‫ ﺍﻻﺟﺘﻤﺎﻋﻲ‬،‫ ﺍﻟﻨﻔﺴﻲ‬،‫ ﻫﺬﺍ ﺍﻟﺘﻼﺣﻢ ﻏﻴﺮ ﺗﻮﺟﻪ ﺍﻟﻤﻤﺎﺭﺳﺔ ﺍﻟﻄﺒﻴﺔ ﺗﺠﺎﻩ ﺍﻟﻨﻤﻮﺫﺝ ﺍﻟﺤﻴﻮﻱ‬.‫ﺍﻟﻤﺴﺎﺭﻳﻦ‬
-‫ﻗﻀﺎﻳﺎ ﺍﻟﺼﺤﺔ ﻭﺍﻟﻤﺮﺽ ﻟﻢ ﻳﻌﺪ ﻣﻦ ﺧﻼﻝ ﻏﻴﺎﺏ ﺃﻭ ﺣﻀﻮﺭ ﺍﻟﻤﺮﺽ ﺃﻭ ﺍﻟﻌﺠﺰ ﻛﻤﺎ ﻫﻮ ﻭﺍﻗﻊ ﺍﻟﺤﺎﻝ ﻓﻲ ﺍﻟﻨﻤ�ﻮﺫﺝ ﺍﻟﻄﺒ�ﻲ‬
‫ ﻭﺍﻟﻤﺒﻨ�ﻲ ﻋﻠ�ﻰ ﺃﻥ ﺍﻟﺼ�ﺤﺔ ﻫ�ﻲ ﺣﺎﻟ�ﺔ ﻣ�ﻦ ﺍﻟﺘﻜﺎﻣ�ﻞ‬،‫ ﺍﻻﺟﺘﻤﺎﻋﻲ‬،‫ ﺍﻟﻨﻔﺴﻲ‬،‫ ﺑﻞ ﺃﺻﺒﺢ ﻣﻦ ﺧﻼﻝ ﺍﻟﻤﻨﻈﻮﺭ ﺍﻟﺤﻴﻮﻱ‬،‫ﺍﻟﺤﻴﻮﻱ‬
،‫ ﺍﻟﻨﻔﺴ�ﻴﺔ‬،‫ ﺍﻟﻤ�ﺪﺧﻞ ﺇﻟ�ﻰ ﺍﻟﻤﻤﺎﺭﺳ�ﺔ ﺍﻟﺤﻴﻮﻳ�ﺔ‬-‫ﻛﻤﺴ�ﺎﺭ ﺻ�ﺤﻲ ﺳ�ﻠﻮﻛﻲ‬- ‫ ﻭﻳﻌﺘﺒ�ﺮ ﻋﻠ�ﻢ ﺍﻟ�ﻨﻔﺲ‬.‫ ﺍﻻﺟﺘﻤﺎﻋﻲ‬،‫ ﺍﻟﻨﻔﺴﻲ‬،‫ﺍﻟﺤﻴﻮﻱ‬
‫ ﻳﺨﺘﻠ�ﻒ ﺍﻟ�ﺪﻭﺭ ﺃﻟﺴ�ﺮﻳﺮﻱ ﻟﻠﻤﺨﺘﺼ�ﻴﻦ ﺍﻟﻨﻔﺴ�ﻴﻴﻦ ﻓ�ﻲ‬.‫ ﻭﻳﻠﻌﺐ ﺩﻭﺭﺍً ﺃﺳﺎﺳﻴﺎً ﻓﻲ ﻓﻬ�ﻢ ﻗﻀ�ﺎﻳﺎ ﺍﻟﺼ�ﺤﺔ ﻭﺍﻟﻤ�ﺮﺽ‬،‫ﺍﻻﺟﺘﻤﺎﻋﻴﺔ‬
‫ ﻭﻳﻘ���ﻮﻡ‬.‫ ﻭﻣﺘﻘﺪﻣ���ﺔ( ﻭﺍﻟﺘﺨﺼ���ﺺ ﺍﻟ���ﺪﻗﻴﻖ‬،‫ ﺗﺨﺼﺼ���ﻴﺔ‬،‫ﺍﻟﻤﺠ���ﺎﻝ ﺍﻟﻄﺒ���ﻲ ﻭﻓﻘ���ﺎً ﻟﻨ���ﻮﻉ ﺍﻟﺨﺪﻣ���ﺔ ﺍﻟﺴ���ﺮﻳﺮﻳﺔ ﺍﻟﻤﺘﺎﺣ���ﺔ )ﺃﻭﻟﻴ���ﺔ‬
‫ﺍﻟﻤﺨﺘﺼ��ﻮﻥ ﺍﻟﻨﻔﺴ��ﻴﻮﻥ ﻓ��ﻲ ﺍﻟﻤﺠ��ﺎﻝ ﺍﻟﻄﺒ��ﻲ ﺑﺨ��ﺪﻣﺎﺕ ﺍﻟﻘﻴ��ﺎﺱ ﺍﻟﻨﻔﺴ��ﻲ ﻭﺻ��ﻮﻻً ﺇﻟ��ﻰ ﺍﻟﺘﺸ��ﺨﻴﺺ ﻭﻋ��ﻼﺝ ﺍﻟﻤﺸ��ﺎﻛﻞ ﺍﻟﻨﻔﺴ��ﻴﺔ‬
‫ ﻛﻤ�ﺎ ﺃﻧﻬ�ﻢ ﻳﻘﻮﻣ�ﻮﻥ‬.‫ﻭﺍﻻﺿﻄﺮﺍﺑﺎﺕ ﺍﻟﺴﻠﻮﻛﻴﺔ ﺍﻟﻤﺴﺒﺒﺔ ﻟﻼﻋﺘﻼﻝ ﺍﻟﻌﻀ�ﻮﻱ ﺃﻭ ﺍﻟﻨﻔﺴ�ﻲ ﺃﻭ ﺍﻟﻨﺎﺟﻤ�ﺔ ﻋ�ﻦ ﺗﻠ�ﻚ ﺍﻻﺿ�ﻄﺮﺍﺑﺎﺕ‬
‫ ﻭﺗ�ﺘﻢ ﻣﻤﺎﺭﺳ�ﺔ ﺍﻟﻤﺨﺘﺼ�ﻴﻦ ﺍﻟﻨﻔﺴ�ﻴﻴﻦ‬.‫ﺑﺪﻭﺭ ﺭﺋﻴﺴﻲ ﻓﻲ ﻣﺠﺎﻝ ﺍﻟﻌﻨﺎﻳﺔ ﺑﺎﻟﺼﺤﺔ ﻭﺍﻟﻮﻗﺎﻳﺔ ﻣﻦ ﺍﻟﻤﺮﺽ ﻭﺗﺤﺴﻴﻦ ﻧﻤﻂ ﺍﻟﺤﻴ�ﺎﺓ‬
‫ ﺗﺼﻒ ﻫ�ﺬﻩ ﺍﻟﻤﻘﺎﻟ�ﺔ ﺍﻟ�ﺪﻭﺭ ﺍﻟﺠ�ﻮﻫﺮﻱ ﻟﻠﻤﺨﺘﺼ�ﻴﻦ ﺍﻟﻨﻔﺴ�ﻴﻴﻦ ﻓ�ﻲ ﻣﺠ�ﺎﻝ ﺍﻟﺮﻋﺎﻳ�ﺔ ﺍﻟﺼ�ﺤﻴﺔ‬.‫ﻭﻓﻘﺎً ﻷﺧﻼﻗﻴﺎﺕ ﻣﻬﻨﻴﺔ ﺻﺎﺭﻣﺔ‬
‫ ﻭﻗ��ﺪ ﻧﻮﻗﺸ��ﺖ ﺍﻟﻘﻀ��ﺎﻳﺎ ﺍﻟﻤﻬﻨﻴ��ﺔ‬.‫ ﺍﻻﺟﺘﻤ��ﺎﻋﻲ( ﻟﻠﺼ��ﺤﺔ ﻭﺍﻟﻤ��ﺮﺽ‬،‫ ﺍﻟﻨﻔﺴ��ﻲ‬،‫ﺍﻟﻤﺒﻨﻴ��ﺔ ﻋﻠ��ﻰ ﺍﻟﻤﻨﻈ��ﻮﺭ ﺍﻟﺸ��ﺎﻣﻞ )ﺍﻟﺤﻴ��ﻮﻱ‬
.‫ﻭﺍﻟﺘﻌﻠﻴﻤﻴﺔ‬

.‫ ﻭﺍﻟﻄﺐ ﺍﻟﺴﻠﻮﻛﻲ‬،‫ ﺍﻻﺟﺘﻤﺎﻋﻲ‬،‫ ﺍﻟﻨﻔﺴﻲ‬،‫ ﺍﻟﻤﻨﻈﻮﺭ ﺍﻟﺤﻴﻮﻱ‬،‫ ﻋﻠﻢ ﺍﻟﻨﻔﺲ ﺍﻟﺼﺤﻲ‬،‫ ﻋﻠﻢ ﺍﻟﻨﻔﺲ‬:‫ﺍﻟﻜﻠﻤﺎﺕ ﺍﻟﻤﺮﺟﻌﻴﺔ‬
_______________________________________________________________________
Advances in the biomedical and the behavioral sciences have paved the way for the integration
of medical practice towards the biopsychosocial approach. Therefore, dealing with health and
illness overtakes looking for the presence or absence of the disease and infirmity (the biomedical
paradigm) to the biopsychosocial paradigm in which health means a state of complete physical,
psychological and social well-being. Psychology as a behavioral health discipline is the key to
the biopsychosocial practice, and plays a major role in understanding the concept of health and
illness. The clinical role of psychologists as health providers is diverse with the varying areas of
care giving (primary, secondary and tertiary care) and a variety of subspecialties. Overall,
psychologists assess, diagnose, and treat the psychological problems and the behavioral
dysfunctions resulting from, or related to physical and mental health. In addition, they play a
major role in the promotion of healthy behavior, preventing diseases and improving patients’
quality of life. They perform their clinical roles according to rigorous ethical principles and code
of conduct. This article describes and discusses the significant role of clinical health psychology
in the provision of health care, following a biopsychosocial perspective of health and illness.
Professional and educational issues have also been discussed.
Key Words: Psychology, health psychology, biopsychosocial, and behavioral medicine.
__________________________________________________________________________________________________________
“Biomedical knowledge is essential for providing medicine” (Lean Eisenberg, 2000). This statement
sound medical care, but it is not sufficient. The is a quotation from the editorial address of the
nature of dysfunctions and the physicians’ British Journal of Psychiatry as its entry into the
transaction with the patient must also be informed 21st century. Eisenberg is one of the leading
P P

by the psychosocial understanding. "Neither the figures of psychiatry.

mindless nor the brainless can be tolerated in
___________________________________________________________________________________
Correspondence to:
Dr. Saeed H. Wahass, P.O. Box 40185, Al-Khobar 31952, Saudi Arabia E-mail: swahass@hotmail.com

Role of Psychologists 63
 Like other authoritative figures in medicine, L. biopsychosocial medicine, characterizes the
Eisenherg found himself at the turn of the century, current holistic model of health provision.
with the reality of integration. His statement Overall, the biopsychosocial model reflects the
clearly emphasizes the importance of integrating belief that biological, psychological, and social
the biomedical, behavioral and psychosocial factors interact in an interdependent or systemic
sciences in understanding the way the brain and way to maintain health or cause illness.1 This
the mind work and interact to generate normality approach (biopsychosocial paradigm) has become
or abnormality. In this integrative approach, universal, and has been endorsed and adopted by
clinical health psychology must play a significant the World Health Organization.2
role. Unfortunately, for many professionals in the Because behavior plays a vital role in mental
medical field, this role is unclear. and physical health, behavioral health is becoming
the cornerstone of the biopsychosocial practice.
INTRODUCTION Cassidy described the way behavior may
Advances in psychological, medical, and positively or negatively affect the body by stating
physiological research have led to a new way of that lifestyles, life-events, and bad behavior are
thinking about health and illness. This is reflected directly related to health and illness; the way we
in the biopsychosocial model that views health think about events determines our response to
and illness as the product of a combination of them in developing healthy or unhealthy
factors including biological characteristics (e.g. behaviors and changes in behavior. Attitudes to
genetic predisposition), behavioral factors, (e.g. health determine whether we hear or listen to
lifestyle, stress, health beliefs) and social advice from health professionals, and a person's
conditions (e.g. cultural influences, family personality may predispose the body to certain
relationships and social support). This dysfunctions.3
conceptualization of health and illness has many Psychology as the science of behavior and
scientific and practical benefits. At the top of this mental processes emphasizes training and
list is the fact that people can reduce their risk of knowledge about such aspects (e.g. development
developing major medical problems, receive more over the lifespan, learning, motivations,
effective treatment, and reduce their health care experiences, emotions, cognition, social behavior
cost when they seek treatment from an and attitudes, personality etc). Moreover, it strives
interdisciplinary team including behavioral health to understand how biological, behavioral, and
providers. social factors influence health and illness.
It is worth noticing here, that in the recent past, Thus, psychologists as behavioral health
dealing with health and illness was based on the providers play a major role in understanding how
biomedical paradigm in which the biological biological, behavioral, and social factors influence
aspects were the main focus of the scientist and health, and illness. They are equipped with
practitioner. Good health was simply seen as the training, skills, and knowledge to understand how
absence of diseases and injuries, and their basic behavioral and cognitive processes (e.g.
presence meant ill health. The proper treatment cognition. emotion, motivation, development,
for that model meant that there were biological personality, social and cultural interaction)
interventions in order to improve the biological prepare the body to develop dysfunctions. They
damage. As a result, health providers were are trained, on the other hand, to perceive how
divided into two groups, the physicians who these behavioral and cognitive functions are
followed the biomedical thinking and who had altered, the factors that contribute to their
complete authority to deal with patients, and their alteration, and how these dysfunctions are
assistants whose role it was to follow the diagnosed and treated. In dealing with such
physicians’ orders. problems, they are also trained and skilled to use
At present, the understanding of the body- several psychological, psychodiagnostic and
mind-behavior relationship has dramatically psychotherapeutic techniques which help and
changed medical system and practice. This affect the abilities of individuals to function in
change, from the biomedical paradigm to the diverse settings and roles. In addition, they help

64 Journal of Family & Community Medicine 2005; 12(2)

people to modify their behavior and lifestyle so as in different cultures and at all socioeconomic
to prevent and recover from health problems. levels.8
Consequently, demands for psychologists in Clinical psychology has several subspecialties
hospitals and medical settings have dramatically such as child and adolescent psychology, clinical
increased and clinical health psychology has adult psychology, clinical gero-psychology,
become one of the most important disciplines in clinical psychology of learning disabilities,
health care.4-5 In the following section, an clinical psychology of substance abuse and
overview of the main clinical specialties of clinical forensic psychology.
psychology is given.
Health Psychology/ Medical Psychology
THE CLINICAL SUB-FIELDS OF Health psychology (sometimes referred to as
PSYCHOLOGY medical psychology or behavioral medicine) can
The development of Psychology as a health be defined as the aggregate of the specific
specialty and discipline has led to the emergence educational, scientific and professional
of several sub-fields and subspecialties. These contributions of the discipline of psychology to
sub-fields include clinical psychology, health the promotion and maintenance of health, the
psychology (also referred to as medical prevention and treatment of illness, the
psychology or behavioral medicine), clinical identification of etiological and diagnostic
neuropsychology, counseling psychology, correlates of health, illness and related
rehabilitation psychology, community dysfunction, and the improvement of the health
psychology, and pediatric psychology with care system and health policy formation.9
subspecialties in each field. Health Psychologists apply psychological
research and methods to the prevention and
Clinical Psychology management of disease, the promotion and
Clinical psychology is the application of maintenance of health, the identification of
psychological knowledge and skills, research and psychological factors that contribute to physical
intervention techniques to health and illness, illness, the improvement of the health care
particularly as related to mental health.5 system, and the formulation of health policy.10
The American Psychological Association The American Psychological Associations’
defines clinical psychology as “a clinical Division of Health Psychology outlined the
discipline that involves the provision of objectives of health psychology as understanding
diagnostic, assessment, treatment plan, treatment, the etiology, promotion and maintenance of
prevention, and consultative services to patients of health, prevention, diagnosis, treatment and
emergency room, inpatient units, and clinics of rehabilitation of physical and mental illness; the
hospitals”.6 Another definition given by the study of psychological, social, emotional and
Canadian Psychological Association sees it as a behavioral factors in physical and mental illness;
broad field of practice and research within the and the improvement of the health care system
discipline of psychology applying psychological and formulation of health policy.11
principles to the assessment, prevention, Thus, health psychologists are interested in
amelioration, and rehabilitation of psychological how biological, psychological, and social factors
distress, disability, dysfunctional behavior, and affect health and illness. Therefore, they are
health-risk behavior, and to the enhancement of engaged in the promotion and maintenance of
psychological and physical well-being. 7 health-related behavior, the prevention and
Overall, the field of clinical psychology treatment of illness and analysis and improvement
integrates science, theory and practice to of the health care system.
understand, predict and alleviate maladjustment,
disabilities, and discomfort as well as to promote Clinical Neuropsychology
human adaptation, adjustment, and personal Clinical neuropsychology focuses on the brain-
development. It, therefore, focuses on the behavior relationship and how behaviour and
intellectual, emotional, biological, psychological, behavioural problems are affected by the way the
social, and behavioral aspects of human function brain functions.12 A clinical neuropsychologist

Role of Psychologists 65
specializes in the diagnostic assessment and Pediatric Psychology
management of individuals with brain Pediatric psychology is an interdisciplinary field
impairment.13 Clinical neuropsychologists are that addresses the full range of physical and
usually located in the departments of clinical mental development, health and illness issues
psychology, neuroscience and neurosurgery. affecting children, adolescents and families.16
Pediatric psychologists, therefore, diagnose,
Counseling Psychology assess, and treat the psychological problems
Counseling psychology is a specialty in the field affecting the physical health of children and
of psychology in which the practitioners help adolescents or resulting from dysfunction of the
people as individuals and groups, to improve their physical health. Moreover, they are involved in
well-being, alleviate their distress, resolve their the improvement of the mental health services, the
crises, and increase their ability to solve problems promotion of health and development, and the
and make decisions.14 Most of those who seek prevention of illness and injury to children and
help from a counseling psychologist are clients adolescents.
who do not have major psychological disorders.
Counseling psychologists, however, work in a Community Psychology
variety of settings such as, hospitals and medical Community psychology moves beyond
centers, academic institutions, prisons, schools, individuals to deal with problems of mental health
business/industry, community health, etc. and and human relationships in communities.17
with people of all ages e.g. children and Community psychologists assist people to achieve
adolescents, adult, and the elderly. Counseling their goals in areas such as health welfare and
psychologists then help people to adjust to change community projects.
or make changes in their lifestyle. They assist
individuals and groups in areas related to personal PSYCHOLOGISTS AND THE HEALTH
wellbeing, interpersonal relationships, work, CARE
recreation, health, and crisis management. They The services of the health care psychologist would
may practice independently or work with clinical be required in the following areas.18-20
psychologists, child psychologists, and health
psychologists or as academic counselors. Primary care
To provide important diagnostic interventions,
Rehabilitation Psychology and preventive services for the psychological
Rehabilitation psychology is an applied clinical problems in primary health care, illness
specialty in professional psychology concerned prevention, and behavioral health promotion.
with the treatment and science of disabling and
chronic health condition.15 Rehabilitation Secondary care
psychologists deal with stroke and accident To give psychological assessments and diagnoses,
victims, people with mental retardation, and those psychological treatments, and rehabilitation.
with developmental disabilities caused by such These services are provided to a variety of age
conditions as cerebral palsy, epilepsy, and autism. groups and special groups of patients. These
They help disabled individuals adapt to their would include children, adolescents, adults, the
situation, frequently they work with other health elderly, and people with special needs such as
care professionals. They deal with such issues as those with learning disabilities, the brain-
pain management, personal adjustment, damaged, and the mentally retarded.
interpersonal relations at home and the work
place. They have become more involved in public Tertiary care
health programs to prevent disabilities. They also A psychologist is a member of the treatment team
testify in the courts as expert witnesses on the caring for the psychological aspects of patients
causes and effects of the disabilities and suffering from acute and chronic life-threatening
rehabilitation required to improve the quality of diseases such as cancer, respiratory and renal
life. disease. In addition, the role of clinical
neuropsychologist in the identification,

66 Journal of Family & Community Medicine 2005; 12(2)

assessment, patient care and cognitive etc. The tests used include behavioral assessment
rehabilitation of brain-damaged patients is and observation encompassing the rating scales;
increasing. intellectual assessments, e.g., IQ tests;
neuropsychological tests e.g., Halstead Reitan
PSYCHOLOGISTS’ ROLES IN HOSPITALS tests; personality scales (objective and projective
AND OTHER MEDICAL CENTERS tests); diagnostic interviews (structured and semi-
Psychologists in hospitals and other health care structured); psychophysiological and bio-
facilities may work independently, or as a part of behavioral monitoring e.g. biofeedback; mental
a team. First as clinical psychologists, they are status examination; forensic assessments; psycho-
mental health providers and usually render service educational measurements and vocational tests.
through mental health units and psychiatric Professional psychologists are the only mental
hospitals. Second, as health or medical and physical health professionals who have the
psychologists, they are behavioral health legal right to use, administer, and interpret the
providers and deal with the behavioral dimensions psychological assessments.12
of the physical health and illness. They provide
the clinical and health services to both inpatient Treatment
and outpatient units as well as to patients who A major activity engaged in by psychologists in
function independently and to those new patients delivering health care is intervention or treatment,
who need evaluation.21 The American Board of providing a wide variety of clinical interventions
Clinical Psychology as a training body states that for individuals, groups, couples, and families with
the services provided by psychologists typically physical and mental health problems. These
include: diagnosis and assessment, intervention interventions are directed at preventing, treating,
and treatment, consultation with professionals and and correcting emotional conflicts, personality
others, program development, supervision, disturbances, psychopathology, and the skill
administration, psychological services and deficits underlying human distress and
evaluation and planning of these services and dysfunction.8 They provide a variety of
teaching and research and contributing to the psychological interventions such as cognitive
knowledge of all of these areas. 22 behavior therapy; behavioral modification; family
and couple therapy; biofeedback; rehabilitation;
Assessment group psychotherapy; psychoanalysis; client-
One of the core roles of psychologists in hospitals centered therapy; pain management;
and primary health care is clinical assessment. neuropsychological rehabilitation; interpersonal
They use psychological tests and measurements psychotherapy etc.
for specific purposes. For instance, to assess Research has indicated that less than 25% of
current functioning in order to make diagnoses physical complaints presented to physicians have
(e.g., confirmation or refutation the clinical known or demonstrative organic or biological
impression and differential diagnosis of the signs and that a substantial number of physical or
abnormal behavior such as depression, psychosis, medical symptoms presented by patients are
personality disorders, dementia etc. and non- unexplained medically (functional symptoms) that
psychiatric issues e.g. relationship conflicts, respond well to the psychological intervention.23
compliance, learning differences, educational Therefore, psychological interventions are
potential, career interest etc); identify the effective and cost-effective for the improvement
treatment needs, assign appropriate treatment and of physical and mental health and the quality of
give prognosis, monitor treatment over time, and life.
ascertain risk management.
To achieve these purposes, psychologists use Consultations
psychometric tests, which are standardized and Many psychologists provide psychological
validated tools to assess a wide range of functions consultation for health care professionals,
including intelligence, personality, cognitive businesspersons, schools, organizations,
neuropsychology, motivations, aptitudes, health communities etc. For example, a psychologist
behavior, and intensity of mental health problems may help a physician to better manage

Role of Psychologists 67
noncompliance with unpleasant medical examination of their reliability and validity;
procedure. A businessman may consult a (b) adapting and testing the efficacy of both
psychologist to help reduce conflicts among psychological and biological interventions to
workers or provide stress management. promote health and overcome disorders;
Psychologists’ consultation might include (c) studies to reveal the cultural and cross-cultural
assessment, teaching, research, and therapy. aspects of psychological abnormalities;
(d) ascertaining the impact of both positive and
Administrative Privileges negative human behavior on the physical health;
As experts in human behavior, psychologists are and (e) supervising projects, thesis and
considered as efficient and competent dissertations of candidates whose researches have
administrators. Because the understanding of psychological components.
human behavior in social contexts is considered
the backbone of management, therefore THE PRACTICAL ISSUES IN
psychologists find themselves in administrative PSYCHOLOGY
positions in hospitals and other residential
treatment settings. Clinicians from psychology Educational Qualification
serve as chairpersons of departments, units, or A licensed clinical health psychologist must
divisions in hospitals e.g. neuropsychology, possess a bachelor degree in psychology. It should
mental health, rehabilitation, and occupational include courses on the development of human
health. They could be directors of graduate beings, personality, individual differences, normal
training programs in mental health, student and abnormal behavior, biological, cognitive,
counseling-psychological centers, hospital social and cultural aspects, psychometric and
outpatient departments, and directors of hospitals. psychological testing, experimental designs and
Moreover, they participate in assigned committees statistics, as well as internship in clinical work.
and are active members of their departments. In Postgraduate studies (MS and PhD) in clinical or
administration, psychologists manage budgets, health psychology are necessary and mandatory.
lead multidisciplinary professional and support For example, in UK and US a Doctorate degree in
staff; they develop policies and procedures for clinical or health psychology is the minimum
planning and personnel issues etc. Finally, they requirement to get the title of a psychologist. It is
participate and contribute to all quality preferably to be followed by a postdoctoral
management activities of hospitals and other care fellowship in a subspecialty of clinical/health
settings. psychology.

Teaching and Training Professional and practice issues

A considerable portion of the time of many As a profession, psychology is represented in
psychologists who work in medical settings is virtually every health care delivery system.
spent in academic activities (teaching and Therefore, in state and federal programs and in
training). They teach all courses of psychology, most communities throughout the United States,
human behavior and behavioral sciences included psychologists are recognized as providing needed,
in the curricula of undergraduate and postgraduate valuable and cost effective health services.19 The
medical, dental, nursing and other allied health USA psychologists, however, are recognized as
professionals as well as psychology students, members of the hospital medical staff with full
interns and residents, and train health privileges.19 They have recently had certain codes
professionals. on the Current Procedural Technology24 in order
to provide the psychological care (behavioral
Research and Supervision health assessments and interventions) to patients
With their training and qualifications, clinical and with physical diagnosis, rather than just mental
health psychologists are research-oriented. health diagnosis. Moreover, some United States
Examples of their research activities include; granted prescription privileges to psychologists to
(a) the development and standardization of prescribe psychotropic medications. In this
clinical tools for diagnostic assessment tests and direction, military psychologists of the US

68 Journal of Family & Community Medicine 2005; 12(2)

Department of Defense (DoD) have prescribed sciences is now a reality in medical education and
psychotropic medications since years. This initial the practice of medicine in the 21st century in the
program (prescription privileges for military USA, Europe, and some developing countries.
psychologists) had been thoroughly evaluated by Unfortunately, the health care systems including
the American governmental bodies such as Vector medical education and training in most of the
Research, Inc., the US General Accounting developing countries are still restricted to the
Office, and the American College of biomedical paradigm that cannot meet their health
Neuropsychopharmacology. The results were that needs.
the program has achieved the primary objective The intellectual challenge, as Lisenberg stated
for which it was established by demonstrating that in integrating neurobiology information with
licensed psychologists can be trained to provide behavior in its social context and that “neither the
safe, high-quality cost-effective pharmacological mindless nor the brainless can be tolerated in
care.25 Consequently, the National Psychological medicine."28
Associations of United States are asking the Consequently, the adoption of the
legislative authority to enact a bill to grant biopsychosocial approach is necessary for a
psychologists prescription privileges after they holistic response to the individuals’ suffering and
have undergone specific training program in community health needs.
psychopharmacology. This project is strongly
supported by the American Psychological CONCLUSION
Association that launched a task Force on Until the mid-1960s, the major role for
psychopharmacology to train psychologists as psychologists in treating illness was to assess
prescribers.26 psychopathology in patients. With the growth of
In this regard, R. E Kendell, another key knowledge on the importance of behavioral and
figure of psychiatry commented: “….in psychosocial factors in the etiology and
California, clinical psychologists may well be on maintenance of dysfunctions, psychologists have
the brink of acquiring the right to prescribe developed more expertise in diagnosing and
antidepressant and neuroleptics, and what happens treating the behavioral aspects of illness.
in California has a habit happening here (in Consequently, psychologists have begun to define
Britain) 10 years later.27 themselves as health care rather than mental
Be that as it may, a huge number of health care providers.29
psychologists are opposed to the prescription This article has outlined and discussed the
privilege for psychologists, advocating that clinical role of psychologists in health care
psychology needs to remain as separate as delivery as diagnosticians, therapists,
possible from psychiatry, and psychologists, as academicians, researchers, and administrators in
health providers, have evidence-based methods of the era of the biopsychosocial practice. The paper,
interventions just as effective as psychotropic however, is restricted to the management roles of
medications. psychologists in medical settings and, does not
expose to the psychologists’ roles in promoting
Ethical issue health and preventing illness.
Psychologists like other health providers have The practice of psychologists in health care
ethical principles and code of conduct. This delivery requires sophisticated teaching, intensive
consists of: (a) general principles (e.g. training, and high professionalism in their attitude
competence, integrity, professional and scientific to the ethical principles and code of conduct.
responsibility, respect for people’s rights and
dignity, concern for the welfare of others and REFERENCES
1. Smith T, Nicassio P. Psychological practice: clinical
social responsibility); and (b) specific ethical application of the biopsychosocial model. In: Smith T, Nicassio
standards related to their role with their patients P, editors. Managing the chronic illness. Washington: APA,
and experiments. 1995.
2. The World Health Organization. The World health report.
Geneva: WHO 2002.
RECOMMENDATIONS 3. Cassidy T. Stress, cognition and health. London: Routledeg,
The integration of biomedical and behavioral 1999.

Role of Psychologists 69
4. The American Psychological Association. Psychology careers 1. Management Advisory Services. UK, 1995.
for the Twenty-first Century. Washington: APA, 1996. 19. The American Psychological Association. Practicing
5. The British Psychological Society. The directory of chartered psychology in hospitals and other health care facilities.
psychologists. Leicester: BPS, 2002. Washington: APA, 1998.
6. The American Psychological Association. Guidelines on 20. Resnick R, Rozensky R. Health psychology through the life
hospital privileges for psychologists: credentialing and bylaws. span. Washington: APA, 1996.
Washington: APA, 1991. 21. Sernberg R. Career paths in psychology. Washington: APA,
7. The Canadian Psychological Association. Definition of clinical 1997.
psychology. Montréal: CPA, 1996. 22. The American Board of Clinical Psychology. Examination
8. The American Psychological Association. Clinical psychology. manual for board certification in clinical psychology.
Washington: APA, 2002. Washington: ABCP, 2000.
9. Matarazzo J. Behavior health and behavioral medicine: 23. Neuz A, Neuz C, Lombardo E. Cognitive-behavioral therapy
frontiers for a new health psychology. American Psychologist for medically unexplained symptoms: a critical review of the
1980; 35:807-17. treatment literature. Behavioral Therapy 2001; 32: 537-48.
10. British Psychological Society. The division of clinical 24. The American Psychological Association. The Monitor on
psychology. Leicester: BPS, 2003. Psychology 2000; 31:46-7.
11. The American Psychological Association. The division of 25. Newman R, Phelps M, Sammons D, Dunivin E, Cullen E.
health psychology.:DVKLQJWRQ$3$ Evaluation of the psychopharmacology demonstration project;
1. Plante G. Contemporary clinical psychology. New York: John a retrospective analysis. Professional Psychology, Research and
Wiley, & Sons 1999. Practice 2000; 31:598-603.
1. The Australian Psychological Society. Psychologists: good 26. Dunivin D, Southwell G. Psychopharmacology training in
thinking. APS: 1998. psychology internship. Professional Psychology, Research and
1. Davis K. Emphasizing strengths: counseling psychologists. In: Practice 2000; 31:610-4.
Sernberg R, editor. Career paths in psychology. Washington: 27. Kendell R. The next 25 years. The British Journal of Psychiatry
APA, 1997. 2000; 176:6-9.
1. Frank R, Elliott T. Handbook of rehabilitation psychology. 28. Eisenberg L. Is psychiatry more mindful or brainier than it was
Washington: APA, 2002. a decade ago? The British Journal of Psychiatry 2000; 176:1-5.
1. Roberts M. Handbook of pediatric psychology. New York: 29. Jonson S, Millstein S. Prevention opportunities in health care
Guilford Press, 1995. settings. American Psychologist 2003; 58:475-81.
1. Iscoe I. Reaching out: community psychologists. In: Sernberg
R, editor. Career paths in psychology. Washington: APA, 1997.

70 Journal of Family & Community Medicine 2005; 12(2)