The Relevance of Trauma to General Clinical Practice.

This introduction to the special issue of Psychotherapy on trauma considers the relevance of knowledge and skills in assessing and treating difficulties associated with trauma exposure to general clinical practice. Research findings on the prevalence in general clinical settings of trauma histories, trauma-related disorders and various other psychological disorders associated with trauma exposure, and physical health problems related to trauma are surveyed. It is argued, on the basis of diverse comorbid conditions associated with trauma exposure, that generalists with varied experience who obtain specialized trauma training are especially well equipped to develop competency in trauma practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

3D automatic expansion: clinical application

Although the total number of active private dentists increased by 21.7 percent between 1982 and 1995, the number of active private part-time dentists increased by 104 percent, while the number of active private full-time dentists increased by 8 percent. Thus, the total number of hours active private dentists spent in the office has not increased to the same extent as the number of active private dentists. During the same period, however, the average number of hours spent treating patients increased, indicating that dentists are becoming more efficient in directing their office hours toward clinical dentistry. The distribution of active private part-and full-time dentists and the actual number of hours they spent in the dental office and spent treating patients provide a more complete picture of the capacity of the dental care delivery system than only looking at the increase in the total number of dentists.     

Alteration of GABAA receptor alpha 1-subunit mRNA in mouse brain following continuous ethanol inhalation

OBJECTIVE: To evaluate what nursing home medical directors actually do, what they and other nursing home personnel believe would be desirable to do, and what problems and deficiencies are perceived. DESIGN: Mail survey with follow-up telephone interview when necessary. SETTING: Forty-five nursing facilities in upstate New York. PARTICIPANTS: The medical directors, administrators, and directors of nursing of the 45 facilities. MEASUREMENTS: Inventory of what medical directors reported as to their actual activities and time spent, and of what they, the administrators, and the directors of nursing felt should be their responsibilities and activities under ideal circumstances. RESULTS: For part-time medical directors, self-reported time spent on medical directorship activities averaged 12 hours per month; of all directors, 45% spent 8 hours or less per month. Proportion of time spent on various specific activities varied widely. There was general agreement that substantially more time should be spent, in particular, on evaluating and addressing problems of adequacy and quality of care, communicating with attending physicians about problems, and assisting with inservice training programs. CONCLUSIONS: To fill the role adequately, more time should be spent by many part-time medical directors, which will require greater financial commitment by facilities and reimbursement systems. Efforts need to made to better coordinate the expectations of medical directors and facility staff.     

Treatment of depression by obstetrician-gynecologists: a survey study

OBJECTIVE: We performed an exploratory survey of depression diagnosis, treatment, and patient referral patterns by Fellows of ACOG. We also examined obstetrician-gynecologists' professional training in the management of clinical depression. METHODS: We sent a questionnaire to a total of 1370 ACOG Fellows. Sixty percent of the surveys were returned. RESULTS: As a group, obstetrician-gynecologists reported diagnosing an average of four new cases of depression per month. Within the overall sample, the number of new diagnoses of depression made each month was significantly greater for those defining themselves as primary care physicians than for those defining themselves as specialists. When treating depression pharmacologically, obstetrician-gynecologists reported that they overwhelmingly (74% of the time) chose selective serotonin reuptake inhibitor antidepressants. Ninety-five percent of obstetrician-gynecologists reported that they referred severely depressed patients to a mental health professional. A majority of respondents neither received residency training (80%) nor completed a continuing medical education course (60%) on the treatment of clinical depression in women. CONCLUSION: Obstetrician-gynecologists who describe themselves as primary care physicians make significantly more diagnoses of depression than those considering themselves specialists. Studies further to assess obstetrician-gynecologists' management of depression and better to define needs for professional education are warranted.     

Training in clinical psychophysiology: Present trends and future goals.

Conducted a survey of directors of programs in clinical psychology that were approved by the American Psychological Association. Data from the 65 responding programs reveal that a substantial number of programs offered formal training in clinical psychophysiology. 69% of the respondents indicated that they currently provide training in clinical psychophysiology, while an additional 17% reported a desire to develop such training in the future. Details are provided regarding (a) types of training available; (b) current and desired content areas covered; and (c) ratings indicating interest, utility, and potential of biofeedback, psychophysiological assessment, and psychophysiological monitoring in therapy. It is concluded that the increased training in clinical psychophysiology is part of a broader trend reflecting the growing interest in the psychobiological foundation of human behavior and its implications for clinical psychology and medicine. Although this trend can be viewed as positive, the current state of research warrants that clinical psychophysiology and the emerging field of behavioral medicine not move too quickly with overoptimistic expectations. The need for quality, research-based clinical training in the area is stressed. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Directed forgetting of trauma cues in adult survivors of childhood sexual abuse with and without posttraumatic stress disorder

The authors used a directed-forgetting task to investigate whether psychiatrically impaired adult survivors of childhood sexual abuse exhibit an avoidant encoding style and impaired memory for trauma cues. The authors tested women with abuse histories, either with or without posttraumatic stress disorder (PTSD), and women with neither abuse histories nor PTSD. The women saw intermixed trauma words (e.g., molested), positive words (e.g., confident), and categorized neutral words (e.g., mailbox) on a computer screen and were instructed either to remember or to forget each word. Relative to the other groups, the PTSD group did not exhibit recall deficits for trauma-related to-be-remembered words, nor did they recall fewer trauma-related to-be-forgotten words than other words. Instead, they exhibited recall deficits for positive and neutral words they were supposed to remember. These data are inconsistent with the hypothesis that impaired survivors exhibit avoidant encoding and impaired memory for traumatic information.     

Psychology training related to AIDS: Survey of doctoral graduate programs and predoctoral internship programs.

Surveyed all APA-approved graduate programs in clinical and counseling psychology and predoctoral internship programs to assess the extent of student training in areas related to acquired immune deficiency syndrome (AIDS). The survey found that 75% of graduate programs do not cover AIDS at any point in their curricula and that less than half train students in human sexuality. Other foundation topics pertinent to AIDS prevention and clinical service provision receive little attention in most graduate and internship programs. The authors discuss reasons why greatly increased prevalence of AIDS and human immunodeficiency virus (HIV) conditions will require more substantial training and research among psychologists, and they outline some possible mechanisms to provide this training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A survey of clinical psychology training in Canadian federal corrections: Implications for psychologist recruitment and retention.

Although survey results seem to indicate an abundant interest among Canadian psychology graduate students in pursuing training in criminal justice psychology, the recruitment and retention of psychologists in the Correctional Service of Canada (CSC) has been of some concern. The present study is a 2008 survey of sites within CSC that provide opportunities for clinical psychology training with offender clientele. Survey findings demonstrated that a broad range of clinical psychology training opportunities were available across 16 sites. The most frequently cited barrier to providing training was lack of time by prospective trainers, and sites reported retaining relatively few of their trainees for subsequent psychologist positions. Information was also obtained regarding vacant psychologist positions across CSC regions. In light of survey findings, substantive discussion is devoted toward the issues of psychologist recruitment and retention in Canadian federal corrections, including a discussion of both potential and existing training initiatives. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Forensic psychology opportunities in Canadian graduate programs: An update of Simourd and Wormith's (1995) survey.

Forensic psychology has gained momentum in North America in recent decades, and Canadian psychologists have made considerable contributions to the field. Strong student interest and a high demand for professionals, however, have not been sufficiently matched with the availability of formal forensic psychology graduate training, nor with sufficient scholarly discussion of this issue. The purpose of the current study was to update Simourd and Wormith's (1995) survey of forensic psychology training available in Canadian psychology graduate programs. Of the 39 universities with psychology graduate programs, 36 (92%) responded to the survey. Twenty-four universities (67%) offered some forensic opportunities for students, although there was considerable variability in the number of courses, students, and faculty members in the forensic psychology programs. Since Simourd and Wormith's (1995) survey, forensic training is available at 10 new universities. Of the 14 programs with forensic psychology content in 1995 and in the current study, however, more than half of them reported a decrease in the number of faculty and students working with forensic issues. Considering the continued demand for trained forensic psychologists in applied settings, further attention to the availability of both education and training in forensic psychology is therefore still needed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Work activities of academic clinical psychologists: Do they practice what they teach?

Do PhD-level clinical psychologists who work in academic settings engage in both research and clinical practice, as the Boulder model recommends? Clinical psychology faculty members in 3 types of psychology departments were surveyed regarding their actual and preferred work activities and their attitudes toward clinical practice. Respondents indicated that they spent more than twice as much time in research as in clinical activity, with many (44%) reporting no involvement in clinical practice. Implications of declining practice among clinical faculty include potentially ineffective instruction in clinical course work, less informed clinical research, and the devaluing of clinical practice in traditional academic settings. Recommendations for facilitating practice among clinical faculty who wish to do so are proposed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A survey of Canadian clinical psychology educators: Recommended readings.

Surveyed Canadian clinical psychology educators to compile a list of recommended readings for clinical training. 36 faculty members from 18 clinical psychology programs completed a survey asking about their training orientation and the 10 best references for training clinical psychology graduate students. The 15 most frequently endorsed references and the 12 most frequently endorsed authors are presented, along with the total number of endorsements by subject area. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Educating and training the next generations of traumatologists: Development of cultural competencies.

Cultural competence in trauma training, education and research has become a necessity given the changes in the U.S. population and the forces of globalization. With few exceptions little attention has been paid to the cultural training of traumatologists and the development of cultural competencies in this field. This paper will focus exclusively on examining the case for cultural competence in trauma psychology. The author reviews three factors that are key in the education and training of culturally informed trauma therapists, including best practices for educating mental health professionals in this field. These include: 1) The development of a trauma psychology curricula and training practices which give a thorough account of cultural factors; 2) The meaningful inclusion of cultural context in trauma psychology research and; 3) The promotion of organizational structures and culture within psychology that support cultural competence. The author offers future practice recommendations that are based on well established cultural competencies in the field of psychology. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Education and training in health psychology: Boulder or Bolder.

Reviews previous conferences on graduate education and training in health psychology (HP) as background for a 1983 conference on career and training issues in the field. Criteria characterizing professions are presented. Expected topics at the conference include societal need for orderly development of HP, work functions and roles of health psychologists, predoctoral specialty training, appropriateness of specializing in HP, official sanctioning, education and training settings, model doctoral programs emphasizing HP within a clinical psychology track, apprenticeship, and pre- vs postdoctoral training in HP. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diversity training: Conceptual issues and practices for Canadian clinical psychology programs.

Conducted a systematic survey of Canadian clinical psychology programs to examine the extent and nature of diversity. Diversity was defined broadly as reflecting the vast number of possible individual differences (e.g., culture, nationality, ethnicity, colour, race, gender, religion, sexual preference, disability, economic disadvantage) that can affect clinical psychology knowledge, research, and practice. 20 Directors of Clinical Training (DCTs) at Canadian clinical psychology programs were asked about the extent to which various aspects of diversity training were deemed important or essential to their program, what training activities were required, and how effective different methods of training were viewed. The results revealed that DCTs varied widely in their opinion of how important diversity materials were, and that few programs require many different methods of training related to diversity. Further, the training methods more commonly adopted did not generally relate well with those that were seen as being most effective. Implications of the survey for training in clinical psychology are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does a Clinical Psychology Education Moderate Relationships Between Personality or Emotional Adjustment and Performance As a Clinical Psychologist?

Does an education in clinical psychology affect relationships between personality or emotional adjustment and clinical knowledge or clinical practice ability? Two groups were assessed at the beginning of their professional development and 1 year later. The 1st group was studying clinical psychology, and the 2nd group was obtaining training under a workplace supervision model. At pretest, measures of defensiveness were correlated with practice ability, and participants who had emotional adjustment problems obtained lower practice ability scores. At posttest, neither pretest personality nor emotional adjustment was correlated with clinical performance. An interaction between education group and problem group suggests that a clinical education enhances the performance of students with emotional problems at the onset of their education. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Selective indications of skull radiography after head injury in children

The Permanent Working Group of European Junior Hospital Doctors (PWG) conducted a survey among surgical trainees in member countries with the aim of describing postgraduate training in surgery throughout Europe. In each country, 10 trainees with surgical training of 2-5 years and 10 trainees with surgical training of 6-9 years answered a questionnaire, completed a diary and kept a log book of operations for 1 week. A total of 165 surgeons from 12 countries completed the survey. A trainee had to care for an average patient load varying from 30 to 80 patients at any one time. The average number of working hours ranged from 52 to 88 h per week, including up to 18 h of unpaid work. The different tasks carried out within these working hours varied considerably, as did the proportion of tasks with educational value. Trainees participated in four to 11 major operations each week, but the number of operations a week did not reflect the number of operations conducted under supervision. In some countries, the majority of the trainees stated that they received their training mainly through unsupervised experience. The average number of days spent on courses and congresses varied from 4 to 15 days per year, with great variation in the percentage of expenses paid. Countries with favourable working conditions, such as fewer working hours, shorter shifts and a day off after being on duty, seemed to have gained these advantages by a reduction in working hours with educational value, rather than by a reduction in routine work. It is concluded that conditions of surgical training vary greatly between the European countries in relation to duration, working hours, tasks undertaken, and resources used on training. Every country is capable of improving its surgical training.     

Trauma, Dissociation, and Disorganized Attachment: Three Strands of a Single Braid.

During the past decade, research findings, theoretical reflections, and clinical experiences have woven together the themes of attachment disorganization, dissociative processes, and vulnerability to trauma-related emotional disorders. The resulting unitary perspective is captured in this article by an overview of inquiries on unresolved traumatic memories based on the Adult Attachment Interview (AAI) and of studies on the sequelae of early disorganized attachments. To illustrate the intriguing clinical implications of this unitary perspective, the author considers such topics as vulnerability to complex trauma-related disorders, delayed dissociative responses to past traumatic memories, and the definition of psychological trauma. Some psychotherapeutic implications of the interplay between trauma-related disorders and attachment disorganization are briefly addressed in the concluding section. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological Services Center at the State University of New York at Albany: A case study.

Discusses a model for the development and implementation of a psychology training center shared by clinical and counseling psychology programs. The history of the psychological services center and its administrative structure are reviewed, and professional issues such as training and service are discussed. Results of an attitudinal survey completed by students show that they considered their experience at the center to have played a positive role in their professional development. (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology Training Directors' Views of Trainees' Readiness to Practice Independently.

When are psychology trainees ready to practice independently? This question has been debated extensively during the past few years. To contribute to this debate, a national survey of training directors of academic programs, predoctoral internships, and postdoctoral fellowships was conducted. The study explored training directors' views regarding the examinations and supervisory hours necessary to become an independent practitioner. The study found that training directors were divided in their opinions of when trainees are competent to practice independently. Academic training directors believed that trainees are ready for independent practice earlier in the training sequence than internship and postdoctoral training directors. The implications for conflicting views are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Graduate training in clinical psychology: Student perspectives on selecting a program.

Although graduate programs in clinical psychology spend considerable energy and resources selecting students, there is limited information regarding the factors students consider important when they choose a training program. A review of recent literature found one study that looked at how first-year graduate students rated the importance of a number of factors in their decision-making process when selecting a clinical psychology training program (Walfish, Stenmark, Shealy, & Shealy, 1989). The current study extends this research by comparing reports from first-year graduate students enrolled in traditional “Boulder model” programs with those enrolled in professional “Vail model” programs. As part of a larger survey project, students answered questions about factors they considered important when they made decisions about applying to and selecting a graduate program to attend. Responses from students enrolled in traditional programs were compared with students attending professional programs. These differences are discussed, as well as their implications for program directors engaged in student recruitment and selection. (PsycINFO Database Record (c) 2010 APA, all rights reserved)