the jo urnal o f the b c psych o lo gical a ss o ciatio n

Vo lume 3 • issue 4 • fall 2014 • future o f psych o lo gy

BC PsyChologist

eDitor in chiefTed Altar, Ph.D., R. Psych.

assistant eDitorMarian Scholtmeijer, Ph.D.

publisherRick Gambrel, B.Comm., LLB.

art DirectorInkyung (Inky) Kang

executiVe DirectorRick Gambrel, B.Comm., LLB.

aDministratiVe DirectorEric Chu

executiVe assistantRukshana Hassanali

mission statement

The British Columbia Psychological Association provides leadership for the advancement and promotion of the profession and science of psychology in the service of our membership and the people of British Columbia.

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aDVertising policyThe publication of any notice of events, or advertisement, is neither an endorsement of the advertiser, nor of the products or services advertised. The BCPA is not responsible for any claim(s) made in an advertisement or advertisements mailed with this issue. Advertisers may not, without prior consent, incorporate in a subsequent advertisement, the fact that a product or service had been advertised in the BCPA publication. The acceptability of an advertisement for publication is based upon legal, social, professional, and ethical consideration. BCPA reserves the right to unilaterally reject, omit, or cancel advertising. To view our full advertising policy please visit: www.psychologists.bc.ca DisclaimerThe opinions expressed in this publication are those of the authors, and they do not necessarily reflect the views of the BC Psychologist or its editors, nor of the BC Psychological Association, its Board of Directors, or its employees.

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BC Psychologist

boarD of Directors

PRESIDENTTed Altar, Ph.D., R. Psych.VICE-PRESIDENTDon Hutcheon, Ed.D., R. Psych.TREASURERMarilyn Chotem, Ed.D., R. Psych.

DIRECTORSMichael 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.

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.)

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Table of Contents

Letter from the President

Letter from the Executive Director

APA Council of Representatives Report — August 2014

BCPA News & Events

Board Statements 2014

BCPA Constitutional Amendments

The RCMP: A Corporate Culture Out of StepMike Webster, Ed. D., R. Psych.

Hopeful Prognosis for PsychodiagnosisNoah Susswein, Ph.D.

Self-Compassion: The Future of Self-Care?Dawn Johnston, Ph.D., R. Psych.

Meeting the Needs of the Community:A Training Model Addressing Psychologists’ CompetenciesMichael Mandrusiak, Psy.D., R. Psych., Vaneeta Sandhu, Psy.D.,R. Psych. & Angie Ji, M.Ed., CCC., MTA.

Current Status, Challenges & Future Directions of TelepsychologyJaye Wald, Ph.D., R. Psych.

Primary Care Psychology – Increasing Capacity & Decreasing Barriers to Psychological Services Through Integrated CareJoachim Sehrbrock, Ph.D., R. Psych. & Theo DeGagne, Ph.D.,R. Psych. (Vancouver Coastal Health)

Sleep Management Workshop & BCPA AGM Registration

4 fall 2014

Letter from the President

teD altar, ph . D. , r. psych .

The President of the BC Psychological Association.Contact for the Board of Directors at board@psychologists.bc.ca

D e ar co lle ag ue s anD frienDs ,

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

BC PsyChologist 5

Letter from the Executive Director

rick gamb rel , b . co mm . , llb .

The Executive Director of the BC Psychological Association. Contact: rick.gambrel@psychologists.bc.ca

this issue o f the b c psych o lo gist

is ab o ut the future o f psych o lo 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 27th, 2015 — Fitness-For-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.

6 fall 2014

this y e ar at apa’s summer co un cil mee 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.

other upDate s in cluD e the fo llowin 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;

je anne leb l an c . ph . D. ,

ab pp, r. psych .

The BC Representative to the APA’s Council of Representatives. Contact: jeannemleblanc@hotmail.com

APA (American Psychological Association)Council of Representatives Report — August 2014

BC PsyChologist 7

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

8 fall 2014

to keep receiVin g n otice s & upDate s fro m us ,

please add communications@psychologists.bc.ca to your address book.

upcoming workshops•

integ r atin g sleep manag ement into

clinical pr ac tice wo rksh o p & b cpa ag m

Presented by Dr. Catherine Schuman9:00am – 4:00pm Friday November 28th, 2014@ University Golf Club

Please see page 29 or visit www.psychologists.bc.cafor more information and registration.

fitne ss - fo r- D ut y & pro fe ssio nal

pr ac tice e Valuatio ns: e thic s anD

a sse ssment techniq ue s

Presented by Dr. Mark Zelig9:30am – 4:30pm Friday March 27th, 2015@ Park Inn & Suites on Broadway

impac t ther apy: a multisens o ry

approach to ther apy (what aDVer tisers

kn ow that ther apists sh o ulD kn ow)

Presented by Dr. Ed Jacobs & Dr. Nina Spadaro9:00am – 4:00pm Friday April 24th, 2015@ University Golf Club

piece of mind @ UBC•

join us fo r o penin g e Vent!

2:00pm – 4:00pm Saturday November 1st, 2014@ AMS Art Gallery (UBC) 6138 Student Union BoulevardOpening Remarks and Panel Discussion begins at 3pm.Exhibit runs from October 27th to November 7th, 2014.

BCPA News & Events

correction•

ple a se accep t o ur ap o lo gy fo r

misprintin 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.

submit articles•

want to write fo r us? 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

we pub lish n otice s 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: info@psychologists.bc.ca

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BC PsyChologist 9

Board Statements 2014

D o u g l a s caVe , msw. rsw.

ph . D. , r. psych . , ma , amp, m cfp.

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.

marily n ch otem , eD. 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.

D o nalD "D o n" hutcheo n , eD. D. ,

c . psych o l . (uk). , r. psych .

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.

paul g . swin g le , ph . D. , r. psych . ,

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.

this y e ar, 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 co n g r atul ate the following candidates who have been elected to the BCPA Board by acclamation. We also thank our returning Board Members for their continuing commitment.

this y e ar b cpa seeks to amenD

the pro ce ss by which its

pre siD ent is elec teD. 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:

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.

BCPA Constitutional Amendments

q Agreeq Do Not Agree

sec tio n 24(1) o f the by l aws shall b e

amenD eD to re aD : “The President, Vice President, Secretary, Treasurer, past President and one or more

other persons shall be the directors of the society.”

sec tio n 25 (3) is renumb ereD sec tio n

25(7) anD is amenD eD to re aD : “An election may be by acclamation; otherwise it shall be by ballot.”

a ne w sec tio n 25(3) is aD D eD a s

fo llows: “The Vice President shall take office as President at the conclusion of the Annual General

Meeting of the year following his/her election.”

a ne w sec tio n 25(4) is aD D eD a s

fo llows: “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 ne w sec tio n 25(6) is aD D eD a s

fo llows: “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.”

a ne w sec tio n 25(5) is aD D eD a s fo llows:

“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.”

BC PsyChologist 11

in this ar ticle 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

The RCMP: A Corporate Culture Out of Step

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

mike web ster, 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.

12 fall 2014

fact, the RCMP has had in-house harassment and anti-discrimination 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...

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, down-sized, 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.

British Columbia School of Professional Psychology406-1168 Hamilton Street • Vancouver, B.C. • V6B 2S2 • (604)682-1909 • Fax (604) 682-8262 • email: wilensky@interchange.ubc.ca

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 hoursDates: 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 priceRegistration: 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 amarica@shaw.ca

referencesCanadian 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

14 fall 2014

Prognosis for Psychodiagnosis

when i think o f the future o f

psych o lo gy, 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 non-scientific, 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

n oah susswein , 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.

to seek mental health treatment reflective of dysfunction, infection, or disease? As I understand it, science has ruled out an illness- or 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

BC PsyChologist 15

causes persons diagnosed with Conduct Disorder to behave in Conduct-Disordered ways. It is clear that Conduct Disordered behavior is a problem, but there is no reason to suppose that Conduct Disorder is correlated with a disease. The potential for reification extends beyond the particular diagnostic categories that happen to exist in any particular edition of the DSM, however.For example, the vocabulary of attachment theory is an invaluable clinical resource, but not because, say, describing a client as ‘insecure-dismissing’ involves a causal explanation of their tendency to devalue relationship. We undermine our professional integrity and credibility when we speak as if such diagnostic and clinical concepts refer to causes underlying behavior. The issue of diagnostic validity is, on the one hand, technical and scientific, but it is also an issue with personal, political and ethical implications. Our ideas of how we should respond to our own and each other’s suffering depend on what we think that suffering means. To my mind, the widely-accepted biopsychosocial perspective on mental health requires that we see multiple meanings in it, and treat clients on the basis of an integrated understanding of the relevant variables. From what I can tell, this is what many if not most clinicians already aspire toward. The disease model’s most famous critic, Thomas Szasz (1960) wrote that he was “concerned with problems in living (and not with diseases of the brain, which are problems for neurology).” Szasz argued that “[p]roblems in human relations can be analyzed, interpreted, and given meaning only within given social and ethical contexts” (p. 116). More than fifty years later, it appears that this once-controversial point of view is commonplace. We take it for granted that clients must be assessed and treated in light of their cultural and individual expectations and preferences, and that the

meaning of particular symptoms depends upon clients’ personal histories as well as on what they themselves understand their symptoms to mean. We have a rich vocabulary of clinical concepts inherited from a variety of therapeutic and research traditions, none of which require the assumption of underlying diseases. Wouldn’t it be great if we had a diagnostic system that was consistent with our science and standards of practice? As I see it, the failure of the disease model of psychopathology is an opportunity for conceptual innovation. The broad base of knowledge — regarding social, cognitive, and neurological development, of group behavior, family dynamics, and cross-cultural variation — that is particularly characteristic of psychologists potentially lays the groundwork for developing a diagnostic framework that best fits the clinical facts. The field is hardly short on good ideas; for example, some authors have considered the possibility of a developmentally-based classification system (e.g., Beauchaine, 2003) while positive psychologists turn traditional clinical concerns upside down and look for sources of well-being that cut across clinical and non-clinical populations (Duckworth, Steen, and Seligman, 2005). Where might psychodiagnosis be led if it were framed in terms of developmental pathways and well-being as opposed to disease and symptom reduction? I don’t pretend to know the answer to this question, and neither am I sure that it is the best particular question to ask. But I think that engaging with this sort of back-to-the-drawing-board conceptual work would make for a very rich future clinical psychology. It is easy to appreciate why Greenberg (2012) chose the clever title Book of Woe, but the story of psychodiagnosis also begs for this positive reframe.

referencesAmerican Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric PublishingBeauchaine, 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. 629–651Mill, 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.

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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 pmWhere: TLC Medical Centre,near Langley Memorial Hospital in Langley, BCCost: $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

Prevention & Recovery: Eating Disorders and Disordered Eating

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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.

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Prevention & Recovery: Eating Disorders and Disordered Eating

KPU Continuing & Professional Studies

Students may register at anytime and will be given six months to complete.

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.

*This course is recognized by the Royal College of Physicians and Surgeons of Canada, the Canadian Nurses Association and the Canadian Counselling & Psychotherapy Association

online course $1996 + GST To register, please go to

kpu.ca/cps

18 fall 2014

haVe yo u e Ver s tru g g leD in a se ssio 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.

what is self - co mpa ssio 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 self-compassion 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 to b e self - co mpa ssio nate:

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.

Dawn jo hnsto 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.

The Future of Self-Care?

BC PsyChologist 19

referencesNeff, 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

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.

self - co mpa ssio n in pr ac tice:

“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 self-compassion 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 self-forgiveness. 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 self-compassion 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.

20 fall 2014

Meeting the Needs of the Community:A Training Model Addressing Psychologists’ Competencies

intro D u c tio n

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 mpe ten cie s fo r e xpanDin g ro le 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

michael manD rusiak ,

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.

Vanee ta sanD hu,

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.

an gie 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.

BC PsyChologist 21

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.

serVin g DiVerse anD DisaDVantag eD

p o pul atio ns

With a diversifying Canadian population and strong support for multicultural competence as a benchmark competency, this domain is critical to the future of psychology. Jones, Sander, and Booker (2013) suggest that the abstract nature of multicultural competence has presented challenges to training programs. They advocate for cultural competency to be integrated across the curriculum rather than relegated to specific courses. In addition, they add a much-needed dimension to cultural competence, advocacy and action, suggesting that psychologists will often find themselves in leadership roles within systems and will have the responsibility to advocate for those with less power. This dimension of cultural competence proposed by Jones, Sander, and Booker (2013) is congruent with the social justice paradigm. The social justice perspective focuses on how distributive, procedural, and interactional injustices are involved in mental health disparities, where distributive justice refers to equitable distribution of resources, procedural justice refers to fairness of decision making processes, and interactional justice refers to fair treatment in relational exchanges involving power differences (Lewis, 2010). From a social justice perspective, the role of practitioners is to use their own position of authority in order to help marginalized groups gain a greater voice in decision making (Goodman, 2004). Crethar, Torres-Rivera, and Nash (2008) argue that multicultural, social justice, and feminist paradigms share two conceptual links:i) that clients exist within environmental contexts that

impact them; andii) that helping professionals must remain aware of and

responsive to issues of power, oppression, and privilege that are detrimental to the client’s quality of life and mental health.

To highlight the reviewed psychologist competencies in meeting the needs of the community in the future, we will examine one particularly promising training experience for

helping to cultivate and develop these competencies, and to encourage future practitioners to assume a diversity of leadership and policy-related roles.

the co mmunit y serVice pr ac ticum

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 to psychological competencies as developed by Hatcher et al. (2013), the CSP has the explicit aim of building competencies related to professionalism (including values and attitudes, reflective practice, ethics, and individual and cultural diversity), relational skills (including how to build and maintain various professional and therapeutic relationships), science (including methodology, research, and evaluation), application (including initiative, leadership, and implementation), and systems thinking (including advocacy, management, and administration). While some literature has addressed the integration of social justice training into clinical practicum experiences (Lewis, 2010; Burnes & Singh, 2010), clinical training inevitably places the trainee in the role of assessor or psychotherapist and is less suited for training in some of the other roles (e.g., consultant, program developer, program evaluator, grant writer, administrator, advocate) that psychologists are increasingly in demand to fulfill. The CSP is therefore ideally suited to supplement traditional training experiences and will be explained further below. The non-clinical Community Service Practicum involves students integrating themselves at a community agency or organization; for example, training contexts may include social profit organizations, government programs, consumer advocacy organizations, and professional organizations. Through service learning, students acquire knowledge about community issues and the range of programs and services designed to address these problems (i.e., public health approaches, and policy development and implementation). Engaging in systems thinking allows students to begin the processes of reflective practice and role definition — skills that are essential to cultivate as they progress to clinical practicums and, ultimately, professional practice. Although students are not engaging in direct psychological services, they fulfill significant roles related to research initiatives to inform policies and procedures,

22 fall 2014

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.

referencesBurnes, 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.xFouad, 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/a0015832Hatcher, 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/a0029401Hunsley, 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/a0029672Hurd, 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.pdfJones, 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/a0017383Rodolfa, 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

BC PsyChologist 23

in this paper 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 pr ac tice anD re se arch

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, Internet-based 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.

jay e walD, 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 drjayewald@gmail.com.

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 , e thical , anD techn o lo gical

challen g e s

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

Current Status, Challenges, andFuture Directions of

24 fall 2014

are suicidal, or those presenting other severe symptoms, such as substance abuse, dissociative or psychotic features), and it can be difficult to deal with emergency situations especially when the service is conducted remotely Professional boundaries can become blurred •particularly given the availability of email and online communication. Furthermore, clients may disclose personal information (including suicidal thoughts) by email or through other on-line mediums between sessions. With telephone-based treatment (and even more so •with other Internet-based applications) it may be may be difficult (or impossible) to verify the identity of clients who are at a distance.

Many of these clinical issues also intersect with, and raise other ethical challenges in the provision of telepsychology services related to competency, informed consent, confidentiality, privacy and security, documentation and record keeping, integrity of relationships (e.g., professional boundaries), duty to care (e.g., responding to emergency situations), and legal, insurance, and jurisdictional requirements (Baker & Bufka, 2011; Nicholson, 2011; Richardson et al., 2009; Shore, 2013; Yuen et al. 2012). In response, various ethical guidelines for telepsychology have been developed (e.g., Joint Task Force for The Development of Technology Guidelines for Psychologists, 2013).2 There has also been growing recognition of the importance of establishing enforceable standards and codes, as reflected in the Code of Conduct (Revised September 2014) by the College of Psychologists of British Columbia (CPBC), which includes a new section on the use of telepsychology. A range of technological challenges can also interfere with the delivery of telepsychology services, and this is particularly evident with video-conferencing, such as poor sound, video, or equipment quality (e.g., headsets, Web-cam) as well as disrupted transmission using mobile phones and Internet connections (Shore, 2013; Richardson et al., 2009; Yuen et al., 2012). Some clients may not have the necessary equipment needed for the service (more so with video-conferencing) or have difficulty setting it up. Furthermore, some research has found that treatment outcome can be impacted by the level of knowledge and comfort with using technology (see reviews by Richardson et al., 2009; Yuen et al., 2012).

2 It is also interesting to look at other allied mental health professional associations and organizations who have also established detailed telepsychology guidelines, such as the British Columbia Association of Clinical Counsellors. A list of other relevant ethical and practice guidelines are provided at the end of this article.

reco mmenDatio ns anD str ategie s fo r

improVin g serVice D eliVery

With no recognized training standards for the provision of telepsychology services, the onus falls on psychologists to obtain sufficient competency for addressing the clinical, ethical, and technological issues relevant to the technology being used. Psychologists are also expected to have the knowledge and skills to assess each client’s suitability, needs, and other relevant factors (e.g., the client’s knowledge of and skill with the technology, geographical location, alternative services, and other available support) and to develop treatment plans accordingly in collaboration with the client, based upon ethical decision-making, and the current research literature. In recent years, there has been an emerging literature of practice recommendations to educate and guide psychologists using these services, some of which are described below.

The • Guidelines for Psychologists Providing Psychological Services via Electronic Media (Canadian Psychological Association, 2006) provides a description of information that should be included in the informed consent. This information ideally is provided to clients in writing in advance of the service, and then discussed, and agreed upon. For example, as part of the consent, clients need to be informed of potential privacy and security breaches of the technology being used (e.g., informing clients that confidentiality cannot be guaranteed when transmitting information electronically).A growing recommendation for psychologists who •use telepsychology services is having an Electronic Communication and Security Policy (as well as a Social Media Policy), which can then be made available to clients prior to initiating the service (see American Psychological Association Practice Organization, 2012 and Standards for the Use of Technology in Counselling, British Columbia Association of Clinical Counsellors, 201l). This information can also help to clarify the professional boundaries of the services, such as indicating when the psychologist will respond to electronic messages. Before providing telepsychology services, it is also •important for psychologists to develop procedures for dealing with emergency situations, which is also communicated to clients at the outset of service delivery. The CPA Guidelines (2006) and others (e.g., Shore, 2013) suggest having the contact number of the client’s family physician and another emergency contact (family member or friend), local crisis hotline numbers, and emergency contact numbers (e.g., nearest hospital). Advance knowledge of the distance between the client’s location and emergency response location (e.g., nearest hospital) and other community resources can also be

BC PsyChologist 25

helpful in emergency decision-making. This information should always be readily available each session. For documentation and maintaining client records, •it is important to remember that this includes all forms of electronic communications (e.g., email correspondence). It is also a good practice to document additional information about the service delivery, such as the location of the client, the type of electronic medium used, technology problems that occurred (and procedures taken) during the provision of service, and who was present during the session. When using videoconferencing, it can be helpful to have •a pre-treatment training session with clients to help them set up the technology and equipment (e.g., such as the positioning of the webcam and lighting issues). The provision of written step-by-step instructions at the training session could also facilitate this process. See Shore (2013) for additional recommendations for optimal room configurations and Yuen et al. (2012) for other suggestions for improving the quality of video-conferencing services. It is also helpful to establish procedures on how •psychologists will address technology problems that might occur during a session (e.g., poor or disrupted transmission). This information should also be communicated to the client at the outset of service (possibly including it in the informed consent form). For these situations, alternative arrangements should be established (e.g., such as rescheduling the appointment or using an alternate technology, such as calling the

psychologist for a telephone session in lieu of a videoconferencing if the Internet connection is disrupted). Clients should also be regularly encouraged to report any technological problems during a session.Psychologists are required to be informed of the •unique jurisdictional requirements of providing telepsychology services (e.g., to clients who are visiting or living in other jurisdictions), and ensure liability insurance coverage (see Baker & Bufka, 2011 as well as the CPBC Code of Conduct, 2014).

summary anD future Direc tio ns

In conclusion, telepsychology offers a promising current and emerging innovative approach to improve and expand the provision of psychological services. In our rapidly changing digital age, telecommunication applications will inevitably continue to evolve and become more available in society. As technology becomes more integrated into our day-to-day life, we are also likely going to see a greater demand for these services in the future. Along with these developments, there will be a need for larger scale controlled research, and ethical guidelines and standards will also continue to be developed and refined. As psychologists, we will also need to be adequately equipped to respond. It will be our responsibility to seek competency and professional development to be able to navigate the technological advances in the context of our clinical and ethical responsibilities and the empirical evidence.

referencesBackhaus, 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 materialAmerican 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.

26 fall 2014

joachim sehrb ro ck , ph . D. , r. psych .

(Van co uVer coa stal he alth)

Dr. Joachim Sehrbrock, R.Psych. is a Behavioural Health Consultant and the Behavioural Health Consultation (BHC) coordinator of clinical programming. He also works in private practice and is Adjunct Professor in the Department of Psychology at UBC and Clinical Associate in the Department of Psychology at SFU.

theo D egag ne , ph . D. , r. psych .

(Van co uVer coa stal he alth)

Dr. Theo De Gagne, R.Psych. is the Regional Psychology Practice Leader and Director of Clinical Training for Vancouver Coastal Health Authority (VCHA). He is on the Executive Committee for Online E-Mental Health VCHA; Member at Large, Psychologists in Hospitals and Health Centres, CPA Section; Adjunct Professor, Department of Psychology, University of British Columbia; Clinical Instructor; Department of Psychiatry, University of British Columbia; and a founding member of the Canadian Association of Cogntive and Behavioural Therapies.

sar ah ’s sto ry

Sarah1 is a young new mother, who presented to her family physician with difficulties breastfeeding. During his assessment, her

physician also found that Sarah showed symptoms of post-partum depression and significant levels of chronic stress, which were likely linked to the adjustment of having a newborn and long-standing marital challenges. In subsequent consultations, her physician recommended post-partum depression support groups numerous times, but Sarah seemed

reluctant to seek out mental health services.

1 For the purpose of this vignette, any potential identifying information has been changed. The vignette serves to model a Behavioral Health Consultation in a primary care office. Permission to discuss physician experiences has been obtained.

the b h c m o D el

Access to psychological services has recently changed in one Vancouver family practice, which adopted an integrated care model this year, making the services of a psychologist available right in the clinic. This Behavioural Health Consultation Program (BHCP) is a collaborative project between Vancouver Coastal Health (VCH), the Vancouver Division of Family Practice and in particular, local primary care offices. In this integrated model a behavioural health consultant (BHC) is placed within the primary care team providing brief, highly accessible consultative services to physicians and patients aimed at detecting and addressing a wide range of behavioural health and mental health concerns with the goals of early identification, quick resolution, long-term prevention, and general wellness. As a Psychologist in the BHC program, I (JS) support physicians in helping patients better cope with life’s challenges. In the aforementioned scenario, typical for a family practice, the physician would simply walk his patient down the hall to my office for an introduction (we call this a

“warm handoff”) and a brief assessment. Sarah and I would meet for 30 minutes and collaboratively developed several strategies for Sarah to better cope with her depressive 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 in the clinic, Dr. Bregman (personal communication, August 21, 2014) said that many of his patients seem reluctant to access mental health treatment because of stigma, lack of financial resources, socio-cultural factors, and other barriers. He noted that having a psychologist directly in the practice, the patient’s familiarity with the office, and the physician’s endorsement of a colleague in the same practice seem to be critical factors to enable patients to seek out mental health support. The BHC Program provides consultation to patients and physicians utilizing a stepped care approach with an emphasis on early intervention. While not intended to replace other psychotherapeutic practices, the program provides an early entry point for intervention. In some cases, patients are referred for longer term or specialized services that can include partnering with psychologists, psychiatrists, registered social workers, dieticians, etc. When a BHC clinical intervention is deemed appropriate,

Primary Care Psychology — Increasing Capacity & Decreasing Barriers to Psychological Services Through Integrated Care

BC PsyChologist 27

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.

fo llowin g the call fo r integ r ateD care

m o D el s

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.

primary care psych o lo gy anD the future

o f psych o lo 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

28 fall 2014

referencesBray, 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.

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 joachim.sehrbrock@vhc.ca or Dr. DeGagne, Psychology Practice Leader at Vancouver Coastal Health at theo.degagne@vch.ca.

F riday N ov e m b e r 28 t h, 2014

9 : 00Pm – 4 : 00Pm @ University Golf Club5185 University Blvd. Vancouver, BC V6T 1X5

Co N tiN uiN g e d u Cati 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.

L e a r NiN g o b j e C tiv 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. s Ch 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,

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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.

e a r Ly b ir d r e g is t r ati o N (u N tiL o C t 10 t h, 2014)

q Early Bird (Non-Members) $246.75 (incl. GST)q BCPA Members and Affiliates $173.25 (incl. GST)

r e g u L a r r e g is t r ati o N (o C t 11 t h – N ov 2 4 t h, 2014)

q Regular (Non-Members) $270.90 (incl. GST)q BCPA Members and Affiliates $197.40 (incl. GST)

m e a L r e q uir e m e N t s

q Regular mealq Vegetarian mealq Special needs or allergies (please include details below)

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.

woRkshop & agmRegistRation foRm

q i WiL L at t e N d b o t h t h e Wo r k s h o P & ag m

q i WiL L at t e N d t h e Wo r k s h o P o N Ly

q i WiL L at t e N d t h e ag m o N Ly

q i ag r e e t o t h e Ca N Ce L L ati o N P o Li Cy (r e q uir e d)

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futuRe (2015) woRkshops:

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Presented by Dr. Mark Zelig9:30am – 4:30pm Friday March 27th, 2015@ Park Inn & Suites on Broadway

impac t ther apy:

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ther apy (what aDVer tisers

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Presented byDr. Ed Jacobs & Dr. Nina Spadaro9:00am – 4:00pm Friday April 24th, 2015@ University Golf Club

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