Handbook of Clinical Psychology in Medical Settings

Handbook of Clinical Psychology in Medical Settings

Edited by

Jerry J. Sweet

Ronald H. Rozensky and Steven M. Tovian Evanston Hospital and Northwestern University Evanston, Illinois and Northwestern University Medical School Chicago, Illinois

Springer Science+Business Media, LLC

Library of Congress Cataloglng-ln-PublicatIon Data

Handbook of c l i n i c a l psychology In «edlcal settings / edited by Jerry J. Sweet, Ronald H. Rozensky, and Steven M. Tovlan.

p. C i .

Includes index. ISBN 978-1-4613-6690-4 ISBN 978-1-4615-3792-2 (eBook) DOI 10.1007/978-1-4615-3792-2 1. C l i n i c a l psychology. I. Sweet, Jerry J. II. Rozensky, Ronald

H. III. Tovlan, Steven M. [DNLM: 1. Psychology, C11n1ca1—handbooks. HM 34 H236]

RC467.H269 1991 616' .001'9~dc20 DNLM/DLC for Library of Congress 91-2606

CIP

10 9 8 7 6 5 4 3

I S B N 978-1-4613-6690-4

© 1991 Springer Science+Business M e d i a N e w Y o r k Or ig ina l ly published by Plenum Press, N e w Y o r k i n 1991 Softcover reprint of the hardcover 1st edition 1991 A l l rights reserved

N o part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher

To Nancy, Christopher, and Jamie -JJS

To Patti, Sarah, and Jordyn -RHR

To Merle, Avra, Zev, Rachel, and Ayal -SMT

Contributors

Roger T. Anderson Behavioral Medicine Branch National Heart, Lung, and Blood Institute Bethesda, Maryland 20892

Cynthia D. Belar Department of Clinical and Health

Psychology University of Florida Health Science Center Gainesville, Florida 32610

Linas A. Bieliauskas Veterans Administration Medical Center

and University of Michigan Ann Arbor, Michigan 48105

Joseph Bleiberg National Rehabilitation Hospital 102 Irving Street N. W. Washington, DC 20010

Bruce Bonecutter Department of Psychiatry Cook County Hospital Chicago, Illinois 60612

Rosalind D. Cartwright Sleep Disorder Service and Research Center Rush-Presbyterian-St. Luke's Medical

Center 1653 West Congress Parkway Chicago, Illinois 60612

Stanley L. Chapman Pain Control and Rehabilitation Institute

of Georgia 350 Winn Way Decatur, Georgia 30030

James P. Choca Department of Psychiatry and Behavioral

Sciences, Northwestern University Medical School, and Psychology Service, Lakeside Veterans Administration Hospital

Chicago, Illinois 60611

Robert Ciulla Islip Mental Health Center 1747 Veterans Highway Islandia, New York 11769

Daniel J. COX Behavioral Diabetes Research Department of Behavioral Medicine and

Psychiatry University of Virginia Health Sciences Center Charlottesville, Virginia 22901

Thomas L. Creer Department of Psychology Ohio University Athens, Ohio 45701

vii

viii

Nicholas A. Cummings American Biodyne, Inc. 400 Oyster Point Boulevard, Suite 218 South San Francisco, California 94080

Patrick H. DeLeon U. S. Senate Staff Washington, DC 20510

Jean c. Elbert Department of Pediatrics University of Oklahoma Health Sciences

Center Oklahoma City, Oklahoma 73117

Kevin Franke Department of Psychiatry Northwestern University Medical School Chicago, lllinois 60611

Alice G. Friedman Department of Psychology State University of New York at Binghamton Binghamton, New York 13901

Linda Gonder-Frederick Behavioral Diabetes Research Department of Behavioral Medicine and

Psychiatry University of Virginia Health Sciences Center Charlottesville, Virginia 22901

Martin Harrow Department of Psychiatry Michael Reese Hospital and Medical Center Chicago, lllinois 60616

David E. Hartman Department of Psychiatry Cook County Hospital Chicago, Illinois 60612

CONTRIBUTORS

Heather C. Huszti Department of Psychiatry and Behavioral

Sciences University of Oklahoma Health Sciences

Center Oklahoma City, Oklahoma 73190

Craig Johnson Laureate Psychiatric Clinic and Hospital Tulsa, Oklahoma 74147-0207, and Department of Psychiatry Northwestern University Medical School Chicago, Illinois 60611

Michael Jospe California School of Professional Psychology 1000 South Fremont Avenue Alhambra, California 91803-1360

Bonnie 1. Katz National Rehabilitation Hospital 102 Irving Street N. W. Washington, DC 20010

Daniel S. Kirschenbaum Department of Psychiatry and Behavioral

Sciences Northwestern University Medical School Chicago, lllinois 60611

Benjamin Kleinmuntz Department of Psychology University of Illinois at Chicago Chicago, Illinois 60680

Mary P. Koss Department of Psychiatry University of Arizona Tucson, Arizona 85724

Harry Kotses Department of Psychology Ohio University Athens, Ohio 45701

CONTRIBUTORS

Asenath La Rue Department of Psychiatry and Biobehavioral

Sciences University of California at Los Angeles Los Angeles, California 90024-1759

Kris R. Ludwigsen Kaiser Foundation Hospital 200 Muir Road Martinez, California 94553

Charles McCreary Department of Psychiatry and Biobehavioral

Sciences University of California at Los Angeles Los Angeles, California 90024-1759

James Malec Department of Psychiatry and Psychology Mayo Clinic and Foundation Rochester, Minnesota 55905

Donald Meichenbaum Department of Psychology University of Waterloo Waterloo, Ontario N2L 3G1, Canada

Barbara G. Melamed Ferkauf Graduate School of Psychology and

Albert Einstein College of Medicine Yeshiva University 1300 Morris Park Avenue Bronx, New York 10461

Russ V. Reynolds Department of Psychology Ohio University Athens, Ohio 45701

Ronald H. Rozensky The Evanston Hospital and Northwestern

University and Medical School Evanston, Illinois 60201

J. Terry Saunders Behavioral Diabetes Research Department of Behavioral Medicine and

Psychiatry

ix

University of Virginia Health Sciences Center Charlottesville, Virginia 22901

Harry S. Shabsin Department of Psychiatry and Behavioral

Sciences Johns Hopkins University School of

Medicine, and Division of Digestive Diseases Francis Scott Key Medical Center Baltimore, Maryland 21224

Edward P. Sheridan Department of Psychology University of Central Florida Orlando, Florida 32816

Kathleen Sheridan Department of Psychology University of Central Florida Orlando, Florida 32816

Sharon A. Shueman Shueman, rroy & Associates 246 North Orange Grove Boulevard Pasadena, California 91103

George C. Stone Department of Psychiatry University of California San Francisco, California 94143

Jerry J. Sweet The Evanston Hospital and Northwestern

University and Medical School Evanston, Illinois 60201

Robert J. Thompson, Jr. Duke University Medical Center Durham, North Carolina 27710

x

David L. Tobin Department of Psychiatry University of Chicago Chicago, Illinois 60637

Steven M. Tovian The Evanston Hospital and Northwestern

University and Medical School Evanston, Illinois 60201

Warwick G. Troy Shueman, Troy & Associates 246 North Orange Grove Boulevard Pasadena, California 91103

Dennis C. Turk Pain Evaluation and Treatment Institute University of Pittsburgh School of Medicine Baum Boulevard at Craig Street Pittsburgh, Pennsylvania 15213

C. Eugene Walker Department of Psychiatry and Behavioral

Sciences University of Oklahoma Health Sciences

Center Oklahoma City, Oklahoma 73190

Sharlene M. Weiss Health Promotion and Disease Prevention

Branch National Center for Nursing Research Bethesda, Maryland 20892

Stephen M. Weiss Behavioral Medicine Branch National Heart, Lung, and Blood Institute Bethesda, Maryland 20892

CONTRIBUTORS

William E. Whitehead Department of Psychiatry and Behavioral

Sciences Johns Hopkins University School of

Medicine, and Division of Digestive Diseases Francis Scott Key Medical Center Baltimore, Maryland 21224

Jack G. Wiggins Psychological Development Center 7057 West 130th Street Cleveland, Ohio 44130

David J. Williamson Department of Clinical and Health

Psychology University of Florida Health Science Center Gainesville, Florida 32610

Diane J. Willis Department of Pediatrics University of Oklahoma Health Sciences

Center Oklahoma City, Oklahoma 73117

w. Joy Woodruff Department of Psychiatry University of Arizona Tucson, Arizona 85724

Logan Wright Department of Psychology University of Oklahoma Norman, Oklahoma 73072

Foreword

For two decades, I have been responding to questions about the nature of health psychology and how it differs from medical psychology, behavioral medicine, and clinical psychology. From the beginning, I have taken the position that any applica­tion of psychological theory or practice to problems and issues of the health system is health psychology. I have repeatedly used an analogy to Newell and Simon's "General Problem Solver" program of the late 1950s and early 1960s, which had two major functional parts, in addition to the "executive" component. One was the "problem-solving core" (the procedural competence); the other was the representa­tion of the "problem environment." In the analogy, the concepts, knowledge, and techniques of psychology constitute the core competence; the health system in all its complexity is the problem environment. A health psychologist is one whose basic competence in psychology is augmented by a working knowledge of some aspect of the health system.

Quite apparently, there are functionally distinct aspects of health psychology to the degree that there are meaningful subdivisions in psychological competence and significantly different microenvironments within the health system. I hesitate to refer to them as areas of specialization, as the man who gave health psychology its formal definition, Joseph Matarazzo, has said that there are no specialties in psychology (cited in the editors' preface to this book). With all respect to Mata­razzo, whose knowledge of the history of psychology is as immense as his experi­ence with present-day psychology, I would suggest that there are, at least, proto­specializations. We can recognize such functional specializations on the basis of the time required for a person trained to the level of joumeyperson in one or more areas of psychology to achieve an equal level of competence in some other specific area.

As one considers that statement, it is also apparent that the time required dependS" on the areas in which competence was previously attained. There are various bodies of theory, of technique, and of knowledge of environments (tacit and otherwise) that are essential to competent performance in many different settings where psychologists are to be found. There is a loosely defined disciplinary core of theory and knowledge that defines a psychologist. Beyond that, there is a vast amount of specialized theory and factual knowledge far too great to be mastered in total by any individual. So there is selective mastery of sections of the whole that produces, perhaps not specialties, but at least fuzzy sets of psychologists who communicate differently within and between their groupings.

xi

xii FOREWORD

There appears to be a growing consensus that there is a core of knowledge and technique common to all practice of psychology, that is, the professional core. Evidence of such a core would be found, I suppose, in the demonstration that it takes less time for someone who has become a competent professional in one type of application to become competent in another than it takes for persons who have never practiced. Surely, that is a plausible expectation. Are there differing degrees of overlapping subsets of professional competence between industrial-organiza­tional, school, counseling, forensic, and clinical psychology? That seems less certain.

In the final analysis, the demonstration of competence must always occur in a particular environment and problem setting. It is at least an implicit assumption of this book that medical environments and problems have more in common with each other than they do with nonmedical settings, induding mental health settings. The book offers a powerful test of this assumption. For the most part, it takes for granted at least an adequate preparation in a generic clinical training program, and it undertakes to demonstrate how the competence acquired elsewhere must be modified and extended if proficiency in medical settings is to be achieved. The first 16 chapters are concerned with issues common to all practices in a medical environment. Of these, the first 6 chapters focus upon types of hospital structure, education and training, and professional and political issues. Chapters 7 through 10 examine quality assurance, finances, marketing, and computers in practice. Chapters 11 through 16 cover broad clinical and research topics that cross diagnostic categories.

The second half of the book consists of 15 chapters that discuss in detail the clinical considerations that arise as the general principles are put to work in specific work environments. These chapters were written by persons actually experienced in the delivery of such services, and they are rich in the practicalities that must be faced day to day. A special quality emerges from the authors' adl).erence to the principle of presenting the assessment and treatment of particular psychomedical problems in the context of developing and operating a successful service program. This reader found himself frequently surprised by the ingenious way that some practical, micropolitical, or administrative problems had been handled rather than avoided, as has often been the case in other presentations, in which common problems have been glossed over or simply ignored. As one reads about program after program, one has a chance to see how and to what degree the general principles advanced in the introductory sections are realized in actual medical settings.

The descriptions of each of the kinds of programs discussed here could be expanded into books in their own right. There are, in fact, books about a number of the chapter topics. Yet the presentations here are informative and comprehensive, and they are short enough so that they can be read for an overall impression. Thus, this book can serve as an orientation for postdoctoral trainees preparing for careers in medical settings, or for psychologists about to start new jobs in such settings, where the specific tasks to be undertaken are not fully defined, or for experienced clinical health psychologists who propose to expand their work into new settings. At this stage of the development of clinical psychology in medical settings, the psychologist associated with a medical center is likely to be functioning in a somewhat exploratory and entrepreneurial manner. Here is an excellent guidebook for such an exploration.

GEORGE C. STONE

San Francisco, California

Preface

The strength of clinical psychology is its scientific basis and its application of scientific methodology to the practice of psychology. It is that psychology of empiricism and that style of problem definition and hypothesis testing that we believe has uniquely fitted the practice of clinical psychology into the medical setting. The expansion of roles and the numbers of psychologists in medical settings set forth in this volume support this position. It was our intent as editors to highlight this growth and the wide range of clinical and nonclinical services provided by psychologists in medical settings. In order to present the information on clinical practice within the proper context, we felt that it was necessary to set the scene by reviewing the characteristics of the medical environment in general, the hospital itself, the politics and professional issues of hospital practice, finances, marketing, quality assurance, research, and the educational and training issues that prepare psychologists for this milieu. In order to truly underscore the strength of psychological practice within medical settings, we asked the chapter authors to stress the scientist-practitioner focus of the field. Clinical programs are described and program development is offered to the reader based on the scientific founda­tions of the practice of clinical psychology.

Throughout the text, the reader will find various generic labels for the activities of clinical psychologists in medical settings. These include health psychology., medical psychology, clinical health psychology, neuropsychology, rehabilitation psychology, behav­ioral medicine, and clinical psychology. The title, Handbook of Clinical Psychology in Medical Settings, reflects our view that the success of psychology in medical settings is rooted in the core knowledge of the field of psychology as discussed by Joseph Matarazzo (1987; there is only one psychology, no specialties, but many applica­tions-American Psychologist).

A brief personal digression by the editors is in order. Each of us entered psychology with an interest in research and practice in "mental health." Under­graduate psychology backgrounds and graduate courses and seminars prepared us for a Boulder model outlook on the mental health field. None of us considered a priori that a medical facility would be a place to carry out the scientific or clinical life of a psychologist. Serendipity found each of us, as part of our training, assigned to a "medical facility." The graduate-student peers of one of us thought that he had received the least desirable practicum spot, as there were "real" mental health facilities within which he could have trained. As they say, the rest is history. The

xiii

xiv PREFACE

applicability of the general skills we learned in clinical training fit so well and so successfully within the medical setting and with medical patients that each of us received strong reinforcement, and we have remained within, and in combination, now have experienced well over 40 years of professional time in, that environment. We hope that this text reflects our commitment to and excitement about the medical setting as a place for research on and the practice of clinical psychology.

Given our enthusiasm, we necessarily had to restrict the size and range of the topics so that they could be covered reasonably within this one book. Therefore, the reader will no doubt notice that not all topics, disease entities, diagnoses, or problems found in the medical setting are covered here. Again, the range of possible topics attests to the scope of clinical psychology in medical settings.

Throughout the text, the reader will find mention of guild, turf, or political issues that can and do influence the daily practice, academic, and financial free­doms of clinical psychologists in medical settings. The cartoon shown below appeared in the New Yorker and hangs in the office of Bryant Welch, Executive Director of the American Psychological Association's Practice Directorate. Little interpretation is needed to see the irony of the heretofore unwanted dragon being asked to address his foes. However, it is time that clinical psychologists in medical settings not see themselves as dragons (or the outsiders we once were) but begin to see themselves as sitting in the audience with the rest of the knights. Our armor may be less well heeled or just as shiny as the next knight's; our armor may be more­or-less tarnished; our helmets may sport blue rather than purple plumes; but we are now and will continue to be members of the modern-day health-care alliance. It is

"To begi" with, I '«.'ouU like to ex~rell my sincere thanks and dee~ anreciatio" for Ihe oPfor",nity to mut with you. While there are still profound differences between us,

think the fJery fact of my presence here today is a major breakthrough."

Drawing by W. Miller; © 1983 The New Yorker Magazine, Inc. Reprinted by pennission.

PREFACE xv

the theme of science and service and the politics of competence that support our place in the medical setting, not the appearance of our knightly accoutrements.

We would like to thank our chapter authors for their energy and enthusiasm. Their forbearance through the editorial process and their gracious acceptance of our comments are gratefully appreciated. We thank Eliot Werner, Executive Editor at Plenum, for his interest and guidance in bringing a dream and an outline to press. We also want to thank our secretaries, Vanessa Schaeffer, Pat Barnes, and Elaine Richardson, for their hours of typing, photocopying, phone calling, and patience.

We owe a debt of gratitude to our professors in psychology, who helped breathe life into the Boulder model, and to our colleagues in psychology, medicine, and psychiatry, who help reinforce the vitality of our professional lives. Thanks are also due to Edward Sheridan for his encouragement and helpful suggestions throughout this project. And a final, special thank you to Ira H. Sloan, Chairman, Department of Psychiatry, Evanston Hospital, for his support in providing a truly collegial, multidisciplinary environment.

Glenwick et al. (1987) have offered a discussion of helpful suggestions and encouragements for, and the pitfalls encountered in, editing a book. Thus far, all of their insights have rung true to the present editors. They suggested that working with coeditors who have a similar value system is a strength. The present editorial product, for us, represents that strength and reflects a process of equal input, equal energy, equal commitment, and equal responsibility of the editors for the whole of this project.

Time spent on this endeavor was personally and professionally enjoyable. Relationships renewed or established with colleagues across the continent reflect for us the vitality of clinical psychology in medical settings.

Evanston, Illinois

References

RONALD H. ROZENSKY

JERRY J. SWEET

STEVEN M. TOVIAN

Glenwick, D., Brodsky, S., Franks, c., Hess, A., Balch, K., Frank, J., Garfield, S., & Jason, L. (1987). Issues in preparing an edited volume in psychology. American Psychologist, 4, 405-407.

Matarazzo, J. (1987). There is only one psychology, no specialties, but many applications. American Psychologist, 42, 893-903.

Contents

Foreword by George C. Stone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi

Chapter 1

Chapter 2

Chapter 3

Chapter 4

Chapter 5

Chapter 6

PART I. INTRODUCTION

Clinical Psychology in Medical Settings: Past and Present .............................................. . 3

Jerry J. Sweet, Ronald H. Rozensky, and Steven M. Tovian

Psychology and the Health Care System: Characteristics and Transactions ...................................... 11

Robert J. Thompson, Jr.

The Structure and Authority of Hospitals

Bruce Bonecutter and Martin Harrow

PART II. PROFESSIONAL ISSUES

Educational Preparation and Clinical Training within

27

a Medical Setting ..................................... 45

Edward P. Sheridan and James P. Choea

Psychologists, Politics, and Hospitals

Ronald H. Rozensky

Professionalism in Medical Settings

Cynthia D. Belar

xvii

59

81

xviii CONTENTS

PART III. PRACTICAL ISSUES: PRACTICE MANAGEMENT

Chapter 7 Quality Assurance and the Clinical Health Psychologist: A Programmatic Approach ............................. 95

Michael Jospe, Sharon A. Shueman, and Warwick C. Troy

Chapter 8 Arguments for the Financial Efficacy of Psychological Services in Health Care Settings . . . . . . . . . . . . . . . . . . . . . . .. 113

Nicholas A. Cummings

Chapter 9 Marketing Psychological Services in Hospitals .......... 127

Jack C. Wiggins and Kris R. Ludwigsen

Chapter 10 Computers in Psychological Practice: Historical and Current Uses ......................................... 139

David E. Hartman and Benjamin Kleinmuntz

PART Iv. PRACTICAL ISSUES: GENERAL CLINICAL ISSUES

Chapter 11

Chapter 12

Chapter 13

Chapter 14

Chapter 15

Chapter 16

Critical Issues in Consultation and Liaison: Pediatrics .... 165

Heather C. Huszti and C. Eugene Walker

Critical Issues in Consultation and Liaison: Adults ....... 187

Linas A. Bieliauskas

Emerging Issues in Women's Health .................... 201

Mary P. Koss and W. Joy Woodruff

Emerging Issues in the Care of the Elderly .............. 223

Asenath La Rue and Charles McCreary

Adherence to Self-Care Regimens: The Patient's Perspective ........................................... 249

Dennis C. Turk and Donald Meichenbaum

PART V. PRACTICAL ISSUES: RESEARCH

Research in the Medical Setting: Implementing the Scientist-Practitioner Model ............................ 269

James Malec

CONTENTS

Chapter 17

Chapter 18

Chapter 19

Chapter 20

Chapter 21

Chapter 22

Chapter 23

Chapter 24

Chapter 25

Chapter 26

xix

PART VI. TEMPLATES FOR PROGRAM DEVELOPMENT

Toward Program Development: An Integration of Science and Service in Medical Settings ........................ 285

Ronald H. Rozensky, Jerry J. Sweet, and Steven M. Tovian

Psychological Evaluation and Testing Services in Medical Settings ...................................... 291

Jerry f. Sweet

Development of an Eating-Disorder Program ............ 315

David L. Tobin, Craig Johnson, and Kevin Franke

Integration of Clinical Psychology into Adult and Pediatric Oncology Programs ................................... 331

Steven M. Tovian

Cardiovascular Disorders: Hypertension and Coronary Heart Disease ......................................... 353

Stephen M. Weiss, Roger T. Anderson, and Sharlene M. Weiss

Psychological Components of Rehabilitation Programs for Brain-Injured and Spinal-Cord-Injured Patients. . . . . . .. .. 375

Joseph Bleiberg, Robert Ciulla, and Bonnie L. Katz

Chronic Pain: Psychological Assessment and Treatment ... 401

Stanley L. Chapman

Program for Behavioral and Learning Disorders in Children ............................................. 421

Jean C. Elbert and Diane J. Willis

Development of a Program for Sleep Disorders .......... 455

Rosalind D. Cartwright

Diabetes: Clinical Issues and Management 473

Daniel J. Cox, Linda Gonder-Frederick, and J. Terry Saunders

xx CONTENTS

Chapter 27 Psychological Theory, Assessment, and Interventions for Adult and Childhood Asthma .......................... 497

Thomas L. Creer, Russ V. Reynolds, and Harry Kotses

Chapter 28 Psychological Characteristics and Treatment of Patients with Gastrointestinal Disorders ........................ 517

Harry S. Shabsin and William E. Whitehead

Chapter 29 Programs for the Treatment of Dental Disorders: Dental Anxiety and Temporomandibular Disorders ............. 539

Barbara G. Melamed and David J. Williamson

Chapter 30 Integration of Clinical Psychology into Hemodialysis Programs ............................................. 567

Daniel S. Kirschenbaum

Chapter 31 Psychosocial Services for Persons with Human Immunodeficiency Virus Disease ....................... 587

Kathleen Sheridan

PART VII. FUTURE DIRECTIONS

Chapter 32 Challenge of the Future: Psychologists in Medical Settings .............................................. 603

Logan Wright and Alice G. Friedman

Afterword ............................................ 615

Patrick H. DeLeon

About the Contributors 619

Index ................................................ 629