The Practiceof

Clinical HealthPsychology

Robin Perkins, Ph.D.Clinical PsychologistArchbold Integrative

Medicine Center

Health Psychology:

Utilizes the contributions of the science of psychology to

promote and maintain health, prevent illness, and identify causes related to

health, illness, and wellbeing.

Titles:

Behavioral MedicineMedical Psychology

Psychosomatic MedicineHealth Psychology

Requirements:

Ph.D. in PsychologyPrefer Specific graduate training and graduate internship in

Clinical Health Psychology

State License in Psychology

Areas of Work:

Academic InstitutionsMedical Centers / HospitalsResearch InstitutionsPrivate PracticePrimary Care Practices

Top Three Professional Activities:

Clinical Practice 65%Research 55%Teaching / Supervision 50%

Clinical Focus:

Individual PsychotherapyGroup PsychotherapyPsychological Testing

Teaching Family Therapy

Specific Areas of Clinical Focus

CardiologyNeurologyPain ManagementSmoking CessationStress ManagementDiabetesCancerPulmonary Diseases

Cardiac Psychology

Prevalence:*** 4,000 People in the U.S.

suffer from myocardial Infarction (MI) eachday***

*** 1 out of 5 Americans have an MI before theage of 60***

Cardiac Risk Factors

Modifiable Non-ModifiableTotal Cholesterol Age

and LDL MaleDiabetes Family HistorySedentary Personal History

LifestyleSmokingObesityStressPsychosocial

Factors

Major Psychosocial Variables

***Type A Behavior***Anger and Hostility***Chronic Stress***Job Strain***Exhaustion***Social Isolation***Depression

Charlie

*Charlie is referred to you by his cardiologist.

*The referral reads: “Stress Management.”

*Charlie’s wife calls and makes the firstappointment.

*Charlie cancels the firstappointment but

attends the second with his

wife.

Charlie

*Assessment:Diagnostic Interview

PsychosocialMental StatusMedical historyPsych Hx / Sx

Psychological Testing?

Charlie

* 48 years old white male* Family history of heart

disease*Father died of a heart

attack at age 50 years*Older brother Fred is a

“cardiac cripple”.

Charlie

*Married (second time) for25 years.

*Oldest son (22 years) is in college.

*Has one daughter still living

at home (16 years).

Charlie

*Completed 4 years ofcollege

*Degree in Criminal Justice*Works as a prison guard in

a low security federalprison for men.

Charlie

*Smokes 1.5 to 2 packs of cigarettes per day.*Does not exercise and

really struggles to meetphysical demands of job.

*Drinks 1 to 2 beers per night, usually after work.

* Diet: SAD

Charlie

*Has no friends outside of afew co-workers that heoccasionally has a beerwith after work.

*Does not attend church with his wife anddaughter.

*Does not have much contact

with other family.

Charlie

*No significant past medicalhistory.

*No significant past mentalhealth history.

*No family history of mentalhealth issues.

Charlie

*Charlie presents as alert and oriented in all spheres.

*Walks with a cane, poorposture.

*Does not make good eyecontact.

*Speech is normal.

Charlie

*Mood seems depressed.*Affect is flattened.*Range is restricted.*He reports not knowing

why he is here anddenies any problems.

Charlie

*Talk with wife? *Important Issues to

address?*Build rapport?

Charlie

*Wife presents as verysupportive of Charlie.

*She reports that she is worried about him:

*He tends to work too hard.*Is not sleeping at night.*He is normally controlling

with a temper – nowworse.

Charlie

Issues to address?

Issues to address?*Personality factors*General stress*Work stress*Smoking*Alcohol?*Exercise*Diet

Issues to address? *Mood: depression?-

Anxiety?*Sleep*Social Isolation

Charlie

Rapport:*How can I help?*What does Charlie want?*Depression / Anxiety / Fear

/Denial?*Start with medical and

work to psychological

Other thoughts about Charlie?

Questions?

Thank You