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Title: Clinical Psychology as a Profession(1998)


1
Clinical Psychologists in India A time for
Reflection and Action
  • A survey conducted by kiran rao Seema mehrotra


2
Introduction
  • Rao Mehrotra (1998) studied about the job
    characteristics, professional stress, role
    satisfaction, coping strategies and overall
    well-being among a group of clinical
    psychologists.
  • The area which received considerable attention in
    the past two decades is work-related stress.
  • Two sets of factors are responsible for work
    related stress-
  • 1. Job environment (building structure,
    lighting, etc.)
  • 2. Job characteristics (nature of the work,
    overload, role conflict, etc.).
  • Basically, there were two groups of health
    professionals in which more occupational stress
    had found in health care domain-
  • General physician
  • Nurses
  • Mental health professionals are said to be
    vulnerable as they work in emotionally demanding
    environments.
  • Burnout as used by Maslach (1982), refers to
    the syndrome of emotional

3
Introduction
  • exhaustion, depression and reduced personal
    accomplishment seen in response to the strain
    dealing with other human beings.
  • 21 mental health professionals had been studied
    by Thara (1997) dealing with chronic mental
    health illness. He reported that over 60 had
    experienced some kind of stress reflected in
    physical symptoms and emotional problems due to
    stress burden and satisfaction.
  • Moderate level of job-stress with work load and
    lack of resources being major sources of stress
    was found in 60 psychiatrists. (Chaudhary
    Rao,1997).
  • Many different studies of clinical psychologists
    have described clinical psychology as profession
    in India but no descriptions were available about
    clinical psychologists job-stress.
  • Verma (1997) reported almost 600 clinical
    psychologists trained from Ahmedabad, Bengalore
    and Rachi, but less than half of them may be
    active in field.
  • Prabhu (1983) reported factors behind this three
    Ms matrimony , migration and misplacement.

4
Method
  • The sample comprised of 273 clinical
    psychologists from the IACP -1995 directory
    and/or from state level directories. Finally,
    116 clinical psychologists were included in the
    sample and rests were dropped out because of
    abroad residing, changed addresses,
    non-responding and incomplete profarmas.
  • Tools
  • 1. A socio-demographic and work related data
    sheet was used.
  • 2. Subjective perception measures to assess
    functional compensation, perception of work as
    routine or mechanical or scope for growth in
    career.
  • 3. Job satisfaction scale ( Quinn and Shephard,
    1974) was used to measure Professional role
    satisfaction.
  • 4. To identify specific sources of stress for
    mental health professionals, Mental Health
    Professional Stress Scale (MHPSS) developed by
    Cushway et al. (1996) was used.
  • 5. An open-end statement was used to assess
    coping strategies. These strategies

5
  • include problem-focused, emotion-focused and
    support-seeking strategies.
  • 6. The subjective well-being inventory (Nagpal
    Sell,1992) was used to measure well-being and
    distress as experienced in day-to day life
    concerns.

6
Results
  • Socio- Demographic Characteristics
  • Almost two thirds of the clinical psychologists
    who responded are male (64) and the average age
    was found to be approximately 42 years. Majority
    are married (88) and beloged to nuclear families
    (75). Half of the clinical psychologists in
    India had M.Phil (49) and half had Ph.D.
    degree(51).
  • The clinical work group is seemed to be well
    settled as, having experience of 15 years, with
    approximately 10 years in current work setting.
  • Work-related characteristics
  • About 60 of the clinical psychologists are
    worked in more than one setting, 40 worked
    independently and 23 work exclusively in private
    practice.
  • More than two-third (80) see individuals across
    all age group and of different diagnostic
    categories (77). Both acute and chronic cases
    are seen(78).

7
Results
  • Time Spent in Different Professional Activities
  • Clinical psychologists spent time in clinical
    work significantly more and time spent in
    research activity is significantly less than that
    considered ideal.
  • Most would prefer to spent about two-third of
    their time in intervention related work and the
    remaining one third for psychological assessment,
    but there is great deal of individual variation.
  • In practice, almost half the group (48) did not
    have any exposure to administrative work and
    about 30 spent their 5-10 time in
    administration.
  • 75 individuals would like to spend 20-30 of
    their time in carrying out research. 29 were
    currently not involved in any research activity,
    while 26 reported spending 20-30 of time in
    research.
  • 40 individuals would like to engage in therapy
    for 40-60 of the time and 11 ,for more than 75
    of the time.
  • They rated a fair degree of autonomy in
    functioning, growth in career as fairly low and
    choice of clinical psychology as a profession,
    high.

8
Results
  • On the whole, clinical psychologists feel low
    level of professional stress. They feel work load
    of too much work to do (78) and too many
    different things to do (84) and lack of
    resources of shortages of equipment (71),
    inadequate clerical backup (68), and lack of
    financial resuorces for attending training
    courses/ workshops (68).
  • They were not fully satisfied with the
    organizational structure in which they were
    working and felt stress with regard to the way
    policies are framed (64) and the manner in which
    conflicts are resolved within the
    organization(62).
  • Clinical psychologists feels professional stress
    who have worked in an out-patient setting and
    those seeing only one diagnostic group for more
    than 50 of the time.
  • Professional stress was negatively correlated
    with professional role satisfaction(r-.28).

9
Results
  • Coping Strategies
  • 35 individuals reported the use of a single
    coping strategy, while others used more than
    one. Emotion-focused coping is the most
    frequently used(67), followed by social support
    utilization (66) and problem solving strategies
    (44).
  • Among the emotion-focused strategy, distraction(
    listening music, spending time with family, etc.)
    was mostly used (56).
  • Subjective well-being and distress
  • Well-being and distress were significantly
    related to professional role satisfaction and
    professional stress. It is found that while age
    and professional role satisfaction significantly
    influence levels of well-being, home/work
    conflict and professional self doubt contribute
    to distress.

10
Discussion
  • In India, Clinical Psychology have become a
    female dominated profession (Prabhu,1983).
    Females were largerly non-responders since there
    was a risk of losing status and momentum, not due
    to a lack of involvement.
  • The individuals who had engaged in clinical
    psychology, have, by and large, settled down to
    family life and have gained considerable
    professional experience in the work domain.
  • In clinical psychologists, the level of
    professional role satisfaction and subjective
    well-being reported is high and the level of
    professional stress and subjective distress
    experienced is low.
  • Several factors may be responsible for the above
    pattern
  • Gender Women , in general, tend to report
    higher levels of distress than men.
  • Marital status Married males have been found to
    report lower levels of job-related stress
    (Cushway et al.,1994,96), because being married
    provides the

11
Discussion
  • presence of a confidant and acts as a stress
    buffer. For women, marriage brings on multiple
    roles which increases the strain( Agarwal,1992).
  • Also the quality of the marital relationship,
    presence of young children and type of work need
    to be kept in mind.
  • Generally, marriage has been found to increase
    job satisfaction( Crosby, 1982), but as Cooper et
    al.(1988) found that single individuals were high
    on job satisfaction and less stressed
    occupationally.
  • Work Experience Professional stress decreases
    with increase in experience, because people with
    more experience are likely to have less direct
    client contact and more control over their
    activities.
  • While trainees and relatively new entrants to the
    profession are more likely to be affected by
    client distress and self-doubt.
  • Age and professional role satisfaction
    contributing to personal well-being and home/work
    conflict and professional self-doubt to distress.

12
Discussion
  • Work related characteristics are important
    determinants of stress and burnout.
  • Thornton(1992) reported increased burnout in
    mental health workers employed in an in-patient
    setting, as compared to those working in an
    out-patient setting.
  • In-patient settings usually cater to the more
    severly and/or chronically ill, and, therefore,
    perceived as stressful. Out-patient settings in
    India, unlike in the west, are characterized by
    large case loads. The pressure of having to see
    many patients in a limited period of time may be
    more emotionally demanding.
  • In India, the clinical work group enjoys a
    relatively high degree of independence in its day
    to day work functioning.
  • While a large number have reported functioning
    independently (41), an almost equal number
    function as part of a multidisciplinary team.
  • There is a general level of satisfaction with the
    current job profile with time spent in role
    related activities. Reports in the seventies had
    debated whether the assessment or the therepeutic
    role was more important for clinical

13
Discussion
  • psychologists( Verma, 1996). Most clinical
    psychologists felt happy with both these roles,
    they also prefer to intervention works.
  • Findings indicated that most Indian clinical
    psychologists would not like to be engaged in
    administrative duties. Proccer et al. (1997)
    explained that while working with people was a
    source of satisfaction, too much administrative
    work or paper work was a source of stress for
    mental health staff members.
  • Prabhu (1974) commented on the glaring absence of
    clinical psychologists from major policy making
    bodies.
  • Clinical psychologists spent significantly less
    time in research. The clinical psychologist is
    trained for this role and is referred to as the
    scientist-practitioner, but rarely is able to do
    justice to both these roles (Stricker,1992).
    However, an increase in research output is
    identify areas to be studied on a priority basis
    and making provisions for funding such research.
  • In addition, workshops could be conducted on
    how to skills such as record

14
Discussion
  • keeping for research, writing project
    proposals for grants and publishing papers.
  • Work load, lack of resources and organisational
    structure emerged as the main sources of stress
    for clinical psychologists.
  • The number of trained clinical psychologists is
    small which puts considerable pressure on the
    ones in the field large case loads and essential
    if we are to make an impact as a professional
    body at the national level.
  • At the level of the professional body, it may
    involve forming a research cell to
  • working in multiple settings/roles become
    necessary.
  • Also a number of existing positions remain vacant
    due to lack of trained personnel.
  • As Prabhu (1974,83) observed that lack of job
    opportunities resulting in two phenomena
  • (1) Within the country, involvement in
    fields other than clinical psychology,
  • (2) Migration to western countries in search
    for better prospects.
  • Despite the high level of role satisfaction, the
    general perception was inadequate

15
Discussion
  • financial compensation and there was not
    much scope for advancing growth in
  • career.
  • In this study, the variety and complexity of
    coping behaviour in relation to work stress was
    not reflected. Emotion focused and social support
    strategies were used more than problem focused
    ones.
  • Emotion focused strategies are usually used when
    the stressor is perceived as being beyond ones
    control or having to be accepted.
  • The emotion focused coping may be effective in
    dissipating or reducing distress at the
    individual level, but also indicates a certain
    degree of helplessness and inability to bring
    about change in the work situation. Therefore ,
    such strategies may not be very adaptive for both
    the individual and the profession.


16
Conclusion
  • It is concluded that the strength of a
    professional body would lie in the strength of
    its individual members. It was found that the
    overall picture for the clinical psychologists
    group as a whole is a positive one.
  • Clinical psychologists would prefer to spent time
    in clinical work, research and teaching, found
    high subjective well-being and low distress work
    load, lack of resources and organizational
    structure as main source of professional stress.
  • Limitations
  • The sample was selected from the IACP membership
    list which may not reflect the views and needs of
    a large number of new entrants, as yet, not
    members of the professional body.
  • While the quantitative methods used, provide
    summery information, it would be more useful to
    identify subgroups of individuals with specific
    concerns.

17
Conclusion
  • The use of single item measures was also a
    limitation. The manner in which coping behaviour
    were measured, was not adequate to understand the
    variety of things actually used in the time of
    distress.
  • Finally, stress, coping and well-being are
    complex ongoing processes which can be best
    examined with longitudinal studies.
  • Presented by
    ANUPAM PANDEY


18
  • Thank you
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