Clinical Psychology as a Profession(1998)

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Clinical Psychologists in India A time for
Reflection and Action

• A survey conducted by kiran rao Seema mehrotra
• 
  

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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

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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.

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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

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• 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.

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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).

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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.

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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).

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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.

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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

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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.

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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

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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

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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.
• 
  

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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.

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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
• 
  

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• Thank you