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PubMed2002

Comparison of psychiatrists and psychologists in clinical practice.

OBJECTIVE: The authors compared data from psychiatrists and psychologists in California to determine whether long-standing differences in clinical practice remain after the introduction of managed care and other changes in mental service delivery. METHODS: Responses from practicing clinicians in California who participated in the 1998 National Survey of Psychiatric Practice and the 2000 California Survey of Psychological Practice were compared on items related to patient caseload, practice profile, and insurance or reimbursement arrangements. RESULTS: Data from 97 psychiatrists and 395 psychologists were available for the study. Psychiatrists reported spending more hours on most aspects of practice and working more total hours per week than psychologists. The weekly caseloads reported by psychiatrists included a greater percentage of persons treated for psychotic conditions than did the caseloads of psychologists. Psychologists reported that their weekly caseloads included a greater percentage of persons treated for anxiety disorders, personality disorders, and other disorders. Psychiatrists reported receiving a greater average payment for services from public insurance, and psychologists reported treating a greater average percentage of patients who did not have insurance coverage. Significant differences in income sources and fee arrangements were observed, and the net reported income of psychiatrists was nearly 80 percent greater than that of psychologists. CONCLUSIONS: Long-standing differences in clinical practice patterns remain between psychiatrists and psychologists despite managed care staffing arrangements and treatment strategies that streamline the practices of both provider groups. The significant income and wage differences between psychiatrists and psychologists may be partly due to supply dynamics of the mental health workforce that adversely affect psychologists.

Female↗
PubMed1998

Cognitive dissonance. 1: An overview of the literature and its integration into theory and practice in clinical psychology.

PURPOSE: Clinical psychology may not be making full use of the experimental psychological research available to it. The purpose of this article is to review the literature on cognitive dissonance in order to assess its usefulness in developing and deconstructing clinical psychological therapies and practice. METHODS: Experimental, theoretical and review articles were examined in relation to their possible clinical implications, and included in this review if they related to the arousal, maintenance and reduction of the state termed cognitive dissonance. Well replicated findings based on experimentally sound paradigms were integrated to produce an overall view of the evidence in favour of the existence of these processes, and of the principles behind them. RESULTS: It is concluded that there is an effect on attitudes and behaviour of creating inconsistency in individuals, and that this is not explained away by alternative theories, which in many cases refer to special conditions which maximally arouse dissonance. The dissonant state lasts for a few minutes, but its effects can last for up to two weeks, and might be reinstated by reintroducing the original inconsistency. Individuals can react to dissonance through a variety of cognitive alterations which reinstate consistency. The choice of response is a function of its salience and the difficulty in its execution. CONCLUSIONS: The literature supports the existence of the phenomenon termed cognitive dissonance, and one can distil the principles underlying its production, maintenance and reduction. This body of literature may provide insights into the conduct of therapy generally, as well as into the mechanisms of specific therapies which may guide modifications or development of alternative interventions.

Arousal↗