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The Practiceof
Clinical HealthPsychology
Robin Perkins, Ph.D.Clinical PsychologistArchbold Integrative
Medicine Center
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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.
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Titles:
Behavioral MedicineMedical Psychology
Psychosomatic MedicineHealth Psychology
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Requirements:
Ph.D. in PsychologyPrefer Specific graduate training and graduate internship in
Clinical Health Psychology
State License in Psychology
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Areas of Work:
Academic InstitutionsMedical Centers / HospitalsResearch InstitutionsPrivate PracticePrimary Care Practices
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Top Three Professional Activities:
Clinical Practice 65%Research 55%Teaching / Supervision 50%
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Clinical Focus:
Individual PsychotherapyGroup PsychotherapyPsychological Testing
Teaching Family Therapy
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Specific Areas of Clinical Focus
CardiologyNeurologyPain ManagementSmoking CessationStress ManagementDiabetesCancerPulmonary Diseases
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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***
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Cardiac Risk Factors
Modifiable Non-ModifiableTotal Cholesterol Age
and LDL MaleDiabetes Family HistorySedentary Personal History
LifestyleSmokingObesityStressPsychosocial
Factors
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Major Psychosocial Variables
***Type A Behavior***Anger and Hostility***Chronic Stress***Job Strain***Exhaustion***Social Isolation***Depression
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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.
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Charlie
*Assessment:Diagnostic Interview
PsychosocialMental StatusMedical historyPsych Hx / Sx
Psychological Testing?
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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”.
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Charlie
*Married (second time) for25 years.
*Oldest son (22 years) is in college.
*Has one daughter still living
at home (16 years).
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Charlie
*Completed 4 years ofcollege
*Degree in Criminal Justice*Works as a prison guard in
a low security federalprison for men.
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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
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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.
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Charlie
*No significant past medicalhistory.
*No significant past mentalhealth history.
*No family history of mentalhealth issues.
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Charlie
*Charlie presents as alert and oriented in all spheres.
*Walks with a cane, poorposture.
*Does not make good eyecontact.
*Speech is normal.
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Charlie
*Mood seems depressed.*Affect is flattened.*Range is restricted.*He reports not knowing
why he is here anddenies any problems.
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Charlie
*Talk with wife? *Important Issues to
address?*Build rapport?
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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.
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Charlie
Issues to address?
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Issues to address?*Personality factors*General stress*Work stress*Smoking*Alcohol?*Exercise*Diet
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Issues to address? *Mood: depression?-
Anxiety?*Sleep*Social Isolation
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Charlie
Rapport:*How can I help?*What does Charlie want?*Depression / Anxiety / Fear
/Denial?*Start with medical and
work to psychological
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Other thoughts about Charlie?
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Questions?
Thank You