practice

At the end of May, I completed a practicum rotation in a long term care facility (aka nursing home). I discovered that I love working in that setting and its something that I hope to gain more experience with while I'm on internship.

Dr. Eleanor Feldman Barbara is a psychologist who works in long term care and writes a blog about her experiences. She recently wrote an interesting guest post on the role of psychology in treating mental illness in nursing home residents for McKnight's Long Term Care News.

Another great resource for those interested in the topic of mental illness in long term care is the group Psychologists in Long Term Care (PLTC). 

Last night I was honored with the 2010 Psychological Society of the Pikes Peak Region Outstanding Graduate Student Award. My mentor Dan Segal (with me in the photo) gave a nice speech about the work we've done together over the past 3 years. I am truly fortunate to have Dan as a mentor and to be in a graduate program where I am encouraged thrive!

On February 10th, the American Psychiatric Association (APA) released the proposed draft of diagnostic criteria for DSM-5 on its website www.dsm5.org. Publication of the new DSM is scheduled for May 2013. The proposed diagnostic criteria will be available on the website for public comment until April 20, 2010. APA is inviting health professionals, consumers of mental health services, and family members to visit the site to review and comment on the draft criteria.

Summer is a great time to make a dent in the pile of books that I want to read, but never get a chance to throughout the academic year. In June, I read Dr. Irvin Yalom's most recent book, "Staring at the Sun: Overcoming the Terror of Death." Yes, this is the type of book I read for fun. :-)

The book outlines Yalom's approach to the universal issue of mortality, which is especially salient for many of the older adults we see at the CU Aging Center. Yalom is a gifted psychotherapist and writer who uses accessible language and several case examples to illustrate his points. Here are a few of the ideas I found most interesting:

- There is a "positive correlation between fear of death and the sense of unlived life" (p. 49).

- An "awakening experience" (p. 36) can jerk us out of the everyday mode of life to an ontological mode where we are more mindful of being. These experiences might include grief over the loss of someone important, a major life milestone, a life-threatening illness, etc.

- "Rippling" (p. 83) refers to the concept that we all leave behind something from our life experience (e.g., a piece of wisdom, guidance, comfort) that passes on to others, known or unknown.

The last third of the book gives advice to therapists on how to address death anxiety with their clients, but any reader would likely appreciate Yalom's words.

Yalom, I. D. (2008). Staring at the sun: Overcoming the terror of death. San Francisco, CA: Jossey-Bass.

Today marked the end of the fifth and final Aging and Mental Health Conference, hosted by the Gerontology Center at UCCS. The topic of this year's conference was "Integrated Health Care for Older Adults." The conference co-chairs were Sara Honn Qualls, Ph.D. and Deborah King, Ph.D. of the University of Rochester Medical Center in Rochester, NY.

Integrated mental health care essentially referrs to mental health services that are delivered in non-traditional settings, such as primary care clinics and long-term care facilities. This can make mental health services accessible to individuals who may not otherwise access mental health treatment because of barriers such as inadequate financial resources, stigma associated with mental health, and limited transportation. In a primary care clinic, for instance, the idea is that physical and mental health are treated together to help improve the quality of life of patients, breaking down the separation of body and mind that often exists in Western medicine.

I've gotten a few questions recently on how one becomes a geropsychologist. While there are many paths leading to a career in geropsychology, here is one of the most efficient routes:

1) Get a bachelor's degree in Psychology: if not Psychology, another social science (e.g., Sociology) or physical science (e.g., Biology) is also helpful, as long as you take enough Psychology classes to get a basic, broad understanding of the field.

2) Get a doctorate degree in Psychology: if you'd like to go into clinical work, you'll need to complete a program in Clinical or Counseling Psychology. With a bachelor's degree, these programs usually take 5 - 6 years to take classes, write a dissertation, and complete one year of internship. The internship year is typically the last year of one's program and involves full-time clinical work.

3) Get a post-doctoral ("post-doc") position: In order to gain enough supervised clinical experience to be eligible for licensure or additional research experience (and rack up publications), many people choose to do a post-doc. Depending on what your goals are, this could take 1 - 3 years to complete.

Some people (myself included) decide to work or get a master's degree before entering a PhD program. This can add several years to the process, but is often very valuable experience.

Division 12 II of the American Psychological Association (APA) has a lot of useful information for students in geropsychology. APA Division 20 has a comprehensive list of graduate programs that provide specialization in adult development and aging.

The Council of Professional Geropsychology Training Programs (CoPGTP) has created an evaluation tool using the Pikes Peak Geropsychology competencies. The purpose of the tool is twofold: (1) for psychologists to evaluate their on-going training needs and (2) for supervisors to evaluate geropsych graduate students' development during a training program.

The 16-page list of competencies is daunting, for geropsych professionals at any level. However, when we discussed the document in my Clinical Geropsychology II class, my classmates and I were pleasantly surprised at how much knowledge and experience we are gaining through our program.

Dr. Ken Pope has compiled a cross-disciplinary list of over 100 links to complete copies of codes, guidelines, and standards for psychotherapy and assessment.

One of programs I was involved in at the CU Aging Center this year was the At Home Mental Health Service program. We partner with a local social service agency for seniors to provide therapy for clients in their homes. These individuals typically have a number of physical or emotional problems that make it difficult for them to leave their homes to obtain services.

Some things I learned through my work in this program:

1) It's OK to set boundaries: For example, asking clients to put pets in another room or not to smoke during the session is not selfish or too demanding, rather it's a way for me to take care of myself in order to give my full attention to the needs of my clients.

2) Therapy goals can never be too clear: This is particularly relevant with older clients who are dealing with loneliness. Sometimes I was seen as a "visitor" coming for social reasons. While increased social contact may be helpful in and of itself this may not be the best use of a therapist's skills.

3) Good supervision is essential: Of course supervision is always necessary, but it's especially important when dealing with complex clients. It was extremely helpful to have a team of peers and more experienced clinicians to discuss cases with and a place where I could admit I had no idea of what I was doing!

4) A lot of older adults who could benefit from therapy are out of the "reach" of traditional services: Several of the clients who I worked with through this program probably would have never engaged in therapy if it meant weekly trips to a clinic to meet with a therapist.

Though challenging, my participation in the At Home program was a valuable experience in helping me to develop as a therapist.

One of my clinical rotations at the CU Aging Center this year was in the Memory Clinic. The Memory Clinic provides brief cognitive screening for individuals who may be experiencing problems with their memory. This type of testing is less extensive than a standard neuropsychological assessment and can determine whether an individual's cognitive abilities are within a "normal" range for their age, if clear cognitive impairment is present, or if further testing is indicated.

As it turns out, most of the clients who I've assessed this year have had emotional problems that were contributing to their memory difficulties, rather than dementia. This is good news in the sense that depression, anxiety, and sleep problems are potentially treatable. Other individuals were having no memory problems, but wanted a baseline measure of their functioning in case they experience a decline in the future (a current fear of thousands of baby-boomers).

If you are in the vicinity of Colorado Springs and are interested in a memory assessment, you can contact the CU Aging Center at 719-471-4884 to schedule an appointment.