Medical Psychologists: What We Do

According to the Academy of Medical Psychology (AMP), there are two educational paths to becoming a medical psychologist. One is to complete medical school and earn a license to practice medicine in the United States. The other is to complete an American Psychological Association-accredited Doctor of Philosophy (Ph.D.) in Psychology or Doctor of Psychology (Psy.D.) program, followed by a post-doctoral master’s degree or certificate program in clinical psychopharmacology (www.amphome.org).

I have my Ph.D. in clinical psychology and spent 23 years working in a pharmacy as a pharmacy technician.  I then spent two years working with a general medical practitioner in his office with his patients.  In the process of all that I learned clinical medicine:  the ability to evaluate and diagnose medical disorders based on clinical symptoms and physical signs.

The “art” of clinical medicine is being lost.  It requires considerable time and, in essence, a mentorship with a physician to notice and understand what is being observed.  Unfortunately that training in clinical medicine is becoming rare.  Instead of clinical medicine leading laboratory medicine, laboratory medicine has ineffectively replaced clinical medicine.  The physicians who know clinical medicine are older.  The impact of managed care on the ability of a physician to take a history has led to nurse practitioners and medical assistants getting that information as a more cost effective method.  But it’s more costly to the patients and adds to the level of misdiagnosis being significantly high.  It’s also led to concierge medical services outside of managed care.

Medical psychology effectively bridges the gap for a physician in providing medical education, ensuring compliance with treatment plans and getting that needed history. Unfortunately, there are few medical psychology practitioners and fewer still know what we do.  I have to explain my role to physicians and psychologists alike.  Most equate what I do to “Dr. House” from the television series.  I just think of it as saving people’s lives.

Margaret A. Donohue, PhD

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Psychologists and Healthy Communities

In my experience, we psychologists often discourage one another from discussing politics. We may wish to think about what paradigms for government (i.e., “politics”) best promote mental health among the citizenry and the growth of healthy communities. As the election season heats up, I suggest we consider this matter as we follow various campaigns at the federal, state, and local levels.

My major professor at Eastern Virginia Medical School displayed a quotation from Sigmund Freud posted on the wall putting forth the notion that for a person to be healthy, three things are necessary: (1) to work with a sense of purpose, (2) to love in a way in which no one is being exploited, and (3) to play as children do. Without any mention of partisan politics, my model for health-enhancing governance follows from these three tenets.I like to see work incentivized with a minimum of deductions, and take-home pay that is as large as possible. This helps families provide for their own needs, such as food, tires for the car, school clothes, mortgage payments, car repair, and other such necessities.

It also requires that the large helping industry, and the assumptions upon which it is built, be re-thought and re-conceptualized. In every instance, we should help the less fortunate in a way that promotes them to become independent of us whenever possible. In my opinion, we do this poorly.Although loving in which no one is exploited can be accomplished with little or no money, that gift in the silver box, dinners in restaurants, scout dues, and a new baseball glove or riding lessons require some measure of discretionary money, and discretionary money is, by definition, what is left over after the basics have been bought. Expressions of love, as they are expressed in charitable donations, are also facilitated via small deductions.

To the extent that we can love those in generations-to-come, I suggest we pay down our 18 trillion dollar national debt and leave those who come after us with government (and a way of thinking about government) that is solidly “in the black.”Larger after-tax checks also help people play. A minimum of deductions makes it easier to buy dance lessons, pay dues to various recreational clubs, movie and concert tickets, sports equipment, and dinners.  Such play experiences also help build a treasure-trove of happy memories.

In each of these three categories regarding a healthy life, there is the undeniable multiplier effect that results from people spending money. Restaurants, auto-repair shops, jewelry stores, waiters, dance instructors, sporting goods stores, department stores, hotel owners, all tend to prosper when people have money and can buy goods and services that you and I provide.

In the model I describe, there is also an increased ability to save and invest, which is a topic I will save for another day.

I encourage my fellow mental health workers to consider these principles and support candidates and vote accordingly.

Andrew J. Billups, PsyD

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Ackerman-Schoendorf Evaluations for Disputed Custody

Oyster Point Psychological is pleased to announce that it is resuming Ackerman-Schoendorf Evaluations (ASPECT) relative to child custody disputes. Call or click for details.

 

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Happiness via Willful Stupidity

It sometimes seems to me that the happiest people I know are people who choose not to know (i.e., those who have embraced willful stupidity). They don’t know how we are protected from tyrants by the Constitution. They don’t know what is meant by “unreasonable search and seizure” and the protections provided by the Fourth Amendment. They don’t know how much of the cost of what government provides is “covered” by money we borrow from unsuspecting nephews, children, and grand-children. They don’t know that the sum total of all this inter-generational plunder is approximately 18 trillion dollars. There are a great many things they don’t know, and they like it that way.

They don’t how important it is to be self-reliant to the greatest extent possible — to pay our own way, to strive to be productive, and to be charitable toward the truly less-fortunate, rather than advocating for huge parental government paid for with borrowed money. They don’t know about freedom of speech, freedom to worship, freedom to assemble, nor do they seem to care as these freedoms are steadily eroded. The people who choose to be stupid in exchange for happiness are a huge and largely un-addressed problem. It does not bode well to leave it un-addressed.

 If the happy are happy because they are intoxicated on alcohol, marijuana, and other para-prescriptive drugs, we would see clearly the nature of what confronts us. The stoners among us have discovered they can avoid the heavy lifting of life via the chemically-facilitated mood alteration. If stoners can find people, welfare programs, and disability benefits to underwrite the cost of this stoner lifestyle, it can continue as far as the eye can see. With those who choose to be stupid (as an alternative route to happiness), it looks different, but the dynamic is the same.

 What is to be done about this willful stupidity as a route to happiness?

 Our well-intentioned but poorly-conceptualized welfare system must be unwound, and dispensers of benefits and the benefit recipients cannot be trusted to do it. The food stamp program would be a good starting point. Benefits should be reduced to anti-hunger items only (baby formula, milk, ground beef, whole chicken, fish, vegetables, fruit, un-sweetened cereal, grains and nuts).

There should be no soda, no desserts, no standing rib roasts, no king crab legs, and no deli items. There is nothing unkind about restoring an anti-hunger program to the parameters of an anti-hunger program. Because those who make Little Debbie Cakes and cheese puffs will continue to object to the changes I suggest, we may need to contact our elected representatives in Washington and demand that they show some courage in the face of such cronyism. I have asked my congressman to take such a position, and, so far, nothing.

We should recognize that there are worse things than being embarrassed. If your child is valedictorian of this year’s senior class, ask your child to name their U.S. Senators, one of the three branches of government, and explain what we celebrate on the Fourth of July. If they cannot answer two of the three questions, request an opportunity to appear before the school board and complain about educational malpractice. If YOU cannot answer all three questions, apologize to the school board for not being more of a collaborative partner in your child’s education and promise to do better.

If both you and your child CAN answer the questions, go out to dinner and buy some crab legs.

– Andrew J. Billups

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Developmental Arrest Issues Regarding Adult Children in Parental Homes

Parents sometimes call me to discuss an adult child who lives in the parental home and how best to motivate his/her leaving the nest. Developmental psychologist Erik Erikson is worth a read.

Erikson speaks of eight developmental stages through which any individual moves from infancy to (we hope) old age. Erikson says each stage involves a transition from one set of dependencies and responsibilities to another and the transition can be made in a way that reflects health and builds upon it or in a way that does not.

A person at age two, who has been provided food when hungry, drink when thirsty, and comfort when frightened will move from the first stage to the second stage with a sense that the world is a safe place and with a capacity for trust. Another person who has been nourished and comforted inconsistently will enter Stage Two with “trust issues” and may seek therapy services later in life for help with the appropriate trusting of others.

Psychotherapists are often called upon to facilitate resolution of developmental arrest in an individual who may (or may not) meet the criteria for a mental health diagnosis that would support a need for psychotherapy. Of course, there may be a psychiatric diagnosis (e.g., depression) that exists in addition to matters of developmental arrest.

Erikson was particularly interested in the adolescent-to-adult stage (i.e., Stage Five) and wrote more about this stage than any other. This is the stage of identity versus role confusion. For the individual stuck in adolescence, therapists often focus upon the enabling of dependency by some combination of well-intentioned but misguided parents, parental figures, and welfare programs.

A good starting point in promotion of independence is identifying subsidies that make the “nest” too comfortable for the adult child (e.g., gas money, an allowance, cellular phone service, car payments, and Internet access). In addition, parents sometimes subscribe to irrational beliefs that impede the development of the adult child’s independence (e.g., — A good parent would pay the cell bill — especially if it is a family plan).

A psychologist can explore these issues more deeply, and it may be worth a referral.

The following link provides an overview regarding the stage theory of Erik Erikson.

http://psychology.about./library/bl_psychosocial_summary.htm

— Andrew J. Billups

 

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Forgiveness, Challenges, and Opportunities for the New Year

The issue of how best to address past injuries (physical and/or emotional) may be the most common element of what motivates emotionally-damaged individuals to seek therapy, and the how, when, and in-what-form forgiveness might be possible.

I saw a poster several weeks ago advising “Don’t waste your time thinking about people you do not like.” This may be as good as it gets — especially when the offender is unwilling to acknowledge the offending behavior and/or is unrepentant. Issues of recognizing and grieving loss are usually central to issues of forgiveness.

 I have also heard it suggested that spending time thinking about an abuser is much like allowing a tenant to live in your head rent free. This metaphor provides some comfort to abuse victims and it facilitates the injured party an opportunity to de-cathect the abuse experiences and re-claim some emotional capital. It has often been noted that hatred and pre-occupation with the abuser is another way of being inter-twined; whereas, indifference is the preferred goal.

 Terry Hargrave of Fuller Theological Seminary and the author of Restoration Therapy: Understanding and Guiding Healing in Marriage and Family Therapy suggests that there are four stages that therapists and clients may find useful as therapy helps clients move toward some degree of resolution:

 (1) Insight — helping victims learn ways to stop the victimizer from perpetrating further violations.

(2) Understanding — focusing on the interplay between the history and limitations of the victimizer and the victim’s own emotional story

 (3) Giving the opportunity for compensation — using sequential interactions to build a sense of safety and trustworthiness

 (4) Overt forgiveness — victim and victimizer confront past violations and restore their relationship through dialogue

As the threshold of a new year rapidly approaches, perhaps the issue of forgiveness is particularly timely.

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Workers Compensation at Oyster Point Psychological

Oftentimes, workers compensation clients have suffered traumatic injury on the job and demonstrate symptoms of posttraumatic stress disorder such as intrusive imagery of the incident (i.e., flashbacks), chronic sympathetic activation (i.e., flight-or-fight syndrome), and catastrophizing thoughts that compromise their safety and that of others. At the same time, these injured workers have wisdom and experience that is difficult to find in new hires. Returning them to work can be beneficial to all concerned.

At Oyster Point Psychological, we provide a combination of assessment, psychotherapy, and coaching services for our workers compensation clients, and we work collaboratively with rehabilitation counselors, attorneys, and insurance companies to help bring about a satisfactory outcome.

We can help with this. Call 804-435-6777 or visit www.oysterpointpsychological.com to discuss your workers compensation needs

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Does Liberalism Promote Mental Health?

I watch “The Five” occasionally and admit that Bob Beckel gets under my skin at times — as does Juan Williams as they put forth liberalism as a paradigm for sound governance. In listening to their liberalism for a while, it soon becomes clear that these two men subscribe to a utopian ideal in which lots and lots of goods and services are available to anyone (including people here illegally) and these goods and services seem to be disconnected from any sort of cost (i.e., They are “free.”).

Bob and Juan like it that way. Hey, who doesn’t like free stuff? Because this utopian ideal is so compelling, they seem unconcerned about inter-generational plunder, duplicity, and spin, to a degree that goes far beyond what most of would consider egregious. To put it another way, “The end justifies the means” (and the means can be absolutely anything).

I do not believe that neither sound mental health or a sound country exist downstream of this paradigm for governance or life.

— Andrew J. Billups

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Where Is The Healthy Skepticism?

I am troubled by the lack of healthy skepticism in our culture — most notably on the part of celebrities who had no shortage of it in the 60’s and 70’s, when the government seemed indifferent to the guardrails provided by the Constitution. At the risk of giving lapdogs a bad name, these celebrities seem to have become just that — lapdogs.

In the last six years, they seem to have become enamored by the lure of huge government with a panoply of womb-to-tomb services — a government that will eavesdrop on our conversations, read our mail, and engage in warrantless snooping in our home. They appear on talk shows and suggest they have the moral high ground in trusting government to provide all sorts of goods and services in a huge seize-and-redistribute paradigm that also includes inter-generational plunder.

To put it simply: what happened to the question-government and question-authority figures of the 60’s (e.g., Graham Nash, James Taylor, and Jackson Brown), who seem to have become lapdogs?? The “question-government people” are now pridefully disparaged as “Tea Baggers.”

Perhaps they have “Low-T.” Come on Graham, some on Sweet Baby James, let’s see some of that old questioning spirit. Let’s see some healthy skepticism.

 

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The Striving-versus-Acceptance Question

With respect to the malaise and rancor in our country currently, I have read several blogs and essays recently advocating for less striving and more acceptance, and these opinion pieces suggest that our happiness and mental health would improve if the striving-versus-acceptance question were resolved by embracing more acceptance and less striving. People less kind than I sometimes call the writers of these pieces “yoga types.”

When I think of “strivers,” I think of our Founding Fathers, who strove for independence. I think of Orville and Wilbur Wright, who strove to build a heavier-than-air machine capable of powered flight. I, for one, admire the strivers, who gave us our freedom and struggle to keep it. I admire those who gave us the integrated chip, the internal combustion engine, digital discs, flat panel televisions, Dolby sound, and cures for a list of diseases and surgical procedures too lengthy to mention. Might I also mention beach music, 3.2 beer, and the five-string bass?

I welcome thoughts and responses to what I view as a question of ever-increasing importance. Strive or accept?

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