Psychologist
Description of Specialty
Practicing psychologists are broadly trained mental health professionals who provide a variety of services including psychological and cognitive assessment, psychotherapy, consultation, education and program evaluation. Services are provided to individuals, couples, families, groups, and organizations. Other work activities include practice management, clinical supervision, education and training, and management/administration.
Psychologists help people learn to cope with stressful situations, overcome addictions, manage their chronic illnesses and break past the barriers that keep them from reaching their goals. Practicing psychologists are also trained to administer and interpret a number of tests and assessments that can help diagnose a condition or tell more about the way a person thinks, feels, and behaves. These tests may evaluate intellectual skills, cognitive strengths and weaknesses, vocational aptitude and preference, personality characteristics and neuropsychological functioning.
Educational Requirements
A doctoral degree is considered the entry-level degree for the independent, licensed practice of psychology. On average, it takes 5-6 years to earn a doctoral degree. Typically, this involves at least four years of study at the academic program including the completion of a dissertation or scholarly research paper and the completion of a year-long (or equivalent) supervised clinical internship. Additional supervised experience, obtained after completion of the doctoral degree, is required for licensure in a majority of states. Psychologists generally receive one of the highest levels of education of all health care professionals, spending at least seven years in education and training after they receive their undergraduate degrees in order to be licensed.
Licensing Requirements
Requirements for licensure vary by State. Most states require a doctoral degree in psychology, one year of supervised postdoctoral clinical practice and passing scores on a test of State regulations related to the specialty.
Specialty Credentials Related to Geriatrics
Professional Geropsychology is a specialty in professional psychology that applies the knowledge and methods of psychology to understanding and helping older persons and their families to maintain well-being, overcome problems and achieve maximum potential during later life. Professional geropsychology appreciates the wide diversity among older adults, the complex ethical issues that can arise in geriatric practice and the importance of interdisciplinary models of care. Professional geropsychology is recognized by the American Psychological Association as a specialty area of practice and, as such, has defined criteria for areas of expertise, levels of training and supervised experience, available at http://www.apa.org/ed/graduate/specialize/gero.aspx. Geropsychologists may also be board certified by the American Board of Professional Psychology (ABPP).
Scope of Services in Long Term Care Settings
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System Integration: Psychologists are well equipped to engage in the complex work of consultation directed at systems change. Psychologists bring expertise in research methods, program development and evaluation, outcome measurement and group facilitation that can promote the integration of new, non-pharmacological interventions into the day to day care of residents. The combined skill sets of advanced communication skills, group facilitation expertise and data management directed at measuring outcomes equips psychologists to serve as effective system change leaders to support ‘culture change’ and quality improvement initiatives.
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Education/Leadership: Psychologists can help nursing home staff to develop the knowledge and skills to implement evidence-based non-pharmacological approaches to care for the unique needs of each resident. Their advanced training in communication, interpersonal interactions, and environmental and systemic influences on behavior prepare psychologists to (1) provide evidence-based staff training tailored to the skills, abilities and interests of the audience and (2) consult with facility leadership to develop new models of practice, team building, and staff training.
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Assessment: Psychologists are experts in assessment. Trained in the assessment of personality, psychopathology, cognition and behavior, psychologists bring a variety of tools and expertise to the process of assessing the behavioral and psychological symptoms of dementia. They can help facilities to choose reliable and valid measures to guide treatment planning and outcomes. Likewise, psychologists can provide training and technical assistance to nursing home staff to utilize systematic processes for documenting behavioral observations and activators of behavioral expressions.
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Clinical Decision Making: By virtue of their familiarity with theory and evidence based practices in the management of behavioral and psychological symptoms of dementia (BPSD), psychologists are positioned to provide leadership in clinical decision making and interdisciplinary care planning related to dementia and BPSD. Psychologists can play a critical role in helping staff to learn and utilize a systematic approach for evaluating and responding to BPSD, and helping the team to communicate effectively in sharing perspectives on patient-centered care strategies. In particular, psychologists are equipped to provide leadership within care planning teams, serving as facilitators, fostering team development and enhanced communication and providing clinical insight and guidance on strategies for addressing psychological needs and implementing behavioral supports for residents.
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Non-pharmacological approaches: Evidence based non-pharmacological practices for addressing BPSD are grounded in psychological theory and research. Indeed most of the well-known approaches for reducing BPSD have been developed by psychologists. Person-centered care and engagement in meaningful activities are the foundation for reducing anti-psychotic medications. Psychologists are well-versed in behavioral principles that underlie non-pharmacological approaches for understanding and responding effectively to residents with dementia. Moreover, due to extensive training in research method and design, psychologists can support the facility in reviewing and developing evidence based programs to manage BPSD and can assist in developing processes for evaluating the effectiveness of these programs. In sum, psychologists are able to provide leadership, consultation and training to other professionals in this area.
Resources for Finding this Specialty in Your Area
Professional Organizations
Additional Resources Related to this Specialty
- American Psychological Association, Office on Aging: The Office on Aging is a coordination point for APA activities pertaining to aging and Geropsychology. The Office on Aging also supports the work of the APA Committee on Aging (CONA), the goal of which is to advance psychology as a science and profession and as a means of promoting human welfare by ensuring that older adults, especially the growing numbers of older women and minorities, receive the attention of the Association. CONA works toward the optimal development of older adults, expanded scientific understanding of adult development and aging, and the delivery of appropriate psychological services to older persons. The Office on Aging website offers a range of resources related to psychology of aging, professional Geropsychology and best practices in services and supports for older adults, e.g.. the Long Term Care Resource Guide, which lists a range of books, articles and other resources related to psychological practice in long term care settings (http://www.apa.org/pi/aging/resources/guides/long-term-care.pdf)
- GeroCentral: This website is a collaborative effort between the American Psychological Association’s (APA) Division 12, Section II: Society of Clinical Geropsychology (12/II) and Division 20: Adult Development & Aging, along with the Council of Professional Geropsychology Training Programs (CoPGTP), Psychologists in Long Term Care (PLTC), and the APA Committee on Aging (CONA) to bring together available resources for geropsychology training, service provision, policy, and research, including online assessment of geropsychology competencies, in a central internet location.
- The Association of State and Provincial Psychology Boards: This website serves as a resource to members of State and Provincial Psychology Boards, providing services and support to member jurisdictions in fulfilling their goal of advancing public protection by serving as the source for the most current and accurate information about the regulation of psychologists; and contributing to the critical consumer protection perspective in the on-going development of the profession.
- Third Party Reimbursement Eligibility:
Licensed psychologists are eligible to be credentialed as “physicians” under Medicare and, as such, are able to provide independent assessment and therapy services to Medicare recipients. The specific services for which psychologists can be reimbursed under Medicare is defined by Federal regulation and interpreted and implemented by the local Medicare Administrative Contractor (MAC) in the area where the psychologist provides services. As a result, reimbursement rates and clinical care policies may vary by area. Links to the local MAC’s in each state can be found at www.pltcweb.org.
- Other Reimbursement Mechanisms for Long Term Care Services:
Many psychologists are credentialed with a range of third party insurance carriers, including managed care companies, preferred provider organizations and fee for services insurances. However, many of the services that psychologists provide in long term care settings, i.e. consultation, training, program evaluation and community education, are not reimbursed by third party payers. In particular, most of the services that psychologists provide to promote and support the use of non-pharmacological interventions to address BPSD are NOT reimbursed under any health insurance plan. As a result, many long term care providers choose to enter into contractual agreements with the psychologist to insure that the facility has access to these services.
