Counseling in Medical Settings
Advances in psychological, medical, and physiological research have led to a new way of thinking about health and illness. This is reflected in the bio psychosocial model that views health and illness as the product of a combination of factors including biological characteristics (e.g. genetic predisposition), behavioral factors, (e.g. lifestyle, stress, health beliefs) and social conditions (e.g. cultural influences, family relationships and social support). This conceptualization of health and illness has many scientific and practical benefits. At the top of this list is the fact that people can reduce their risk of developing major medical problems, receive more effective treatment, and reduce their health care cost when they seek treatment from an interdisciplinary team including behavioral health providers.
It is worth noticing here, that in the recent past, dealing with health and illness was based on the biomedical paradigm in which the biological aspects were the main focus of the scientist and practitioner. Good health was simply seen as the absence of diseases and injuries, and their presence meant ill health. The proper treatment for that model meant that there were biological interventions in order to improve the biological damage. As a result, health providers were divided into two groups, the physicians who followed the biomedical thinking and who had complete authority to deal with patients, and their assistants whose role it was to follow the physicians’ orders.
At present, the understanding of the body-mind-behavior relationship has dramatically changed medical system and practice. This change, from the biomedical paradigm to the bio psychosocial medicine, characterizes the current holistic model of health provision.
Overall, the bio psychosocial model reflects the belief that biological, psychological, and social factors interact in an interdependent or systemic way to maintain health or cause illness.1 This approach (bio psychosocial paradigm) has become universal, and has been endorsed and adopted by the World Health Organization.2
Because behavior plays a vital role in mental and physical health, behavioral health is becoming the cornerstone of the bio psychosocial practice. Cassidy described the way behavior may positively or negatively affect the body by stating that lifestyles, life-events, and bad behavior are directly related to health and illness; the way we think about events determines our response to them in developing healthy or unhealthy behaviors and changes in behavior. Attitudes to health determine whether we hear or listen to advice from health professionals, and a person’s personality may predispose the body to certain dysfunctions.3
Psychology as the science of behavior and mental processes emphasizes training and knowledge about such aspects (e.g. development over the lifespan, learning, motivations, experiences, emotions, cognition, social behavior and attitudes, personality etc). Moreover, it strives to understand how biological, behavioral, and social factors influence health and illness.
Thus, psychologists as behavioral health providers play a major role in understanding how biological, behavioral, and social factors influence health, and illness. They are equipped with training, skills, and knowledge to understand how basic behavioral and cognitive processes (e.g. cognition. emotion, motivation, development, personality, social and cultural interaction) prepare the body to develop dysfunctions. They are trained, on the other hand, to perceive how these behavioral and cognitive functions are altered, the factors that contribute to their alteration, and how these dysfunctions are diagnosed and treated. In dealing with such problems, they are also trained and skilled to use several psychological, psych diagnostic and psychotherapeutic techniques which help and affect the abilities of individuals to function in diverse settings and roles. In addition, they help people to modify their behavior and lifestyle so as to prevent and recover from health problems.
Health Psychology/ Medical Psychology
Health psychology (sometimes referred to as medical psychology or behavioral medicine) can be defined as the aggregate of the specific educational, scientific and professional contributions of the discipline of psychology to the promotion and maintenance of health, the prevention and treatment of illness, the identification of etiological and diagnostic correlates of health, illness and related dysfunction, and the improvement of the health care system and health policy formation.
Health Psychologists apply psychological research and methods to the prevention and management of disease, the promotion and maintenance of health, the identification of psychological factors that contribute to physical illness, the improvement of the health care system, and the formulation of health policy
The American Psychological Associations’ Division of Health Psychology outlined the objectives of health psychology as understanding the etiology, promotion and maintenance of health, prevention, diagnosis, treatment and rehabilitation of physical and mental illness; the study of psychological, social, emotional and behavioral factors in physical and mental illness; and the improvement of the health care system and formulation of health policy,
Thus, health psychologists are interested in how biological, psychological, and social factors affect health and illness. Therefore, they are engaged in the promotion and maintenance of health-related behavior, the prevention and treatment of illness and analysis and improvement of the health care system.
A major activity engaged in by psychologists in delivering health care is intervention or treatment, providing a wide variety of clinical interventions for individuals, groups, couples, and families with physical and mental health problems. These interventions are directed at preventing, treating, and correcting emotional conflicts, personality disturbances, psychopathology, and the skill deficits underlying human distress and dysfunction.8They provide a variety of psychological interventions such as cognitive behavior therapy; behavioral modification; family and couple therapy; biofeedback; rehabilitation; group psychotherapy; psychoanalysis; client-centered therapy; pain management; neuropsychological rehabilitation; interpersonal psychotherapy etc.
Research has indicated that less than 25% of physical complaints presented to physicians have known or demonstrative organic or biological signs and that a substantial number of physical or medical symptoms presented by patients are unexplained medically (functional symptoms) that respond well to the psychological intervention. Therefore, psychological interventions are effective and cost-effective for the improvement of physical and mental health and the quality of life.
Many psychologists provide psychological consultation for health care professionals, businesspersons, schools, organizations, communities etc. For example, a psychologist may help a physician to better manage noncompliance with unpleasant medical procedure. A businessman may consult a psychologist to help reduce conflicts among workers or provide stress management. Psychologists’ consultation might include assessment, teaching, research, and therapy
Psychologists like other health providers have ethical principles and code of conduct. This consists of: (a) general principles (e.g. competence, integrity, professional and scientific responsibility, respect for people’s rights and dignity, concern for the welfare of others and social responsibility); and (b) specific ethical standards related to their role with their patients and experiments.
With the growth of knowledge on the importance of behavioral and psychosocial factors in the etiology and maintenance of dysfunctions, psychologists have developed more expertise in diagnosing and treating the behavioral aspects of illness. Consequently, psychologists have begun to define themselves as health care rather than mental health care providers.
This article has outlined and discussed the clinical role of psychologists in health care delivery as diagnosticians, therapists, academicians, researchers, and administrators in the era of the biopsychosocial practice. The paper, however, is restricted to the management roles of psychologists in medical settings and, does not expose to the psychologists’ roles in promoting health and preventing illness.
The practice of psychologists in health care delivery requires sophisticated teaching, intensive training, and high professionalism in their attitude to the ethical principles and code of conduct.