Morgan T. Sammons, PhD, ABPP

This issue of The Register Report is dedicated to the memory of Dr. Judy E. Hall. As you know, the National Register has had only three Executive Officers in its 40-plus year history. Al Wellner, PhD, ran the Register from its inception in 1974 until 1989. Judy became our Executive Officer in 1990, and held the position until her retirement in 2013. Judy defined the Register in many ways, and presided over its transition from a traditional, paper-based office to the strong web presence we have today. Her tenure was marked by innovation and change and by an increased presence of the Register as a force in national and international psychology. Her accomplishments are too numerous to mention here, so I will confine myself to just a few examples. Under her leadership, the Register began our initiative to expedite licensure mobility for Registrants. To accomplish this, Judy networked extensively with state and provincial psychology boards, often flying directly to hearings in those states to assist them in creating language that enabled Registrants to more quickly gain licensure. Also reflecting Judy’s long interest in international psychology, the Register became a player in the development of common standards for the education and training of clinicians in Europe and the Americas. The publications that Judy was perhaps most justifiably proud of appeared in the context of developing standards for international psychology.

Sadly, Judy did not get a chance to enjoy her well-deserved retirement. Soon after she retired, she was diagnosed with pancreatic cancer. She fought this diagnosis with her characteristic determination and resolve. There was early hope that she might succeed in overcoming her diagnosis, as she had overcome so many earlier hardships in her life. But the untimely death of her only son, Chad, sapped the energy she so vitally needed to continue her own struggle, and she succumbed in November 2015.

We will remember Judy for many things. Her insistence on clear and decisive discussions, which were always followed by excellent food and carefully chosen wine, will be what many of us will recall most fondly. Even those who didn’t agree with Judy’s point of view (or came up short in an argument) could be comforted by her gracious hosting and infectious laugh. Judy’s sense of style brought flair to otherwise drab psychology meetings. But Judy chose to downplay some of her more lasting contributions. Judy got her PhD in 1969, a time when women were just breaking through old barriers in academia. Like many women of the era, she had few female mentors on whom to rely, and she had to juggle academic duties with those of parenthood. Never forgetting her earlier struggles, Judy became a generous mentor to a generation of female psychologists. Judy also had a passionate commitment to equal rights and social justice which deeply affected her personal and professional activities. Judy could be brash and assertive, but her loyalty and commitment to her friends, who included many of the staff of the Register, never wavered.

Time passes, and sorrow with it, as the old proverb says. So on reading this, I urge you not to respond with sadness, but think a bit on the good times that Judy enjoyed so much. I’ll raise a glass to her memory, and I hope you will as well.

On to the Issue

Occupational stress, also known as job burnout, is an enduring problem in healthcare professions. A psychologist’s occupational distress or burnout can lead to undesirable outcomes such as premature departure from the profession, development of substance abuse or other mental health problems, ethical breaches, and clinical errors that may rise to the level of malpractice. Although occupational stress is a frequent topic of discussion in graduate training and in professional meetings of psychologists, the literature on the deleterious effects of such distress is relatively scant for psychologists, particularly vis-à-vis the body of knowledge that has accrued for other professions such as medicine. A recent search of PsycArticles using the terms “occupational stress,” “burnout,” and “psychologists” returned only 31 journal articles published over the last 30 years, while a similar search on Medline using the terms “occupational stress,” “burnout,” and “physician” revealed more than 1,500 articles published in roughly the same timeframe.

Our understanding of the individual and organizational factors contributing to job distress is limited. Many psychologists still continue to see patients in independent practice settings, where the inability to consult with colleagues is constrained. Some have speculated that this presents an additional risk factor for occupational distress and burnout, although at least one study discovered a higher job satisfaction and lower perceived burnout in private practitioners as compared to those working in agency settings (Rupert & Kent, 2007). Additionally, evidence of effective interventions is even more limited. A recent analysis of controlled trials examining interventions—such as relaxation techniques, education, cognitive training, and psychosocial support for workers in a high-stress occupational setting (palliative care) —did not find that workers exposed to systematic interventions had better outcomes compared to controls (Hill, Dempster, Donnelly, & McCorry, 2016).

Limited data notwithstanding, most practicing psychologists will readily identify sources of occupational distress. This issue focuses on various occupational settings for psychologists and unique factors in those settings associated with increased occupational stress. Eckleberry-Hunt and Kirkpatrick examine occupational distress in physicians. These authors make the important point that burnout cannot be understood as an isolated phenomenon, but must be considered in the context of the personal enrichment, or in their terms, the “joy” that physicians derive from working with patients. They have identified three measurement scales that encompass individual and organizational stressors and are associated with job satisfaction in physicians: cognitive flexibility, career purpose, and lack of distress. Interestingly and somewhat counterintuitively, their research did not find that commonly perceived enhancers of occupational satisfaction, such as social support, wise nutritional strategies, and exercise, loaded highly on their dimensions of occupational satisfaction. Eckleberry-Hunt and Kirkpatrick have included the rating scale used in their research and have made it available to readers in the hopes that they may consider using it in their own investigations of occupational distress among psychologists.

Christensen and Shen-Miller examine the interplay between organizational factors and individual vulnerabilities as a determinant of job distress. They employ a perspective derived from environmental science that posits that job stress cannot be understood unless both organizational and personal contributions are considered. In this model, individuals behave like ecosystems, and break down when the ‘load’ imposed by the organizational setting overwhelms the individual’s resources. Noting that much of modern healthcare delivery is, like much of our exploitation of natural resources, based on a depletion rather than a sustainability model, they examine individual and organizational factors that may be subject to manipulation in order to reduce distress and improve occupational sustainability.

Our next articles then examine the phenomenon of occupational distress and burnout in the context of three challenging environments. Thomat and Greenberg note that effective psychological interventions are often ignored in oncology service delivery to the detriment of both patients and providers alike. Assisting patients in coming to terms with the discomforts of treatment in frequently terminal situations also assists providers in coming to terms with their own limitations. This is important if one is to sustain a capacity to render care.

Magaletta and Perskaudas also report on psychologist self-care in an equally challenging environment: the penal system. As those authors report, job fulfillment is possible if the psychologist displays the ability to adapt treatment goals to the institutional setting, can accurately discern malingering and other pathological behavior, and demonstrates the ability to ease the suffering of those incarcerated with chronic and severe mental illness. The interaction between law enforcement and mental illness imposes tremendous burdens on caregivers, as Magaletta and Perskaudas note in correctly identifying appropriate peer consultation and mentorship as extremely important factors in maintaining job satisfaction in the prison system.

Bonvie and Staal extend the relatively scant literature pertaining to occupational stress in military psychology. In addition to previously recognized stressors, such as those associated with frequent moves, deployment to combat areas, and other unique characteristics of the military environment (e.g., Linnerooth, Mrdjenovich, & Moore, 2011), they extend our understanding of the pressures imposed on military psychologists by conflicting ethical guidance. In particular, they address the potential consequences, in light of recent APA actions, for military psychologists who might be called upon to provide support to detainee operations. Although Bonvie and Staal rightfully note that no active duty military psychologist has ever been found to be practicing in an unethical or unprofessional manner, the question of how psychologists can continue to provide valuable services to the military while operating according to the highest ethical standards is an urgent one. The implementation of appropriate guidance to safeguard individual military psychologists who practice according to the highest ethical standards will benefit all of us.

Finally, as you may have noticed from the cover of this issue, we have begun filming a series of videos on the role of psychologists in integrated healthcare delivery systems. We have amassed a nationally recognized group of presenters, including Drs. Parinda Khatri, Kent Corso, Neftali Serrano, Jeff Goodie, Patti Robinson, Robert McGrath, Marlin Hoover and others who are well known for their expertise in the planning and delivery of behavioral healthcare services in the primary care environment. These training videos will provide clinicians with immediately applicable clinical information that they can use in devising, implementing, and billing for services in the integrated environment. Once complete, the series, along with associated backup material, will be available in a web-based format for viewing and continuing education credit. We will wrap up filming by early June, and plan on rolling out the series in the early Fall of 2016.

References

Hill, R.C., Dempster, M., Donnelly, M., & McCorry, N.K. (2016). Improving the wellbeing of staff who work in palliative care settings: A systematic review of psychosocial interventions. Palliative Medicine, . pii: 0269216316637237

Linnerooth, P. J., Mrdjenovich, A. J., & Moore, B. A. (2011). Professional burnout in clinical military psychologists: Recommendations before, during, and after deployment. Professional Psychology: Research and Practice, 42(1), 87-93. http://dx.doi.org/10.1037/a0022295

Rupert, P. A., & Kent, J. S. (2007). Gender and work setting differences in career-sustaining behaviors and burnout among professional psychologists. Professional Psychology: Research and Practice, 38(1), 88-96. doi:10.1037/0735-7028.38.1.88