Clinical Practice Patterns

All PracticeNet Enrollees

General Demographics and Early Career Psychologists

All PracticeNet Enrollees (n=536)

55% Female, 44% Male Early career: 64.2% Female, 35.8% Male

Average age 50.8 years, Range 25-79 Early career: Average age 40.74, median age 38, range 29-66

94.4% White 2.4% Hispanic/Latino, 0.9%Asian, 0.8% Multiracial, 0.6% Native

American/ Indian, 0.6% African American Early career: 92.6% White, 6 people of color (2 Hispanic/Latino, 2

Indian, 1 Asian, 1 Multiracial)

All PracticeNet Enrollees, cont.

Years of serviceAverage 17.8 years, range 1-55 years

Degrees78.4% hold PhDs, 13.6% hold PsyDs, 2.2% hold EdDs, 3.6% hold Masters, 2.2% otherEarly career: 74.1% PhD, 23.5% PsyD, 2.5% EdD*

Degree Fields65.5% clinical, 19.7% counseling, 4.3% school, 10.5% otherEarly career: 74.1% clinical, 23.5% counseling, 2.5% school, 2.5% other*

Practice Settings of Enrollees

Primary Employment Setting*47% private practice only, 19% organizational settings only, 34% both settings

Early career psychologists33% private practice only, 38% organizational settings only, 29% both settings

Hours Worked Per Week

Average of 38.8 hours worked per week Average of 25 hours of direct health services, range

3-55 Early career: Average of 22 hours of direct health services

are provided across settings, range 5-45*

Average of 30 hours per week in private practice Early career: 24.3 hours*

Average of 27 hours per week in organizational settings Early career: Average of 35.6 hours*

Psychologist Demographics and Client Diagnoses Across Surveys

Psychologist Demographics Across Surveys

Fall 02

(n=291)

Winter 03

(n=225)

Summer 03

(n=241)

Gender 54% female 54% Female 56% Female

Age Average 50

Range 24-77

Average 51.7

Range 25-78

Average 51.9

Range 25-79

Race 95% White 94% White 95% White

Employment Setting

48.5%Priv prac

16.5% Org only

35% Both

49% Priv prac

19% Org only

32% Both

52% Priv prac

16% Org only

32% Both

DSM-IV Diagnoses Across Surveys

Fall ’02 Winter ’03 Summer ’03

% Diagnosed 84% (of 264) 86% (of 206) 90% (of 203)

Predominant diagnoses

Mood (33%)

Anxiety (21.6%)

Adjustment (11.4%)

Mood (37%)

Anxiety (19%)

Adjustment (12%)

Mood (42%)

Anxiety (17.5%)

Adjustment (17%)

Personality dx 11% 14% 15.5%

Dx not complete

9% 5% 5.5%

No dx 6% 8% 4.5%

Results of Summer ’03 Survey

Clinical Encounter Settings and Services (Summer ’03)

Independent/private practice – solo 49% or group 29% Organizational health care setting – 16%

Mental health services setting – 31% 80% Outpatient, 20% Inpatient

Primary health care setting – 25% Other health care setting - 40%

Individual therapy or counseling – 78% Formal assessment or evaluation – 26% Providing educational information and/or materials – 18% Medication evaluation/management –3.9%

Primary Source of Payment (n=185)

4%3%3%

7%

30%

5%4%

12%

21%

Self pay

Indemnity Insurance/Feefor service

Managed care

Public/Govt funding

Military/VA

Medicare

Other ins

Other

Not charging

Unknown

27% of self-pay clients have insurance but are not using it

Reasons for Self Pay (n=27)

1 No insurance

2 Preferred provider not covered

3 Concerns about privacy or stigma

4 Coverage too limited (either benefits already used up or benefits are too minimal to bother using)

5 Other (forensic evaluation, “choice”)

6 Insurance status unknown

0

1

2

3

4

5

6

7

8

1 2 3 4 5 6

Reason

Client Demographics

Gender 56% Female 44% Male

Average age 36, Range 2 - 92 Race/Ethnicity

5% Hispanic 82% White 5% Black/African American 3% Multiracial

Marital Status 25% Married 53% Never married 15% Divorced

Referral Source

Other Professional (52.2%) Primary Care Physician (23.6%) Psychiatrist (17.9%) Other mental health professional (39.6%) Other health care provider (18.9%)

Self (26.1%) Friend (7.4%) Legal system (5.9%) and Family (5.9%) School (2.5%)

Comparisons: Early Career and More Established

No differences between groups in terms of gender, race or type of degree

Significant differences between groups in terms of practice setting (early career psychologists more likely to be employed in organizational settings)

Of those who do private practice, early career psychologists do fewer hours

Of those who work in organizational settings, early career psychologists work more hours

No differences in average total hours worked but early career psychologists average fewer hours of direct client care

Correlates of Treatment Length

Treatment setting (private practice) Capacity to pay for treatment (self pay and indemnity

insurance) Greater number of treatment goals White race Psychologist theoretical orientation (psychodynamic

and combination) Diagnosis (depression v adjustment disorder,

especially) Age of client (older clients had more sessions)

Psychopharmacology and Psychotherapy

Over half (54.2%) of clients are receiving psychotropic medications

Psychopharmacology and psychotherapy were equally likely to have begun first

Most clients (70%) see a psychiatrist for medications although 24% receive medications from a primary care physician

Only 20% of psychologists had no contact with the prescriber, 60% of psychologists have exchanged written reports with the prescriber or have had ongoing telephone conversations

71% of clients referred by psychologist for medication evaluation receive medications, 80% receive them from a psychiatrist

Problematic Life Domains

0

10

20

30

40

50

60

Family School Rel'ps Other

Domain

Theoretical Orientation and Clinical Interventions

Theoretical Orientation

General theoretical orientation (n= 177) Psychodynamic 17% Cognitive behavioral 28% Combination 45%

Orientation specific to this session (n=177) Psychodynamic 15% Cognitive behavioral 35% Combination 42%

General and specific theoretical orientation were correlated .58 (p < .01)

Clinical Interventions

Virtually all therapists reported doing the following two things in session:

Discuss current stressors relevant to client’s problem (196/200 psychologists)

Discuss interpersonal relationships or relationship patterns or themes (192/200)

Clinical Interventions

Clinical Interventions Employed in Session

n = %

Identify or challenge thoughts

138 86.8%

Relate thoughts and affect

136 85.5%

Validate, label, release affect

135 84.9%

Gather information 125 78.6%

Guide, direct or re-focus client

124 78%

Interventions Employed in Session

Strategy Psychodynamic CBT Combination

Educate client 3 1 2

Encourage q’s 3 1 2

Set agenda 3 1.5 1.5

Child experienc 1 2.5 2.5

Enc activities 3 1 2

Teach skills 3 1 2

Homework 3 1.5 1.5

Reactions tx 1 2.5 2.5

Repeated dysfn

1 2.5 2.5

Specific Clinical Interventions

Early career psychologists were more likely to discuss past treatment problems and gains

Early career psychologists were less likely to provide feedback regarding therapist’s understanding of presenting problems or direction of treatment

Early career psychologists were less likely to discuss client’s communication patterns

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Early Career Psychologists, Summer ’03 (n=32)

59.4% female, 40.6% male

93.8% white, 1 American Indian, 1 Multiracial

Average age 42.3 years, range 31-63

Degree

81.3% PhD, 15.6% PsyD, 3.1% EdD

Degree field

62.5% clinical, 31.3% counseling, 3.1% school, 3.1% other

Spirituality and Psychotherapy

Psychologists had discussed spirituality with 56% of clients (n=113)

Spirituality was identified as a source of strength and coping for 35% of these clients

Spirituality was a source of distress for 6% of these clients and psychologists reported that spiritual matters directly contributed to the presenting problems for 4 individuals

70% of these clients had expressed a belief in God, a higher power, deity or “other”

Participating Psychologist Demographics- Summer ‘03

56% Female 44% Male

Average age 51.9, Range 25-79

9 people of color 2 Hispanic/ Latino, 2 Asian, 2 African American, 2

multiracial, 1 American Indian 95% White

Primary Employment Setting 125 private practice ONLY 39 organizational setting ONLY 77 divide practice time between both settings

Participating Psychologist Demographics- Winter ‘03

54% Female 46% Male

Average age 51.7, Range 25-78

2% Hispanic 3% Other people of color 94% White

Primary Employment Setting 111 private practice ONLY 42 organizational setting ONLY 72 divide practice time between private and organizational

settings

Participating Psychologist Demographics- Fall ‘02

54% Female 46% Male

Average age 50, Range 24-77

2% Hispanic 95% White

Primary Employment Setting 141 private practice ONLY 48 organizational setting ONLY 102 divide practice time between private and organizational

settings

DSM-IV Diagnosis

90% of clients have been diagnosed Predominantly depression/ dysthymia (37%),

anxiety (17.5%) and adjustment disorders (16.9%)

15.5% personality disorder diagnosis

5.5% diagnosis not yet completed 4.5% no diagnosis

Primary Axis I Diagnoses of All Clients

Diagnosis N= 203 Mood Disorders 75 42%

MDD (n=49), Dysthymia (n=18)

Anxiety Disorders 31 17.5% PTSD (n=12), GAD (n=8)

Adjustment Disorders 30 17% Psychotic Disorders 5 2.8% Substance Use Disorders 4 2.3%

Primary Axis I Diagnoses of All Clients, cont.

ADD/ADHD 8 4.5% Developmental disorder 4 2.3% Diagnosis not yet completed 11 5.5% No DSM-IV diagnosis assigned 9 4.5%

Primary Axis I Diagnoses of All Clients (winter ’03)

Diagnosis N= 206 Mood Disorders 76 37%

MDD (n=37), Dysthymia (n=22)

Anxiety Disorders 39 19% PTSD (n=11), GAD (n=13)

Adjustment Disorders 24 12% Childhood Onset Disorders13 6.3% Psychotic Disorders 9 4.4% Substance Use Disorders 4 1.9%

Primary Axis I Diagnoses of All Clients, cont. (winter ’03)

Cognitive Disorders 5 2.4% Eating Disorders 1 0.5%

Medical/ Psychological Issues 4 1.9% Diagnosis not yet completed 10 4.9% No DSM-IV diagnosis assigned 16 7.8%

DSM-IV Diagnosis (fall ’02)

84% of clients have been diagnosed Predominantly Mood, Anxiety and Adjustment

disorders n=10 Axis I Primary Substance Abuse disorder 11% Axis II diagnosis

9% diagnosis not yet completed 6% no diagnosis 1% not assessed

Early Career, Summer ’03, cont.

22 individuals do private practice (11 do only private practice), average hours are 21.9, range 1-50

21 work in organizational settings (10 work only

organizational settings), average hours are 36.48, range 1-55

11 work in both settings

Average of 21.5 hours of direct services, range 5-40

Comparisons: Early Career and More Established

No differences between groups in terms of theoretical orientation in general or endorsed for specific session

No differences in number of treatment goals endorsed for particular session or for overall treatment

No differences in types of clinical activities engaged in during session (including therapy, assessment, medication evaluation, providing education and other)

No differences in payment sources