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
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