The CAP Monitor Professional Development Day Issue Issue 56 | Fall 2018
Whoâ€™s Who Council
President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Kevin Alderson President-Elect . . . . . . . . . . . . . . . . . . . . . . . . . . . Kerry Mothersill Past-President . . . . . . . . . . . . . . . . . . . . . . . . . . . Paul Jerry Treasurer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Reagan Gale Members-at-Large . . . . . . . . . . . . . . . . . . . . . . . . Farrel Greenspan Kathleen Kelava Greg Schoepp Public Members . . . . . . . . . . . . . . . . . . . . . . . . . . Elaine Andrews Gene Marie Shematek Garrett Tomlinson
Supervision consultants are available to advise provisional psychologists and supervisors. They also assist in the resolution of conflicts between provisional psychologists and supervisors. Jon Amundson 403-289-2511 firstname.lastname@example.org Walter Goos 780-986-7592
Committee Chairs Credentials Evaluation Sub-Committee . . . . . . . . Ali AL-Asadi Oral Examinations Committee . . . . . . . . . . . . . . . Erik Wikman Practice Advisory Committee . . . . . . . . . . . . . . . . Christoph Wuerscher Registration Advisory Committee . . . . . . . . . . . . . Christina Rinaldi Registration Approvals Sub-Committee . . . . . . . . Jill Turner Substantial Equivalency Sub-Committee . . . . . . . Ali AL-Asadi
College Staff Registrar & CEO . . . . . . . . . . . . . . . . . . . . . . . . . . Richard Spelliscy Deputy Registrar and Complaints Director . . . . . . Troy Janzen Assistant Deputy Registrar and Director of Professional Guidance . . . . . . . . . Deena Martin Finance and Administration Coordinator . . . . . . . Wendy El-Issa Complaints Coordinator and Hearings Director . . Lindsey Bowers Administrative Assistant to the Registrar . . . . . . . Kathy Semchuk Registration Coordinator . . . . . . . . . . . . . . . . . . . Ingrid Thompson Registration Assistant and Oral Examinations Coordinator . . . . . . . . . . . . Sheri Price Credentials Evaluation Coordinator . . . . . . . . . . . Kymberly Wahoff
Continuing Competence Consultants Consultants are available to provide advice and guidance to members who wish to participate voluntarily in the Continuing Competence Program. The consultants are also available in special circumstances, for example, when a member does not have access to other regulated members who are able to review their plan. Such circumstances would occur on a very limited basis, as psychologists are encouraged to develop a network of professional peers. Dennis Brown 780-441-9844 email@example.com Christoph Wuerscher 403-234-7970 firstname.lastname@example.org
Communications Coordinator . . . . . . . . . . . . . . . . Melanie Barclay
Receptionist/Office Assistant . . . . . . . . . . . . . . . . Renetta Geisler
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10 Improving Psychotherapy Outcomes
4 Registrar’s Letter 5 President’s Letter 6 College News 8 CAP & PAA AGM 2018
12 Why We Need to Talk About Psychology in Primary Care
14 Evidence-Based Practice for
Anxiety and Related Disorders
17 Collaborative Research and Practice with Alberta’s Refugee Community
20 Member Consultation:
Practice Guidelines Feedback Summary
Registrar’s Letter On behalf of College Council and staff I would like to thank all of you who attended the first College of Alberta Psychologists and Psychologists’ Association of Alberta annual meetings and joint professional development day on September 22, 2018. At the Annual Meeting an overview of the many College accomplishments over the past year, and the direction we are headed, was provided. Secondly, the importance of regulated psychologists’ work was highlighted. Finally, the importance of how we do our work was emphasized. Each year the College of Alberta Psychologists, as required by government, produces an Annual Report. This report is required in order to stay aligned with the other 28 regulated health professions in Alberta, demonstrating that we are meeting our fiduciary obligations. I am very pleased to report that with the efforts and strength of both College staff and Council we have not only met but are exceeding our legislated requirements. The College continues to be a leader not only within Alberta but both nationally and internationally in collaboratively resolving public concerns and complaints. Importantly, this typically involves the complainant and regulated member being full and equal participants in all resolution activities leading to transparent outcomes and enhanced satisfaction for all. This past year the College adopted the Canadian Code of Ethics for Psychologists, Fourth Edition. It is also in the process of revising our Standards of Practice to coincide with the new Code as well as enhanced public and government expectations in addressing issues such as the TRC’s Calls to Action, sexual boundary violations by regulated members, and prohibitions on harmful practices such as conversion therapy. Prevention of public concerns and complaints is a key aspect of the College’s member engagement strategy. This is achieved through our entry to practice requirements (graduate level course in ethics, 1600 hours of supervised practice and jurisprudence examination) and through our professional guidance department. This past year the College received approximately 500 requests for guidance, up approximately 10 percent from the previous year. Additionally, new professional practice guidelines in the areas of Medical Assistance in Dying, Telepsychology, and Disclosure of Confidential Information were developed and approved by College Council. The CAP Monitor and province-wide town hall meetings were additional channels offering practice and regulatory information to our membership. The College partnered with PAA for professional workshops in the areas of MAiD and Ethics in Calgary and Edmonton. The College is also engaged in numerous governmental and regulatory initiatives provincially, nationally, and globally. This is to ensure we are on the forefront of contemporary issues facing the professional regulation of psychology. It is also to ensure we have a place and voice at the table when regulatory issues are being determined and the public interest is at the forefront.
Richard J. Spelliscy, PhD, RPsych Registrar & CEO
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President’s Letter Although it was only 15 months ago, It seems like just yesterday that your Council created a dynamic 5-year strategic plan that even our facilitator described as excellent and model-like in quality. You may recollect the six E’s that are like the spokes of a wheel guiding the College’s practice. They are: 1. ENSURE (our ethical principles and standards of practice serve our clients and the public at large). 2. ENGAGE (and connect to psychologists routinely). 3. ENHANCE (the profession by encouraging psychologists to work in their full scope of practice). 4. ENDORSE (evidence-based decision-making). 5. EXCEL (as a regulator). 6. ENCOURAGE (and inspire psychologists toward continuous learning, self-care, and work-life balance). The six E’s are an evolution from what began as 4 C’s (i.e., compassionate, caring, competence and connected) at our strategic meeting. As we move forward, it is critical that the public continue to view psychologists in a positive light and hold a high degree of confidence in our work as a profession. My confidence in the work of the College has flourished with my increasing knowledge of the multitude of tasks and accomplishments that are undertaken daily by staff and volunteers. My term as President will focus on the “E” that stands for Engage – in other words, I want to foster better connections between our members so that we may better serve the public interest. Regulated members who are engaged with the profession are better able to collaborate, consult, refer and learn within and outside of our practice areas and field. Engagement allows to us to benefit for the collective knowledge of the profession of psychology. More importantly, research indicates that engaged psychologists are better able to serve the public good. It is important to build upon the synergy between the College and the PAA that has been growing over the past 18 months. While each organization has their own mandate, they are unified in efforts to enhance the profession which in turn serves the interests of the public. Our continued shared educational opportunities are one avenue to share our public and member interests. Finally, during the current year, let us find opportunities to celebrate the many and diverse significant contributions our members are making to the mental health of all Albertans. The recent CAP/PAA joint professional development day is a reminder of just how many skilled and committed psychologists there are in Alberta and that we can do so much more for the public and the profession together rather than as individuals. College Council looks forward to continuing our work together to serve the public interest.
Kevin Alderson, PhD, RPsych President
College News The College welcomes our new Members-at-Large and looks forward to their contributions to Council. The College says goodbye to Hanita Dagan, Lorraine Stewart and Roger Gervais and the significant and valuable contributions during their time on Council. They will be missed. Council ratified that Kevin Alderson moves to the position of President, Kerry Mothersill to the position of President-Elect and Paul Jerry to the position of Past-President. We welcome Reagan Gale as the new Treasurer.
Farrel Greenspan grew up in Johannesburg, South Africa, and lived
there for fifteen years before immigrating to Canada. He completed his Master’s degree in counselling psychology at City University. As well, he has also completed two Bachelor degrees, one with a major in Psychology from the University of Alberta and a Bachelor of Management and Organizational Studies with a specialization in human resources from the University of Western Ontario. A registered psychologist in Edmonton, Farrel owns and operates his private practice. He specializes in working with depression, anxiety, as well as ADHD, PTSD, Bipolar Disorder and Borderline Personality Disorder.
Kathleen Kelava graduated from Saint Mary’s University in 2001 with
a Bachelor of Commerce degree (Small Business & Entrepreneurship). She moved to Calgary to begin recruit training with the Calgary Police Service, with which she was a sworn member for just over 6 years. Next, she spent several years at home raising her 3 boys with her husband. During this time, she completed her Master of Counselling degree (thesis route) through Athabasca University and was a Masters Intern, Provisional Psychologist, and Staff Psychologist at Foothills Academy. She now operates Prevail Psychology with Christina Groth.
Greg Schoepp is a registered psychologist with the Stollery
Children’s Hospital where he consults with children, teens, and their parents on coping with acute or chronic illness as well as mental health issues. Current supervision responsibilities include University of Alberta psychology practicum students and psychology residents in the Edmonton Consortium Clinical Psychology Residency Program and previously, psychiatry residents. He and Shandra Taylor co-chair the Edmonton Zone Psychology Professional Practice Council for Alberta Health Services. With the College, Dr. Schoepp and Dr. Jill Turner, cochaired the Registration Approvals Sub-Committee, which includes sitting on the Substantial Equivalency Sub-Committee. He was also a member of the College’s Complaints Review and Hearing Tribunal Committee. Outside of work, he enjoys volunteer bike repair at Sports Central, hiking, biking, and back country skiing.
College Staff Changes The College is pleased to welcome Sheri Price as the new Registration Assistant and Oral Examination Coordinator. She is replacing Danielle Salame, who will be missed.
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AGM 2018 Feedback
“I have planned a conference of similar size before, and I appreciate how much work each and every one of the members of the planning committee has clearly put in to this day. It is evident with how well it flowed and how clear and well thought out every element was.”
“I valued the opportunity to network and connect with colleagues.” “Openness of the profession in bringing in new and engaging speakers.”
Click HERE for the speaker handouts available on the CAP website!
“Glad that the PAA and CAP are working together and combined their annual events!”
“I was thrilled and am exceptionally grateful for the most thoughtful/best menu choices, and quality of GF/DF food (throughout the whole day) that I have ever had, at any professional event.” www.cap.ab.ca
CAP & PAA Annual Meeting and Professional Development Day 2018 Highlights This year, 350 regulated members, researchers, students, allied health professionals, and invited guests gathered in Calgary to network and participate in sessions addressing Evidence-Based Psychological Practice. Local, provincial, and national leaders shared their research and insight on a variety of topics bringing invaluable awareness to contemporary issues facing practicing psychologists. For the first time, this event was co-hosted by the College of Alberta Psychologists and Psychologistsâ€™ Association of Alberta and involved access to current practitioner research, invaluable networking opportunities, promotion of books authored by local psychologists, and much more. Notably, the Deputy Premier and Health Minister, the Honourable Sarah Hoffman provided greetings on behalf of the Alberta Government followed by a land acknowledgment and prayer by Metis Elder Sky-Blue Morin. Following the annual meetings and official welcome were the morning speakers. Dr. David Dozois offered the keynote address on Evidenced-Based Practice of Psychological Assessment and Treatment. Next was feature speaker, Dr. Derek Truscott, who addressed Improving Psychotherapy Outcomes: The Power and Potential of Feedback. The afternoon sessions created the opportunity for attendees to select speakers/topics of personal interest. Speakers included: Dr. David Dozois (EvidencedBased Treatment for Depression), Dr. Deborah Dobson (Evidenced-Based Practice for Anxiety), Dr. Candace Konnert (Geropsychology) and Dr. Karlee Fellner (Indigenizing Psychology). Returning together as a large group, attendees had the opportunity to hear from five Enlightening speakers using a unique format that is intended to be informative, concise, fast-paced, and energizing. In order of presentation: Dr. David Hodgins (Cannabis
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and Opioids); Ms. Sonia Fines (Gender and Sexuality); Dr. Sophie Yohani (Refugees); Dr. Dennis Pusch (Adverse Childhood Experiences); and Dr. Jaleh Shahin (Psychology in Primary Care). Feedback from the attendees was plentiful (approximately 31% response rate) and overwhelmingly positive. The majority (78-92%) of speaker ratings and comments positively highlighted the content, quality, and diversity of speakers. This year, there were 11 speakers, 8 researchers, and even more published authors ready to share their experiences and insight. As to be expected with this many knowledgeable and passionate colleagues, it is understandable that a handful of folks suggested ‘that the day felt rushed.’ From a planning perspective, the record-breaking registration numbers meant the planning committee engaged in ongoing decision-making. The remarkably positive feedback (90%+ satisfaction) in areas such as advertising, ease of registration, event space, and event check-in desk recognizes the invaluable efforts of staff from both organizations to make the day a success. Twenty percent of registrants identified dietary requests and the venue provided an outstanding selection of food choices and meal accommodations. Feedback from the survey indicated a 96% satisfaction with the meals and 91% satisfaction with hotel accommodations. Lastly, many respondents highlighted the renewed relationship between the College of Alberta Psychologists and the Psychologists’ Association of Alberta as a positive development. Indeed, the planning and hosting of this first co-hosted professional development day required (and benefited) from the collective vision, wisdom, and efforts from both organisations over the past year. And with that being said, the success of hosting an event like this extends beyond the planning team which, along with our respective staff, we whole-heartedly thank. We would also like to extend our appreciation to Sarah Meade, Event Sales and Planning Manager at the Hyatt Calgary along with her team. Throughout the planning and delivery, they offered valuable insight and smoothed out wrinkles. Lastly (and most importantly), we thank each of you who joined us in our collective efforts to promote currency in Evidence-Based Psychological Practice! Deena Martin CAP Planning Committee
Improving Psychotherapy Outcomes: The Power and Potential of Feedback By Derek Truscott, PhD, RPsych University of Alberta
Psychotherapists are often asked if we get depressed listening to people’s problems all day. They don’t realize that although we do hear about a lot of troubles, we are usually able to help alleviate them. Often very much so. Which, far from being depressing, is a very gratifying way to spend our days. The research on psychotherapy outcomes tells us that we have good reason to feel good about what we do. Eighty percent of our clients are better off than they would have been if they hadn’t received psychotherapy (Wampold & Imel, 2015). Fifty percent experience a resolution of the problem that prompted them to seek our help (Wampold & Imel). Improvement is usually forthcoming within the first few sessions, and clients typically get better after a dozen sessions (Haas, Hill, Lambert, & Morrell, 2002). Most even find that they continue to get better after they finish therapy (Wampold & Imel). And the benefits last for years if not lifetimes (Hansen, Lambert, & Forman, 2002). So, overall the state of affairs is a good one. We might even say that there is no problem that needs fixing. Yet we all attend talks, read books, and watch videos in an effort to learn how to do therapy better. We want to help more clients. After all, the flip side of our 50% success rate is a 50% failure rate. There is, in other words, room for improving psychotherapy outcomes. In fact, it is possible to achieve measurable benefit for as many as 90% of our clients, and significant clinical improvement for 75% (Barkham, Lutz, Lambert, & Saxon, 2017). Imagine how fulfilling our careers would be if three out of four clients had their problems resolved. While we might worry about curing ourselves out of a job, only a fraction of those who could benefit from our help ever get it (Andrews, Issakidis, & Carter, 2001). And the most common reason people give for not seeking psychotherapy is doubts about its effectiveness
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(Vogel, Wester, Wei, & Boysen, 2005). If it were to become known that we help 90% and cure 75% of our clients, I think we can reasonably expect that our caseloads would remain full. How are therapists able to achieve a 75% success rate? Well, it’s not by choosing any particular profession, earning any particular degree, accumulating any particular amount of experience, adopting any particular theoretical orientation, or achieving competence in any particular form of therapy (Baldwin, Holtforth, & Imel, 2017). It’s not some quality or qualification they possess. It’s what they do. And what they do is pay very close attention to each particular client’s experience in order to ensure they are benefitting fully from therapy (Hansen, Lambert, & Vlass, 2015). Because the client’s experience of therapy is where change happens (Miller, Bargmann, Chow, Seidel, & Maeschalck, 2016). Objective measures such as demographics or diagnosis do not predict therapeutic outcomes (Wampold & Imel). What determines whether a client will benefit from psychotherapy is their subjective experience of (1) working with a credible therapist, (2) receiving a helpful explanation of their problem, (3) collaborating toward meaningful goals, and (4) participating in a useful solution to their problem (Frank, 1982). As a group, therapists read people’s minds better than most. But it is a common occurrence that we never quite manage to understand something important about a client. Sometimes we don’t grasp their problem. Sometimes we don’t catch that they are placating us and not saying what they really think or feel. Sometimes they discontinue therapy with no forewarning or explanation. Most concerningly, sometimes they get worse and we don’t notice (Hatfield, McCullough, Frantz, & Krieger, 2010). We often simply don’t know what’s going on inside our client’s head, and our ability
to help them is impeded to the extent that we are mistaken about their experience of therapeutically significant processes. What will improve our effectiveness is reliable information about those aspects of the client’s experience that are related to psychotherapy outcomes. Think how a physician uses simple instruments to assess a patient’s temperature, respiration, pulse, and blood pressure. If we can assess each client’s “therapeutic vital signs” and adapt treatment accordingly, our outcomes will improve. Picture having a snapshot of a client’s experience of therapy that looked something like this:
In this example we would know that the client sees us as a credible source for help and that we are doing a pretty good job of collaborating toward goals they value. We would also know that the explanation we have offered doesn’t fit all that well for the client, that they don’t consider the solution we have proposed to be particularly useful, and that their overall level of distress is in the clinical range. Revisiting our explanation of the client’s problem is indicated and doing so will probably necessitate a needed change of our proposed solution. We’ll know from the client’s subsequent feedback if we’ve made the right adjustments to these aspects of therapy, and if the client’s wellbeing improves in response. Note that these vital signs are relevant to all forms of psychotherapy. Some caution is warranted, however. For starters, we don’t fully understand all of the processes that produce therapeutic gains. Those we seek feedback on will displace others that could be more
important. Also, feedback can discourage therapist risk-taking and innovation by encouraging “treating to the test.” Perhaps most significantly, Campbell’s law states that any indicator used by a third party (such as a hospital board or insurance company) for decision-making is subject to corruption pressures that degrade the process it is intended to monitor in proportion to how high the stakes are (Muller, 2018). We therefore ought not use feedback to evaluate therapists. Doing so will diminish the very outcomes we seek to improve, as well as our occupational satisfaction. Much better for everyone is collaborating with our clients to provide feedback that is meaningful for them, not anyone else. The best role for feedback is probably in the training of therapists from the outset, through continuing education, and in supervision. Formative and normative feedback provide powerful opportunities for learning how to be more helpful (Grossl, Reese, Norsworthy, & Hopkins, 2014). Even here collaboration will be crucial to mitigate any effects of high-stakes monitoring. Talking to people about their problems and being able to help them overcome those problems is a source of justifiable professional pride and satisfaction. Obtaining client feedback has the power to enable us be even more helpful, and promises to increase the already generous rewards of practicing psychotherapy.
Derek Truscott, PhD, is a Professor and Director of Training of Counselling Psychology at the University of Alberta and a Registered Psychologist. He is the author of three books, including Ethics for the Practice of Psychology in Canada, Ethics and Law for Teachers, and Becoming an Effective Psychotherapist, as well as many book chapters, articles, and conference presentations on the topic of being a good— that is, ethical and effective—psychologist. He has practiced, researched, taught, lectured, and written about professional psychology for over thirty-five years. www.cap.ab.ca
Why We Need to Talk About Psychology in Primary Care By Jaleh Shahin, PhD, RPsych University of Alberta My first exposure to a primary care clinic as a psychology graduate trainee happened by accident. I was looking for volunteer opportunities and stumbled across a student-run interdisciplinary medical clinic that was serving the inner-city youth of Edmonton. It was through that experience that I progressively learned more about primary care settings and working collaboratively with other healthcare professionals. The more I learned about psychology in primary care, the more conviction I found in the belief that primary care is an essential avenue for psychologists to advocate for the profession and the clients they serve. Here are the top five reasons why I believe every psychologist, whether they work in primary care or not, should advocate and talk about primary care psychology:
In a study exploring the attitude of Canadians towards psychologists and access to psychological services (Ekos, 2011), participants were asked if they decided to access the services of a psychologist how they may go about finding one. A staggering 78% of the participants identified going to their family physician to access a psychologist.
1) Primary care is the first point of contact for most Canadians experiencing mental health difficulties
Family medicine in Canada is faced with a growing demand for mental health resources while experiencing significant challenges in accessing appropriate consulting services (Peachy, Hicks, & Adams, 2013). Many physicians feel uncomfortable in providing counselling services themselves due to a number of factors including time constraints, inadequate mental health and psychological intervention training, perceived pressure to address physical health concerns and personal preferences (Chodos, 2017; Grenier & Chomienne, 2006).
Every year, 20% of Canadians are estimated to suffer from a mental illness or substance use concern (Smetanin, Briante, Stiff, Ahmad, & Khan, 2011). By age 40, about half of the Canadian population will experience or have had experienced a mental illness (Smetanin et al., 2011). The Mental Health Commission of Canada (2017) clearly articulates that there is a “significant unmet need” for treatment and resources for Canadians experiencing and living with mental health difficulties. This unmet need is especially pronounced in accessing evidence-based psychological interventions and counselling services. Most Canadians access support services for their mental health concerns through their family physicians. Approximately 50% of family physicians’ time is concerned with mental health problems and they are the single source of support in roughly 84% of individuals seeking mental health services (Chodos, 2017).
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These studies leave little doubt that in the current Canadian mental health services landscape, family physicians in primary care settings are predominantly the first point of contact for Canadians seeking mental health services.
2) Medicine and Psychology are natural and complementary allies (Grenier & Chomienne, 2006)
This has led to a severe gap in addressing the needs of many individuals who require psychological interventions and counselling. Peachy et. al (2013) described the fragments and challenges in mental health service delivery in Canada as a “silent crisis.” Integration of psychologists in primary care settings can bridge the gap between demand for mental health services and challenges in accessing appropriate resources. Physicians are interested in collaborative and interdisciplinary care of patients, and psychologists in primary care can offer patients the interventions and supports that are needed (Grenier & Chomienne, 2006).
“Physicians are interested in collaborative and interdisciplinary care of patients, and psychologists in primary care can offer patients the interventions and supports that are needed.” 3) Stronger together As a psychologist who has worked on multidisciplinary teams since my early training years, I have had the privilege of witnessing firsthand the strength in advocacy for the best care of patients as a collaborative team. Integration of psychologists in primary care allows for a sense of community on healthcare teams. We are no longer seen as a separate, fragmented service, but as a core component of a patient’s healthcare. Therefore, when advocating for mental health services locally, provincially or nationally, the advocacy is far more effective when a much broader group of healthcare professionals are advocating for improving service delivery. Other healthcare professions including but not limited to medicine, nursing, and pharmacy are allies that can strengthen our advocacy efforts in improving the Canadian mental health system.
4) Primary care psychology increases the visibility of the profession In addition to having other healthcare professional groups working as allies to advocate for the best care of patients, primary care psychology enhances the visibility of the profession of psychology. Working alongside our colleagues from other healthcare professions, primary care psychologists can help in establishing mental health as a crucial component of our healthcare system.
5) Primary care psychology provides opportunities to enhance psychological literacy in other healthcare professions. Medical education emphasizes collaborative care with allied health professions. There are courses offered during medical, nursing and other healthcare programs that focus entirely on multidisciplinary practice and how to effectively work together as a team. In my experience, formal opportunities for psychologists and/or psychology graduate trainees to participate in multidisciplinary education and training have been fairly limited. As a result, other
healthcare professionals’ knowledge of the role of psychologists, their training and skills are primarily reliant on the individual healthcare professional’s interest and initiative to seek out this information. As a profession, we need to do more to educate and communicate with our healthcare colleagues about our profession, credentials and skills. Primary care psychology provides a unique opportunity to improve the psychological literacy of our colleagues by offering information about the profession of psychology but also enhancing awareness of psychological and behavioural interventions. This will only serve to strengthen the quality of care for patients as well as strengthening the relationships on healthcare teams. The reasons why I believe every psychologist should advocate for primary care psychology are abundant. For me, advocating for a better mental health system is the embodiment of the fourth ethical principle of “Responsibility to Society” as outlined in the Canadian Code of Ethics for Psychologists! My hope in writing this article is to begin a conversation around ways that we can advocate for our profession, our colleagues, the clients we serve and every Canadian and their family who is affected by mental illness.
Jaleh Shahin, PhD, is the in-house psychologist for the Faculty of Medicine & Dentistry at the University of Alberta as well as a consulting psychologist at Copeman Healthcare Centre. Dr. Shahin has extensive experience working as a mental health professional in a wide variety of settings including: hospitals, community mental health clinics, medical clinics, primary care settings, university counselling centers, and private practice. Over the past 7 years, Dr. Shahin’s research and clinical practice have primarily focused on issues related to medical professionals’ mental health and well-being across the continuum of their training.
Evidence-Based Practice for Anxiety and Related Disorders By Deborah Dobson, PhD, RPsych University of Calgary
Anxious clients are common in virtually all clinical practices as anxiety is a familiar human experience and the most frequently experienced and diagnosed group of mental health problems. All psychologists will encounter anxious clients in their practice whether or not they typically use a diagnostic system, such as the DSM-5 (American Psychiatric Association, 2013). As psychologists, we want to provide the best therapy for our clients, consequently, this brief paper reviews the current outcome literature to help determine the most empirically supported treatments for all of the anxiety disorders diagnosed in adults. These include specific phobia, social anxiety disorder, panic disorder and generalized anxiety disorder. While obsessive-compulsive disorder and trauma related disorders are no longer included within the DSM-5 anxiety disorders, they will also be briefly touched upon. The treatment with the most empirical support for the anxiety disorders is cognitive behavioural therapy. As the literature in this area is vast, selected meta-analytic studies are only included. Dobson, McEpplan and Dobson (in press) provide
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a comprehensive review of the literature. As readers are likely aware, clinical practice guidelines, such as those provided by the National Institute for Health and Care Excellence in the UK and implemented by the Improving Access to Psychological Therapies, typically recommend cognitive behavioural (CBT) approaches and usually recommend against the use of benzodiazepine medications for anxious clients (Clark, 2011). Finally, the common elements of the treatments will be described so that these elements can be utilized in clinical practice.
Specific Phobia CBT, particularly exposure therapy is a widely accepted approach for clients presenting with specific phobias. Wolitzky-Taylor, Horowitz, Powers and Telch (2008) conducted a large metaanalysis, comparing 90 treatments with over 1100 participants. Treatment was generally brief, with an average just over 3 sessions and the majority of the studies used exposure therapy, particularly in vivo exposure. This treatment demonstrated significant benefits to participants compared to wait-list control, no treatment as well as to other treatments. Multiple sessions were also found to be more helpful than a single session, leading to longer lasting effects measured at follow-up. There are no other treatments recommended for specific phobia, including prescribed medication treatment.
Social Anxiety Disorder Social anxiety disorder (SAD) is common and can be very disabling, often presenting with other problems such as depression and substance abuse. CBT typically includes exposure therapy, cognitive techniques and anxiety-management. Several studies have shown that both CBT and pharmacotherapy are effective, as are group and individual treatments. In their summary of five meta-analyses, Rodebaugh, Holaway and Heimberg (2004) reported moderate to large effect sizes for CBT. Canton, Scott and Glue (2012) found that CBT and medication showed similar results immediately following treatment, but these outcomes were only maintained for CBT at followup. They concluded that while CBT and medications were most helpful and generally recommended, other therapies such as interpersonal therapy or mindfulness may be useful for those who do not respond to CBT. Exposure, cognitive restructuring with and without exposure, and social skills training also appear to not differ in efficacy (Taylor, 1996). Differences among the components of CBT treatments are difficult to determine from the above meta-analyses. CBT which incorporates cognitive restructuring and exposure may be the best supported psychological treatment for SAD.
Panic Disorder and Agoraphobia Bandelow, Seidler-Brandler, Becker, Wedekind et al. (2007) compared medication, psychological and combined interventions for the treatment of panic disorder with or without agoraphobia. Medication treatment or CBT alone, and their combination, demonstrated strong effect sizes from pre- to post-treatment on both clinician and self-report ratings. The combination of CBT with medication was more effective than CBT alone. Another large meta-analysis examined the efficacy of CBT (exposure and cognitive restructuring), medication, and their combination for treatment of Panic Disorder (Mitte, 2005). Both treatments were found to be very effective. The inclusion of cognitive elements to behavioural ones did not lead to reduced anxiety, however, the combination did lead to more reduction for depressive symptoms. This paper suggested that CBT is at least as effective as medication treatment. While there are individuals for which either CBT or
pharmacotherapy may be more helpful, there were no important differences between CBT, behaviour therapy or pharmacotherapy in terms of treatment outcome (Mitte, 2005). Contrary to the findings of Bandelow et al. (2007), the combination of CBT and medication was not more effective than CBT alone, either at the completion of treatment or follow-ups of over one year.
Generalized Anxiety Disorder In a large meta-analysis that included over 40 studies, Cuijpers, Sibandji, Koole, Huibers et al. (2014) compared CBT to wait-list controls, applied relaxation and pharmacotherapy. CBT was effective for the reduction of both the symptoms of generalized anxiety and depression. The clinician rated outcomes were somewhat better than the self-reported results. CBT showed similar results compared to applied relaxation in the short-term, but was potentially more effective over the longterm. Face-to-face treatments showed similar results compared to internet delivered treatments. CBT appears to be effective in the treatment of GAD in adults; in fact, the results show there were large reductions for anxiety and depression as well as the key symptom of worrying for both self and clinician ratings. CBT showed somewhat better results compared to pharmacotherapy, however, this finding was nonsignificant.
Obsessive-Compulsive Disorder Obsessive-compulsive disorder (OCD) has been removed from the DSM-5 section on anxiety disorders into its own category, entitled ObsessiveCompulsive and Related Disorders. As the core feature of OCD is anxiety, this problem is included in this review. A number of meta-analytic studies have examined CBT for OCD. Olatunji, Davis, Powers and Smits (2013) included 16 randomized clinical trials in their study that examined treatment effects as well as outcome moderators. CBT was compared to placebo treatments or wait-list controls. CBT demonstrated very positive effects compared to control groups showing strong large effect sizes following treatment. In the comparison for outcome moderators, such as depression symptoms, there was a medium effect size for CBT. The outcomes for cognitive therapy were similar to exposure and response prevention, although
it should be noted that ERP typically leads to cognitive change and vice versa. There was no significant association between initial symptom severity and outcomes. McKay, Sookman, Neziruglu, Wilheim et al. (2015) found that CBT appears to have lasting effects over time. As ERP is typically used for OCD, most of the trials in their meta-analysis included ERP, whereas fewer trials included cognitive components. Consequently, it was somewhat difficult to separate the differential efficacy of behavioural versus cognitive treatments. They did conclude that about half of the people experiencing OCD will benefit from ERP alone, although the added use of cognitive elements may improve other problems, such as distress tolerance and dysfunctional beliefs. As ERP can lead to anxiety, the addition of cognitive elements may also reduce treatment drop-out. Even with these positive results for CBT, there is room for improvement, as almost 1/3 of people with OCD (McKay et al., 2015) do not respond to any evidence-based treatment.
Post-traumatic Stress Disorder Post-traumatic Stress Disorder (PTSD) has also been removed from the anxiety disorders into distinct category entitled Trauma- and StressorRelated Disorders. Several studies have compared the outcomes for eye movement desensitization reprocessing (EMDR) to specialized types of CBT for the treatment of PTSD. In a large meta-analysis, Chen, Zhang, Hu and Liang (2015) investigated the symptom clusters of intrusion, avoidance and arousal for PTSD. Overall, EMDR had slightly better outcomes compared to trauma-focused CBT (TFCBT) and showed strongly results better for intrusive symptoms (e.g., visual flashbacks), was somewhat better for arousal and approximately equal for avoidant symptoms. These results make sense, as EMDR specifically targets intrusive symptoms. TFCBT tends to focus more upon different types of avoidant symptoms compared to EMDR. While EMDR tends to follow similar protocols across studies, there are a number of variants of TFCBT. TFCBT includes treatments such as prolonged exposure as well as cognitive processing therapies (Chen et al., 2015). In a broader study, Ehring, Welboren, Moring, Wicherts et al. (2014) compared over 15 randomized
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clinical trials that investigated different types of psychological treatments for PTSD in adult survivors of sexual abuse. They found that there were strong effects for psychological treatments generally, and these positive results continued to be present at follow-up. All of the active treatments showed moderate to large effect sizes in the reduction of symptom severity, including PTSD, dissociation, depression and general anxiety. Individual and specialized, trauma-focused treatment showed stronger effects compared to group and non-trauma-focused CBT or other nonspecialized treatments.
Summary and Key Points •
Cognitive behavioural interventions are very effective, first line treatments for all anxiety disorders, OCD and PTSD; CBT has been widely studied and is generally the treatment of choice for all anxiety problems, with the possible exception of EMDR for PTSD; It is difficult to determine the effective ingredients of CBT, although exposure to feared stimuli (either internal or external) is likely very important for recovery; Although not reviewed in this paper, therapeutic alliance is essential for any effective treatment for anxiety. For a review of therapeutic alliance in CBT, see Dobson and Dobson (2017).
Deborah Dobson, PhD, is an Adjunct Professor in the Department of Psychology, University of Calgary and has a private practice providing psychotherapy to adults with mental health problems as well as psychological assessments. Up to 2013, she was the Director of Clinical Training for the Calgary Clinical Psychology Residency Program. She is a founding member and served on the board of the Canadian Association of Cognitive Behavioural Therapies from 2010 until 2016. She began the first Certificate in CBT program in Western Canada through the University of Calgary in 2014. She has served in several roles on the Board of the Canadian Mental Health Association—Calgary Region and was awarded the Governor General’s Caring Canadian Award in 2015 for her volunteer work.
Collaborative Research and Practice with Alberta’s Refugee Community By Sophie Yohani, PhD, RPsych University of Alberta
Between November 2015 and February 2017, Canada received an unprecedented 40,000 Syrian refugees (Citizenship & Immigration Canada, 2017). While there is awareness that Syrian refugees have had traumatic experiences that may shape their psychosocial adaptation to Canadian society, the tendency to overemphasize Post-traumatic Stress Disorder (PTSD) as the foremost factor impacting their adaptation can be misleading and potentially harmful. I am not suggesting that the Syrian people have not encountered trauma. Syrian refugees have experienced atrocities that threatened feelings of safety in their communities, with studies reporting a range of psychological difficulties (see Ahmed, Bowen, & Xin Feng, 2017; Ghumman, McCord, & Chang, 2016; Hassan et al., 2015; Yohani, Kirova, Georgis, Gokiert, Mejia, & Chiu, 2017).
My argument is that the association of refugee trauma to PTSD can contribute to three misconceptions regarding refugee mental health and experiences. First, it presents a rather simplistic view of the experience of mass violence, conflict, and dislocation. Second, this view places restoration of safety, and clinical treatment of the individual, as the main pathway for rebuilding of life in Canada. Lastly, it sets up a binary view of refugees as either traumatized and victimized “others” in need of help, or resilient, “heroic” individuals who can somehow manage on their own. In my clinical experience and research, both can be present, often requiring a dialectical (vs. binary) perspective and appreciation of the complexity of the refugee experience.
My current research intervenes in this discourse by seeking a more complex understanding of refugee psychosocial adaptation and integration after mass violence and trauma. I posit that psychologists, who have a deepened understanding and sensitivity to these complexities, are best prepared to work with this population. My projects use community-based participatory research approaches grounded in principles of collaboration, relationality, and cocreation of knowledge (Freire, 1990; Higginbottom & Liamputing, 2015) to articulate the lived experiences of refugees, while empowering them to lead their healing and integration processes.
From Simple Assumptions to Complex Realities Refugee trauma is multifaceted. The resettlement and integration process is equally complex. In most parts of the world where recent civil war and genocide have taken place, there are complex social and political histories associated with these conflicts, some of which include slavery and colonialism whose impacts continue to reverberate across generations. An understanding of the unique contextual factors and collective/individual experiences associated with them is necessary - as these are often reflected in the concerns, meanings, and narratives of refugees. Beyond safety concerns, mass violence and community destabilization in conflict and post-conflict environments threatens four other psychosocial domains that are universally important for psychological wellbeing (i.e., justice, relationships, existential meaning, and identity) (Silove, 2005). In most cases, these threats occur as a collective experience. Both during and in the aftermath of conflict, individuals and communities attempt to adjust to new information and experiences (i.e., adapt), by learning and adopting new behaviours to cope with change and changing environments (Silove, 2013; Yohani, 2015). Relocation and resettlement in a new environment, while necessary, presents additional challenges to refugees as they are not able to reconfigure these psychosocial domains in a familiar manner and context. Furthermore, the common Canadian newcomer integration models are conceptualized in terms of long-term health, education, housing, and employment outcomes, and do not address psychosocial issues or the impact of pre-migration experiences on adaptation.
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This is why the overemphasis on PTSD as the main mental health framework for understanding refugee psychosocial concerns, risks presenting a singular clinical solution to what requires multifaceted and holistic solutions. So how do we address refugee mental health and trauma in a manner that does not create misconceptions, perpetuate stereotypes, and suggest simplistic solutions? There are no easy answers. One approach is to learn by working alongside those who have a lived expertise with these experiences - the refugee communities themselves. This collaborative approach also allows the sharing of knowledge both from western psychology and knowledge systems from cultures and countries represented by refugees. Below is an example of one such project.
The Syrian Mental Health Training & Support Project This pilot project was a collaborative effort between with Multicultural Health Brokers Cooperative (MCHB), Catholic Social Services (CSS), The University of Alberta, and members of the Syrian community in Edmonton. The goal was to mentor natural leaders among the Syrian community to build their communityâ€™s capacity to support mental wellbeing and increase access to mental health services during early resettlement. Ten leaders (representing diverse Syrian groups including Assyrian, Kurdish, Christian, Muslim, men, women, seniors, and youth) worked over a year with me (Dr. Yohani) and an Arabic-speaking bi-cultural broker who was familiar with, and trusted by, Syrian community members. These natural leaders participated in developing a trauma-informed curriculum using the Adaptation and Development After Persecution and Trauma (ADAPT) model (Silove, 2013; Yohani, 2014). This is a conceptual framework that highlights the previously mentioned psychosocial domains (safety, attachment/bonds, identity, justice, and existential meaning) most often impacted during times of conflict and mass violence. This model is non-binary (focuses on both resilience and trauma) and also takes into consideration pre- and postmigration contexts affecting mental healthÂš. Our train-the-trainer mental health promotion strategy hoped to break down barriers to seeking and
accessing mental health services by enhancing community capacity and shared knowledge during early resettlement. In a post-conflict environment, early attention to these pillars both within the individual and collective contexts can be essential to restoring psychological and social wellbeing (Silove, 2013).
Project Activities Consisting of two phases, the first phase of training involved reviewing each of the five domains of the ADAPT model with the leaders, and reflecting on these domains in relation to the Syrian experience and culture. After initial adaptation of the model, the leaders replicated the training through learning circles with small groups of community members, during the second phase. Leaders continued to meet with me to further refine the model using input from community members during this second phase. Over the course of a year, approximately 50 newly arrived Syrian community members of different ages, religions and ethnicities, participated in small group discussions on topics related to identity, safety, relationships, justice and meaning. Leaders and community members involved in this pilot project also received information on accessing mental health services and supports.
are often areas of silence in refugee groups. As a result of this pilot project, we were able to gather enough information to determine that this community-based mental health model has potential with the Syrian population. We have now received Social Sciences and Humanities Research Council (SSHRC) funding to complete a formal study on this model, and to develop a curriculum that can be adapted and used with other refugee communities.
Project Learnings and Future Research The result was rich and deep discussions amongst community members and the identification of key strengths and challenges faced by members during early resettlement. Importantly, the community itself articulated challenges (vs. a public discourse purporting a single narrative) within their own cultural understandings of psychosocial issues. The community capacity building effort showed potential as a powerful approach to post-conflict adaptation, centered within a mental health promotion framework that integrates relevant cultural and contextual factors. This approach also encourages community dialogue around experiences of trauma and mental health, which
Sophie Yohani, PhD, is an associate professor of counselling psychology with an interest in multicultural counselling and the mental health of refugees and migrants. Her current projects use community-based participatory approaches to explore psychosocial adaptation after mass violence and trauma with members of the Rwandese and Syrian communities in Edmonton.
An important aspect of this model is its recognition that many initial reactions to threats to these psychosocial domains are
normal responses under the circumstances in which they take place. Mass trauma is associated with the breaking down of normal coping mechanisms that help to sustain these domains, both within the individual and within the environment. When there arenâ€™t resources available either internally or within the environment to restore coping mechanisms, peopleâ€™s ability to adapt decreases, and what was initially a normal attempt to adapt becomes maladaptive, and can lead to the development of mental health disorders.
Member Consultation: Practice Guidelines Feedback Summary Spring 2018 By Deena Martin, Director of Professional Guidance
In the spring, the College of Alberta Psychologists Practice Advisory Committee released three new and/or revised practice guidelines for feedback to the members. The survey was distributed on April 12, 2018 (along with The CAP Monitor) and remained open until May 1, 2018. Following is a summary of the feedback on the surveys as well as from the consultation process. Eighty (80) surveys were completed online: Disclosure (34 surveys submitted), Telepsychology (28 surveys submitted), and Medical Assistance in Dying (18 surveys submitted). Four CAP members followed up with additional feedback (i.e., two phone calls and two emails). Overall, the Spring 2018 Member Consultation yielded positive feedback on the PAC’s efforts to provide helpful practice guidelines. Specifically, 91% of all respondents across all three practice guidelines indicated they found the guidelines to be helpful. As expected, there was some constructive feedback offered on the guidelines that informed minor but important revisions to the three documents. The focus of the feedback ranged from requests for further regulatory clarification, comments on the impact to practice, and general remarks on writing style.
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Feedback was also offered regarding the member consultation process. Specifically, one of the callers asked for more clarity in the description of the member consultation process as well as advocated for a longer period of time to provide feedback. The Practice Guideline: Disclosure of Personal or Confidential Information garnered 40% of the feedback survey provided. Of those who responded, 93% reported finding the practice guideline as helpful or very helpful. One respondent reported that the guideline was neither helpful/unhelpful, and one respondent reported that the guideline was somewhat unhelpful/very unhelpful. Following is a sample of some of the qualitative positive comments: •
“This clarifies many areas of disclosure that have previously not been as clear in terms of the standards, guidelines, and ethical expectations. This provides more straightforward information for specific areas that psychologists have been asking about for years – for example the information about police requests, requests from lawyers who provide their own release form, etc. I am pleased to see this level of clarity.” “It is going into our policies and practice manual, and up on our “important documents
to review” server folder for clinicians to have easy access to. Thank-you!” “I appreciate the use of non-gendered language!” “Clear and well-detailed. It covers a wide range of disclosure circumstances that psychologists encounter. It will be useful for me as a clinical supervisor in mental health and its alignment with AHS.”
As with any guideline, there is room for further consideration and revision. Areas identified to be addressed by the PAC included: assessment (e.g., requested a statement about releasing copyrighted test materials and test scores, third-party contributors and consent), a statement addressing collaboration, and a need to re-examine the requests for third-party consent. The consistency across constructive feedback was helpful and will support the PAC in refining the sections identified for additional review at a later date. The Practice Guideline: Telepsychology received 35% of the total survey feedback, and also resulted in a handful of telephone inquiries regarding practicing psychology outside of Alberta. Of those surveyed, 95% reported finding the practice guideline as helpful or very helpful. The following is a sample of some of the qualitative positive comments: •
“Thank you for addressing the topic of technology and telepsychology as it is becoming an emerging ethical issue.” “It clarifies the jurisdictional boundaries for providing service.” “I like that it explicitly states that you can provide psych services using technology. Very clear on that point.” “Clear discussion of risks associated with telepsychology. Clear boundaries around service regulation for services delivered from other provinces or countries.” “Informative and comprehensive. Inclusive of all the relevant issues. Clear language and expectations.” “I felt the sections and informed consent, confidentiality, and ethics were strong.”
In terms of constructive feedback for the guideline, the feedback reflected clinical practice issues such as supporting clients who travel for work, or traveling clients who may call in from outside the psychologist’s jurisdiction in crisis. The Practice Guideline: Medical Assistance in Dying received 18% of the total survey feedback submitted. Even with the fewer surveys, there was noticeably less consistency in the feedback. Of those who responded, 78% reported finding the practice guideline as helpful or very helpful. The following is a sample of some of the qualitative positive comments: •
“… this guideline provides me with a wealth of important information, references, and even resources to begin to navigate this issue if and as needed in my own practice. I feel more confident in navigating the situation should it arise in my practice and I am reassured knowing that there is something from the College I can refer to in this area….” “I like the “Do/Don’t” list, the checklist, the links to resources, etc., a LOT.” “Thank you for this. Very helpful as there are panels working on MAiD for minors etc. so there is more to come. Especially regarding a person’s choice to receive MAiD and their choice to not disclose this to family.”
The constructive feedback requested additional clarity on the issues of when someone can and/or cannot talk about MAiD, and if there are additional informed consent processes associated with providing MAiD psychological services. Notably, there was also some concern with if psychologists are able to ‘consciously object’ to participating in MAiD. Insight was also obtained in regard to the member consultation process. In terms of Survey Monkey, it was effective in supporting data management (including analysis) and tracking data trends such as the response time line and response patterns over time. In closing, the College of Alberta Psychologists’ Practice Advisory Committee (PAC) would like to express their appreciation to those who provided
valuable insight and feedback on the three practice guidelines released for member consultation. As communicated previously, the process of soliciting member consultation is integral to several of CAP’s strategic goals.
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By inviting members to provide feedback on the practice guidelines, the College was able to: (a) ensure guidance that aligns with ethical principles and Standards of Practice, (b) engage and connect with our members, and (c) encourage psychologists in continuous learning.
Please click here for the CAP Practice Guidelines.
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If you need any assistance please contact the College at Deena Martin, PhD (in Special Education), RPsych, is the Director of Professional Guidance for the College of Alberta Psychologists. Since the early 2000’s Deena’s career has focused on the professional development of those in the helping professions. Her teaching portfolio includes undergraduate and graduate coursework in: professional ethics and law, counselling, leadership, research methods, and statistics. As well, she brings national and international insight into policies and practices informing psychology and regulatory bodies.
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References Page 10-11
Improving Psychotherapy Outcomes By Derek Truscott, PhD, RPsych
Andrews, G., Issakidis, C., & Carter, G. (2001). Shortfall in mental health service utilisation. The British Journal of Psychiatry, 179(5), 417–425. Baldwin, S. A., Holtforth, M. G., & Imel, Z. E. (2017). What characterizes effective therapists? In L. G. Castonguay & C. E. Hill (Eds.), How and why are some therapists better than others? Understanding therapist effects (pp. 37–53). Washington, DC: American Psychological Association. Barkham, M., Lutz, W., Lambert, M. J., & Saxon, D. (2017). Therapist effects, effective therapists, and the law of variability. In L. G. Castonguay & C. E. Hill (Eds.), How and why are some therapists better than others? Understanding therapist effects (pp. 13–36). Washington, DC: American Psychological Association. Frank, J. (1982). Therapeutic components shared by all psychotherapies. In J. H. Harvey & M. M. Parks (Eds.), The master lecture series. Vol. 1: Psychotherapy research and behavior change (pp. 5-38). Washington, DC: American Psychological Association. Grossl, A. B., Reese, R. J., Norsworthy, L. A., & Hopkins, N. B. (2014). Client feedback data in supervision: Effects on supervision and outcome. Training and Education in Professional Psychology, 8(3), 182–188. Haas, E., Hill, R., Lambert, M. J., & Morrell, B. (2002). Do early responders to psychotherapy maintain treatment gains? Journal of Clinical Psychology, 58(9), 1157–1172. Hansen, B. P., Lambert, M. J., & Vlass, E. N. (2015). Sudden gains and sudden losses in the clients of a “Supershrink”: 10 case studies. Pragmatic Case Studies in Psychotherapy, 11(3), 154–201. Hansen, N. B., Lambert, M. J., & Forman, E. V. (2002). The psychotherapy dose-response effect and its implications for treatment delivery services. Clinical Psychology: Science and Practice, 9(3), 329–343. Hatfield, D., McCullough, L., Frantz, S. H. B., & Krieger, K. (2010). Do we know when our clients get worse? An investigation of therapists’ ability to detect negative client change. Clinical Psychology and Psychotherapy, 17(1), 25–32. Miller, S. D., Bargmann, S., Chow, D., Seidel, J., & Maeschalck, C. (2016). Feedback informed treatment (FIT): Improving the outcome of psychotherapy one person at a time. In W. O’Donohue & A. Maragakis (Eds.), Quality improvement in behavioral health (pp. 247-262). Cham, Switzerland: Springer. Muller, J. Z. (2018). The tyranny of metrics. Princeton, NJ: Princeton University Press. Vogel, D. L., Wester, S. R., Wei, M., & Boysen, G. A. (2005). The role of outcome expectations and attitudes on decisions to seek professional help. Journal of Counseling Psychology, 52(4), 459–470. Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work (2nd ed.). New York, NY: Routledge. www.cap.ab.ca
Psychology in Primary Care
By Jaleh Shahin, PhD, RPsych
Chodos, H. (2017). Options for improving access to counselling, psychotherapy and psychological services for mental health problems and illnesses. Prepared for the Mental Health Commission of Canada. Cohen, K. R., & Peachy, D. (2014). Access to psychological services for Canadians: Getting what works to work for Canadaâ€™s mental and behavioral health. Canadian Psychology, 55 (2), 126-130. Ekos. (2011). Survey of Canadian attitudes toward psychologists and accessing psychological services [PowerPoint slides]. Retrieved from https://www.cpa.ca/docs/ File/Poll/Alberta%20Findings.pdf Grenier, J., Chomienne, M. J. (2006). Access to Psychotherapy in Ontario Family Health Teams: experiences from a Family Physician and a Psychologist [PowerPoint slides]. Retrieved from http://capqc.ca/sites/capqc.ca/files/uploads/articles/2014/c homienne_grenier.pdf Grenier, J., Chomienne, M. J., Gabouary, I., Ritchie, P., Hogg, W. (2008). Collaboration between family physicians and psychologists. 54 (2) 232-233. Peachey, D., Hicks, V., & Adams, O. (2013). An imperative for chance: access to psychological services for Canada (PDF]. Retrieved from https://www.cpa.ca/docs/ File/Position/An_Imperative_for_Change.pdf Smetanin, P., Briante, C., Stiff, D., Ahmad, S., Khan, M. (2011). The life and economic impact of major mental illnesses in Canada. Prepared for the Mental Health Commission of Canada. Toronto: RiskAnalytica.
Evidence-Based Practice for Anxiety and Related Disorders
By Deborah Dobson, PhD, RPsych
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders 5th Edition). Arlington, VA: Author. Bandelow, B., Seidler-Brandler, U., Becker, A., Wedekind, D., & RĂźther, E. (2007). Meta-analysis of randomized controlled comparisons of psychopharmacological and psychological treatments for anxiety disorders. The World Journal of Biological Psychiatry, 8(3), 175-187. Canton, J., Scott, K. M., & Glue, P. (2012). Optimal treatment of social phobia: Systematic review and meta-analysis. Neuropsychiatric Disease and Treatment, 8, ArtID 203 215.
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Chen, L., Zhang, G., Hu, M. & Liang, X. (2015). Eye movement desensitization and reprocessing versus cognitive-behavioral therapy for adult posttraumatic stress disorder: Systematic review and meta-analysis. Journal of Nervous and Mental Disease, 203, 443-451. Clark, D. M. (2011). Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: the IAPT experience. International Review Psychiatry, (4), 318-327. Cuijpers, P., Sijbandji, M., Koole, S., Huibers, M., Berking, M. & Andersson, G. (2014). Psychological treatment of generalized anxiety disorder: A meta-analysis. Clinical Psychology Review, 34, 130-140. Dobson, D. & Dobson, K. S. (2017). Evidence-Based Practice of Cognitive-Behavioral Therapy (2nd Edition). NY: Guilford Press. Dobson, K., McEpplan, A. & Dobson, D. (In press). Empirical validation and the CBTs. In Dobson, K. S. & Dozois, D. J. A. (Eds). Handbook of Cognitive-Behavioral Therapies (4th Ed.). NY: Guilford Press. Ehring, T., Welboren, R., Morina, N., Wicherts, J. M., Freitag, J. & Emmelkamp, P. M. G. (2014). Meta-analysis of psychological treatments for posttraumatic stress disorder in adult survivors of childhood abuse. Clinical Psychology Review, 34, 645-657. McKay, D., Sookman, D., Neziroglu, F., Wilhelm, S., Stein, D. J., Kyrios, M., Matthews, K. & Veale, D. (2015). Efficacy of cognitive-behavioral therapy for obsessive-compulsive disorder. Psychiatry Research, 225, 236-246. Mitte, K. (2005). A meta-analysis of the efficacy of psycho- and pharmacotherapy in panic disorder with and without agoraphobia. Journal of Affective Disorders, 88, 27-45. Olatunji, B.O., Davis, M. L., Powers, M. B., Smits, J. A. (2013). Cognitive-behavioral therapy for obsessive-compulsive disorder: A meta-analysis of treatment outcome and moderators. Journal of Psychiatric Research, 47, 33-41. Rodebaugh, T. L., Holaway, R. M., & Heimberg, R. G. (2004). The treatment of social anxiety disorder. Clinical Psychology Review, 24, 883-908. Taylor, S. (1996). Meta-analysis of cognitive-behavioral treatments for social phobia. Journal of Behavior Therapy and Experimental Psychiatry, 27, 1-9. Wolitzky-Taylor, K. B., Horowitz, J.D., Powers, M. B., & Telch, M. J. (2008). Psychological approaches in the treatment of specific phobias: A meta-analysis. Clinical Psychology Review, 28, 1021-1037.
Collaborative Research and Practice with Albertaâ€™s Refugee Communities By Sophie Yohani, PhD, RPsych Citizenship and Immigration Canada. (2017). Retrieved from http://www.cic.gc.ca/english/refugees/welcome/milestones.asp Ghumman, U., McCord, C. E., & Chang, J. E. (2016). Posttraumatic stress disorder in Syrian refugees: A review. Canadian Psychology, 57(4), 246-253. doi: 10.1037/cap0000069 Ahmed, A., Bowen, A., & Xin Feng, C. (2017). Maternal depression in Syrian refugee women recently moved to Canada: A preliminary study. BMC Pregnancy and Childbirth, 17, 1-11. doi: 10.1186/s12884-017-1433-2 Freire, P. (1970). Pedagogy of the oppressed. New York, NY: Continuum. Hassan, G., Kirmayer, L. J., Ventevogel, P., Mekki-Berrada A., Quosh, C., el Chammay, R., Deville-Stoetzel, J. B., Youssef, A., Jefee-Bahloul, H., Barktell-Oteo, A., Coutts, A., & Song, S. (2015). Culture, context and the mental health and psychosocial wellbeing of Syrians: A review for mental health and psychosocial support staff working with Syrians affected by armed conflict. Geneva: UNHCR. Higginbottom, GMA & Liamputtong, P. (Eds.). Participatory Qualitative Research Methods in Health. London, UK: Sage Publications. Silove, D. (2005). From trauma to survival and adaptation: Towards a framework for guiding mental health initiatives in post-conflict societies. In D. Ingleby (Ed.), Forced migration and mental health: Rethinking the care of refugees and displaced persons (pp. 29-51). New York, NY: Springer Science Silove, D. (2013). The ADAPT model: A conceptual framework for the mental health and psychosocial programming in post conflict settings. Intervention, 11, 237-248. Yohani, S. C. (2015). Applying the ADAPT psychosocial model to war affected children and adolescents. SAGE Open July-September, 1â€“18, DOI: 10.1177/2158244015604189 Yohani, S., Kirova, A., Georgis, R., Gokiert, R., Mejia, T., & Chiu, Y. (2017). Cultural brokering with Syrian refugee families with young children: An exploration of challenges and best practices in psychosocial adaptation. Manuscript submitted for publication
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Harvey Brink, James Canniff and Paul Jerry are members of the Publications Committee who monitor the content of The CAP Monitor to ensure the information being conveyed is consistent with the Collegeâ€™s mandate, governing documents and policy. The CAP Monitor is a regular publication of the College of Alberta Psychologists. To the best of our knowledge it is complete and accurate at the time of publication.