January 28, 2011

Resolutions Resolved

One month after New Year’s, a lot of us are assessing how we’re doing with our resolutions. If you’re happy with your progress, nice work. If not, two different psych concepts might help:
1)    Timing: A basic principle of behaviour change is that, to be effective, the reward or punishment for a given behaviour has to occur close in time to the behaviour. For example, giving the dog a treat an hour after it rolls over or sending your child to her room the day after she misbehaves is not effective. The timing principle explains why lifestyle-related behaviour changes like losing weight, getting fit, or quitting smoking can be hard. The delay between behaviours like skipping dessert or working out and the rewards of losing weight or seeing changes in your physique is too long. The same holds for punishment. Lung cancer 15 years from now is not an effective punishment; it would be much easier to quit if a cigarette this morning gave you cancer this afternoon.

What to do: close the distance between the behaviour and the reward or punishment by creating interim rewards or punishments. For example, decide that eating three healthy and balanced meals today means you can watch an extra episode of whatever show you’re hooked on before bed. Get your partner to agree to give you a half-hour massage on Saturday if you go to the gym three times this week and to hide your laptop (or crochet needles, chocolate, camera, other important item) for 24 hours if you smoke more than one cigarette per day.  Adjust the rewards and punishments until they work for you!
2)    Values: Why do you want to quit smoking, lose weight, or spend more time with friends this year? Values describe what’s meaningful to you, what you stand for, and how you want to relate to and interact with other people and with the world. Values provide direction and motivation; connecting with them can help you commit to behaviour change and give you the sense that your hard work is worth the effort (in fact, there exists an entire school of therapy based on mindfulness and commitment to taking action guided by values).  For example, remembering that I value my physical health will help me exercise and eat well even when I don’t feel like it; connecting with my value of close family ties will help me keep my resolution to spend more time with my family, even when it’s inconvenient or requires expensive travel.

Let me know if this helps!

January 23, 2011


To date, no meetings have taken place between representatives of Quebec psychologists and representatives of the provincial Ministry of Health and Social Services.
Other things are happening, though.
1)   Even if the Ministry isn’t paying attention, the press is. In the past two weeks, articles about the issue have appeared in the Montreal Gazette and in La Presse. Rose-Marie Charest, president of the Ordre des Psychologues du Québec, and Marcel Courtemanche, president of the comité des chefs de service en psychologie en milieu hospitalier du Québec, were interviewed on Radio-Canada; both commented on the impact of the shortage of public sector psychologists on public accessibility to services, and on the roles of poor working conditions and of the disparity between educational requirements and compensation in perpetuating the shortage. 

2)   Students waiting for news about internships for next year were advised to expect letters from the sites we applied to, confirming receipt of our applications and advising us that they are keeping our unopened applications on file and will let us know when things change. Here’s the rub, though: not all internship sites are participating in the pressure tactic; even within hospitals that have announced their solidarity with the tactic, some clinics are offering applicants interviews as usual. This means that students who have applied to participating and non-participating sites may be in the awkward position of having to accept or reject an offer from one site before sites in which they are equally interested even review their application. To say nothing of the potential awkwardness of starting an internship as scheduled in September while your fellow students are forced to make other plans.
What to do? Although students are not obliged to support the Quebec psychologists’ position, those who plan to work in Quebec after graduation certainly have an interest in improved salary and working conditions.
Professional respect and decent pay are important. Supporting your future colleagues is important. But so is continuing your training and finishing your degree in a timely fashion.
I’ll keep you posted.

January 12, 2011

Winter of Discontent

In a pressure tactic designed to get the attention of the provincial Ministry of Health and Social Services, Quebec public sector psychologists announced in December 2010 that they are refusing to accept psychology interns for the 2011/2012 school year. Their problem: poor working conditions and lack of respect for their work, as demonstrated by remuneration not commensurate with the demands and the training requirements of the profession.
Yearly salary for a full-time psychologist in the public sector in Quebec is between $37,219 and $70,759 and comparisons with the salaries of psychologists in the rest of Canada ($57,000 to $130,000) and with other health care professionals in Quebec reveal significant discrepancies. For example, although Quebec social workers, nurses, and physiotherapists are eligible to practice as professionals after completing their undergraduate training and psychologists have to complete a PhD (i.e., a minimum of five more years of school, creating a corresponding five more years worth of student loans, and a five-year delay before starting to earn), the former professionals earn salaries that are equal to or higher than that of Quebec psychologists.
In response to the lack of respect and recognition, Quebec psychologists are leaving the public system en masse to work in private practice, where they can earn between $85 and $150 per one-hour session. The holes in the mental health care system mean that full-time psychologists are stretched extremely thin between clinical work (e.g., evaluation, psychometric testing, treatment, crisis management, consultation with other professionals), research, administrative tasks, and teaching and supervision, and that Quebeckers who can’t afford private services face long waiting lists for mental health care.
Refusing to train interns effectively stalls the education of new psychologists in the province, threatening to even further increase the number of vacant psychologist positions in the public system. For Quebec citizens, it means even less accessibility to services. For me, it means that my internship applications for next fall, mailed before Christmas, are being received but not opened, and that my degree—already long—risks being delayed by one year.
However, in the past few days, the Ministry acknowledged the pressure tactic, and a preliminary meeting between Ministry representatives and representatives of Quebec psychologists is in the works. Stay tuned.

January 06, 2011

Now This Is Happening

Mindfulness—a state of conscious awareness in the present moment—is a centuries-old Buddhist practice and one of the biggest trends in mental health right now. Mindfulness means full attention and presence in the now, on purpose and without judgment. It means being in tune with one’s self, and noticing and embracing the experience of each moment, good or bad. Mindfulness doesn’t necessarily imply formal meditation; it can simply mean a conscious effort to be present and aware during every moment. 
How is mindfulness related to mental health? 

1)   Proponents of mindfulness believe that much of what ails us stems from our habits of acting unconsciously and automatically, and of ignoring the present moment in favour of focusing on the past or the future. Lack of attention to the present leads to a poor understanding of our selves, our actions, and our perceptions, and promotes automatic reactions driven by insecurity or fear. Advocates suggest that practicing mindfulness improves mental health by increasing insight and understanding, and by helping us slow down and respond rather than react.
2)   Mindfulness implies not only observation and awareness of the present, but acceptance, too. I like to sum up the concepts of acceptance and mindfulness with the phrase “Now this is happening,” adopted from a funny scene with Jack Black in the non-mindfulness-related movie Anchorman. “Now this is happening” reminds me that what’s happening is indeed happening--whether or not I like it, approve of it, or am prepared for it--and that refusing to accept it won’t make it stop happening. The acceptance inherent to mindfulness is not an attitude of passivity, but rather a realization that the faster and the greater grace with which you accept that you are, for example, locked out of your house, not getting the job you wanted, or rejected romantically, the sooner you have a strong position from which to start dealing with it.

The mindfulness movement is everywhere right now in clinical and popular psychology. Psychology conferences are replete with symposia such as “Eat, Drink, and Be Mindful: Mindfulness Interventions for Binge Eating,” bookstore self-help sections boast titles like “Mind Your Manners: Teaching Children Respect Through Mindfulness,” and there doesn’t seem to be a single mental health problem that some clinician or researcher, somewhere, isn’t trying to treat through mindfulness.

For mental health professionals who don’t like it, don’t believe in it, or aren’t prepared for it: Now this is happening.

January 02, 2011

Multiple Personalities

Dissociative Identity Disorder (DID) is pretty much the most fascinating DSM diagnosis of all. Formerly called Multiple Personality Disorder, DID is a rare disorder diagnosed when a client presents more than one discrete identity or personality state that recurrently takes control of his or her behaviour. Each identity has a distinct and enduring way of behaving, perceiving, and interacting. Correspondingly, in addition to significant memory lapses and time unaccounted for, symptoms of DID include things like being told that one behaved extremely uncharacteristically, not responding to one's name, and being frequently accused of lying.

DID is associated with early traumatic experiences, particularly childhood physical or sexual abuse, often by a parent or other trusted caregiver. The hypothesis is that dissociation is an extreme response to severe trauma: the mind splits off the memory and awareness of the abuse; the memories go into the subconscious and eventually emerge in another personality, meanwhile allowing the original identity to exist as though untraumatized. 

Without forgetting the anguish and suffering inherent to DID, I can't help but be impressed by the brain's capacity to protect individuals from their own terrible experiences by creating a separate personality to whom the terrible experiences happened. Some research has even found evidence for differences between identities in handwriting, and in physiological variables like heart rate and blood pressure! 

Clinical psychology doesn't get more amazing than that.