Clinical psychology in a general hospital : conflicts and paradoxes

Abstract

Over the past decade clinical psychologists have increasingly begun to work in general hospital settings, but little published research has dealt in depth with the adjustments and negotiations that need to occur at the interface of clinical psychology and medicine. In this dissertation, the relationship of the psychosocial to medicine and the professional relationships of psychologists and doctors are discussed. Consultation- liaison psychiatry and multidisciplinary treatment teams are presented as two ways in which medicine has attempted to deal with the psychosocial, and which provide potentially useful models of practice for psychologists. Four cases that were referred to the author while working as an intern clinical psychologist in a Neurosurgery unit are discussed in terms of the insight they provide in understanding implicit assumptions about and expectations of psychology. In addition, the head of this Department of Neurosurgery and the two clinical psychologists working in this department were interviewed, and these interviews, together with the cases, provide the material for a discussion of various issues which face clinical psychologists in this unit. These include: the power structures and relationships in the unit; the use of consultation-liaison psychiatry and multidisciplinary treatment team models of practice; the inability of psychologists to fulfil present demands for their services; and the issue of reactive or proactive definition of psychological functions. Finally, some suggestions for enhancing the psychological contribution to patient care in Neurosurgery are made, based on the principles that arise out of the discussion.