Clinical Practice

Where do you find VA Psychologists?

 This section currently under development.  It will contain a summary of the kind of practice psychologists engage in and personal experience from some VA psychologist who practices in the areas below.

If you would like to contribute to the area descriptions on this page, the following guidelines should be used to develop your narrative.  Email the narrative to Brian M. Pilgrim, Ph.D.:

 

“Traditional” settings for VA Psychologists

 

Expanding the clinical roles of VA Psychologists

 

What will they think of next?

 

(Return to the top)

 

DESCRIPTIONS OF PRACTICES:

“Traditional” settings for VA Psychologists  

Acute Inpatient Units

 

COUPLES AND FAMILY PSYCHOLOGY

During the 1970s, the relatively young family therapy movement gained influence in and acceptance by the Central Office of the Veterans Administration.

Family therapy programs emerged in a dozen medical centers as professionals trained to provide family assessment and treatment were hired with centrally "fenced" funds. 

Psychologists, social workers and a few psychiatrists began offering whole-family therapy, couples treatment, parenting training, divorce counseling and psycho-educational programs to veterans and their families, and consultation services to medical and psychiatric colleagues.

Family psychologists and their peers in other professions have continued to champion a systems perspective in the services provided to veterans.  The interaction between the veteran's well being and family process has become a concept central to mental health care in the New VA.

(Return to the top)

 

Mood Disorder Teams

Post Traumatic Stress Disorder Teams

Neuropsychology Teams

Research Departments

SUBSTANCE USE DISORDERS TEAMS

q       General History:  Substance use disorder (SUD) treatment has been a specialized mental health service within the Department of Veterans Affairs health care system since the Vietnam War.  When increasing numbers of veterans returned home with unremitting substance abuse problems, the VA recognized the need to develop and implement comprehensive rehabilitation programs to better meet the needs of these veterans and to support their readjustment to civilian life. Over the years VA psychologists in the field of substance abuse treatment have contributed toward expanding our clinical knowledge and developing innovative approaches to address one of the nation’s top public health problems. VA psychologists have been key in developing effective and efficient comprehensive treatment systems that meet the special needs of chemically dependent veterans. VA research and clinical psychologists in this area have a national reputation and continue to make outstanding contributions at all levels of care.

q       Common Tasks:  Psychologists providing SUD treatment typically offer the following services:  Intake and consultation, psychosocial assessments and psychodiagnostic evaluations, treatment planning and case management, patient education, psychosocial individual and group therapies, supervision and training, and program management and development.

q       Services/Interventions:  Group treatment approaches are common in the delivery of SUD treatment including patient education, support groups for recovery, process groups, and cognitive behavior groups.  Psychologists are usually responsible for both the planning and delivery of these psychosocial group interventions.

q       Patient/Client Characteristics: While no patient group is immune from being at risk to develop SUD problems, the veteran patient/client population overall is characterized as being predominantly male, middle aged, alcohol or polysubstance dependence with a high incidence of divorce, homelessness, and unemployment.  Co-morbid psychiatric and medical disorders are common, i.e., PTSD, affective disorders, chronic health problems, with a tendency to be relapse prone.

q       Treatment Challenges:  The greatest challenge in SUD treatment is that this is a relapsing disorder, which continues to fuel a downward course over time. The earlier an individual establishes an active recovery program, the better the outcome. In that the SUD veteran population is aging, they often become more debilitated physically and emotionally and consume greater resources to order to re-direct the downward cycle and achieve a positive outcome. Since some community resources have become more limited, veterans rely on the VA for comprehensive SUD treatment. This results in the challenge of treating an increasing number of more impaired individuals. Yet, we know that the greater impact we have on stopping the cycle of addiction not only benefits the veteran, the veteran’s family and community, but also lowers overall medical costs within the larger VA health care system.

Psychologists by their training and professional expertise are well suited to meet these challenges and increasing demands by developing more efficient and effective treatment approaches, including technical resources, systems development, outcome evaluations, etc.

q       Practice Rewards:  While being a psychologist in the SUD treatment field is challenging, the work is clearly rewarding!  The changes a veteran makes in the quality of his/her life as a part of recovery are dramatic and benefit all aspects of the individual’s lifestyle. Often a VA SUD program becomes the veteran’s lifeline to survival and serves as the primary support in becoming drug free, stabilized, and able to engage in active recovery.  Psychologists have the opportunity to continue to advance the field of addictions research and treatment and make significant contributions to address this major public health problem in the United States. Certainly the greatest reward is contributing toward fighting the war on drugs with veterans who have given so much! 

(Return to the top)

 

Administration & Policy Making

 

DOMICILIARY CARE

Background.

Domiciliaries were initially created to serve discharged soldiers returning from the American Civil War.  Initially and throughout much of their history Domiciliaries have provided supportive living environments for veterans who are homeless or, because of medical or psychiatric disability, unable to maintain themselves independently in the community.  Beginning in the late 1980’s Domiciliaries became to take on a more active rehabilitative role, first with programs targeting homeless veterans, and subsequently with more specialized or narrowly defined treatment populations (PTSD, substance abuse, medical rehabilitation).  Concurrent with this, psychologists have come to play a more important role in the services offered by Domiciliaries.

Roles and Functions.

 Psychologists now fulfill a wide variety of roles in Domiciliaries.  Domiciliary programs and Domiciliary patients are extremely diverse, though the modal patient is one with substance abuse and psychiatric diagnoses and significant associated medical comorbidities.  Many Domiciliary psychologists provide traditional clinical functions, i.e., general assessment and therapy, both individual and group.  Many also provide more traditional counseling and rehabilitative functions; this includes vocational assessment and counseling within Domiciliary programs that focus on psychosocial rehabilitation, behavioral medicine within programs that focus on coping skills and behavioral adaptation to chronic illness and disease, and addiction treatment for programs that focus on chemical dependency.

Many psychologists in Domiciliaries assume leadership roles.  This may include leading a clinical team, assuming responsibility for a specific program within a Domiciliary, or even becoming Chief of the Domiciliary.  Especially in this last role, psychologists have opportunities to assume significant managerial duties, at times associated with grade advancement.

Challenges and Opportunities.

 Psychologists in Domiciliaries typically work in an interdisciplinary team.  Domiciliary environments tend to be “non-medicalized,” with a distinctly rehabilitative (vs. acute care) focus, and, as noted above, patients tend to be diverse and complex.  Psychologists usually find Domiciliary work stimulating and rewarding if they enjoy working in a team context, have a wide range of skills, are flexible and creative, and enjoy the opportunity to work intensively with patients over a significant time span.  Leadership skills also are typically valued and recognized. (Return to top)


 
(Return to the top)

 

Expanding the clinical roles of VA Psychologists 

Behavioral Medicine Teams

Interdisciplinary Pain Teams

Spinal Cord Injury Units (SCI)

PSYCHOSOCIAL REHABILITATION

The field of Psychosocial Rehabilitation is growing rapidly within the VA, as is the role of VA psychologists in developing and implementing the programs and policy responsible for that growth.  Though Psychosocial Rehabilitation (PSR) encompasses several treatment venues, the Department of Veteran’s Affairs lists three programs under the title PSR.  These three programs include Incentive Work Therapy, Compensated Work Therapy and various VA residential programs, most notably the Transitional Residence and the Psychosocial Rehabilitation Residential Treatment Programs.

Relative to other areas of professional practice, there are still only a few psychologists working in PSR but psychology’s contributions are considerable.  Psychologists working in PSR programs are most often the directors of those programs, often overseeing the program development and functioning of more than one related program such as psychologists who oversee both the Work Therapy and Residential programs.  As well, psychologists serve as influential members of national VA boards that are responsible for the development and implementation of policy that guides the future of PSR within the VA.

Psychologists working in VA PSR programs are often called upon to develop and maintain strong generalist skills in the areas of group and individual psychotherapy as well as assessment.  It is not uncommon for PSR psychologists to be called upon to conduct psychological, cognitive, educational and sometimes even vocational assessment of the clients served.  Since the primary purpose of a VA PSR program is to help veterans develop and implement the skills necessary to maximize their independence, the day-to-day activity of a PSR psychologist is quite dynamic and draws heavily on knowledge from not only Clinical Psychology, but also Social Psychology, Organizational Psychology, Biological Psychology and Developmental Psychology.

It is difficult to “pin down” the “typical” client served by a VA PSR program but some of the major commonalities are that they are homeless or have a significant history of homelessness, are unemployed and have either psychological or substance abuse problems that significantly impact their ability to sustain employment and have several Axis IV concerns. Once you have helped a client successfully complete a PSR program you are often able to see dramatic and concrete results.  The veteran is able to secure housing, gain employment and reach a level of stability where they can realistically benefit from the many other programs that the VA has to offer.  While this client population can be quite challenging to work with, there are substantial personal and professional rewards.  Personally, there is the reward of being able to see the concrete results mentioned above.  Professionally, it is both interesting and challenging to try and untangle the web of complex psychological and social issues that are present in each client’s life and serve to prevent substantial personal development. (Return to top)

 

Rural Mental Health Services (CBOCs)

Vocational Rehabilitation

(Return to the top)

 

What will they think of next? 

Home Based Primary Care

Homeless Outreach

Mental Health Intensive Case Management

Disaster Mental Health

Terrorism/Homeland Security

(Return to the top)