Should I see a Psychologist for a Gastrointestinal Problem?
A person with a disease or disorder of the gastrointestinal system is vulnerable to the effects of anxiety. Studies show that stress induced anxiety may worsen the symptoms of such gastrointestinal disorders as stomach ulcers, ulcerative colitis, and irritable bowel syndrome (IBS), in some cases. It may increase the experience of pain and aggravate the disease process. Research has not shown whether anxiety can cause structural problems in the gastrointestinal system, only that stress can make gastrointestinal problems worse.
Psychologist have developed a range of methods for helping people to handle stress more effectively. Some of the more frequently used treatment methods include relaxation therapy, time management, lifestyle changes, and cognitive restructuring. It is important when selecting a therapist to help you through times of stress, that you select a qualified, trained individual.
In this article, I will explain what a psychologist is, what types of things a psychologist can and cannot do and how they differ from other health professionals.
What is Psychology?
First of all, let’s start with two definitions of psychology:
- Psychology is the science that studies behaviour and mental processes, and
- Psychology is the attempt to understand the self.
The second definition may bring up images of a psychotherapist working with an individual to treat an emotional disturbance. The first definition may make one think of men in white lab coats putting mice (or people?) through gruesome experiments involving electric shocks and other tortures best left unsaid. In truth, psychologists can engage in a wide variety of activities which range from conducting basic animal research, teaching, doing assessments of intellectual or vocational functions, to engaging in psychotherapy.
Of course not all psychologists can do everything nor should they. Imagine if your family doctor suddenly said that she/he wanted to perform a heart transplant or your gastroenterologist said he wanted to do psychotherapy with patients suffering from writer’s cramp. Although some individuals could be sufficiently talented and competent to successfully accomplish these activates, it would be unusual given their normal training and experience. Knowledge has exploded in the past 50 years and resources have become increasingly concentrated in urban centers. As a result, many scientific and occupational fields, like psychology and medicine, have become more specialized. Although psychologists can be highly specialized, most do not start out that way because they share a common general training.
Are all Therapists Equal?
Since psychology is a profession regulated by the law, most provinces and states have special legislation that governs the profession. The purpose of these laws is to acknowledge the profession and make sure its members operate responsibly. That is, the profession of psychology is bound by law to work at ensuring its practitioners are qualified and do not harm members of the public. In BC, a person must now have a PhD or equivalent doctoral degree in psychology to become a psychologist. That translates into about 10-11 years of university education. After obtaining the university degrees, candidates must write certain exams and pass other tests involving ethics and how they intend to practice before they can become registered as psychologists. The law states that only people who meet all these requirements can call themselves ‘psychologists’.
Psychologist are Regulated by Law
The reason for this restriction of the word Psychologist is to make sure, that if someone is harmed by a psychologist, then there is a formal way the psychologist can be dealt with (including criminal charges and loss of his/her license). In short, psychologists are bound to the ethical and legal constraints of their profession. What this means for the person seeing a therapist is that there are some assurances that psychologists are trained, constrained by their codes of legal and ethical conduct and should not practice outside of their areas of competence. In contrast to those registered as psychologists, anyone can put up a shingle calling themselves a ‘therapist’ and do any kind of therapy they wish with any population who is willing to receive (or pay for) their services. This is not to suggest there are not excellent therapists who have degrees in social work or other kinds of training, but to emphasize that these other therapists have much less legal and professional responsibility. In the counselling or psychotherapy market it truly is a ‘buyer beware’ situation.
You may be wondering what training psychologist have versus other therapists. I already mentioned that psychologists need to have doctoral degrees plus supervised experience plus go through registration process which includes test and reviews by the provincial regulatory agency. In contrast, counsellors do not necessarily have any training! Most do have degrees in social work, nursing or psychology, some have taken specialized counselling courses and some even have Master’s degrees.
In recent years organizations have formed which allow a member to put letters after his/her name to designate membership in the organization. Unfortunately, the public may believe that one set of letters after a name is the same as any other set. In fact, the standard for membership in such organizations varies tremendously, to muddy the waters even further, let’s take two organizations that demand a minimum education requirement. Does this mean the qualifications are the same? Not for a minute – since there are good schools and bad schools. In some cases it is so bad that you can literally buy a degree from the classified ads in a magazine. As a consumer you have the right and responsibility to ask a potential therapist of his/her training and experience. In the case of registered psychologists, a credentials committee must evaluate the training program, so someone with a degree from the back of a cereal box will be prevented from joining the College of Psychologists.
What about a Psychiatrist?
Hopefully, you now have some idea about psychologists versus some other therapists. Next is the often-asked question about the difference between a psychologist and a psychiatrist. A psychologist typically begins with a bachelor’s degree, then a Master’s, then a doctoral degree (i.e. PhD) in psychology, plus internships and other clinical training experiences. A psychiatrist usually starts with a bachelor’s degree then goes to medical school to become a physician and then completes a 4 year residency specializing in psychiatry. Both sets of training take at least 10 years. The biggest difference in practice is that psychiatrists are physicians who can prescribe medical treatments like medication whereas psychologists are not able to prescribe medications and tend to use more talking therapies. Also within psychology there are two main streams, with one set of psychologists pursuing areas that do not involve therapy or other clinical practices. These people are often research-focused and are sometimes called experimental or applied psychologists. The other group, known as ‘clinical psychologists, is trained to assess and treat psychological disturbances. It should be added that many tests used by psychologists (for example, IQ tests) are restricted and nobody except psychologists can give and interpret them.
Finally, clinical psychologists can be trained to view and treat human conditions from a variety of different theories of schools of thought. For example, many are committed to cognitive/behavioural school that emphasizes problem solving, action and reasonable thinking. Others may employ methods derived from Jung or other schools that emphasize the unconscious and past experience and pursue the development of personal insight. Indeed, the list of schools is long and most psychologists are usually comfortable using elements from more than one school depending upon the client and nature of the problem.
What sorts of problems can a Psychologist help you with?
Psychologists, like other therapists, promote mental health and treat a wide range of psychological and emotional disturbances. In my work at Vancouver General Hospital, I see individuals who have such conditions as inflammatory bowel disease (IBD), hepatitis C, and irritable bowel syndrome. Many of these people are experiencing a loss of their health, occupational setbacks, financial worries, relationship problems and may other repercussions arising from their illness.
Many notice that their illnesses worsen or they cannot cope as well with their illness when they are under stress. Symptoms of anxiety and depression from any cause may arise and add another burden to their lives. As a psychologist I will assess the severity of the emotional symptoms, the stressors which are present and try to work with the client to reduce these symptoms. This may be done by working as solving problem s related to work, home or medical management, improving social relationships, teaching skills relating to lifestyle such as relaxation and exercises or by exploring the ways an individual vies events. Sometimes, we discuss important choices which have to be made and the risks and benefits of following through on those choices.
A very important area entails learning how to see the connection between thoughts and feelings. Once people become aware of how their thoughts influence their feelings they can gradually learn to change the types of thoughts they have.
For example, if a person has learned that dogs are dangerous (because s/he got bit by one as a child or because his/her parents instilled such a belief), then as soon as they see a dog, s/he might immediately think “I gotta get out of here – that dog will hurt me”. Unfortunately, this thinking leads to a fear that may not be justified. What if the dog was wagging its tail and wanted to simply say hello? The person will have experienced considerable anxiety for nothing and perhaps will even be deprived of the pleasure of playing with the dog.
Anxiety is felt in the body as shakiness, racing heart, muscle tension, etc. but its root is most often based on the perception that something or someone is a threat. As we say with the dog example, it doesn’t matter if the dog is really a threat or not – what matters is the perception. Now imagine what would happen if someone was in a chronic state or arousal because he saw danger lurking around every corner – threats to his financial well-being, threats to his ego, threats to his family life, his friendships, his job – imagine what the effect of chronic worry and arousal could do over extended periods of time?
Amazingly, most people can do fairly well when they are stressed but many will eventually get worn down if the stress is sufficiently prolonged. I’m emphasizing that the stress doesn’t have to have an external source such as a loss of income, a death or some other major life event – rather, the stress can be generated by distorted interpretations of everyday events. Whether the stress arises from adverse life experience stress or internal ways of viewing the world, it can create all kinds of problems in emotional, physical and functional areas. The exact nature of the interaction between stress and illness is not clear but there has been a lot of research that shows they can significantly effect each other. Certainly the strain of having a chronic painful or disabling illness is a real burden. The catch seems to be how to cope with the illness since there are some people who appear to simply carry on with living and loving and doing meaningful things while others flounder a lot. The flip side of the stress/illness equation posits that stress can create or exacerbate illness. With respect to IBD (and probably many cases of IBS), it does not appear that stress creates the disorders. Whether stress can worsen an existing problem or lead to relapses seems very plausible. Plausible but not inevitable, since I have known many people with IBD who went through extremely stressful times, like a marriage break-up, without having a relapse. A psychologist is well suited to assist you with problems arising from stress since psychologists tend to be well-versed in the treatments for those stress related conditions that have been extensively studied.
Psychologists are also trained in the assessment and diagnosis of mental disorders. This specialized training helps prevent individuals being treated for the wrong problem. Although psychologists are not qualified to diagnose other medical conditions, they are likely to be able to pic up disturbances in emotional or cognitive functioning that might be due to organic causes and then refer the person for appropriate medical evaluation.
Finally, most psychologist are trained in what is called the ‘scientist-practitioner’ model that means they are expected to adopt both a clinical and scientific stance to their work. In proactive this means that psychologist often engage in research. Courses in statistics and experimental design were necessary in order to complete their doctoral dissertation. It also means that psychologists are quite likely to try and measure things more than other types of therapists.
When I give my patients a questionnaire on depression to fill in I describe it as ‘taking your emotional temperature’. Of course the assessments can get very complicated and detailed depending upon the reason for treatment. As I said earlier, many of the tests can only be interpreted by registered psychologist since the owners of the tests believe that only psychologists are qualified to safely employ them.
Why should I choose a Psychologist?
The question of whether to see a psychologist depends on the problem and its severity. If you find you are having trouble functioning or are slipping and can’t seem to get out of it yourself, then by all means see someone. If you are thinking of killing yourself or are unable to carry on with many of your normal routines then see someone right away. However, if you are merely curious about how to become a better person or want to grow in some way then you may benefit from consulting a psychologist.
The issue of seeing a psychologist versus another counsellor is your choice. I you really want medication then you might be well served by seeing a physician and allowing him/her to assess your situation. If you want talking therapy then you will probably end up going to either a psychologists, psychiatrist, or a counsellor.
Typically, psychiatrists are hard to see since they have long waiting lists and not many do a lot of psychotherapy anymore. Psychologists tend to be more expensive than most counsellors, who tend to have the least training. If specialized neuropsychological assessment is indicated, then you have to see a psychologist.
There is no easy answer as to who might be best qualified for your particular needs. Hopefully this article has shown you the basics about how psychologist are trained, how they are regulated to protect the public, how many are quite specialized in what they do and some of the ways they differ from other professionals who also assist people experiencing problems in living.
Tom Ehmann, PhD
First published in The Inside Tract® Newsletter Issue 112 March/April 1999