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Chap 4. Working with adults or working age - Coggle Diagram
Chap 4. Working with adults or working age
Clinical psychology represents just one source of help
Within clinical psychology, there are a range of model
Setting of clinical work
Early days: only in inpatient or outpatient psychiatric settings
Just for assessment of personality or cognitive functioning
Nowadays: Provided in community or primary care settings
Common psychological difficulties
Depression (The common cold of psychiatry)
Cognitive model
No hope in oneself, the future, or the world
Be triggered by loss/ External events that support someone's beliefs (schemas)
Anxiety: Phobias, panic, social anxiety, generalized anxiety disorder, OCD, post-traumatic stress disorder (PTSD) & health anxiety
Lacks the ability to function effectively in life because of fears of negative consequences
Lack a sense that the fear is out of all proportion
Unable to reassure themselves or reason away their fears
Other difficulties: Eating disorders, psycho-sexual difficulties, interpersonal problems, psychosomatic problems, and personality disorders
Borderline Personality Disorder
Difficulties in settling in relationship, may swing chaotically between jobs, partners and life-styles, and may have harmed themselves or attempted suicide
A feeling of chronic emptiness, and meaninglessness, alternating with a sense of importance or "specialness"
May have had a history of childhood sexual abuse
Often seen as untreatable
Hard to see how they fit into a medical, illness model of mental distress
With background knowledge of personality and social development, clinical psychologists may be well placed to offer some way of resolving the distress experienced
Classification of mental health problems
Internal Classification of Disease (ICD-11)
Diagnostic and Statistical Manual (DSM)
DSM-IV
Axis 1: Disorders
Axis 2: Characterological
Many psychologists have questioned the value of using what is essentially a psychiatric, medically oriented system to describe human unhappiness
Operate does require some form of classification for both record keeping and communication between different professional groups
The competent clinical psychologist
Assessment
Formulation
Treatment
Evaluation
Communication
Communication with the wider network around the client
A key skill is therefore that of communication and the ability to present psychological reports in ways that make sense to the wider care network as well as to the clients themselves
Teamwork and training
Mental health services, particularly or more complex cases, are almost always delivered by teams
The assessment and treatment of complex cases is increasingly being seen as the core task of clinical psychologists working in secondary care settings, although delivery of treatment may be carried out in collaboration with the wider mental health team
Psychotherapy is not however the prerogative of psychologists
They need to be able to demonstrate their unique contribution to the delivery of care, and as such to ensure that they contribute psychological research skills and evidence-based practice to a multidisciplinary health service
A relatively high level of research training
Additional role for clinical psychologists is that of a trainer or supervisor
Competence in dissemination is therefor recognized as crucial, and many training course include some inputs on the skills of teaching and supervision
Policy and organization of services
Be clear and firm about their particular professional contribution in multidisciplinary settings
Challenges:
High level of demand for services, and the limited resources that are available
A number of initiatives have been attempted to reduce waiting times: opt-in systems, triaging, and the provision of self-help material
The need to ensure that services are equally available and accessible to all sectors of the community
Ensuring the appropriateness of services are provided, and the need for cultural sensitivity
Effectiveness, research, and ethical practice
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Evaluation of the effects of treatment should be monitored both during and at the termination of treatment
Psychometric assessment: repeat the measure on termination
Whatever model is taken, effective clinical psychology treatment works best when it is based on a model, which is used to guide intervention and which can in turn lead to modification of the model in the light of experience
Duration and mode of treatment varies
Models: Cognitive Behaviour Therapy and Cognitive Therapy
Reasonably solid evidence base for treatment
Ready applicability of cognitive models, which provide a clear framework for intervention and evaluation
Basic assumption: Emotional problems are best understood and resolved by addressing the meanings, beliefs, or cognitions the person hold about themselves and their difficulties
Many mental health difficulties have developed via maladaptive learning, and that solutions to them may also be understood and learned
A careful assessment & specification of how problems arose and how faulty cognitions, or inappropriately learned behaviours, may be maintaining the problem
With an emphasis on problem solving in the present, rather than trying to reach an understanding of the past
Careful history of the symptoms, beliefs and current and earlier life circumstances
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CBT for panic, anxiety, OCD, and depresison
a) Panic disorder
Sudden onset of intense fear, associated with uncomfortable feelings
Fear that they are having a heart attack or going mad
Cognitive model: Enduring tendency to misinterpret bodily sensations in a catastrophic fashion
Normal sensations of anxiety = indications of an immediate impending disaster
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b) Social anxiety
A strong desire to convey a particular or favorable impression of oneselfto others
Insecurity about one's ability to do so
Fears that other people will notice his or her anxiety symptoms
He/she will make a fool of himself or herself, leading to rejection and ostracism
Self-focusing, combined with a range of behaviours adopted to cope with the situations --> vicious cycle
Feels as if they were the centre of attention, which leads to higher levels of anxiety and increased self-consciousness
c) Obsessive-compulsive disorders
Distressing thoughts, impulses or image (obsessions), and stereotyped, ritualistic behaviours (compulsions)
The compulsions may follow the obsessions as a way of trying to control or neutralize the obsessions
Often feel an excessive sense of responsibility for negative events or consequences
A coomon aspect: client's assumption of thought-action fusion
Treatment: Requires clients to take what is to them a huge risk in reducing or abandoning rituals
e.g. response prevention (expose to something without carrying out their compulsions)
d) Depression
Some patients are reluctant to take antidepressants, and for others, pharmacological treatment is insufficient
A combination of CBT and antidepressant medication is the most effective long-term approach
Psycho-dynamic Therapy
Gain an understanding of the dynamics that underpin the symptoms, and to resolve them by helping the client obtain insight or understanding of the conflicts, which have led to the symptoms
The use of transference and counter-transference whereby the client's relationship with the therapist is analysed and discussed
Eclectic and integrative approaches
High proportions of practising clinical psychologists draw upon a number of different models
Cognitive Analytic Therapy (CAT): draw upon the strengths of both cognitive and psychodynamic approaches
CAT is a time-limited focussed approach which aims to help people to shift their distress in significant ways in a relatively short time, and to give clients tools, or ways of thinking, which will enable them to avoid dysfunctional patterns of relating to themselves and others
Family and group therapy
May offer additional therapeutic benefits, such as the sense of not being the only one with a problem, and enhanced self-esteem
The model applied here is systemic: Problems are thought to be best understood and addressed in relation to the system as a whole
Collaborate with the client to make sense of the difficulties
Some models act as convenient template
All clients differ (Still require critical and creative skills)
e.g. Background, predisposing factors, adverse childhood experience or learning
Physiological, behavioural, cognitive and affective reactions interact in maintaining the ongoing dysfuntional symptoms
CBT: A diagrammatic representations
The links between previous experience, the formation of dysfunctional assumptions or behaviours, how they were triggered by critical incidents, how this led to the negative automatic thoughts or imagery, being maintained by an interlinked set of behaviours & physical reactions & cognitions & affect
Assessing clients' needs in psychological terms
Reach an understanding of what an appropriate treatment response should be
Own view of the difficulty, and for some background details (e.g. history & context of the problem, key relationships, details of employment; Significant life events, early family experiences, prior experience of therapy, self-assessment)
According to the model, different attentions:
1) Cognitive: How a client describes + uncover some negative assumptions
2) Psycho-dynamic: Way of seeking to relate personally to the pschologists
Purpose of the 1st interview:
Establish a working alliance
Explore the difficulties & develop understanding
Assess motivation and ability to work psychologically
Complete some form of psychometric assessment: Permit comparison (Before & After treatment)
Invited to self-monitor, keep a diary
An ongoing process to ensure the treatment is having the desired effects
Modify the formulation/ change the treatment if necessary
An important source of information:
1) Clients' ability and wish to engage in treatment
2) What they want from treatment has to be assessed carefully
3) Client is fully consenting to the intervention
4) Describing the likely course of treatment, and giving an indication of what can be expected
Scientific knowledge, reflective awareness, ethical and culturally sensitive practice