2. Science & Art of Practice

Question 1

What are the 3 waves of therapy formulations?

Answer 1

1st wave - behavioral therapy
2nd wave - CBT
3rd wave - mindfulness-based therapy

Question 2

What are the 3 horse riding stances in psychological practice?

Answer 2

1) scientist-practitioner
2) reflective-practitioner
3) critical-practitioner

Question 3

Who are the kinds of people that can work together in the team?

Answer 3

teachers, social workers, counselor, psychologist, psychiatrist, nurse, probation officer, child protection officer, family members etc. (depends on the case)

Question 4

What can stress do to the multidisciplinary team?

Answer 4

Can strain working relationships in the professional system and failure to collaborate can do a disservice to the client.

Question 5

What does the direct work of a clinical psychologist entail?

Answer 5

• clinical golden chain: assessment, formulation, communication, intervention, evaluation
• deal with the client and his/her social system

Question 6

What does the indirect work of the clinical psychologist entail?

Answer 6

• service evaluation work
• mental health research
• joint meeting and consultation with other professionals and caregivers
• leadership and professional development (strategic planning, team development, clinical governance)

Question 7

Recall what are the 3 aspects you must consider in choosing an intervention for the client? (TRIPOD)

Answer 7

1) research evidence (evidence-based; follow guidelines)
2) Clinical expertise
3) Client preference (if client is not receptive to a specific type of treatment it could be an issue)

Question 8

Why is evidence-based practice difficult to carry out in reality?

Answer 8

• constraints of service context: clinical psychologists in hospitals can only see clients once every month and for short term treatment only because there is a long waiting list
• client constraints: clients work full time and they may not be able to pay for long treatment. socialisation of client (eg. singaporean clients tend to be very agreeable with clinician’s preferences and not have much preference due to white coat syndrome)
• evaluation of outcomes using questionnaires can be annoying for client.

Question 9

Where do you go in search for empirically supported therapies (EST)?

Answer 9

NICE guidelines!

National Institute for Health & Care Excellence

Question 10

What is the difference between effectiveness and efficacy of randomised controlled trials (RCTs)?

Answer 10

Effectiveness - is there an effect?

Efficacy - after controlling for every aspect besides therapy, is there an effect?

Question 11

What are some limitations of the scientist-practitioner approach?

Answer 11

• heavy reliance on diagnosis and CBT

- sometimes neglect systemic factors and does not cater for more complex cases (eg. comorbidity)

Question 12

What constitutes being a scientist-practitioner?

Answer 12

1) evidence-based practice

2) empirically supported therapies. RCTs as the ‘gold standard’

Question 13

What constitutes being a reflective practitioner?

Answer 13

• reflect on how the psychologist’s own cultural background and life experiences influence his assumptions
• meet supervisor to discuss and reflect on these issues
• some clinical psychologists have their own psychologists to increase their self-awareness and understanding of how they relate to others. selves are part of the work because therapy is a relationship between client and therapist.

Question 14

What are 2 kinds of reflective practice?

Answer 14

• in-vivo

- post-hoc

Question 15

What kind of issues are dealt with in in-vivo reflective practice? (4)

Answer 15

Self-Reflection

• what thoughts and feelings did you have when you were conducting the interview?
• what was happening during the interview that made you think and feel that way?
• how might these thoughts and feelings influence your responses during the interview?
• what contextual factors, personal biases and assumptions from your past experiences might explain the thoughts and feelings you had?

Question 16

What are the 2 kinds of issues involved in post-hoc reflective practice?

Answer 16

Application of learning

1) thinking about past action
- “how would you have done the interview differently?”
2) thinking about future practice
- “what have you learnt that could help you on your own journey as a professional psychologist?”

Question 17

What kind of issues should critical-practitioners think about?

Answer 17

1) considering social inequalities and injustices. manifests in:
- the power of language (classifying people as ‘disordered’ can be self-fulfilling)
- their story goes beyond diagnostic labels. focus is on wellness. think in terms of formulations.
2) interventions should be at the community level. preventive care rather than remedial.

Question 18

Within the multidisciplinary team (MDT), what models are there?

Answer 18

1) Medical model
2) Psychological model
3) Biopsychosocial model
4) Recovery oriented model
Each model has its own purpose and strength.

Question 19

What is the emphasis of the medical model?

Answer 19

Diagnosis and symptom reduction

Question 20

What is the emphasis of the psychological model?

Answer 20

Formulation

Question 21

What is the emphasis of the biopsychosocial model?

Answer 21

Integrating each perspective with an understanding of how social context impacts mental health

Question 22

What is the emphasis of the recovery model?

Answer 22

emphasizes maximising of human potential over a specific focus of allieviation of symptoms

Question 23

What are the different professions within the mental health multidisciplinary teams?

Answer 23

• service managers (leadership and coordination)
• psychiatrist (assessment, diagnoses, oversee, prescription of drug treatments)
• clinical psychologists/psychological therapists
• nurses
• occupational therapists (OTs)
• social workers
• support workers; peer support workers

Question 24

What is the purpose and emphasis of the medical model?

Answer 24

Diagnosis

• Views human distress as conditions or illnesses.
• Diagnosis helps to identify and ‘label’ the types of problems the client is facing and point to appropriate treatment (DSM-V).
• Can be reassuring for clients as clients can have some idea of what to expect. Feel empowered by understanding possible treatment.
• Services can also organise themselves around these labels.

Question 25

What is the controversy revolving labelling? (3)

Answer 25

1) little explanatory power due to broad range of symptoms and human experiences that the label itself says very little.
2) can be demeaning and stigmatising.
3) over-medicalises their condition

Question 26

What is a formulation?

Answer 26

• A working hypothesis about the nature of an individual’s problems that attempt to explain why this person has developed this type of problem at this point in time, and what may be maintaining it.
• Less categorical than a diagnosis
• Can formulate cases based on single modalty therapy (eg. CBT) or integrative approach by drawing upon a range of psychological theories.
• Formulation may then be used to determine most appropriate treatment.

Question 27

Describe the biopsychosocial model.

Answer 27

Attempt to move beyond a purely biological approach to understanding illness. Consider biological, psychological, and social factors contributing to symptoms. Fits well with multidisciplinary approach

Question 28

Describe recovery-oriented practice.

Answer 28

• Acknowledgement of the individual’s right to health and wellbeing even while having the mental health condition.
• Proposes that people need to be supported to develop a meaningful and satisfying life, whether or not there are ongoing symptoms.
• Not so much about ‘getting well’ but rather about maintaining the highest quality of life in spite of ongoing symptoms. Especially for people with severe and enduring conditions.
• Focus on strengths, empowerment, and development of meaningful and satisfying roles
• Especially important for people with severe and enduring conditions

Question 29

What is the clinical psychologisy’s role in the MDT?

Answer 29

• Golden chain: AFCIE

Question 30

What is team formulation?

Answer 30

The process of facilitating a team of professionals to construct a shared understanding of the client’s difficulties. Based on all their diverse experiences, develop a shared understanding and a comprehensive care plan.