4PS007 - Clinical psychology [C.P.] Flashcards
Definition of CP:
- General
- BPS [British psychology society ]
- APA [American psychiatrist association] + [I.P.F]
General
A science based profession, based firmly on scientifically supported psychological theories and principles
The application of psychological theory to human distress, manifested as psychological problems (Coolican, 2007:16, Hunsley and Lee, 2010). Concerns with the alleviation of psychological problems.
BPS
Reduce psychological distress & to enhance/promote psychological well-being by systematic application of knowledge derives from psychological theory/data
APA
-INTEGRATES science, theory and practice to understand/predict/alleviate maladjustment, disability & discomfort
- PROMOTE human adaption, adjustment & personal development
- FOCUS on intellectual/emotional parts of B.P.S & behavioural aspects of human functioning across their life span [varying cultures + all socioeconomical level]
What are the principles that CP is based on
E
P
P
C
E
I
G
D
- EMPIRICALLY tested, peer-reviewed evidence
- An evidence based published in the PUBLIC domain
- The PROCESS of theory or practice development being credible and open to replication
- COLLABORATIVELY generated hypotheses about client problems.
- EMPOWERMENT of clients
- INDIRECT through others or by teaching,
training or research. - There is GROWTH in the importance placed
upon reflective practice - Different from Psychiatry.
- Works are based on professional code of
conduct (BPS, 2013; HCPC, 2016 Code
of ethics and professional conduct)
Describe the history of CP [before the 60’s]
- what opens [W-W] + contrib. [E.C]
- important book? [E-K] + contrib. [C.P.D.C]
- WW1
- 1st of what?
- the amount?
- start WW2
- end WW2
- what model
- what was published
Wilhem Wundt (1879) Germany: Opens the first psychology LABORATORY
contribution: psycho seen as a valid EXPERIMENTAL science shown from the careful CONTROLLED conditions
Emil Kraeplin 1883: Compendium of Psychiatry. Proliferation of Psychological Testing instruments in the US, France and Switzerland.
contributions:
specific COMBINATIONS of symptoms = PARTICULAR mental disorder [hypo]
Endogenous psychosis concept [DIFFERENTIATION of dementia praecox = schizo & manic depression]
his new CLASSIFICAITON system laid the ground for modern systems [DSM/ICD]
1914: The role of the WW 1
- The development of Alpha and Beta
and its controversies [low intelligence US citizen = inferior race]
1934 – First meeting of the Pennsylvania CPists
1935 – 150 clinics in the US.
1939 - WW2 (1939-1945) – huge demand for
psychologists [shell shock/PTS + 40% of med discharge is from psychiatric problems]
1945- Following the 2nd WW increase in
demand for cps– more need training.
Veterans Administration (US Govt. Department) – doctoral level training – leading to the development of ACCREDITIED CP training programme
APA: 1949 – Boulder model – Scientist-practitioner
(i) CP should be primarily psychologists scientist with practical skills:
(ii) Clinical training should be as STRICT as in other non-clinical fields of psychology.
(iii) TRAINING should focus on assessment, treatment and research.
end of 1952 – First publication of the DSM!
What are some of the noteable achievements from Whitmer
[C.J]
1st distinguish between pure and applied
psychology and the inter-relatedness of the two.
1904 – First clinical psychology course established
1908 – Witmer founded the first journal ‘The
Psychological Clinic’
CP history in the UK [up to the 2000’s]
- what was created
- what was adopted
- what stage of development was it at the time
- what was founded
- key part of reformation for the NHS
- what was diminished due to that reformation
- what was made
- what joined together
- 1930 – Child guidance clinic was created
(based on US applied psychological treatment
of juvenile delinquents); - “Clinical” [phrase] with staff in said clinics –> diff of clinical/educational psychologists
*1948 [est.] - CP development MIRRORED the UK’s NHS development [A funded clinical training]
- 1958 – DIVISION of CP was founded [solve NHS employment issues + form a career structure]
NHS [2 key developmental stages]
1. Royal commission in the NHS headed by
Lord Donovan (1968)– roles and structure of
various professions but omitted psychology
- BPS lobby – subcommittee chaired by
Trethowan focused solely on the role of
clinical psychologist.
- By the late 1980s pay and conditions had
diminished for clinical psychologists due to
structural changes in the NHS.
2. The Manpower advisory group report (1990) - outline new career structure
- clinical teaching/research work = core
By 2004, CP [integrated] into a unified structure within the NHS
What does the work/role of a CPist entail?
- Role? [I.A.S.T]
- what happened in the 80’s
- what was introduced?
- three general models?
Role - INTRODUCE psychological theory to AIDE understanding of SUBTLE psychological process that operate on the terms THEMSELVES like group working
80’s - services was delivered via MDT after large institutions, hospitals, development of community services being closed
IAPT introduced – mostly CP inputs
Three general models of working:
1)Independent practitioner = self-employed & run their own private practice
2)Consultant practitioner = specializes in delivering evidence-based psychological assessment/interventions
3)Consultant supervisor = offers counselling/support when needed, manage own work load, check up on their supervisee’s professional goals.
What stages are there when CP are working on individual cases
[I.F.I.E]
- Initial assessment:
intro
Establish rapport
- empathetic environment
- appropriateness
- intensity
- frequency & duration of difficulties
- diaries
- assessments - Formulation of the problem:
- Linking psycho theory to practice
- test theory predictions -> apply to the client
- simplify theory’s hypo testing/ predisposing/ precipitating/ maintaining factors - Intervention: follows from the formulation
may incorporate family/social systems, typically therapists are biased - Evaluation:
Is the intervention effective in alleviating the difficulty or is it ineffective?
If so why?
Collaborative approach + reformulation
What types of therapeutic approaches do CP use
- P therapy [E.R.U.E-S]
- F therapy
- B therapy
- 3 approaches?
- 1. [consist of 2 interventions]
- 2. [emotion based] x [psychiatric approach based]
- RET
- aspects of depression + examples
PSYCHODYNAMIC therapy - Freud -
Rational front v. unconscious hidden conflicts; id, ego & superego.
Defensive responses (Denial, projection, rationalisation, displacement, sublimation)
Free association - P’s EFFORT to say what’s on their mind
Dream analysis - investigate REPRESSED feelings expressed in one’s dreams [due to defences low = sleeping]-> therapeutic breakthrough + solve psycho difficulties
Transference - P’s UNCONCIOUS reactions/emotions to sig figures of the past onto the therapist = deeper understanding of P’s life.
counter transference - therapist’s EMOTIONAL reactions & SUBJECTIVE responses -> help [find blind spots + biases to give better care]
FAMILY Therapy – Systems theory – optimising the organisation of the family .
clarifying boundaries + reducing distress
BEAVIOURAL therapy :– develop behaviours via 3 routes – internally, externally and observation; Concerned with maladaptive responses change to adaptive
Humanistic approach – CCT/PCT
being your true self = most fulfilling life [importance]
Gestalt approach - having more self-awareness, freedom, self-direction [present environment influences over your growth]
Existentialism approach - anxiety from the conflicts inherent in life [use humanistic approach to deal with this]
1.Behaviour modification (e.g. aversion therapy, systematic desensitisation); Functional analysis; Behavioural programmes
2.Cognitive Behavioural Therapy – emotions mediated by thoughts prone to systematic bias - ‘faulty thinking’
*Cognitive-behaviour therapy (CBT) therapy – Beck – psychiatric approach – depression as a thought disorder similar to delusion
*Rational Emotive Therapy (RET) – Ellis - Responsible hedonism:
self interest
self- direction
self-responsibility
tolerance
flexibility
*– triad of depression:
themselves –> [key thinking errors]
world –> [selective abstraction]
future –> [magnification]
Describe the biopsychosocial [BPS]approach
- who was the developer
- training?
- approach
- what system is the BPS following along
- explain the BPS systems [E.A.E]
- which quality is highly valued
- how does it differ to another approach
developed by Drs. George Engel and John
Romano but Engel proposed it first in 1977
BPS training - understanding human health and illness in their fullest contexts [IMPORTANCE]
BPS Approach: SYSTEMATIC/ALLY CONSIDERS
- bio, psycho, social factors
- their complex interactions in understanding health, illness and health care delivery
- psycho/social needs relevant SOCIAL sciences = bio needs relevant NATURAL sciences -> both sciences being basic in med practice [psycho/social is understood in the same scientific manner as bio factors]
BPS factors exist along a continuum of natural systems,
Bio system = EMPHASIZES the anatomical, structural, and molecular substrates of disease and their effects on the P’s bio function
Psycho system = ADDRESSES the contributions of developmental factors, motivation, and personality on the P’s experiences/reactions to illness
Social system = EXAMINES cultural/ environmental/familial influences on the P’s experiences/expression of illness.
Humanistic qualities = highly valued complements.
- the application of the scientific method to diverse BPS phenomena as related to human health.
Bio-med approach:
- reductionistic view on all phenomena are seen as the lowest lvl of natural system [cellular or molecular]
but BPS = recognizes diff clinical scenarios is most usefully understood scientifically at SEVERAL lvls of the natural system continuum
In clinical practice how is BPS approach applied?
[R.S.E.I.M]
- RECOGNIZE that relationships are central to providing health care
- Use SELF-AWARENESS as a diagnostic and therapeutic tool
- ELICIT the patient’s history in the context of life circumstances
- Decide which aspects of bio, psycho, and social domains are most IMPORTANT to understanding and promoting the P’s health
- Provide MULTI-DIMENSIONAL treatment
what other health care professions that CP overlap with during their work
Work revolves round [MDT] such as social workers, nurse, physiotherapist, speech and language therapist, dieticians, occupational therapists and counsellors.
CP is the largest single division of the BPS. In 2005, constituted 52% of registered chartered psychologists (50 yrs anniversary 2015)
Who are some of the key figures & describe what they are known for in addition to general-ish history if its been stated
W [P.I]
S [D.F.P]
P [D.B.T]
Watson:
- PIONEER of behaviourism -> research of conditioning process -> little albert experiment [resulted a child to fear a previously associated neutral stimulus]
- IMPACTED the debate of nature v. nurture [early experiences shape ones personality]
Skinner:
- DEVELOPED behaviour analysis [philosophy of radical behaviourism]
- FOUNDED the experimental analysis of behaviour
= 1st to results in quantitatively repeatable & predictable result
- PIONEERED behaviourism [20th century]
= development of skinner box -> made positive reinforcement have significance
Pavlov:
- more detail for behaviourism -> DISCOVERY of classical conditioning [C.C.]
- BROUGHT about school of thought in said discovery
- 1901 was first theorized with assistant Ivan Filippovitch TOLOCHINOV
- 1926 publications of conditioned reflexes
