Clinical Psychology Year 1 Flashcards
4 populations of clients a clinical psychologist works with
children and adolescents
working aged adults
older adults
people with learning disabilities
2 divisions of settings clinical psychologists can choose to work in
setting by age group - children and adolescents, working aged adults or older adults
setting by presentation - EDs, learning disabilities, health psychology, etc
training required to become a clinical psychologist
undergraduate degree with graduate basis for chartered membership (GBC)
work experience is required
doctoral training course is needed - this covers 4 key areas and a specialist placement
(total = minimum 7 years - with only one year of work experience)
graduate basis for chartered membership (GBC)
GBC is a standard set by the BPS. it ensures that before anyone can start a clinical psychology course they have already studied psychology in enough breadth and depth
BPS uses a process called accreditation to assess whether degrees offered by UK unis cover enough psychology for GBC
the clearing house
the organisation where applications are made for clinical psychology training
british psychological society (BPS)
professional body that supports clinical psychologists - BPS holds the standard/ title of a chartered psychologist
health & care professions council (HCPC)
this is the registered body for clinical psychologists
clinical psychologists can be members of the HCPC and not BPS
to be a practicing clinical psychologist you need to be a member of the HCPC
2 main mental health classification systems
ICD-11 and DSM-5
2 main models of mental health
biomedical model - psychiatry
biopsychosocial model (George Engell, 1977)
biopsychosocial model - George Engell, 1977
more holistic approach to wellbeing
mental illness occurs due to biological + psychological + social factors
the biopsychosocial model is compatible with the ICD and DSM diagnostic tools
4 types of interventions
-CBT
-psychodynamic therapy
-systemic therapy
-3rd wave CBT
what therapies are included as part of ‘3rd wave CBT’
-dialectical behavioural therapy (DBT)
-acceptance and commitment therapy (ACT)
-interpersonal therapy (IPT)
what are the IQ levels for the different severities of learning disabilities
IQ = 0-20 = profound
IQ = 20-34 = severe
IQ = 35-49 = moderate
IQ = 50-70 = mild
B.F Skinner
behaviourist
known for reinforcement and operant conditioning
skinner box experiment (rats)
Ivan Pavlov
known for classical conditioning
pavlov’s dog salivation experiment
Sigmund Freud
founder of psychoanalysis
developed a theory of the unconscious with a model of psychic structure - id, ego, superego
Hermann Rorschach
psychiatrist and psychoanalyst
developed artistic inkblots - used experimentally to measure various parts of the subject’s personality
commonly known ‘Rorschach test’
iterations of Rorschach test used today to identify personality, psychotic and neurological disorders
David Wechsler
developed standardised intelligence assessments
intelligence/ memory tests
John Bowlby
known for his work on attachment
Aaron Beck
father of cognitive therapy + CBT
theories widely used in treatment of clinical depression and various anxiety disorders
Michael White
social worker and family therapist
founder of narrative therapy
Marsha Linehan
developed dialectical behavioural therapy (DBT) - seen as part of third wave CBT
cognitive behavioural therapy (CBT)
founder = Aaron Beck
talking therapy
common for anxiety and depression
based on the concept that your thoughts, feelings, physical sensations and actions are interconnected, and that negative thoughts and feelings can trap you in a vicious cycle
CBT deals with your current problems, rather than your past issues
psychodynamic psychotherapy
form of depth psychology
primary focus: to reveal the unconscious content of a client’s psyche, in an effort to alleviate tension
systemic therapy
seeks to address people not only on the individual level, but also as people in relationships. dealing with the interactions of groups and their interactional patterns and dynamics
systems can be family, school, residential settings, wider community networks, etc
what is third wave CBT
third wave CBT refers to a group of emerging approaches to psychotherapy that represent both an extension of and deviation from traditional cognitive behavioural treatment approaches
includes:
-dialectical behavioural therapy (DBT)
-interpersonal therapy (IPT)
-acceptance and commitment therapy (ACT)
dialectical behavioural therapy (DBT) - Marsha Linehan
evidence-based psychotherapy that began with efforts to treat emotionally unstable/ bordeline personality disorder (EUPD/BPD)
there is evidence that DBT can be useful in treating mood disorders, suicical ideation, and for change in behavioural pattern, e.g. self harm or substance misuse
DBT evolved into a process in which the therapist and client work with acceptance and change-oriented strategies, and ultimately balance and synthesise them
acceptance and commitment therapy (ACT) - Hayes
form of counselling and a branch of clinical behaviour analysis
it is an empirically based psychological intervention that uses acceptance and mindfulness strategies mixed in different ways with commitment and behaviour-change strategies, to increase psychological flexibility
developed by Hayes
interpersonal therapy (IPT)
a talking treatment that helps people with depression identify and address problems in their relationships with family, partners and friends
the idea is that poor relationships with people in your life can leave a person feeling depressed
depression in turn can make relationships with others worsen
IPT is usually 16-20 sessions long
primary types of psychological assessment
-clinical interview
-assessment of intellectual or other domains of functioning (e.g. IQ or memory)
-personality assessment
-behavioural assessment
assessment process
begins with a referral question
clinicians must ensure the q is clarified and clear and select the best assessment type
data/ info is gathered from a range of sources, including historical, interview, observation and tests
using clinical judgement, the practitioner ensures the right assessment process is utilised, most relevant data is gathered and analysed, and appropriate assessment tools used
integration of all of the info from the sources results in a coherent assessment
lastly, the clinician communicates the conclusions and provides recommendations in a manner that is clear and helpful to the referrer
the question (for clinical assessment)
the question being asked will lead to the type of assessment and also indicate if any tests are needed
clarifying the referral question is needed before an assessment can be undertaken
broad q (e.g. what type of psychological distress does the person experience, if any?) = more open clinical assessment
specific q (e.g. does the individual have learning disabilities?) = a targeted assessment with tests would be needed
confidentiality in the assessment process
at the start of the assessment process or therapeutic intervention, confidentiality needs to be explained, and the limitations of it
limitations: need to discuss info with the team you are part of (e.g. concerns about risk or safeguarding)
clinical interview aims
to obtain relevant info and arrive at a decision, such as a diagnosis, and/or intervention needed
to cover specific content areas that can include developmental history, history of the presenting problem, current risk concerns, things that have worked/ not worked in the past, etc
how long does a clinical interview usually last
usually takes place in one or two sessions
any longer becomes an extended assessment
psychological tests
formal tests, e.g. questionnaires or checklists
these can be described as norm-referenced tests, meaning the tests have been standardised so that test-takers are evaluated in the same way, no matter where they live, or who administered the test
norm-referenced tests have been developed and evaluated by researchers and proven to be effective for measuring a particular trait or disorder
formulation
‘formulation is the tool used by clinicians to relate theory to practice’ - Bulter, 1998
formulation = hypotheses to be tested
formulation and diagnosis
can be complementary to one another
definitions differ:
-diagnosis - is descriptive and non-theoretical, provide discrete clusters of symptoms
-formulation - provides psychological description and explanation of presenting difficulties at a given point in time
formulation is more detailed and comprehensive
formulation - what has happened to you rather than what is wrong with you
principles of formulation - Johnstone, 2018
clinician takes a reflective stance to reduce the risk of using formulation in an insensitive, non-consenting or disempowering way
clinician should consider the possible role of trauma and abuse. a trauma-informed formulation can be a powerful way of integrating this knowledge into interventions
the 5 P model of formulation
provides a structure for formulation
5 P’s:
-predisposing
-precipitating
-presenting
-perpetuating
-protective
predisposing factors
factors which make the individuals vulnerable to the problem
could be biological factors, past life events, etc
precipitating factors
factors which triggered the problem
presenting factors
what difficulties is the person reporting - or what are the systems around them identifying as a problem
perpetuating factors
factors such as mechanisms which keep a problem going, or unintended consequences of an attempt to cope with the problem
protective factors
factors that help with resilience, and indicate the person has other strengths or interests that can help to overcome the presenting difficulties
types of individual CBT formulation
-the 5P model
-hot cross bun model
-vicious flower model
hot cross bun model of individual CBT formulation
concept that thoughts, emotions, behaviour and physical factors are all interlinked and all contribute to an individuals formulation
vicious flower model of individual CBT formulation
the vicious flower model is a flower where different components interact to cause a psychological problem. the centre is the psychological problem. the petals surrounding it are comprised of:
-automatic negative thinking
-ruminations and self-attacking
-mood/emotion
-withdrawal and avoidance
-unhelpful behaviours
-motivation and physical symptoms
systemic formulation
formulation is not seen as something a therapist does to a family, but as something they do WITH the family.
it is a co-constructional process
compassion focused therapy (CFT)
compassion focused therapy (CFT) has been described as integrating concepts from evolutionary, social and developmental psychology alongside neuroscience findings and Buddhist teachings
formulation within compassion focused therapy (CFT)
-developing insight into how early life experiences created safety strategies, drive-based strategies and soothing strategies
-how each strategy is externally (how we interact with the outside world) and internally (how we manage our own thoughts and feelings) directed
-formulation of sense of self, based on core memories
antecedent, behaviour and consequence (ABC)
in applied behaviour analysis (ABA), the antecedent, behaviour, consequence (ABC) provides building blocks in understanding, analysing and potentially changing how an individual acts
ABC charts can be used to provide ‘snapshots’ into the situation, potentially enabling further comprehension of the behaviour
the individual can be observed to help provide ‘snapshots’ about the emotional reasons why they are behaving in a certain way
an analysis of behaviour via an ABC chart can be included in a comprehensive functional assessment of the behaviour
antecedent
event/environment that occurs before a behaviour, and serves as a trigger/cue for it
features of an effective therapist
therapy is an interpersonal activity thus the therapist needs to have strong interpersonal skills - this includes skills related to communication, relationship building and self-monitoring
therapists who can recognise differences and intensities in client’s emotional experiences = more effective communication and understanding with clients
key to therapeutic process
therapeutic relationship building skills
relationship building skills
communicating with sincerity and warmth
supporting individuals without judgement
^whilst simultaneously having the skill to remind the individual of their capacity and responsiblity for making beneficial changes in their life
Rogerian qualities - Carl Rogers
clinical skills - genuineness, empathy and unconditional positive regard
Carl Rogers argued that these are the necessary and sufficient conditions for bringing about therapeutic change
which types of interventions typically DO NOT stress the importance of the therapeutic alliance as a major role in the therapeutic process
CBT
psychodynamic therapy
which branch of psychology highlights the importance of the therapeutic alliance as part of the therapeutic process
behaviourism
behavioural therapists see the therapeutic relationship playing a larger role, seeing it as a crucial element in bringing about behavioural change because it gives the therapist the opportunity to model new skills and reinforce improvements in the clients behaviour
what attitudinal qualities in a therapist contribute to more effective therapy
therapists that convey warmth, acceptance and who hold a positive, hopeful orientation are more effective when compared with therapists who hold a challenging or overly confrontational stance
reflective practitioner
self reflection is important for a practitioner
it is when a clinician engages in an active process of thinking about their work and experience and learning from it
goals of individual therapy
-to reduce emotional suffering
-fostering the clients insight
-psychoeducation
-assigning homework tasks
-developing hope and expectations for change
group dynamics
term coined by Kurt Lewin
describes the positive and negative forces within groups of people
the attitudinal and behavioural characteristics of a group - concerns how groups form, their structure and how they function
principle of universality - Ivan Yalom
sharing our experience with those that have similar experience is often itself therapeutic
health psychology
the study of psychological and behavioural processes in health, illness and health care
concerned with understanding how psychology, behavioural and cultural factors contribute to physical health and illness
approach of a health psychologist
health psychologists take a biopsychosocial approach, understanding health to be the product of biological factors (e.g. a virus/ tumour/ etc) but also psychological factors (e.g. thoughts and beliefs), behavioural factors (e.g. habits like smoking) and social processes (e.g. socioeconomic status/ ethnicity/ etc)
historical clinical risk management (HCR-20 V3)
used to help inform the assessment of risk
HCR-20 V3 - a comprehensive set of professional guidelines for the assessment and management of violence risk
embodies and exemplifies the structured professional judgement (SPJ) model of violence risk assessment
applicable for 18+ people who may pose a risk of violence
includes historical, clinical and risk management factors
consultation objectives
-to provide practitioners with consultation on their work with clients
-to enhance the quality and competence of practice offered to all clients
-in line with BPS practice guidelines
why is research important for clients
-to receive effective care and support
-to improve current care and support provision
-to monitor and maintain standards
why is research important for practitioners
-to consume research and apply to practice
-to advance their knowledge of the field
-to understand process issues
-for quality improvement
scientist-practitioner model
occurred as a result of the Boulder conference 1949
views developed seeing research and practice as co-existing and complementary
useful for:
-scientific protocols for assessment and support
-integration of scientific findings into practice - empirically supported therapies
-hypothesis testing in practice
-quality improvement
evidence-based practice
complementary to scientist-practitioner model, NOT the same
-use of current best evidence in decision making and care provision
-systematic review and randomised controlled trials (RCTs) are the best methods according to evidence-based practice
-ensures quality and accountability
best research evidence + clinical expertise + client preferences
mental capacity act (MCA)
designed to protect and empower people who may lack the mental capacity to make their own decisions about their care and treatment
applies to age 16+
ethics and code of conduct
code - provided by the BPS ethics committee
focuses on 4 main ethical principles:
-respect
-competence
-responsibility
-integrity`
