Intervention L6 - Competency in Clinical Practice Flashcards
What is competency?
- Competency is not the accumulation of knowledge. It is also the ability to know how to appropriately APPLY the knowledge.
- The ability to form a working ALLIANCE with the client.
- The ability to work and practice in a professional and ETHICAL manner with clients, supervisors and the organisation.
What are the core competencies for all psychologists?
Series of orgs oversee competency - APHRA, APS..
a) KNOWLEDGE of the discipline, including:
i) psychological THEORIES and MODELS
ii) the EMPIRICAL EVIDENCE for the theories and models iii) the major METHODS of inquiry eg. structured interviews, using DSM..
b) ETHICAL, LEGAL & PROFESSIONAL matters, including detailed knowledge and understanding of ethical, legal and professional issues relevant to the area of practice
c) Thorough understanding of psychological ASSESSMENT & MEASUREMENT relevant to the area of practice - see client, understand the situation and know where to go next for assessment, and understand the different inventories and what they mean.
d) INTERVENTION strategies relevant to the area of practice - important in terms of what is rebated by medicare - eg. CBT, motivational interviewing, interpersonal psychotherapy.
e) RESEARCH & EVALUATION, including the systematic identification, critical appraisal and application of relevant research evidence - systematic way of critically weight up evidence, gathering info, to determine course of action, knowing the research for interventions.
f) COMMUNICATION and INTERPERSONAL relationships, including the ability to communicate in written and oral form from a psychological perspective, and oral communication professionally with a wide range of client groups and other professionals
g) Practice across the LIFESPAN, which involves demonstrating the core competencies with clients in childhood, adolescence, adulthood and late adulthood.
h) Working within a CROSS-CULTURAL context, including demonstrating core capabilities to adequately practise with clients from cultures and lifestyles different from the psychologist’s own (these include issues relevant to Aboriginal and Torres Strait Islander peoples, issues of lifestyle diversity including gender equity, sexual orientation and mixed families, and issues to do with migration, ethnic identity, and cross- generational cultural factors).
What is a clinical psychologist ?
Clinical psychologists have specialist training in the assessment and diagnosis of major mental illnesses and psychological problems
- ability to have a model to assess these disorders.
- what does someone whose depressed vs anxious person look like?
- Need to understand the assessment and its suitable intervention.
What are clinical psychologists expected to do in terms of treatment?
Clinical psychologists are trained in the delivery of a range of techniques and therapies.
They are specialists in APPLYING psychological theory and scientific research to solve complex clinical psychology problems requiring individually tailored interventions.
- No cookbook techniques - need to be able to tailor techniques to the client.
What are clinical psychologists expected of in terms of research?
Research is often conducted on prevention, diagnosis, assessment and treatment.
Clinical psychologists are involved in the design and implementation of treatment strategies in various settings (such as primary care, psychiatric and rehabilitation) and in the subsequent evaluation of treatment outcomes.
What is neuropsychological assessment?
Provides a detailed profile of the patient’s strengths and weaknesses, and is recognised as a sensitive tool for the diagnosis of cognitive impairment, particularly in cases where changes are subtle and not evident on screening assessments or neuroimaging.
Neuropsychological conditions can worsen or improve with time and treatment, neuropsychological assessment is valued as providing a baseline for future comparison of changes over time.
- need to use clinical judgement to decide which tests to use.
- repeated testing to monitor change.
What is neuropsychological treatment?
Given what is found in assessment, need to set up appropriate intervention - often work alongside clinical psychs.
Treatments use a holistic framework where cognitive, emotional, motivational and non-cognitive functions are addressed, integrating learning theory, cognitive psychology and neuropsychology.
Neuropsychological treatments can range from a few short sessions to multiple, extended sessions.
Why is training important?
- Boundary Violations
- Vulnerability
What are Boundary Violations?
- Need to understand the position of POWER, and your client is VULNERABLE.
- Need to learn how to behave ethically and professionally.
- People without extensive training are more likely to commit boundary violations
- 7-12% of mental health practitioners in US have erotic contact.
What is the profile of practitioners to make boundary violations?
- males are more likely to make sexual violations
- females more likely to engage in financial dealings
- usually mid-career
- Situational factors leading therapist to be vulnerable have and difficulty coping.
- warning signs are when there are special accommodations being offered - late sessions, double sessions, hugging.
^ these are usually rationalised as therapeutic, but are part of the ‘slippery slope’.
- often working in an isolated setting
What is are risk factors that might lead a psych to be vulnerable?
longstanding fear of negative evaluation - sometimes in therapy it will not be pleasant, and the client can feel negatively towards you
rescue fantasies (covert) - they like the sense of power of rescuing others.
intolerance of negative feelings expressed towards self - desire to be liked
childhood history of emotional deprivation and sexualization - puts them at emotional risk
family history of covert sanctioned boundary transgressions - where violations have been supported, so they don’t have clear boundaries
unresolved anger toward authority figures - might push to break violations by pushing their own power.
restricted awareness of fantasy (especially hostile/aggressive) - restricted awareness of their own processes. self reflection
covert desire to transform negative feelings directed towards self to admiration of self
What are the ways that the registration board protects your clients?
- you must declare your own mental and health issues
- ongoing supervision for all practicing psychologists - whether you are training or not.
- peer supervision
What are the 6 clusters of therapeutic alliance?
- Commitment to therapy - Honesty
- The therapeutic environment - Care
- Out of session processing- Transition - How to make sense of things that happened in-session, outside.
- Therapeutic relationship – Trust and Exploration of self even in face of threat
- Therapist Characteristics- Caring yet Firm
- Therapeutic intervention - Structure to enable self-reflection and self discover - allowing the client to realise what’s happening on their own.
what is the relationship between symptom change and therapeutic alliance?
- therapeutic alliance is NOT a product of symptom change
- symptom change can enhance the therapeutic alliance, but is not solely responsible for the dynamics
- similar findings with women with ED’s, symptom severity of change was not completely responsible for dev of therapeutic alliance - had to connect with the group.
