What clinical psychologists do

Question 1

What is clinical psychology?

Answer 1

Clinical psychology involves the application of psychological theories to understand, prevent and alleviate distress. In the UK, Clinical Psychologist is a protected title and you must meet criteria to call yourself a clinical psychologist. HCPC registration is required.

Question 2

Who do clinical psychologists work with?

Answer 2

Working age adults, children and families, people with learning disabilities, people in forensic settings, older people.

Question 3

What do clinical psychologists do?

Answer 3

Clinical psychologists work in a range of settings and across a range of client groups. Psychologists may work in private practice, within privately funded organisations, or within the National Health Service (NHS)

Question 4

What activities do clinical psychologists do?

Answer 4

o Psychological therapy
o Psychometric assessment (including neuropsychological assessment) – which cognitive abilities does the person struggle with, and which are still intact?
o Team working and supporting colleagues to work psychologically
o Understanding individuals and organisations from a psychological perspective
o Supervision of psychologists and other professions
o Writing reports
o Evaluating their work
o Training and continuing professional development
o Psychological research
¥ Work in a range of settings: hospitals, community clinics, people’s homes, care homes, universities, psychology departments, inpatient units, prisons, and cafes.

Question 5

What is team working?

Answer 5

¥ Clinical psychologists often work in multidisciplinary teams (MDTs)
¥ These can include other disciplines; e.g:
o Team manager – organises and manages the team
o Psychiatrists – medical doctors specialising in mental health
o Mental health nurses – nurses specialising in mental health
o Social workers – professionals that focus on social care needs
o Occupational therapists – clinicians who specialise in occupational and daily living skills
o Community support workers – people without a professional qualification who work with clients and may have an NVQ
o Secretarial and support staff – responsible for administration
o Psychotherapists, counsellors and counselling psychologists – other professionals who can provide psychological therapy
o Other specialist disciplines – physiotherapists, medical doctors, prison staff etc.

Question 6

What is a scientist practitioner?

Answer 6

¥ Applying psychological science to clinical practice
¥ CPs are trained in empirical research skills and critical appraisal of evidence
¥ They work as applied scientists
¥ Training courses emphasise scientific knowledge and research skills
¥ Recommended by the American Psychological Association in 1924 and endorsed at the Boulder Conference in 1949

Question 7

What is a reflective practitioner?

Answer 7

¥ Ability to ‘reflect’ on the work they are doing.
¥ General reflection (on the work) and self reflection (on themselves)
¥ Self reflection = ability to think about their own history, personality and assumptions and how it affects practice.
¥ Adapted from Schön (1987)

Question 8

What are the four key tasks?

Answer 8

¥ Assessment
¥ Formulation
¥ Intervention
¥ Evaluation

Question 9

What are methods of assessment?

Answer 9

¥ Clinical interview – client, family/carers
¥ Psychometrics – questionnaires (self and other report), standardised neuropsychological tests – looking at variety of cognitive function
¥ Self-monitoring – diary sheets, record forms
¥ Observation – school, residence
On the basis of this assessment, move on to formulation.

Question 10

What is a formulation?

Answer 10

A psychological formulation is a psychological understanding of the development and the maintenance of an individual’s problems. It draws on individual history and characteristics and psychological therapy and research.

Question 11

What are formulations based on?

Answer 11

Formulations are based on the BioPsychoSocial model. Different levels are useful to consider:

• Social - relationships, family, culture, society.
• Psychological - thoughts, emotions, memories.
• Biological - genetics, physiology, neurology.

Question 12

How do formulations seek to explain the problem?

Answer 12

Formulations seek to explain the problem in terms of development (how did it begin?) and maintenance (what keeps it going?). A good formulation should involve the combination of specific understanding of psychological processes and the individual’s history. E.g. Ken is anxious about his exams because his parents were very critical of him and we know that critical parenting is a risk factor for childhood anxiety. Formulations are tentative hypotheses and subject to change.

Question 13

What is a trans theoretical formulation? (The 5 P’s)

Answer 13

In the middle have the presenting problems (e.g. anxiety), then try to figure out whether there were any predisposing factors, what was the precipitant event (trigger), what are the maintaining factors (what keeps it going) – this is where psychological interventions can help, and finally what are the protective factors (what support can the person get to improve).

Question 14

What is model specific formulation in CBT?

Answer 14

Highlights the importance of cognitions (thoughts and beliefs) and how these influence and are influenced by mood, bodily sensations and behaviour. Treatment usually involves helping people to understand and modify unhelpful cognitions and behaviours. A structured, practical approach. Based on scientific psychology models with an emphasis on evidence. One of the most dominant approaches in the NHS today.

Question 15

How does a CBT formulation work?

Answer 15

Understands a problem an individual is presenting with in terms of: Cognitions: includes underlying beliefs and negative automatic thoughts (may also include automatic thinking processes such as cognitive and attentional biases) Behaviours: includes learned responses and reinforcement contingencies (from behavioural models) and voluntary coping strategies. Emotions: Includes moods and feelings. Physiology: Includes bodily sensations and physical problems/issues.
End up with 5 areas:
1. Situation
2. Thoughts (what are the triggers) – may be catastrophic train of thought: over-emphasise risk and how bad the consequences are
3. Mood/feelings
4. Physical reactions (e.g. increased heart rate)
5. Consequential behaviour.
For some, people can become stuck with these areas feeding each other, and creates a vicious cycle.

Question 16

What are interventions?

Answer 16

Interventions are acts intended to help someone ‘get better’. What this might mean depends partly on the psychologist’s theoretical view. Psychological interventions are psychological - not pharmacological or social care, may take the form of talking therapies, behavioural programmes, self help, activity scheduling. Interventions are derived from psychological theory and driven by the formulation. Methods usually need to have been shown to be effective in clinical trials, i.e. have an evidence base.

Question 17

What are some possible interventions?

Answer 17

¥	Understanding
¥	Normalising
¥	Relaxation, exercise
¥	Weighing the evidence re likelihood and consequences
¥	Reducing avoidance
¥	Connecting with others
¥	Learning from experience

Question 18

How is clinical work evaluated?

Answer 18

As scientist practitioners clinical psychologists are expected to evaluate their clinical work, i.e. “did this therapy work?” This usually involves getting feedback from your patients. This could formal or informal:
o Asking for verbal feedback
o Observing what you thought worked well
o Questionnaires – client satisfaction, well-being, symptom reduction
o Evaluation also occurs on a wider basis for different mental health problems and often drives funding.
Therapies are usually evaluated by how well they reduce symptoms of mental health problems. This is a problem for the approaches that do not focus on symptom reduction or fit well with the medical model.

Question 19

What is a summary of the treatment model?

Answer 19

1. Assessment - gather info to answer the question (‘can I help this person?’)
2. Formulation - use psychological theory to understand why their difficulties have developed an how they are maintained.
3. Intervention - use psychological methods to help someone improve.
4. Evaluation - determine how helpful these methods were.

Question 20

What is psychodynamic psychotherapy?

Answer 20

First developed by Sigmund Freud (1856-1939). He emphasised the importance of different motivational forces within the mind, and how these can be in conflict. He focussed on unconscious thoughts and feelings, and how these can cause mental health problems in some people.

Question 21

What is systemic family therapy?

Answer 21

Developed by Gregory Bateson (an anthropologist) and colleagues in the 1950s. Think of people as people in relationships, dealing with the interactions of groups and their interactional patterns and dynamics.

Question 22

What is behaviour therapy?

Answer 22

e.g. Pavlov (classical conditioning) - the science of increasing or decreasing certain behaviours through changing what is paired with or follows these behaviours. Operant conditioning (Thorndike) - behaviour can be increased and decreased depending on consequences associated with the behaviour.

Question 23

What is the behavioural view of psychological distress?

Answer 23

All human behaviour is determined by classical and operant conditioning. Establishment of maladaptive anxiety is through process of classical conditioning, maintenance through the process of operant conditioning. Symptoms have arisen through faulty/unhelpful learning. Maladaptive behaviour can be altered by means of unlearning. Focus of therapy isn’t on the past - how behaviour can be changed in the here and now.

Question 24

What are different forms of psychodynamic therapy?

Answer 24

Short-term dynamic psychotherapies e.g. time-limited and short-term and brief dynamic interpersonal therapy. Short term focuses on the ways emotional and relationship dynamics set up early in life are replayed later in life in ways which are unhelpful and give rise to psychological problems. Does not focus on the reduction of symptoms, aims to bring these patterns into consciousness - enable them to understand and integrate these experiences into their conscious awareness.

Question 25

What is the core feature of systemic therapies?

Answer 25

Tend not to focus on individual problems, but rather the role of the system (e.g. couple, family, group of organisation) in which the individual is located. Focus on treatment of the person isn’t on the individual themselves, or directly their symptoms, but rather on the ‘stuckness’ in the system (usually the family) that is giving rise to these symptoms. Must work with the stuck system to promote change.

Question 26

What is a critical practitioner?

Answer 26

Critically evaluate concepts, e.g. how language used affects people, the strengths and weakness and challenge it where it contributes to problems.