PS1009 Applied Psychology Lecture: Clinical Psychology in Practice

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PS1009 Applied PsychologyLecture Clinical
Psychology in Practice

• Dr Claire Gibson (cg95_at_le.ac.uk)
• School of Psychology, University of Leicester

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Overview

• What is clinical psychology?
• What do clinical psychologists do?
• The development of clinical psychology.
• Issues that clinical psychologists deal with.
• Stages in a case history.
• Therapeutic approaches in clinical psychology.
• The future of clinical psychology.

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What is clinical psychology?

• Primarily alleviates peoples psychological
  problems.
• But, so do psychiatrists, psychotherapists,
  hypnotherapists, nurses, priests etc.
• Clinical psychologist vs. psychiatrist medical
  qualification
• Clinical psychologist vs. therapist approved
  training and qualifications

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How to become a clinical psychologist?

• BPS recognised psychology degree
• At least a 2i
• Relevant work experience
• Acceptance onto 3-year training programme
• Doctorate in Clinical Psychology (D Clin Psy,
  Clin Psy D, Psy D)
• Doctorate qualification without PhD
• Very competitive
• 1 in 5 accepted
• Salary/bursary available
• Interview/selection very intense

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Principles of clinical psychology

• Operate on a scientific basis
• Verified research findings
• Publication of results
• Objectivity and precision
• Public debate and communication
• Hypothesis creation and testing
• Also applied psychologists
• Provide a service to others
• Professionals
• Agreed Code of Conduct
• Own division of BPS
• The British Journal of Clinical Psychology

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What do clinical psychologists do?

• Some examples
• Implementation of care in the community
• Work with children and adults with different
  levels of learning difficulties
• Individual therapy/personal help
• Work with sick clients or those with disabilities

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What do clinical psychologists do?

• Assume different roles
• Assessor/diagnostician
• Use of standardised methods to perform diagnosis
• Researcher
• Generally interested in researching therapeutic
  interventions, i.e. Does it work?
• Therapist
• Plan therapy with client (and family?), aimed at
  alleviating difficulties
• Consultant
• May work at an overall planning level

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The development of clinical psychology

• Witmer, 1896
• First recognised clinic for psychological testing
  in an abnormal context
• In the UK in 1939 no clinical psychologists
• World War II
• 1942, Hans Eysenck appointed as Research
  Psychologist (and then Chief Psychologist)
• 1948, The Institute of Psychiatry, London (still
  world-leading)
• 1948, National Health Service (NHS)

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Issues that clinical psychologists deal with

• Necessary to follow some sort of category system
• Diagnostic and Statistical Manual, 4th revision
  (DSM-IV) requires individuals to be assessed
  along five axes
• I Clinical syndromes
• II Personality disorders
• III General medical conditions
• IV Psychosocial and environmental problems
• V General level of adaptive functioning

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• DSM-IV
• Withhold judgement until all relevant data
  gathered
• Assess individual symptoms along with the
  likelihood of changing them in relation to the
  persons surrounding environment and individual
  circumstances

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Definitions

• Psychoses
• e.g. schizophrenia
• Includes a splitting of cognitive functions
  from reality
• Irrational thinking
• Delusion and fantasy
• Paranoia
• Neuroses
• e.g. agoraphobia
• Maintains reality
• Operates efficiently within constrained limits
• Heightened anxiety
• Clear-cut division?

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Stages in a case history

• Reaching the clinical psychologist
• Initial Assessment
• Formulation of the overall problem
• Construction of and implementation of the
  intervention programme
• Completion of the programme
• Evaluation, review, reformulation

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1. Reaching the clinical psychologist

• Doctor (stigma)
• Friends, colleagues, family pressure?
• Other medical problems
• Helping organisation
• Clinical Psychologist

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2. Initial Assessment

• Excellent interpersonal skills
• Is there a problem?
• Case history background, relationships
• Assessment instruments
• e.g. Spielberger Trait Anxiety Inventory

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3. Formulation of the overall problem

• Identify and separate genuine problem behaviour
• Triggers, consequences, problem situations and
  accompanying thoughts
• Hypothesis development
• Prediction
• If a particular behaviour (or stimulus) is
  removed or client taught to respond differently
  improvement in symptoms?
• Apply treatment
• Monitor results

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4. Construction of and implementation of the
intervention programme.

• Personal preference
• Diverse in approach
• Behavioural programme
• Education
• Cognitively-orientated discussion etc.
• Involves
• Therapist
• Family and friends
• Other professionals (e.g. social worker, care
  staff)

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5. Completion of the programme.

• When should a programme stop?
• Achieve a complete cure
• When the client feels they can cope with life
  again

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6. Evaluation, review, reformulation.

• Every case complex and individual
• Initial stages completed complex problems?
• If on a larger scale
• Evaluate the method
• Review
• Publish
• Inform other members of the clinical psychology
  community

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Major Therapeutic Approaches in Clinical
Psychology

• The psychoanalytic (or psychodynamic) approach
• Behaviour Therapy
• Cognitive Therapy
• Humanistic Therapy
• All covered in PS1014 (last semester)

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The future of clinical psychology

• Traditional clinical psychologist and client
  meet within a hospital environment
• Current and future
• bringing together the clinical psychologist and
  client outside of the traditional hospital
  meeting place
• This is being achieved by
• Care in the community
• Consumerism

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1. Care in the community

• 1960/1970s
• radical thinkers patients benefit more if not
  confined to mental hospitals,
• treated as sick
• relatively little (if any) psychiatric treatment
• 1980/1990s
• closure of mental hospitals move towards care
  in the community
• BUT major political issue
• Supporters of care in the community assumed
  adequate resources would be provided e.g. day
  centres, respite care, training
• But, health authorities viewed closure of large
  Victorian hospitals as a chance to cut spending
• Care in the community must be efficient and
  safe
• Majority feel that adequate funding has never
  been provided
• Successive health ministers

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2. Consumerism

• Patients are much more demanding
• Am I getting the best possible service from my
  doctor?
• Is the best treatment for me?
• Patients will question doctors
• Beneficial
• Strive for healthier lifestyles
• Organise the environment to promote health
• Major development
• Involvement of clinical psychologists in health
  care strategy

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Clinical Psychologists

• Ongoing issues
• Who is the client?
• patient, family
• GP, health trust
• The number of clients
• Consultancy
• Training
• Group therapy

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Further Reading

• Reading List (module website)
• Coolican, H. (1996) Applied Psychology. London
  Hodder Stoughton.
• Main Library, 158 COO