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PS1009 Applied Psychology Lecture: Clinical Psychology in Practice

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Title: PS1009 Applied Psychology Lecture: Clinical Psychology in Practice


1
PS1009 Applied PsychologyLecture Clinical
Psychology in Practice
  • Dr Claire Gibson (cg95_at_le.ac.uk)
  • School of Psychology, University of Leicester

2
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.

3
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

4
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

5
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

6
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

7
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

8
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)

9
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

10
  • 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

11
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?

12
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

13
1. Reaching the clinical psychologist
  • Doctor (stigma)
  • Friends, colleagues, family pressure?
  • Other medical problems
  • Helping organisation
  • Clinical Psychologist

14
2. Initial Assessment
  • Excellent interpersonal skills
  • Is there a problem?
  • Case history background, relationships
  • Assessment instruments
  • e.g. Spielberger Trait Anxiety Inventory

15
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

16
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)

17
5. Completion of the programme.
  • When should a programme stop?
  • Achieve a complete cure
  • When the client feels they can cope with life
    again

18
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

19
Major Therapeutic Approaches in Clinical
Psychology
  • The psychoanalytic (or psychodynamic) approach
  • Behaviour Therapy
  • Cognitive Therapy
  • Humanistic Therapy
  • All covered in PS1014 (last semester)

20
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

21
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

22
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

23
Clinical Psychologists
  • Ongoing issues
  • Who is the client?
  • patient, family
  • GP, health trust
  • The number of clients
  • Consultancy
  • Training
  • Group therapy

24
Further Reading
  • Reading List (module website)
  • Coolican, H. (1996) Applied Psychology. London
    Hodder Stoughton.
  • Main Library, 158 COO
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