What are the standards for responsible caring & maximizing benefits?
! II.8: provide coordinated services.
- avoid duplication or working at cross purposes.
2. II.9 record should support continued and coordinated care.
3. II.20: be aware of the knowledge and skills of other disciplines and advise the use of such knowledge and skills where relevant.
4. II.21: strive to provide and obtain services.
- may include recommending professionals other than psychologists.
What is counselling?
- counselling= generic term used to describe a range of mental health professionals.
- varied training and licenses required.
- the registered clinical counsellor does not equal clinical psychologists.
- the requirement in BC (registered clinical counsellor- RCC)
- Masters degree
- fields vary - completed counselling course requirements:
- 1 course in each of the 6 areas (4 of which must be grad level, but all 6 can be taken in grad school). - 100 hours of clinical supervision
- but only 25 hours has to be direct.
- problem with this is that it’s not enough.
What are the requirements for counselling psychology and what is it?
- counselling psychology requires mA
- You can either get an mD or mA in counselling, but an mA is better because you can get your Ph.D. afterwards if you want to, but you can’t do that with mD.
- mD usually expires after two years, whereas mA never expires.
- mAs are thesis-based (research-based)- go through the same process as clinical psych- more psych focused than education focused.
- evaluation and counselling of individuals, couples, families, and groups.
- help people adjust to problematic events and accomplish life tasks within major spheres of work, education, relationships, and family.
- focus on facilitating functioning across the lifespan.
- work is generally with reasonably well-adjusted people.
- main tasks:
- preventive treatment, short-term counselling/ therapy, vocational counselling.
- consultation
- outreach
required training:- PhD + internship.
What are the differences and similarities between counselling psych & clinical psych?
Clinical vs. Counseling
* Distinction becoming less meaningful?
* Not according to the College of Psychologists of BC
* Both may be trained in diagnosis and evidence-based practice, and both may work with psychopathology in a range of settings.
* Training programs differ.
* Counseling often within education, clinical within psych.
* Counseling = more career and vocational services
* Research focus often differs.
* clinical= psychopathology, clinical child and adolescent psychology, clinical health psychology
* counseling= minority/ cross-cultural issues, academic/ vocational issues
* Biggest distinction = the severity
o Clinical; more severe cases / more intensive
o Counseling; more day-to-day issues
What is school psychology?
- Specialized training in psychology and education
- Typically work in schools- can’t call yourself a school psychologists outside of school settings, new rule.
- Focus on children functioning, particularly learning.
- Assess intellectual functioning and learning difficulties.
- develop/ evaluate programs to facilitate learning and mental health.
- Consult regarding strategies for optimizing learning.
- Some diagnoses, interventions, prevention (ADHD)
- Attend to social, emotional, and medical factors in the context of learning and development.
- Required training:
- Master’s or PhD
- Internship 1 year of supervised practice.
What are Therapists and psychotherapists
- Unregulated; could mean anything.
- Psychotherapy sometimes used to describe the multidisciplinary practice.
- College Restrictions use of psychologists
- Can’t call yourself a psychologists unless registered.
- Buyer beware.
What do psychiatrists do, and how do you become one?
- Physicians who specialize in the diagnosis, treatment, and prevention of mental illness
- Rooted in medicine, the medical model.
- Can treat medical problems, order tests, prescribe medications.
- Identify relevant medical conditions, tease apart physical and emotional disorders.
- Required training.
- Basic medical training
- Residency (about 5 years post MD).
- Switching to mental health after residency- don’t use medical training too much, mainly treatment.
Psychiatry vs. clinical psychologists
- Psychiatry focuses more on physiological and biochemical systems/functioning.
- Less emphasis on development, cognition, learning psychological functioning.
- Biopsychosocial model
- Less research training.
- Generally, emphasizes psychopharmacological treatment.
- Less training in formal psychological assessment and psychotherapy
- Is an emphasis on evidence-based treatment.
What are the differences in consultation between psychiatrists and clinical psychologists?
Consultation
* Goal = Increase the effectiveness by sharing expertise
* Remedial or preventative
* Clinical consultation:
* Providing information, advice, and recommendations about how best to assess, understand, or treat a client.
* Specific to one client or general to group
* Organizational consultation
* Developing prevention or intervention programs, evaluating service provision, or providing opinions on health care policies etc.,
* Includes legal consultation.
Clinical consultation- an ethical imperative
* In multidisciplinary teams
* With Other psychologists
* Regarding competence (standard II.8), objectivity, dual relationships (standard III.34), ethical issues (iii.38, iv. 18)
* Draw on expertise, the difference in perspective.
* With employees’ supervisees students and trainees (standard ii.25)
* With other professional
* With community members
* If concerned with cultural competence (standard ii.21).
Organizational consultation
* Needs assessment.
* Determine the extent of unmet health needs in the identified population.
* Program development
* Program evaluation
* Policy consultation
* With specific agency
* With government
What counts as clinical supervision?
- Group or individual
- Instruction
- Modeling
- Role plays
- Major part of clinical training
- Learn by doing
- Many practice settings
- Part of the registration process
- Supervise junior colleagues
Research supervision - Undergrad & grad
- Help students;
- Understand literature
- Conceptualize research project
- Design (ethical) studies
- Collect and analyze data
- Interpret findings
- Prepare presentations/manuscripts
- Instruction may be formal or informal
what kind of training can you do as a RCP? and what respective standards are there?
Training
* Train other mental health professions
* Orientations
* Skills training
* Providing consultations
* Train staff at your own practice
* Extended responsibility (standards, I.46-I.47, II.49-II.50, III.39-III.40)
* Everyone working under/with you must follow ethical guidelines
Relevant ethical standards
* Instruction should be current and scholarly (ii.24)
* Facilitate development by:
* Ensuring that students understand ethics
* Providing timely evaluations and constructive consultation and experience opportunities (Standard II.25)
* Encourage and assist in the publication of worthy papers (standard ii.26)
* Give proportionate credit for work/ ideas contributed by others (including students; standard III.37).
What are the two pillars of psych?
Science & Ethics
Science
* Use research evidence whenever available
* If not available, use a scientific frame of mind
* Systematic
* Questioning
* Self-critical
* Monitor effects\
* Formulate and test hypotheses
* Beware intuition
Ethics
* Why do we need ethical guidelines?
* Numerberg; a place in Germany where they ran unethical experiments, e.g., torture, etc., so they set out guidelines of ethics.
* Set out guidelines for professional practice.
* Important to question one’s actions/ services
* Evidence
* Potential risks and benefits
When was the code of ethics developed and by whom?
Canadian Code of Ethics
* Not developed until the 1980s
* Developed from analysis of the literature
* Incorporated knowledge of Canadian psychologists
* Includes an explicit model of ethical decision-making
* Differential weighting of ethical principles
* Respect for dignity
* Responsible caring
* Integrity in relationships
* Responsibility to society
What are the steps of ethical decision making?
Steps of ethical decision making
1. Identify the individual and groups potentially affected
2. Identify ethically relevant issues and practices, including the interest, rights, and characteristics of those individuals involved and the system/ circumstance in which the issue arose
3. Consider how personal biases, stresses, or self-interest might influence development/choice of action.
4. Develop alternative courses of action.
5. Analyze likely risks and benefits of each course of action on all involved/likely to be affected.
6. Choose a course of action after considering principles, values, and standards.
7. Act and assume responsibility for actions.
8. Evaluate results.
9. Assume responsibility for consequences, including correcting negative consequences or re-engaging in ethical decision making.
10. Act appropriately to prevent future occurrences of the dilemma.
Why do we classify/ categorize? And what are two things to consider when doing so?
- Helps us to describe, understand, and predict others’ responses
- Search for common elements, patterns
- Central to science
- Organize, describe, and relate subject matter
Two things to consider… - Validity
- Do the principles that you use to classify behaviour capture the nature of the behaviour?
- Utility
- Is the resulting classification scheme useful?
Why do we need to define what’s “normal”?
- Usually aren’t concerned when things are going well.
- When experience problems and symptoms, often want to know if they are normal.
- Some problems very common and reflect normal reactions.
o Some problems are not common and reflect clinical disorders. - Normative behavior can be described being able to complete daily tasks and abnormal can be described as anything that doesn’t allow us to complete our daily tasks.
Why is it hard to define “abnormal behavior”?
- No single descriptive feature is shared by all forms of abnormal behavior.
- No one criterion for “abnormality” is sufficient.
- There is no discrete boundary between “normal” and “abnormal.”
- Not just rare, unusual, bizarre, or shameful.
- Need to consider context.
What are Different Definitions of Abnormal Behavior?
- Statistical infrequency or violation of social norms.
- The experience of subjective distress.
- Disability, dysfunction, or impairment.
what does Satisfactory Infrequency or Violation of Social Norms mean?
- Failure to conform as “abnormal.”
o Depart from the mean (e.g., intellectual disability)
o Depart from social norms. - Pros
o Can use quantitative cut-offs.
o Intuitively appealing – if we see it as abnormal, others likely do too. - Cons
o Cut-offs are arbitrary.
o How much deviation is too much?
o It’s all relative/
o Not all infrequent behaviors are problematic.
What are norms influenced by?
Values, Experiences
- Personal, cultural, and professional values can influence definition of abnormal.
- Can include beliefs based on theoretical models.
o E.g., belief that newborns don’t experience pain, that children don’t experience depression.
- Professional Relativity.
o What we see as abnormal may depend on our professional context.
- Incredibly important to base definitions on scientific evidence.
what does subjective distress mean?
- Abnormal if it is distressing for the person.
- Pros:
o Seems reasonable to expect that people can assess whether they are experiencing problems.
o Clinician does not have to make judgement call on whether maladjustment is “bad enough.” - Cons:
o People can experience serious maladjustment and not experience distress (e.g., personality disorders, psychosis).
o Ego syntonic vs. ego dystonic
Ego syn; your actions follow your goals.
Ego dys: your actions don’t follow your goals.
How much distress is too much?
Disability, dysfunction, or impairment
- Abnormal if it causes social (interpersonal) or occupational/ educational problems.
- Pros:
o Often requires little inference.
o Problems often prompt people to seek treatment.
- Cons: who defines dysfunction?
o Impairment is relative.
- Hard to agree on “adequate” level of functioning.
Abnormal Behavior vs. Mental Disorder
- Abnormal behavior ≠ mental illness
- Some problems/ symptoms are actually fairly normative.
o Examples: panic attacks, intrusive thoughts. - Consider statistics on what is normal/ typical.
- Mental disorders = syndromes
o Cluster of abnormal behaviors that co-occur. - Should meet ALL diagnostic criteria.
How does the dsm-5 define mental disorder?
DSM- 5 Definition of a Mental Disorder.
- Syndrome characterized by clinically significant disturbance in cognition, emotion regulation, or behavior.
- Reflects dysfunction in psychological, biological, or developmental processes underlying normal functioning.
- Usually associated with significant distress or disability in social. Occupational, or other important activities.
o Harmful dysfunction
- Distress and/ or impairment.
