Wednesday, December 16, 2009

Proposal for the Integration Paper

Hi Everyone,

Here is the approximate plan of action that Hitha and I have drawn out for our theme on the ethical issues around ECT, and it's "popularity" among the mental health professionals. We wish to also address the question of the factors responsible for its alleged misuse, the measures taken by hospitals to ensure the safe use of ECT for the treatment of the patient and what the available "safer" alternatives are today.
As we set about answering these questions, we will first review the literature in the field to see:
• pros and cons
• laws for and against (Indian context)
• if client's narratives have been taken into account.
We wish, if possible, to interview 2 psychiatrists (with opposing views), a clinical neuro-psychologist, a representative NGO/activist against ECT and a client who has undergone ECT.

Summary of the class of 15th of December, 2010

Summary of the class of 15th of December, 2010

Of all those times we psychology students have had to, time and again, study the importance and the nuances of the clinical interview, I do believe yesterday’s CP class was one of the most entertaining sessions on the topic!
The class was begun in the expectation (!) that the class had read chapters 7 and 8 from Pomerantz. The opening discussion was on the prerequisites of conducting a clinical interview. Pomerantz had listed the following 3 prerequisites:
• “Quieting” of the mind
Self awareness
Positive working Relationship/ Rapport
However, the class saw fit to add more items to his list:
• Active listening skills
• Attending skills (eye contact, body posture, paralinguistic qualities)
• Communication skills
• Adequate training
• Genuineness
• Openness
• Non-judgemental attitude
Sir pointed out that whatever the interview is intended to accomplish (Intake, assessment, intervention, etc), a comfortable professional relationship will smooth the way. Several factors determine how tough or easy it would be to build such a relationship with the client. One obvious factor is the personality of the therapist, and another is the level of self awareness in him/her.
Things took an interesting turn at this point: It is obviously essential it is for clinical psychologists, to appreciate how absolutely indispensable and difficult to achieve self awareness can be. And what better place to hear that than straight from the horse’s mouth? DC sir sportingly shared with the class his own moments of uncertainty and doubt- and had some of us in class sharing our own experiences, too…!
Moving onto questioning skills, sir mentioned it is very important to strike a balance in the proportion of open-ended to close ended questions. He also talked about listening responses, which include clarification, paraphrasing, reflection (of content and of feeling) and summarizing.
The purpose of interviews, he said, generally lie on a continuum with assessment at one end and intervention at the other, and depends on specific populations and objectives. The importance of setting and its relation to the referral question was stressed.
In enumerating the various types of interviews, 3 criteria are kept in mind:
Role (directive / non-directive)
Structure of interview (structured / semi-structured/ unstructured)
Purpose (Intake interview, case history interview, MSE, crisis interview, diagnostic/clinical interview and collateral interviews).
Of course, it is usually the case that more than one type of interview is rolled into one.
The class ended on a most hilarious note- with mimicry, music and holiday spirit, although the holidays were (technically) a week away. Altogether, those who missed this class are to be pitied! :D

The Son’s Room


‘la stanza del figlio' (The Son’s Room)-
A Review (Spoiler Alert)







‘la stanza del figlio' (The Son’s Room) is a 2001 Italian film written and directed by Nanni Moretti. The film won the Palme d’or at the 2001 Cannes Film Festival. It depicts the psychological effects on a family and their life after the death of their son (Wikipedia).

A family of four, Giovanni – played by Moretti, his wife Paola ,teenage daughter- Irene and son - Andria have a happy family life, which provides the Giovanni with a sense of stability. Juxtaposed on the family scenes are Giovanni’s psychoanalysis sessions. One patient never speaks. Another complains about everything. Then the woman with obsessive compulsive disorder. And a sex addict whose lust seems to be getting out of control, bordering on violence.

One day, Andrea is accused of stealing a rare fossil at school. There is unrest in the family, and a domestic run of whodunit which questions morality in general and puts Andrea in a fix follows. The film then changes tracks and Andrea dies in a scuba diving accident. This breaks the family, and we see finer layers of each character as they go through this emotional turmoil and face their own demons out in the open- guilt, despair, remorse, anger. In grief they seem to be locked in their own private hells and unable to reach out and connect with each other.

Post Andrea’s demise, we see the lead couple getting into a different kind of gloom, something which almost starts defining or rather redefining their daily life. They revisit the past through their conversations, mull over the tragedy over and over, discussing and analyzing possibilities and what-if’s, as they realize it is all taking them even deeper into the gloom and despair. One event that happened for the bad is taking all the worse possible proportions and a void that one gradually fills or looks to fill with the passage simply is refusing to fill.

In one sequence, Irene gets into a fight during her basketball match and is booed out by the crowd and is consequentially disqualified from the championship. On their way back, the parents who are sitting few seats away from her in the bus try to console her unsuccessfully. Another sequence follows where Irene is trying to score ‘empty baskets’ to her further dismay and haplessness.

At Andrea’s mourning- Giovanni gets restless at the priest’s consolation. All the divine justification does not, and maybe it is the first time ever for that, make sense to him. He questions all that is being said, albeit in the dead comfort of his wife and house, but does.

“Everything is broken, chipped, scratched, in this house...”

We see Giovanni unable to listen to his clients during the psychoanalysis sessions. He loses ‘all objectivity’ as he puts it. During his sessions he finds his client’s narratives inconsequential and starts thinking of all ways in which he could have prevented his son’s death.

Amidst all the other events, Paula discovers a love letter in Andrea’s room. This letter was written by Arianna, a girl who Andrea had met during a camping trip. Paula is deeply touched by the letter and hopes to find some solace in this girl, who seems to know their son so well.

On hearing about this, Giovanni attempts to write to Arianna, informing her about their son’s death. However for all his efforts, he is simply unable to pen the letter. Paula eventually calls her. But it does not turn out the way they expected. And another hope of them reconciling with life’s strange ways dies.

In a decisive sequence, Giovanni says it is time he says goodbye to practicing psychoanalysis. The patients, as expected, all react differently to the news. Some accept it with mild opposition while others react violently.

In a beautiful montage sequence around this time, we see all 3 members of the family finding it hard to do what they are trying to do. Giovanni who is trying to have dinner can’t have it, the lack of attention manifests itself in myriad ways, glasses break, wine gives way to breadcrumbs, bar conversations go futile, sleep is a rarity…

“You can’t turn back time.”

“That is exactly what I want to do!”

There is a hint of all money and material possessions proving to be futile in bringing a hint of happiness or hope to their now-saddened lives.

The film though moves emotionally from one event to the other, mere failed attempts of the family headed by Giovanni to regain their mundane yet comforting happiness, it sometimes gets a little bleak and detached in the way the scenes play out. When Giovanni visits the record store to get a flavor of Andrea’s favorite music and the music plays on while the tad familiar shopkeeper looks from the corners before walking away, there is a strange sense of alienation in this attempted reunion of sorts. You have mixed feelings for Giovanni. He is not outright convincing as a remorseful, regretful father, yet there is a strange music that rather literally hangs in the air as he walks out of the store with the song still playing on. The same song would conclude the film rather beautifully and matter-of-factly a few scenes later.

Last portions of the film are the strongest. Arianna’s unannounced visit to the family, the family’s reactions, the minor intricacies, the mannerisms, is the film’s quiet triumph over this rather tough approach of a grieving family plot. And then there is the tried angle of the undying spirit of quest, the long winding road of life that the film decides to leave us with. After going through denial, anger, bargaining, depression, finally acceptance is shown in the most unassuming yet convincing manner.

“…well, if Stefano says so...”

This is the only positive message that the film rather reassuringly delivers and negates the strong sense of ennui and a world of gloom that it creates all this while .

“Do not fall asleep, let’s keep each other awake.”

The long, impending night gets over in this typical road-movie-family-trip-transformation as they reach the French border. “What’s so funny”, Irene asks Giovanni and Paula. They simply smile back and we know things are going to be different for this grieving family this day on.


Monday, December 14, 2009

Integration Paper- Update 1.0

Hi.
I have taken away the list that was put up on 2MPCL classroom notice board. Today was the deadline for listing out the topics. I will be putting up the list shortly on the blog. In the meantime, students who haven't written their topics may do so latest by tomorrow (15th Dec). They have to meet me personally during lunch hr with their topics and the group members.

Sunday, December 13, 2009

Answer Key to Quiz

To see the answers to Monday's quiz (CIA), click here.

Wednesday, December 9, 2009

Reading Resources for Module I and II

Introduction to Clinical Psychology: Reading Resources for Module I and II


MODULE – I (For CIA- QUIZ)

• Pomerantz (Clinical Psychology: Science, Practice & Culture) – Chapters 1 & 2 (Essential)
• Witmer’s (1907) article on Clinical Psychology (Essential)
• Roger’s article (Supplementary)
• Plante (Contemporary Clinical Psychology) – Chapter 1 (Supplementary)
• Hecker & Thorpe (Introduction to Clinical Psychology) - Chapter 1 (Essential)
• Clinical Psychology in India (bunch of 4 articles: Janak Pandeys entry on ‘India’ in Encyclopedia of Psychology, S K Verma’s article in CCP, GGP’s book Ch in Mental Health: An Indian Perspective(1946-2003), GGP’s article in NACIACP-06 Souvenir) (Essential)
• Brief History of Practice in Clinical Psychology (Article by Resnick) (Supplementary)

MODULE – II

• General Issues in Psychological Assessment – Chapter 5 (Hecker and Thorpe) (Esssential)
• Encyclopedia of Applied Psychology – 2 entries: Psychological Assessment – Overview; Clinical Assessment (Supplementary)
• The role of assessment in clinical psychology (Sechrest, Stickle & Stewart) – Comprehensive Clinical Psychology – Chapter: 4.01 (Supplementary- briefly)
• Pomerantz – Chapters 7& 8 (Essential) + Chapters 9 & 10 (Essential- briefly)
• Plante – Chapters 7& 8 (Supplementary)
• Relevant research articles - to be given (Supplementary)


Also, please refer to the course blog (http://psychyatra.blogspot.com) and other emails circulated till date.

Wednesday, December 2, 2009

Class Summary

Class of Tuesday, the 24th of November

This class began with a recap of the Nature of Clinical Psychology which had been discussed the class before. It was agreed that the following are the major descriptive characteristics of the field of clinical psychology:
1) Scientificity/scientific approach
2) Idiograpihc approach
3) Focus on abnormality/pathology
4) Designed to answer the question, "How can I help?"
5) Diversity, and
6) More focus on assessment and diagnosis than on intervention (as per today's state of affairs).
Although these are the "generally agreed upon" characteristics of clinical psychology, some experts in the field feel differently about one or more of these points. For instance, sir highlighted, with reference to 2 books (namely, Science and Pseudoscience in Clinical Psychology by Lilienfeld, Lynn and Lohr and Introduction to Clinical Psychology by Hecker and Thorpe), how some parts of clinical practice may border on pseudoscience. What do clinical psychologists have against graphology, for example, which seems to work on the same principles as projective tests?
This is where further discussion on the merits and pit-falls of sticking to evidence based practice began. On the one hand, using EBP gives one the confidence of a tried and tested method, with sufficient scientific proof of its efficiency. On the other hand, what does one do if validation by empirical evidence is not possible for a certain practice? As DC sir said, "Do we then throw psychoanalysis out of the window, provided we have a large enough window?" Also, if one never tries new methods, how is the science of clinical psychology ever to grow? This is the age-old problem of Professional development vs. Creativity that Carl Rogers (1950) also alludes to, in his article "Where Are We Going In Clinical Psychology?"
Proceeding on to the development of clinical psychology in India, the question was raised: "Has it been exactly as in the West? Or has the Indian history of clinical psychology varied in some way?" Summarizing the lively debate that followed is a challenging task; but in essence, some of us felt that insofar as India has been using the "photocopy approach" in the words of Ramalingaswamy (a historian of Indian psychology), yes: The development of Indian clinical psychology may have been the same- but only to an extent. Things may soon change, as awareness of an Indian psychology is on the rise. But others in class were of the opinion that one cannot say the development has been exactly the same, because, after all, India is no stranger to psychology. Ancient seers and sages of India have long since contemplated on human nature, and that the difference lies in our not having enough written records of what they had discovered, albeit cloaked in philosophy and mysticism. Other factors such as the focus on the family, and the ever-present element of religiousness cannot, too, be ignored.
Traces of Indian psychology and psychotherapy has undeniably been found in the Vedas, in Siddha and Ayurveda, in the writings of Charaka and Sushruta. And although the Mughals later brought with them a different cultural tinge, it is nevertheless considered Indian. The British brought with them, along with allopathy, a whole new psychology that was influenced by what was initiated in the West by those like Tuke, Pinel and so on. The first asylum (for the British, not yet for the Indians) was established in 1787 in Calcutta: but not much in the way of treatment was offered to the unfortunate "madmen" (and alleged adultresses!). They were just waiting to be shipped away to Britain. Later, on being questioned, the British started admitting Indians as well into these asylums. Gradually, asylums were opened in Bangalore, Agra and an important one in Ranchi, all of which are now called hospitals.
On the academic side of things, as we know, the first University that taught psychology was Calcutta University, around 1916, facilitated by Sri Brajendra Nath Seal (who taught Psychology as part of Philosophy masters course way back in 1905 in CU). Mysore University soon followed (1924). The articles written by Sanjeev Jain and by G.G.Prabhu (GGP, as he seems to be fondly known) shed much light on the development of Mental Health Services/ clinical psychology in India, Specifically around NIMHANS in Bangalore. According to GGP, the 3 Gs responsible for bringing this feat about were Dr. Girindrasekhar Bose (psychologist/psychiatrist), Prof. M.V. Gopalaswamy (psychologist) and Dr. Govindaswamy (psychiatrist/psychologist, student of Gopalaswamy). It is GGP's opinion that when Gopalaswamy and Govindaswamy together started clinical psychology in NIMHANS, their conceptualization of clinical psychology was very different from what it has turned out to be today, and that if at all there was a Golden Era for Indian clinical psychology, it was till 1960 (this is debatable!).
Other courses in clinical psychology soon cropped up in CIP (estbd in Ranchi by Berkeley Hill), BHU (Varanasi), Ahmedabad, and so on. The path of development of CP in India has not by any means been smooth. The courses at Varanasi and Ahmendabad were not popular for long. The name of the course at NIMHANS has changed nearly half a dozen times, recently because of their disagreements with the RCI: Diploma in Medical Psychology -> Diploma in Medical and Social Psychology -> MPhil in Medical and Social Psychology -> MPhil in Clinical Psychology -> MPhil in Mental Health and Social Psychology->->??.
The class was wound down with one provocative question for those who wished to write an integration paper: WHY has there been no truce declared between NIMHANS and the RCI? Is a truce forthcoming at all?


Major Reading Resources:
• A bunch of 4 articles on Clin Psych in India- (Janak Pandeys entry on ‘India’ in Encyclopedia of Psychology, S K Verma’s article in CCP, GGP’s book Ch in Mental Health: An Indian Perspective(1946-2003), GGP’s article in NACIACP-06 Souvenir- ESSENTAIL READING)
• Plus some other articles on the same topic (Clin Psych in India) mainly published in IJCP from time to time, available with DC (Supplementary reading)
• Hecker & Thorpe (Ch 1- Characteristics of Clin Psych)
• Other regularly referred textbooks for general overview (Trull & Phares, Pomerantz, Plante, etc)
• Lilienfeld’s book (see the text above)

Friday, November 27, 2009

CIA options for semester II

By DC sir's suggestion, let's begin the first post on our blog with a challenge! :)
As in last semester, there are 2 options to choose from for CIA of Introduction to Clin Psy:
A) Combined CIA
B) A collection of 2 mini-CIAs.

A) Combined CIA: For this semester's combined CIA, we are required to write an Integration Paper, in which we are expected to 'integrate' what we learn from the text books with what we gather from the field. Interviews with well-established, practicing clinical psychologists are the preferred way to go about this, although interviews with other mental health professionals are also permitted. DC sir has recommended a list of themes, but has made it clear that he would be happy if we were to think 'out of the box', and choose to do a theme not included in the following list:
1) Psychosocial intervention in reconciliation: The role of clinical psychologists in conflict zones such as the Gujarat riots, Srilanka, natural disaster-struck areas, and so on.
2) Understanding violence in modern life: Intervention by clinical psychologists (Not just in terms of stress-relief, but other ways as well).
3) Spirituality and clinical psychology.
4) Terminal illness and clinical psychology (Do clinical psychologists have new roles today?)
5) Will clinical psychology become very neurologically or biologically oriented in future?
6) Forensic psychology (Sensationalism vs. Reality).
7) Clinical psychology and other fields (Eg. Sports, law, etc).
8) Human diversity and clinical psychology (Eg. Gender, sexual orientation, etc).
9) Psychology and religion.
10) Ethics and/in clinical psychology.
11) Media and clinical psychologists.
12) Evidence-based practices and clinical psychology (Do we need a notion of research tat is different from the one existing today?)
13) Primary care and clinicla psychology (Is it possible to link the two in India?)
14) Mental health acts in India.
15) Continuous professional development for clinical psychologists in India. (Do clinical psychologists update themselves? What sort of CPD is available in India?)
And apart from these, some topics sir has mentioned in passing during class discussion:
16) What are the different conceptions of clinical psychology by both clinical psychologists and non-clinical psychologists (Eg. Psychiatrists, social workers, teachers and students of various departments like science, commerce..., counselors and students of counseling, laymen, UG students, and so on).
17) What are the differences between psychiatrists, (clinical) psychologists and social workers? How do they clash?
18) Why are psychiatrists now considering more psychotherapy as opposed to pharmacotherapy, and starting to call themselves "clinical psychiatrists"?
19) What sort of model of training is used in training clinical psychologists today?
20) What do clinical psychologists feel about employing so called "pseudo-scientific" methods in their practice? (Eg. Graphology, past-life regression therapy, hypnotherapy, etc.) [This is could also be a focus of the 12th topic- evidence based practice].
21) Why has there been no truce declared with RCI yet? How soon can it be expected (if at all)?
22) Practice guidelines: Economic-political forces Vs Professional/scientific need.

B) Mini-CIAs: In case of the mini-CIAs, as in last semester, we are required to submit ANY TWO of the following:

1) MCQ quiz on chapter 1.
2) Putting up summaries of 3 or 4 class discussions on this blog.
3) Personal narrative paper. (Sir prefers that ALL of us write this, but it is still optional).
4) Reports on the IACP conference in NIMHANS.

Apart from these, sir mentioned in class that he would be willing to consider marking us if we were to present a paper (which must be clinical psychology related) at our own conference. However, we can NOT use the same paper to be marked for the CIA of developmental psychology.

All the best! :)