5. Repeat 7 digits in reverse order:
4162593, 3826475, 9452834
6. Free Association (80 words, 3 minutes)
Alt 1. Vocabulary (60 words)
Wednesday, August 4, 2010
Tuesday, July 20, 2010
Wednesday, July 14, 2010
Tuesday, July 13, 2010
Wednesday, July 7, 2010
One Minute Short Film
Hey Guys ...
I've made a short one minute film on diagnostic categorizing ...
http://www.4shared.com/video/AM9b7Na6/DPMIAB1.html
Would like some reactions ...
Seema ...
I've made a short one minute film on diagnostic categorizing ...
http://www.4shared.com/video/AM9b7Na6/DPMIAB1.html
Would like some reactions ...
Seema ...
Friday, July 2, 2010
Monday, June 28, 2010
Thursday, June 24, 2010
Tuesday, June 22, 2010
Fish's Clinical psychopathology
Hey guys...
Click HERE for the Fish's Clinical Psychopathology e-book pdf file...
A very good reading material...
Best of luck!!!
Click HERE for the Fish's Clinical Psychopathology e-book pdf file...
A very good reading material...
Best of luck!!!
Monday, June 21, 2010
Saturday, June 19, 2010
UGC NET Paper 1 Study Material
Hey!
If you're planning to write UGC NET, here's all you need for Paper 1... :D
http://www.4shared.com/document/VLASiPzn/Paper_1_study_material.html
http://www.4shared.com/document/CvMMemy8/ugcdata.html
http://www.4shared.com/document/So20cW77/ugclogic.html
http://www.4shared.com/document/QThJAu3b/ugcmathsreasoning.html
And click HERE for the syllabus for Paper 1 and HERE for syllabus of Papers 2 and 3.
If you're planning to write UGC NET, here's all you need for Paper 1... :D
http://www.4shared.com/document/VLASiPzn/Paper_1_study_material.html
http://www.4shared.com/document/CvMMemy8/ugcdata.html
http://www.4shared.com/document/So20cW77/ugclogic.html
http://www.4shared.com/document/QThJAu3b/ugcmathsreasoning.html
And click HERE for the syllabus for Paper 1 and HERE for syllabus of Papers 2 and 3.
Thursday, June 17, 2010
Culture and Psychology
Click HERE to download your copy of The Handbook of Culture and Psychology by D. Matsumoto.
Raja Yoga
Click HERE to download the fully English version of Swami Vivekanada's Raja Yoga and HERE to download Patanjali's Yoga Sutra.
PS: The text in the Patanjali file is weird! Also, it has a whole lot of Spanish - IGNORE THAT! The file has a transliteration AND translation of the Yoga Sutra into English (and Spanish).
PS: The text in the Patanjali file is weird! Also, it has a whole lot of Spanish - IGNORE THAT! The file has a transliteration AND translation of the Yoga Sutra into English (and Spanish).
QRM course plan, history
Wednesday, April 7, 2010
Friday, March 19, 2010
Sunday, March 14, 2010
ABSTRACT
Spirituality and psychotherapy are two different entities that are always talked about in the field of mental health. Spirituality cannot be totally separated from religion. For the purpose of our paper we consider spirituality as Essence of religion. It is about an individual's inner life, ideals, attitudes, thoughts, feelings and prayers towards the Divine, and about how he or she expresses these in daily way of life. It is a very subjective experience and it might happen even within the context of religion. If this is the case, therapist might have a difficult time in handling clients coming from different religious backgrounds. So we thought of focusing if spirituality could be used in psychotherapy and whether the spirituality of the client and that of the therapist conflict. If it conflicts how does the therapist handle it? Whether the therapist has the right to introduce spirituality even without the consent of the client? We thought of interviewing psychotherapists and clinical psychologists in order to gain more insights into it.
KEY WORDS
Spirituality, Psychotherapy, Religiosity, Mental health.
INTRODUCTION
The World Health Organization defines mental health as "a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”.
Traditionally, mental health problems were handled by the Shamans or the faith healers with medical knowledge. Mental health patients used to get cured at the place of worship. Later on psychology and psychiatry and other such disciplines emerged and professionally trained people like psychiatrists and psychologists started handling the problems with mental health and they took over. Freud viewed religion as an illusion and, and connected it with pathology such as obsessive compulsive behavior. This view encouraged many therapists to avoid the topic altogether. Yet recent statistics shows that about ¾th of the population of USA who are suffering from mental health problems are less likely to go such professionals. Instead they go to the traditional healers. While this is a statistics from a developed country, for the developing countries, the number would even more increase. Even in this 21st century,if people are still going for the traditional healers, then there should be some scope for the integration of spirituality and psychotherapy. We often do not think about this possibility because of the bio medical model that we are following and when the spiritual dimension is missing from mental health, a good chance is lost to connect with the person as a whole.
"Psychotherapy is the art, science, and practice of studying the nature of consciousness and of what may reduce or facilitate it." - James Bugental, (1978). In order to seek integration between spirituality and psychotherapy, it is necessary to differentiate between Religiosity and spirituality. Both these terms are interrelated Religiosity means the participation in particular beliefs, rituals and activities of traditional religion. Spirituality is more basic than religiosity. It is the essence of the religion. It is a subjective experience that exists both within and outside of traditional religious systems. Spirituality relates to the way in which people understand and live their lives in a view of their sense of ultimate meaning and value. So spirituality exists in all the patients. For those who follow any particular religion, spirituality happens within the religion while for others it happens outside.
It is seen that about 80- 90% of the population believes in a higher power. This belief may reflect in their perception of the cause of the illness. The main reason why mental health professionals are not using spirituality is that it opens up patients to powerful ideologies that may be dangerous. Because any powerful belief system has the potential for good and bad. Usually it is concluded without sufficient evidence that spirituality is bad for the patient. The spiritual side of a person should be considered as an important dimension in the therapeutic process.
Over the years, however, there have been attempts by therapists such as Carl Jung and others to integrate spirituality and psychotherapy. Many therapists now are beginning to consider the healing opportunities available when incorporating a more holistic view of mind, body, and spirit. Even the American Psychiatric Association (APA) has begun to consider the role of religion and spirituality in psychiatry. For example, the Diagnostic and Statistical Manual of Mental Disorders (DSMIV) (APA, 1994) includes a category, "religious and spiritual problems," which, while it focuses on problems, separates spiritual issues from psychological problems for the first time. At present among different approaches, only the transpersonal approach uses spiritual dimension directly in psychotherapy.
PROBLEM
• Can spirituality be used in psychotherapy?
• If so, under what circumstances it could be used?
• Do the therapists face any problems while using spirituality?
• Is there enough training for the use of spirituality?
• Is spirituality relevant in psychotherapy?
REASONS
Personally we believe that belief in a supreme being is necessary in coping with the world. Moreover, the moment we get out of the curriculum, most of us forget about the science and scientific things and retreat into the traditional beliefs. So when someone close to us have a mental problem, the immediate thought that comes into our mind is the traditional healers, may it be a priest, monk or someone of that kind. Only if they are not able to cure the person, we think about the professionals such as a psychologist or a psychiatrist. Also when we become therapists, it would be helpful for us if we know whether to use spirituality and what would be the consequences.
REVIEW OF LITERATURE
There are several studies indicating that people who are religiously or spiritually affiliated are 40% less likely to have depression. Also if they get into Depression, it is found that they recover faster. It is found that for every 10- point increase in the intrinsic religion score, there was 70% increase I the remission from Depression. When psychotherapy is religiously oriented, it had better improvement after treatment. Studies have found that adults who are above the age of 50 and have never participated in religious activities are at 4 times higher risk for committing suicide. And the religious or spiritual commitments are found to be having reduced risk for substance abuse and suicide. Another study found that chance for alcohol dependency is 60% greater when there is no religious affiliation. Also those who participated in a spiritually oriented therapy for alcohol abuse were found most likely to be abstinent after the treatment. In a study conducted by D’ Souza to find out the applications of spirituality augmented CBT, they found that is significantly beneficial in extinguishing hopelessness and despair and to reduce relapse.
In an article titled Spirituality and Mental Health- Synergic, antagonistic or the missing Dimension, Avdesh Sharma points out the benefits of using spirituality in mental health. The integration increases the positivity of the person about self and healing. It also creates a connection with the Higher Power to draw the power to heal.
In a survey conducted in Australia, 68.7% of the clients suggested that they want the therapist to be aware of their spiritual needs and beliefs. To do the therapy with the spiritual or religious clients, the therapist would be more self-aware to enhance their work (Bartoli 2007). According to Wiggins (2008) the awareness of themselves like their own ideas and beliefs as well as the biases about the religion or the spirituality would help the therapist to avoid imposing their own values on their clients. He explored a solution for therapists are that to write a spiritual autobiography.
In the beginning of the twentieth century, the spirituality has not a significant role in psychotherapy. It has overcome these issues in the last twenty years. There are number of researches focused on this issue and this is an emerging issue in psychology. The APA has formulated the role of religion and spirituality in psychiatry. These give a new chance or a new shift in the field through the integration of spirituality in psychology. Nicholas (1994) talks that now a day’s patients are seeking for not only for reducing psychological issues but also to compensate for the lack of reliable and humane guideposts that are available in society as a whole. In these scenario the psychologists should support the client who are emptiness and hopeless in nature. Kaurusu(1999) emphasis that therapist who are giving a traditional kind of therapy gives only a transitory relief and he would not be provide any techniques for the wider development rather than pathology.
Clinicians are using spiritually oriented therapy to reduce the various psychological problems. Coelho, Canter, Ernst (2007) reported the significance of the integrated interventions on the prevention of depression for patients with three or more episodes of depression. There are recent studies on the implications of spiritual oriented treatments and this would help in reducing drug use or addictive behaviors, (Avants, Beital, Margolin(2005) and intervention for sexual abuse victims (Murray, Swank, Paragment, 2005). These interventions are mainly likely to help spiritually oriented people to an extent and this can be used by the therapists who are not necessarily religious in nature. The researched interventions that are effectively used in psychotherapy are prayer, teaching spiritual or religious concepts, mindfulness etc.
Religion is considered to be institutionalized spirituality (Abraham V). Spirituality provides or initiates humane qualities like love, honesty, patience, tolerance etc. Spirituality has a prominent role in everyone’s live as though they are aware or not. To treat the person spiritually means treat the whole person in the therapy session, few of the therapists address the spiritual beliefs in their daily practices (Shafranske, 1996). A meta analysis study conducted by Walker, Gorush,Siang-Yang in 2004 reported that therapists sees spirituality as important and there are psychologists who work with the integrated therapy, this study gives the outcome that there is a positive relationship between participating in spiritual beliefs and the use of spirituality in counselling.
Spiritual clients give importance to their own spiritual part of their life. According to Gallop and Lindsey 90% of people in United States prayed and they do their daily rituals without any fail. What they says that the therapist might be remiss if they neglect the spiritual aspect during therapy because these people considers that spiritual values have the ability to shape and influence their own lives.
Spirituality is considered to be vital for growth and it is essential for dealing with life’s problems (Lukoff, Turner, Lu, 1992, Sperry, 2001). The psychotherapy and spiritual dimension can be incorporated by identifying the relationship between these two concepts. The personal experience of clients, personal and professional responses by psychotherapists, the business setting, and the increasing tolerance for spiritual issues are the four aspects that can affect the relationship between spirituality and psychotherapy. The spirituality oriented patients seeks the treatment in which they eagerly wanted to discuss the spiritual issues and concerns, particularly spiritual experiences are considered to be appropriate (Westfield, 2001).
FINDINGS
Ms. Shobana Managoli, a well known clinical psychologist, who has been working in this field for 22 years spoke about the use of spirituality in psychotherapy. Psychotherapy works on to forget the event or situation which is a threat to the client. Psychotherapy teaches the client to let go the event or incidence which causes distress to the client. The patient has to learn from the incidence and then follow up the learning which she or he has been learned from the therapist. In spirituality, the spiritual healer teaches the client to forgive the incidence. It gives emphasis on the forgiveness. Then the client has been carried up to the acceptance of the sin. The client should be aware of the sin and should admit the right to be punished.
According to her, if the therapist uses the psychotherapy only, it is not effective for the holistic development of the individual. In the psychotherapy, forgiveness is not taking place; instead forgetting has a major role in the psychotherapy. But the anger or distress remains in the client. Anger could not be completely resolved by the therapist.
In the case of spiritual healer, forgiving has a major role, where forgetting the threatening situation is not taking place. If images of the event still persist in the client, it would arise the feelings of anger. Here the spiritually oriented psychotherapy works. In this case psychotherapy teaches the client to forget and spirituality focuses on the forgiveness aspect. These together works towards the development of the individual in various dimensions.
Comparison with the biomedical model
The medical model works in a specific way in which illness, health and fitness are taken care of. The patient comes to the doctor with some kind of illness and he/she wants to be cured. This is the first stage. Then the doctor provides with medications and takes the patient to the second stage that is health. Now the patient is healthy and has to move into the third stage of fitness. Here the doctor provides some tips to maintain fitness such as exercise or meditation etc. therapist with a certain kind of distress and a desire to be cured the illness.
In spiritually oriented psychotherapy the holistic development of the individual works through three steps: the illness_ eustress_ empowerment. The patient meets the therapist with a distress and the cure of the distress should be done with supportive psychotherapies till the person attains the eustress. Here the learning process works and for that, the therapist might be using different types of therapies like behavioral, psychoanalytic, cognitive behavioral therapy etc. The next and the final step is to empower the client with the help of spirituality. Through this the client maintains the fitness and promotes what he has been done with the previous sessions. Through the role of spirituality the self exploration of the client gets activated and it promotes a well being in the individual.
So in her therapy she uses spirituality towards the end. She strongly believes that nothing should be done that would hurt the religious beliefs of the client and the family. For her, she has not faced any problems as such in using spirituality. For her, if a client comes with a belief of an unforgiving and punishing god, she would still work on the aspect of forgiveness because for them it would reduce the degree of punishment.
According to Ms.Shobha, the therapist can use spirituality only after the self –exploration of the therapists themselves. The therapist should be aware of what is going on his or her mind. Self-exploration is the fundamental qualification of using spirituality in the therapy and it is attained only after long years of experience. Through experiences the therapist would acquire a balanced state of mind. Spirituality can be introduced to the therapy if the client is inclined to the spiritual orientation and when the therapists themselves have a very clear idea about their spiritual path. There is no appropriate training available for spiritually oriented psychotherapy model. According to her the spiritually oriented therapy is beneficial and it is worthful in nature.
Dr. S.C, is a clinical psychologist practicing in Kerala. According to him spirituality is the faith in the Supreme Being and it is very closely connected to psychology. Because it provides us with a better physical and mental health. For him it is always good to have spirituality for everyone. As the famous sayings suggests you become what you think. Faith is also a kind of thinking. This could be the reason why people get cured during the worships. Because the patient has a faith in God and he or she believes that God has cured him that is enough for the patient. If you believe that god has created you with a purpose and whatever happens in your life has got a purpose, this belief itself can make lot of difference in your life as per the above quote. Spirituality is also very useful in adjusting the problems of life. According to him an atheist would not be able to cope with the life as a believer does. Spirituality is also self-promoting and it is very helpful for a healthy mind.
Dr. S.C talked to us about the famous story of Jim, a child who was severely injured and was hopeless according to the medical science. But he recovered significantly within 16 days. When the boy asked about this miracle said that he heard the voice of God telling him that “Jim, God is here”. So the belief is that God is with him helped him to recover from the dead bed. So according to him, faith heals. Studies conducted among the soldiers suggest that soldiers who have faith took only half the time to get cured when compared to others. Studies also suggest that nuns and the priests have higher life span because of the spiritual element in their life.
Suggestion is the base for the psychological treatment. Similarly faith can also act as a suggestion. It can also trigger the neurotransmitter actions. According to him psychologist should be a spiritual person. This can improve the treatment effectiveness.
Dr S.C uses spirituality in his therapy only when the client is convinced or inclined to the spiritual dimension. For an atheist he would not use the spiritual element because he believes that the patient is there for not a conflict but for help. The aspect of forgiveness and prayer can only be brought into the patients notice through the spiritual dimension. So he explains to the patient about the scientific side of forgiveness and the importance of faith. For example, if we do not forgive someone, it would create hostile feelings in you which in turn cause excessive adrenaline in the body. This increases tension, depression and other biological changes and can cause health of mind and body. So the base for all these problems is the unforgiving mind. Still the if the patient is not convinced he uses pure biological techniques to reduce the harm. If a client comes to him with the concept of an unforgiving God, he uses the same strategy of explanation. He believes that people with moderate education would understand the scientific side of spirituality and would cooperate with the therapy.
In his practice he does not face much conflict because of the application of spirituality. Clients from different religious background do not cause a problem in using spirituality because spirituality is different from religiosity. For him, the training for the use of spirituality is necessary and he is highly optimistic about the integration of spirituality and psychotherapy.
We interviewed some other Clinical Psychologists also. Mr. G, who is a working in Kerala, said that he himself is an atheist and does not believe in using spirituality in his practice. At the same time, another Clinical Psychologist JP from Mangalore stressed on the importance of spirituality in therapy and is using it as well. He does not face any conflict in dealing with the clients from different religious background because he believes that spirituality and religion are different.
OUR OWN POSITION
For most of us important things in our life can only be experienced and cannot physically hold. Spirituality is also the same. Just because spirituality is not directly subjected to science, we cannot reject its significance. More over there are plenty of researches that have proved the significance of spirituality in health in general, especially mental health. But most clinicians feel that they are not well equipped to use spirituality in their practice. This is mainly because the mechanistic view of patients as only a material body. This view is no longer satisfactory. Patients and the therapist have begun to realize the importance of spirituality in the therapy. The therapist should consider the therapy as a healing process rather than just a business. They should look into the whole person rather than just a patient. They should treat all the dimensions of the patient, including spiritual healing. For example, if a patient comes to the therapist who just had a break up with his girl friend, and the person is suffering from depression because of this, the therapist can actually bring in the spiritual element here provided the patient is firm in his spirituality. Suppose the client is a Christian, according to Christianity, your life partner is pre-determined and ultimately you will end up marrying that person. If the therapist can focus on this aspect, it would actually speed up the healing process better than any other methods. Through our readings and findings we came to a conclusion that self- exploration and experience is highly necessary for the use of spirituality in psychotherapy.
CONCLUSION
Psychotherapy should take all the dimensions in a person’s life into consideration and should not be restricted only to the biomedical model. The goal of both psychotherapy and spiritual practice is often thought to be the relief of suffering. But not all the psychotherapists can do the role of a spiritual guide and vice versa. Yet psychotherapy and spirituality also have a great deal in common. In particular, many of the processes that contribute to psychological health and well-being contribute to spiritual growth as well.
Before some years, spirituality was just a marginalized issue in psychotherapy. Now it has moved to the forefront and there are several schools offering the integration between spirituality and psychotherapy. Now the clinicians are well aware of the importance of the importance of spirituality in mental health. But most clinicians feel that they are not well equipped to use spirituality in their practice. A therapist cannot just use spirituality in psychotherapy after attending a workshop on the topic. It needs thorough knowledge of the history and the present of religion, spirituality and mental health. The therapist should know how to answer the patient’s questions regarding spirituality and psychology. Ethics should be given importance throughout the training. The therapist should keep in mind that they should not impose their values and beliefs on to the clients. Many of them do it even without understanding that they are doing it. Another important point is that the therapists should have a thorough understanding of their belief system. Because many of the clients who come to the therapy would not have a very clear idea about their belief system. This might lead to therapist imposing their own beliefs on to the clients. Different approaches of psychotherapy have different views of religion and spirituality. So it is necessary for the therapist to know the different perspectives and not just one view. Also, there are diversity among spiritual trends. It might happen within the religion as well as outside of it. The therapist should be aware of the major trends emerging. If the therapy incorporates the belief system of the person in an appropriate way , it would be helpful for the client and the family to cope with the distress. This aspect improves the quality of life for the patients.
REFERENCES
• D’souza R F(2006). The spirituality augmented cognitive behavioural therapy- a meaning therapy for sustaining mental health and functional recovery, Archives of Indian psychiatry 8(1), 10-15
• Kapur R L, Can Indian spiritual practices be used in psychotherapy, Oriental philoshopical thoughts in mental health.
• Jacqelie A ,Smith L (2005). Spirituality and coping mechanism in the lives with congential disabilities, American Psychiatric press.
• Jim Myers, attending the soul; psychotherapy and spirituality
• Rangaswamy K, (1998). Spirituality and health, Oriental philoshopical thoughts in mental health
• Sharma A,(2008) Spirituality and mental health- synergistic, antagonistic or the missing dimension, Delhi Psychiatric Journal ,11(1),9-11
• Trautmann R L , psychotherapy and spirituality
• Vaishanav M, (2006). Spirituality and psychiatry, Archives of Indian Psychiatry,8(1), 1-9
• Varghese A, (2008). Spirituality and mental health, Indian Journal of Psychiatry.
Spirituality and psychotherapy are two different entities that are always talked about in the field of mental health. Spirituality cannot be totally separated from religion. For the purpose of our paper we consider spirituality as Essence of religion. It is about an individual's inner life, ideals, attitudes, thoughts, feelings and prayers towards the Divine, and about how he or she expresses these in daily way of life. It is a very subjective experience and it might happen even within the context of religion. If this is the case, therapist might have a difficult time in handling clients coming from different religious backgrounds. So we thought of focusing if spirituality could be used in psychotherapy and whether the spirituality of the client and that of the therapist conflict. If it conflicts how does the therapist handle it? Whether the therapist has the right to introduce spirituality even without the consent of the client? We thought of interviewing psychotherapists and clinical psychologists in order to gain more insights into it.
KEY WORDS
Spirituality, Psychotherapy, Religiosity, Mental health.
INTRODUCTION
The World Health Organization defines mental health as "a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”.
Traditionally, mental health problems were handled by the Shamans or the faith healers with medical knowledge. Mental health patients used to get cured at the place of worship. Later on psychology and psychiatry and other such disciplines emerged and professionally trained people like psychiatrists and psychologists started handling the problems with mental health and they took over. Freud viewed religion as an illusion and, and connected it with pathology such as obsessive compulsive behavior. This view encouraged many therapists to avoid the topic altogether. Yet recent statistics shows that about ¾th of the population of USA who are suffering from mental health problems are less likely to go such professionals. Instead they go to the traditional healers. While this is a statistics from a developed country, for the developing countries, the number would even more increase. Even in this 21st century,if people are still going for the traditional healers, then there should be some scope for the integration of spirituality and psychotherapy. We often do not think about this possibility because of the bio medical model that we are following and when the spiritual dimension is missing from mental health, a good chance is lost to connect with the person as a whole.
"Psychotherapy is the art, science, and practice of studying the nature of consciousness and of what may reduce or facilitate it." - James Bugental, (1978). In order to seek integration between spirituality and psychotherapy, it is necessary to differentiate between Religiosity and spirituality. Both these terms are interrelated Religiosity means the participation in particular beliefs, rituals and activities of traditional religion. Spirituality is more basic than religiosity. It is the essence of the religion. It is a subjective experience that exists both within and outside of traditional religious systems. Spirituality relates to the way in which people understand and live their lives in a view of their sense of ultimate meaning and value. So spirituality exists in all the patients. For those who follow any particular religion, spirituality happens within the religion while for others it happens outside.
It is seen that about 80- 90% of the population believes in a higher power. This belief may reflect in their perception of the cause of the illness. The main reason why mental health professionals are not using spirituality is that it opens up patients to powerful ideologies that may be dangerous. Because any powerful belief system has the potential for good and bad. Usually it is concluded without sufficient evidence that spirituality is bad for the patient. The spiritual side of a person should be considered as an important dimension in the therapeutic process.
Over the years, however, there have been attempts by therapists such as Carl Jung and others to integrate spirituality and psychotherapy. Many therapists now are beginning to consider the healing opportunities available when incorporating a more holistic view of mind, body, and spirit. Even the American Psychiatric Association (APA) has begun to consider the role of religion and spirituality in psychiatry. For example, the Diagnostic and Statistical Manual of Mental Disorders (DSMIV) (APA, 1994) includes a category, "religious and spiritual problems," which, while it focuses on problems, separates spiritual issues from psychological problems for the first time. At present among different approaches, only the transpersonal approach uses spiritual dimension directly in psychotherapy.
PROBLEM
• Can spirituality be used in psychotherapy?
• If so, under what circumstances it could be used?
• Do the therapists face any problems while using spirituality?
• Is there enough training for the use of spirituality?
• Is spirituality relevant in psychotherapy?
REASONS
Personally we believe that belief in a supreme being is necessary in coping with the world. Moreover, the moment we get out of the curriculum, most of us forget about the science and scientific things and retreat into the traditional beliefs. So when someone close to us have a mental problem, the immediate thought that comes into our mind is the traditional healers, may it be a priest, monk or someone of that kind. Only if they are not able to cure the person, we think about the professionals such as a psychologist or a psychiatrist. Also when we become therapists, it would be helpful for us if we know whether to use spirituality and what would be the consequences.
REVIEW OF LITERATURE
There are several studies indicating that people who are religiously or spiritually affiliated are 40% less likely to have depression. Also if they get into Depression, it is found that they recover faster. It is found that for every 10- point increase in the intrinsic religion score, there was 70% increase I the remission from Depression. When psychotherapy is religiously oriented, it had better improvement after treatment. Studies have found that adults who are above the age of 50 and have never participated in religious activities are at 4 times higher risk for committing suicide. And the religious or spiritual commitments are found to be having reduced risk for substance abuse and suicide. Another study found that chance for alcohol dependency is 60% greater when there is no religious affiliation. Also those who participated in a spiritually oriented therapy for alcohol abuse were found most likely to be abstinent after the treatment. In a study conducted by D’ Souza to find out the applications of spirituality augmented CBT, they found that is significantly beneficial in extinguishing hopelessness and despair and to reduce relapse.
In an article titled Spirituality and Mental Health- Synergic, antagonistic or the missing Dimension, Avdesh Sharma points out the benefits of using spirituality in mental health. The integration increases the positivity of the person about self and healing. It also creates a connection with the Higher Power to draw the power to heal.
In a survey conducted in Australia, 68.7% of the clients suggested that they want the therapist to be aware of their spiritual needs and beliefs. To do the therapy with the spiritual or religious clients, the therapist would be more self-aware to enhance their work (Bartoli 2007). According to Wiggins (2008) the awareness of themselves like their own ideas and beliefs as well as the biases about the religion or the spirituality would help the therapist to avoid imposing their own values on their clients. He explored a solution for therapists are that to write a spiritual autobiography.
In the beginning of the twentieth century, the spirituality has not a significant role in psychotherapy. It has overcome these issues in the last twenty years. There are number of researches focused on this issue and this is an emerging issue in psychology. The APA has formulated the role of religion and spirituality in psychiatry. These give a new chance or a new shift in the field through the integration of spirituality in psychology. Nicholas (1994) talks that now a day’s patients are seeking for not only for reducing psychological issues but also to compensate for the lack of reliable and humane guideposts that are available in society as a whole. In these scenario the psychologists should support the client who are emptiness and hopeless in nature. Kaurusu(1999) emphasis that therapist who are giving a traditional kind of therapy gives only a transitory relief and he would not be provide any techniques for the wider development rather than pathology.
Clinicians are using spiritually oriented therapy to reduce the various psychological problems. Coelho, Canter, Ernst (2007) reported the significance of the integrated interventions on the prevention of depression for patients with three or more episodes of depression. There are recent studies on the implications of spiritual oriented treatments and this would help in reducing drug use or addictive behaviors, (Avants, Beital, Margolin(2005) and intervention for sexual abuse victims (Murray, Swank, Paragment, 2005). These interventions are mainly likely to help spiritually oriented people to an extent and this can be used by the therapists who are not necessarily religious in nature. The researched interventions that are effectively used in psychotherapy are prayer, teaching spiritual or religious concepts, mindfulness etc.
Religion is considered to be institutionalized spirituality (Abraham V). Spirituality provides or initiates humane qualities like love, honesty, patience, tolerance etc. Spirituality has a prominent role in everyone’s live as though they are aware or not. To treat the person spiritually means treat the whole person in the therapy session, few of the therapists address the spiritual beliefs in their daily practices (Shafranske, 1996). A meta analysis study conducted by Walker, Gorush,Siang-Yang in 2004 reported that therapists sees spirituality as important and there are psychologists who work with the integrated therapy, this study gives the outcome that there is a positive relationship between participating in spiritual beliefs and the use of spirituality in counselling.
Spiritual clients give importance to their own spiritual part of their life. According to Gallop and Lindsey 90% of people in United States prayed and they do their daily rituals without any fail. What they says that the therapist might be remiss if they neglect the spiritual aspect during therapy because these people considers that spiritual values have the ability to shape and influence their own lives.
Spirituality is considered to be vital for growth and it is essential for dealing with life’s problems (Lukoff, Turner, Lu, 1992, Sperry, 2001). The psychotherapy and spiritual dimension can be incorporated by identifying the relationship between these two concepts. The personal experience of clients, personal and professional responses by psychotherapists, the business setting, and the increasing tolerance for spiritual issues are the four aspects that can affect the relationship between spirituality and psychotherapy. The spirituality oriented patients seeks the treatment in which they eagerly wanted to discuss the spiritual issues and concerns, particularly spiritual experiences are considered to be appropriate (Westfield, 2001).
FINDINGS
Ms. Shobana Managoli, a well known clinical psychologist, who has been working in this field for 22 years spoke about the use of spirituality in psychotherapy. Psychotherapy works on to forget the event or situation which is a threat to the client. Psychotherapy teaches the client to let go the event or incidence which causes distress to the client. The patient has to learn from the incidence and then follow up the learning which she or he has been learned from the therapist. In spirituality, the spiritual healer teaches the client to forgive the incidence. It gives emphasis on the forgiveness. Then the client has been carried up to the acceptance of the sin. The client should be aware of the sin and should admit the right to be punished.
According to her, if the therapist uses the psychotherapy only, it is not effective for the holistic development of the individual. In the psychotherapy, forgiveness is not taking place; instead forgetting has a major role in the psychotherapy. But the anger or distress remains in the client. Anger could not be completely resolved by the therapist.
In the case of spiritual healer, forgiving has a major role, where forgetting the threatening situation is not taking place. If images of the event still persist in the client, it would arise the feelings of anger. Here the spiritually oriented psychotherapy works. In this case psychotherapy teaches the client to forget and spirituality focuses on the forgiveness aspect. These together works towards the development of the individual in various dimensions.
Comparison with the biomedical model
The medical model works in a specific way in which illness, health and fitness are taken care of. The patient comes to the doctor with some kind of illness and he/she wants to be cured. This is the first stage. Then the doctor provides with medications and takes the patient to the second stage that is health. Now the patient is healthy and has to move into the third stage of fitness. Here the doctor provides some tips to maintain fitness such as exercise or meditation etc. therapist with a certain kind of distress and a desire to be cured the illness.
In spiritually oriented psychotherapy the holistic development of the individual works through three steps: the illness_ eustress_ empowerment. The patient meets the therapist with a distress and the cure of the distress should be done with supportive psychotherapies till the person attains the eustress. Here the learning process works and for that, the therapist might be using different types of therapies like behavioral, psychoanalytic, cognitive behavioral therapy etc. The next and the final step is to empower the client with the help of spirituality. Through this the client maintains the fitness and promotes what he has been done with the previous sessions. Through the role of spirituality the self exploration of the client gets activated and it promotes a well being in the individual.
So in her therapy she uses spirituality towards the end. She strongly believes that nothing should be done that would hurt the religious beliefs of the client and the family. For her, she has not faced any problems as such in using spirituality. For her, if a client comes with a belief of an unforgiving and punishing god, she would still work on the aspect of forgiveness because for them it would reduce the degree of punishment.
According to Ms.Shobha, the therapist can use spirituality only after the self –exploration of the therapists themselves. The therapist should be aware of what is going on his or her mind. Self-exploration is the fundamental qualification of using spirituality in the therapy and it is attained only after long years of experience. Through experiences the therapist would acquire a balanced state of mind. Spirituality can be introduced to the therapy if the client is inclined to the spiritual orientation and when the therapists themselves have a very clear idea about their spiritual path. There is no appropriate training available for spiritually oriented psychotherapy model. According to her the spiritually oriented therapy is beneficial and it is worthful in nature.
Dr. S.C, is a clinical psychologist practicing in Kerala. According to him spirituality is the faith in the Supreme Being and it is very closely connected to psychology. Because it provides us with a better physical and mental health. For him it is always good to have spirituality for everyone. As the famous sayings suggests you become what you think. Faith is also a kind of thinking. This could be the reason why people get cured during the worships. Because the patient has a faith in God and he or she believes that God has cured him that is enough for the patient. If you believe that god has created you with a purpose and whatever happens in your life has got a purpose, this belief itself can make lot of difference in your life as per the above quote. Spirituality is also very useful in adjusting the problems of life. According to him an atheist would not be able to cope with the life as a believer does. Spirituality is also self-promoting and it is very helpful for a healthy mind.
Dr. S.C talked to us about the famous story of Jim, a child who was severely injured and was hopeless according to the medical science. But he recovered significantly within 16 days. When the boy asked about this miracle said that he heard the voice of God telling him that “Jim, God is here”. So the belief is that God is with him helped him to recover from the dead bed. So according to him, faith heals. Studies conducted among the soldiers suggest that soldiers who have faith took only half the time to get cured when compared to others. Studies also suggest that nuns and the priests have higher life span because of the spiritual element in their life.
Suggestion is the base for the psychological treatment. Similarly faith can also act as a suggestion. It can also trigger the neurotransmitter actions. According to him psychologist should be a spiritual person. This can improve the treatment effectiveness.
Dr S.C uses spirituality in his therapy only when the client is convinced or inclined to the spiritual dimension. For an atheist he would not use the spiritual element because he believes that the patient is there for not a conflict but for help. The aspect of forgiveness and prayer can only be brought into the patients notice through the spiritual dimension. So he explains to the patient about the scientific side of forgiveness and the importance of faith. For example, if we do not forgive someone, it would create hostile feelings in you which in turn cause excessive adrenaline in the body. This increases tension, depression and other biological changes and can cause health of mind and body. So the base for all these problems is the unforgiving mind. Still the if the patient is not convinced he uses pure biological techniques to reduce the harm. If a client comes to him with the concept of an unforgiving God, he uses the same strategy of explanation. He believes that people with moderate education would understand the scientific side of spirituality and would cooperate with the therapy.
In his practice he does not face much conflict because of the application of spirituality. Clients from different religious background do not cause a problem in using spirituality because spirituality is different from religiosity. For him, the training for the use of spirituality is necessary and he is highly optimistic about the integration of spirituality and psychotherapy.
We interviewed some other Clinical Psychologists also. Mr. G, who is a working in Kerala, said that he himself is an atheist and does not believe in using spirituality in his practice. At the same time, another Clinical Psychologist JP from Mangalore stressed on the importance of spirituality in therapy and is using it as well. He does not face any conflict in dealing with the clients from different religious background because he believes that spirituality and religion are different.
OUR OWN POSITION
For most of us important things in our life can only be experienced and cannot physically hold. Spirituality is also the same. Just because spirituality is not directly subjected to science, we cannot reject its significance. More over there are plenty of researches that have proved the significance of spirituality in health in general, especially mental health. But most clinicians feel that they are not well equipped to use spirituality in their practice. This is mainly because the mechanistic view of patients as only a material body. This view is no longer satisfactory. Patients and the therapist have begun to realize the importance of spirituality in the therapy. The therapist should consider the therapy as a healing process rather than just a business. They should look into the whole person rather than just a patient. They should treat all the dimensions of the patient, including spiritual healing. For example, if a patient comes to the therapist who just had a break up with his girl friend, and the person is suffering from depression because of this, the therapist can actually bring in the spiritual element here provided the patient is firm in his spirituality. Suppose the client is a Christian, according to Christianity, your life partner is pre-determined and ultimately you will end up marrying that person. If the therapist can focus on this aspect, it would actually speed up the healing process better than any other methods. Through our readings and findings we came to a conclusion that self- exploration and experience is highly necessary for the use of spirituality in psychotherapy.
CONCLUSION
Psychotherapy should take all the dimensions in a person’s life into consideration and should not be restricted only to the biomedical model. The goal of both psychotherapy and spiritual practice is often thought to be the relief of suffering. But not all the psychotherapists can do the role of a spiritual guide and vice versa. Yet psychotherapy and spirituality also have a great deal in common. In particular, many of the processes that contribute to psychological health and well-being contribute to spiritual growth as well.
Before some years, spirituality was just a marginalized issue in psychotherapy. Now it has moved to the forefront and there are several schools offering the integration between spirituality and psychotherapy. Now the clinicians are well aware of the importance of the importance of spirituality in mental health. But most clinicians feel that they are not well equipped to use spirituality in their practice. A therapist cannot just use spirituality in psychotherapy after attending a workshop on the topic. It needs thorough knowledge of the history and the present of religion, spirituality and mental health. The therapist should know how to answer the patient’s questions regarding spirituality and psychology. Ethics should be given importance throughout the training. The therapist should keep in mind that they should not impose their values and beliefs on to the clients. Many of them do it even without understanding that they are doing it. Another important point is that the therapists should have a thorough understanding of their belief system. Because many of the clients who come to the therapy would not have a very clear idea about their belief system. This might lead to therapist imposing their own beliefs on to the clients. Different approaches of psychotherapy have different views of religion and spirituality. So it is necessary for the therapist to know the different perspectives and not just one view. Also, there are diversity among spiritual trends. It might happen within the religion as well as outside of it. The therapist should be aware of the major trends emerging. If the therapy incorporates the belief system of the person in an appropriate way , it would be helpful for the client and the family to cope with the distress. This aspect improves the quality of life for the patients.
REFERENCES
• D’souza R F(2006). The spirituality augmented cognitive behavioural therapy- a meaning therapy for sustaining mental health and functional recovery, Archives of Indian psychiatry 8(1), 10-15
• Kapur R L, Can Indian spiritual practices be used in psychotherapy, Oriental philoshopical thoughts in mental health.
• Jacqelie A ,Smith L (2005). Spirituality and coping mechanism in the lives with congential disabilities, American Psychiatric press.
• Jim Myers, attending the soul; psychotherapy and spirituality
• Rangaswamy K, (1998). Spirituality and health, Oriental philoshopical thoughts in mental health
• Sharma A,(2008) Spirituality and mental health- synergistic, antagonistic or the missing dimension, Delhi Psychiatric Journal ,11(1),9-11
• Trautmann R L , psychotherapy and spirituality
• Vaishanav M, (2006). Spirituality and psychiatry, Archives of Indian Psychiatry,8(1), 1-9
• Varghese A, (2008). Spirituality and mental health, Indian Journal of Psychiatry.
Class Summaries (dt. 23/02/'10, 26/02/'10 and 1/03/'10)
23rd Feb 2010
Ethical principles of psychologists and code of conduct, 2002
The code of conduct for clinical psychologists was framed in the year 1953. The code has undergone 9 revisions since conception. The following factors, in the opinion of the class, have led to major shifts in our understanding of ethics in general and specifically in the moral demands from the profession.
1) Research interest: as attested by more research on ethics in other fields too such as general activism, animal rights, laws in other fields, etc, contributing to more rigid ethics.
2) With the client becoming the consumer, (consumer protection act, 1986) there was a necessity to strengthen the code in order to protect the professionals against law suits.
3) Sudden popularity in the field as gauged by an increase in the number of professionals warranted a sound code of conduct to protect the integrity of the field. In 1990, there were about a hundred thousand clinical psychologists all over America and it was the 5th most popular subject opted in schools.
Relationship between law and ethics: Ethics binds a professional by principles and directs him/her to strive for the best possible service to the client but there is no legal mandate. Violation doesn’t lead to imprisonment. Whereas, laws don’t tolerate violation. The exceptions to this rule are “Violable laws” that are included in the code of conduct.
It is to be noted that ethics are aspirational whereas law is enforceable.
a) Aspirational laws don’t lay down a mandate that professionals have to follow it stringently 100% of the times but rather, should aspire to diligently follow them. No specific details of what to do and what not to do are laid down.
b) Mandatory ethics can be violated with the risk of putting one’s membership with the APA in jeopardy. APA’s ethical committee is the final jury on taking the decision to cancel the membership. Once the membership is cancelled, APA committee refers the guilty on to a local state council/ court, which takes the final decision as to continuation of the professional as a clinical psychologist.
An example was cited for a better understanding of the gray areas in adhering to certain guidelines of the code on the part of the professional.
A Bengali doctorate student was undergoing therapy from a Clinical psychologist where the patient confessed to having romantic feelings for a lady who didn’t reciprocate. In course of the therapy the patient also expressed his wish to hurt and eventually kill her. The Clinical psychologist, who was practicing in the same university as that of the patient, promptly informed the local police who interrogated the client. The police didn’t find enough evidence and the patient was given a restraint order against the lady. After a few months, the patient murdered her. Tara’s family complained that the clinical psychologist didn’t inform them.
Since then so many laws have been passed that recognize clients as consumers. Clients, who are disgruntled for any reason, file cases against clinical psychologists to the ethical committee. The general experience is that many times the cases are found to be false. Ironically, in spite of revisions and tightening of the code of conduct and more number of dos and don’ts, the number of ethical violations has been on the rise. Does it reflect the failure of the code of conduct? To better appreciate the complexities, it is opined by the class that it may become necessary to include ethics in a major way as part of a masters’ syllabus.
The 1980s and 1990s saw lots of research in this area. In 1987 about 460 practicing clinical psychologists in the USA responded to a survey where case vignettes were given and the participants were asked to say what they would do and not do. Only few participants could clearly answer the questions. Majority felt that response to any given situation will depend on contextual factors. This study clearly establishes that gray areas are involved in a clinical psychologist’s professional practice. One clear outcome of the study was that it came out very clearly that there was widespread consensus among the professionals that there can’t be a dual relationship with the client in the context of sexuality. Shaking hands with the client was not an ethical violation. Any confession of sexual abuse involving family members or otherwise would be immediately informed by the clinical psychologist.
Even if this research is replicated, it can be seen that a majority of cases fall in the gray areas. Ethical dilemmas have to be accepted as a part of professional practice. The rest of the session was about dealing with such ethical dilemmas.
There’s been a rise in ethical activism and rise in law suits, leading to a lot of loose ends being tied up by different associations. Hence to accommodate necessary behavioral principles, codes have been revised.
Any violation of the code may attract a Reprimand or cancellation of license depending on the severity of violation. The existing code of conduct probably has to go through an introspective deliberation as to the need to tighten it.
After discussion that continued in the same vein, case studies were distributed. Students were asked to note what constituted a violation and what did not. Went back to APA code of conduct to clarify and confirm.
To access the Ethical principles of psychologists and code of conduct, 2002, check this link out: http://www.apa.org/ethics/code/code.pdf
A few examples of the kind of case vignettes circulated around:
Case I: Dr.A recently became a licenced practitioner. He is a very competent professional. He sets up a private practice. Dr.A is very excited, wants a satisfactory and profitable career. Dr.A however nurtures ambitions of enhancing his financial status. His family situation also places high expectations of early success what with his wife being pregnant with their first child. A colleague refers a patient suffering from panic attacks to him. Dr.A has never treated panic attack before. The patient is wealthy which tempts Dr.A to counsel him several times a week when the right number of sittings would have been 3 times a week or less. But he sought out academic and scholarly material to improve his competence. What are the possible violations of ethics he has committed and what would you do if you were on the Ethical Committee? If you were Dr. A, what would you have done?
Students’ response: Violations: Asking him to come for more than 3 sessions is a violation as this doesn’t leave the client with enough time to do his homework. The sessions have to be paced according to the competencies of the client.
By APA’s guideline, this amounts to violation of mandatory ethics: 2.01, 2.06, 3.04, 3.10 (Pls refer link above for the specific principles.)
If we were put on this case, it is likely that it would have resulted in the following verdict:
1) A Warning to the practitioner
2) Should be made to take help and guidance of a supervisor or should have referred him on to someone if he was not sure of his competencies. Learning is not the primary goal. Helping is.
What should have been done: Dr.A should have informed the client of his inexperience but assured him of his knowledge of the client’s problem and give him an option of having an evaluative first session, following which, if he is satisfied, he can carry on with him while Dr.A takes guidance from his supervisor. Alternatively, Dr.A could also have referred the client on to some other professional.
Case 2: Dr B has been doing psychological testing for 5 yrs. He has a high level of competency. He used to enjoy his work once but then burned out. He gets into the habit of omitting tests and taking shortcuts. As this continued, on an occasion his diagnosis landed in error. A Child with LD was diagnosed as having MR. The child was put in special school. When the child was retested, it was found that his level of functioning was higher.
This amounts to violation of clause 2.06. The solution is to offer breaks to practitioners, inculcate the system of continuous professional education, and proper supervision.
26thFeb 2010
The Future of Clinical Psychology
This class saw a presentation by Subhasree who presented a paper that attempted to answer several questions about the future of clinical psychology, including the following:
1) Will clinical psychology be able to retain its identity or will it be dissolved into a number of sub-disciplines? This concern was brought up by her in the face of a widening boundary between research and practice within the field, and also the emergence of super-specialities within the scope of clinical psychology such as child clinical psychology, clinical health psychology, clinical neuropsychology and geropsychology.
2) However, if we were to think of clinical psychology of an undivided field, what do we stand to gain? In response to this question, the paper concluded that the developments in the different areas of the field (practice, research, diagnosis and therapy) seem to enrich and take leads from one another rather than establish any hard difference between the goals of one another, which is eventually, evidence based help to the clients in need.
3) The next concern is a never-ending question. What is our relationship with psychiatrists? The position this paper seems to take is that clinical psychologists will win the favour of the public if they collaborated with psychiatrists because of the public’s preference for a ‘quick cure’, that seemingly only medications and psychiatrists can offer.
4) The next premise addressed in this paper was the relationship with education. With clinical psychologists striving to place the field at a position of high regard, there has been great emphasis on rigorous research, competitive exams to admit the most competent students to master-level programs, sound ethics, etc.
5) The final question is a very interesting one. This paper tries to answer who is fit to treat whom? That is, what kind of therapist is most likely to succeed in treating what kind of clients? This question is answered by exploring the client-therapist variation strategy, which looks at the various client and therapist characteristics and what combinations of these characteristics are slated for success.
The demands that have been placed on this field were also discussed:
1) The number of clinical psychologists who are efficiently trained and who hold years of clinical experience are very few in the teaching forum. It is also felt that it is essential to offer students exposure to clinical materials which will only add to increase the competency of the training programs.
2)The division of labour between psychiatrists and psychologists when it comes to dealing with problems that are in the borderline between those of a purely psychiatric and psychological nature, as is feasible.
3) A need to construct further developments in the area of child psychology.
4) Including psychometrics in higher level courses.
5) Training of clinical psychologists in the biological sciences, such as anatomy, pathology, pharmacology, etc. so as to get an overall understanding of the client as a psychological and a biological organism.
1st march 2010
PANEL DISCUSSION
Opening question: What is the future of clinical psychological training and education? What would be our suggestions for improvements and modifications?
The panelists primarily felt that a gap exists between what’s happening in the field and what is being taught in class.
The question that was grappled with throughout the discussion was why not have a UG course with clinical specialization? The counter-argument to this proposition was that many don’t know if the clinical track is what they want to take up. Many universities don’t have a great UG course in order in the first place. Integration would make education worse.
Another counter argument posed was what happens to the inter disciplinarity of the field if we were to have an early specialization- Compromise on exploration.
A very pertinent suggestion that was made and agreed by all present was that maybe UG courses can have in depth papers that have been structured optimally to reduce the need to do such papers as systems of psychology and social psychology at the masters level, as this would permit the masters level courses to focus more on integration with the field of practice.
Another argument that rose was what role does the level of maturity of a student play in the process of decision making concerning opting for a specialized clinical psychology course and what are the implications that it has in taking the most from training? What then is the right age? To this, the class responded that a good number of people do not feel the calling even after completing a masters in clinical and this is not necessarily because of fading passion. Other considerations such as finances, personal dilemmas and others play a role. So age is not all. Even people who are a cent percent certain of things after UG may be thought to be going through a phase of rethinking because of the way masters course is structured.
Who gets disillusioned in such a case?!
Another position: It’s not only the course that decides why we want to do clinical psychology. It is also about seeing for yourself what the field is about and how much we get inspired by out- of- class exposures. A person who is interested will be interested no matter what course is inflicted on them.
The discussion then moved on to what the supposed “competencies” of a clinical psychologist are? How should it be developed?
The class thought such skills as observation, reflection, need to help, self- awareness (of one’s own motivations, competencies, etc), intrinsic motivation to remain committed, a well developed understanding of cause-and-effect, personal emotional stability, and the ability to use oneself in therapy to an optimal level.
Ethical principles of psychologists and code of conduct, 2002
The code of conduct for clinical psychologists was framed in the year 1953. The code has undergone 9 revisions since conception. The following factors, in the opinion of the class, have led to major shifts in our understanding of ethics in general and specifically in the moral demands from the profession.
1) Research interest: as attested by more research on ethics in other fields too such as general activism, animal rights, laws in other fields, etc, contributing to more rigid ethics.
2) With the client becoming the consumer, (consumer protection act, 1986) there was a necessity to strengthen the code in order to protect the professionals against law suits.
3) Sudden popularity in the field as gauged by an increase in the number of professionals warranted a sound code of conduct to protect the integrity of the field. In 1990, there were about a hundred thousand clinical psychologists all over America and it was the 5th most popular subject opted in schools.
Relationship between law and ethics: Ethics binds a professional by principles and directs him/her to strive for the best possible service to the client but there is no legal mandate. Violation doesn’t lead to imprisonment. Whereas, laws don’t tolerate violation. The exceptions to this rule are “Violable laws” that are included in the code of conduct.
It is to be noted that ethics are aspirational whereas law is enforceable.
a) Aspirational laws don’t lay down a mandate that professionals have to follow it stringently 100% of the times but rather, should aspire to diligently follow them. No specific details of what to do and what not to do are laid down.
b) Mandatory ethics can be violated with the risk of putting one’s membership with the APA in jeopardy. APA’s ethical committee is the final jury on taking the decision to cancel the membership. Once the membership is cancelled, APA committee refers the guilty on to a local state council/ court, which takes the final decision as to continuation of the professional as a clinical psychologist.
An example was cited for a better understanding of the gray areas in adhering to certain guidelines of the code on the part of the professional.
A Bengali doctorate student was undergoing therapy from a Clinical psychologist where the patient confessed to having romantic feelings for a lady who didn’t reciprocate. In course of the therapy the patient also expressed his wish to hurt and eventually kill her. The Clinical psychologist, who was practicing in the same university as that of the patient, promptly informed the local police who interrogated the client. The police didn’t find enough evidence and the patient was given a restraint order against the lady. After a few months, the patient murdered her. Tara’s family complained that the clinical psychologist didn’t inform them.
Since then so many laws have been passed that recognize clients as consumers. Clients, who are disgruntled for any reason, file cases against clinical psychologists to the ethical committee. The general experience is that many times the cases are found to be false. Ironically, in spite of revisions and tightening of the code of conduct and more number of dos and don’ts, the number of ethical violations has been on the rise. Does it reflect the failure of the code of conduct? To better appreciate the complexities, it is opined by the class that it may become necessary to include ethics in a major way as part of a masters’ syllabus.
The 1980s and 1990s saw lots of research in this area. In 1987 about 460 practicing clinical psychologists in the USA responded to a survey where case vignettes were given and the participants were asked to say what they would do and not do. Only few participants could clearly answer the questions. Majority felt that response to any given situation will depend on contextual factors. This study clearly establishes that gray areas are involved in a clinical psychologist’s professional practice. One clear outcome of the study was that it came out very clearly that there was widespread consensus among the professionals that there can’t be a dual relationship with the client in the context of sexuality. Shaking hands with the client was not an ethical violation. Any confession of sexual abuse involving family members or otherwise would be immediately informed by the clinical psychologist.
Even if this research is replicated, it can be seen that a majority of cases fall in the gray areas. Ethical dilemmas have to be accepted as a part of professional practice. The rest of the session was about dealing with such ethical dilemmas.
There’s been a rise in ethical activism and rise in law suits, leading to a lot of loose ends being tied up by different associations. Hence to accommodate necessary behavioral principles, codes have been revised.
Any violation of the code may attract a Reprimand or cancellation of license depending on the severity of violation. The existing code of conduct probably has to go through an introspective deliberation as to the need to tighten it.
After discussion that continued in the same vein, case studies were distributed. Students were asked to note what constituted a violation and what did not. Went back to APA code of conduct to clarify and confirm.
To access the Ethical principles of psychologists and code of conduct, 2002, check this link out: http://www.apa.org/ethics/code/code.pdf
A few examples of the kind of case vignettes circulated around:
Case I: Dr.A recently became a licenced practitioner. He is a very competent professional. He sets up a private practice. Dr.A is very excited, wants a satisfactory and profitable career. Dr.A however nurtures ambitions of enhancing his financial status. His family situation also places high expectations of early success what with his wife being pregnant with their first child. A colleague refers a patient suffering from panic attacks to him. Dr.A has never treated panic attack before. The patient is wealthy which tempts Dr.A to counsel him several times a week when the right number of sittings would have been 3 times a week or less. But he sought out academic and scholarly material to improve his competence. What are the possible violations of ethics he has committed and what would you do if you were on the Ethical Committee? If you were Dr. A, what would you have done?
Students’ response: Violations: Asking him to come for more than 3 sessions is a violation as this doesn’t leave the client with enough time to do his homework. The sessions have to be paced according to the competencies of the client.
By APA’s guideline, this amounts to violation of mandatory ethics: 2.01, 2.06, 3.04, 3.10 (Pls refer link above for the specific principles.)
If we were put on this case, it is likely that it would have resulted in the following verdict:
1) A Warning to the practitioner
2) Should be made to take help and guidance of a supervisor or should have referred him on to someone if he was not sure of his competencies. Learning is not the primary goal. Helping is.
What should have been done: Dr.A should have informed the client of his inexperience but assured him of his knowledge of the client’s problem and give him an option of having an evaluative first session, following which, if he is satisfied, he can carry on with him while Dr.A takes guidance from his supervisor. Alternatively, Dr.A could also have referred the client on to some other professional.
Case 2: Dr B has been doing psychological testing for 5 yrs. He has a high level of competency. He used to enjoy his work once but then burned out. He gets into the habit of omitting tests and taking shortcuts. As this continued, on an occasion his diagnosis landed in error. A Child with LD was diagnosed as having MR. The child was put in special school. When the child was retested, it was found that his level of functioning was higher.
This amounts to violation of clause 2.06. The solution is to offer breaks to practitioners, inculcate the system of continuous professional education, and proper supervision.
26thFeb 2010
The Future of Clinical Psychology
This class saw a presentation by Subhasree who presented a paper that attempted to answer several questions about the future of clinical psychology, including the following:
1) Will clinical psychology be able to retain its identity or will it be dissolved into a number of sub-disciplines? This concern was brought up by her in the face of a widening boundary between research and practice within the field, and also the emergence of super-specialities within the scope of clinical psychology such as child clinical psychology, clinical health psychology, clinical neuropsychology and geropsychology.
2) However, if we were to think of clinical psychology of an undivided field, what do we stand to gain? In response to this question, the paper concluded that the developments in the different areas of the field (practice, research, diagnosis and therapy) seem to enrich and take leads from one another rather than establish any hard difference between the goals of one another, which is eventually, evidence based help to the clients in need.
3) The next concern is a never-ending question. What is our relationship with psychiatrists? The position this paper seems to take is that clinical psychologists will win the favour of the public if they collaborated with psychiatrists because of the public’s preference for a ‘quick cure’, that seemingly only medications and psychiatrists can offer.
4) The next premise addressed in this paper was the relationship with education. With clinical psychologists striving to place the field at a position of high regard, there has been great emphasis on rigorous research, competitive exams to admit the most competent students to master-level programs, sound ethics, etc.
5) The final question is a very interesting one. This paper tries to answer who is fit to treat whom? That is, what kind of therapist is most likely to succeed in treating what kind of clients? This question is answered by exploring the client-therapist variation strategy, which looks at the various client and therapist characteristics and what combinations of these characteristics are slated for success.
The demands that have been placed on this field were also discussed:
1) The number of clinical psychologists who are efficiently trained and who hold years of clinical experience are very few in the teaching forum. It is also felt that it is essential to offer students exposure to clinical materials which will only add to increase the competency of the training programs.
2)The division of labour between psychiatrists and psychologists when it comes to dealing with problems that are in the borderline between those of a purely psychiatric and psychological nature, as is feasible.
3) A need to construct further developments in the area of child psychology.
4) Including psychometrics in higher level courses.
5) Training of clinical psychologists in the biological sciences, such as anatomy, pathology, pharmacology, etc. so as to get an overall understanding of the client as a psychological and a biological organism.
1st march 2010
PANEL DISCUSSION
Opening question: What is the future of clinical psychological training and education? What would be our suggestions for improvements and modifications?
The panelists primarily felt that a gap exists between what’s happening in the field and what is being taught in class.
The question that was grappled with throughout the discussion was why not have a UG course with clinical specialization? The counter-argument to this proposition was that many don’t know if the clinical track is what they want to take up. Many universities don’t have a great UG course in order in the first place. Integration would make education worse.
Another counter argument posed was what happens to the inter disciplinarity of the field if we were to have an early specialization- Compromise on exploration.
A very pertinent suggestion that was made and agreed by all present was that maybe UG courses can have in depth papers that have been structured optimally to reduce the need to do such papers as systems of psychology and social psychology at the masters level, as this would permit the masters level courses to focus more on integration with the field of practice.
Another argument that rose was what role does the level of maturity of a student play in the process of decision making concerning opting for a specialized clinical psychology course and what are the implications that it has in taking the most from training? What then is the right age? To this, the class responded that a good number of people do not feel the calling even after completing a masters in clinical and this is not necessarily because of fading passion. Other considerations such as finances, personal dilemmas and others play a role. So age is not all. Even people who are a cent percent certain of things after UG may be thought to be going through a phase of rethinking because of the way masters course is structured.
Who gets disillusioned in such a case?!
Another position: It’s not only the course that decides why we want to do clinical psychology. It is also about seeing for yourself what the field is about and how much we get inspired by out- of- class exposures. A person who is interested will be interested no matter what course is inflicted on them.
The discussion then moved on to what the supposed “competencies” of a clinical psychologist are? How should it be developed?
The class thought such skills as observation, reflection, need to help, self- awareness (of one’s own motivations, competencies, etc), intrinsic motivation to remain committed, a well developed understanding of cause-and-effect, personal emotional stability, and the ability to use oneself in therapy to an optimal level.
Saturday, March 13, 2010
Interesting!..Could have been discussed in class under ethics
Maintaining Your Professional Boundaries
By Cynthia M. A. Geppert, MD, PhD | March 1, 2010
"I’m one of the only psychiatrists practicing in this area. What am I realistically supposed to do when I see one of my patients in public? Whenever I go to the gym or library or grocery store, I see several patients I’m actively treating. Some want to say hello and some want to socialize. My response so far has been to try to avoid them.
As a fee-for-service psychiatrist, I am in a tough spot because I cannot totally ignore patients when they approach me without seeming to be uncaring.
How can I maintain my professional boundaries in this 'small town' environment?"
By Cynthia M. A. Geppert, MD, PhD | March 1, 2010
"I’m one of the only psychiatrists practicing in this area. What am I realistically supposed to do when I see one of my patients in public? Whenever I go to the gym or library or grocery store, I see several patients I’m actively treating. Some want to say hello and some want to socialize. My response so far has been to try to avoid them.
As a fee-for-service psychiatrist, I am in a tough spot because I cannot totally ignore patients when they approach me without seeming to be uncaring.
How can I maintain my professional boundaries in this 'small town' environment?"
Thursday, March 11, 2010
Wednesday, March 10, 2010
Reading Resources for Module IV
Primary:
Chs. 3, 4 & 5 from Pomerantz
APA's 2002 version of Ethical Principles (click HERE).
Supplementary:
Ch 3 of Trull and Phares
Ch 13 and 14 of Plante (click HERE for 13, and HERE for 14)
Past and present of the field of clinical psychology (click HERE)
Professional Ethics (click HERE)
Strategies for avoiding legal and ethical perils (click HERE)
Subha's presentation material (click HERE)
Chs. 3, 4 & 5 from Pomerantz
APA's 2002 version of Ethical Principles (click HERE).
Supplementary:
Ch 3 of Trull and Phares
Ch 13 and 14 of Plante (click HERE for 13, and HERE for 14)
Past and present of the field of clinical psychology (click HERE)
Professional Ethics (click HERE)
Strategies for avoiding legal and ethical perils (click HERE)
Subha's presentation material (click HERE)
Tuesday, March 9, 2010
Monday, March 8, 2010
Saturday, March 6, 2010
Integration Paper: Exploratory Study on Animal Assisted Therapy and its Applicability in India
Click HERE to read Seema's integration paper.
Integration Paper: Will biology eventually eat up Psychology?
Click HERE to read Anu Shaji's integration paper.
Thursday, March 4, 2010
MESSAGE REGARDING COURSE MPS: 231- INTODUCTION TO CLIN. PSYCH.
Dear Students
The course MPS: 231- Introduction to Clinical Psychology is almost coming to an end. I have enjoyed teaching and learning from you in the last 3-4 months. I hope you have liked it also.
ABOUT THE LAST FEW CLASSES/CIA DEADLINES
1. I have put up a tentaive in-progress list (click HERE) of CIA marks/grades of all the students of this course. This is the 'semi-final' version and the final version would be put up on blog latest by March 11 (thursday evening). I will have my last class of this course with you on March 12 (Friday, 11-12 pm).
2. The hard copy of the integration papers are to be submitted to me TODAY (March 5th, by 4 pm). A soft copy of the same needs to emailed to me (diptarup.chowdhury@christuniversity.in) and a copy marked to Ms. Hitha (our courseblog manager, hitha.hilara@gmail.com ). Hitha would later put up all the IPs on the blog for students to go through and comment on them.The integration paper presentations will continue till March 9 (Tuesday), with each presentation for about 15 mins and 10 mins for discussions. I would like to meet all the IP students, one by one, to have an informal chat about their experience of doing the IP (by fixing up a mutually convenient time anyday between Mar 8 and Mar 10).
3. The hard copy of other (individual special CIAs like class summary, NACIACP Report, etc) should reach me latest by Mar 8, 10 am), alongwith a softcopy emailed to me and Hitha.
4. Finally, since we are coming to the end of the course, i would like all of you to do a quick revision of what we learnt in the whole semester and send me your last-minute questions/doubts about anything and everything pertaining to the course. An email with such questions from your side reaching me latest by Mar 10 would be highly appreciated. I would try to address those questions/clarifications in our last class on Mar 12.
ABOUT COURSE FEEDBACK
In order to get an elaborate feedback abt the course I have created a gmail account (id: feedbacktodc@gmail.com, password: happyness). You could, with the help of the password, log on to the gmail id and could send me (diptarup.chowdhury@christuniversity.in or diptarup.chowdhury@gmail.com) an email with your honest comments and feedback abt the course(s) which I taught you. This whole process would ensure complete anonymity (you are also most welcome to disclose your name, if you want to!) and would facilitate the process of giving a feedback. Please note that this feedback mechanism has nothing to do with any other feedback that you are supposed to give to anybody else. This feedback would be only for me and would help me to learn and grow as a teacher.
THANK YOU AND BEST WISHES.
diptarup
The course MPS: 231- Introduction to Clinical Psychology is almost coming to an end. I have enjoyed teaching and learning from you in the last 3-4 months. I hope you have liked it also.
ABOUT THE LAST FEW CLASSES/CIA DEADLINES
1. I have put up a tentaive in-progress list (click HERE) of CIA marks/grades of all the students of this course. This is the 'semi-final' version and the final version would be put up on blog latest by March 11 (thursday evening). I will have my last class of this course with you on March 12 (Friday, 11-12 pm).
2. The hard copy of the integration papers are to be submitted to me TODAY (March 5th, by 4 pm). A soft copy of the same needs to emailed to me (diptarup.chowdhury@christuniversity.in) and a copy marked to Ms. Hitha (our courseblog manager, hitha.hilara@gmail.com ). Hitha would later put up all the IPs on the blog for students to go through and comment on them.The integration paper presentations will continue till March 9 (Tuesday), with each presentation for about 15 mins and 10 mins for discussions. I would like to meet all the IP students, one by one, to have an informal chat about their experience of doing the IP (by fixing up a mutually convenient time anyday between Mar 8 and Mar 10).
3. The hard copy of other (individual special CIAs like class summary, NACIACP Report, etc) should reach me latest by Mar 8, 10 am), alongwith a softcopy emailed to me and Hitha.
4. Finally, since we are coming to the end of the course, i would like all of you to do a quick revision of what we learnt in the whole semester and send me your last-minute questions/doubts about anything and everything pertaining to the course. An email with such questions from your side reaching me latest by Mar 10 would be highly appreciated. I would try to address those questions/clarifications in our last class on Mar 12.
ABOUT COURSE FEEDBACK
In order to get an elaborate feedback abt the course I have created a gmail account (id: feedbacktodc@gmail.com, password: happyness). You could, with the help of the password, log on to the gmail id and could send me (diptarup.chowdhury@christuniversity.in or diptarup.chowdhury@gmail.com) an email with your honest comments and feedback abt the course(s) which I taught you. This whole process would ensure complete anonymity (you are also most welcome to disclose your name, if you want to!) and would facilitate the process of giving a feedback. Please note that this feedback mechanism has nothing to do with any other feedback that you are supposed to give to anybody else. This feedback would be only for me and would help me to learn and grow as a teacher.
THANK YOU AND BEST WISHES.
diptarup
A report on 2 sessions that took place during the NACIACP conference, NIMHANS.
Poster presentation P2I.2 –Indian Psychology:
Effectiveness of Yoga therapy on subjective well-being and basic living skill of schizophrenic patients. Mr. Babu P.
Yoga is seen as important in a country like
Poster presentation P2I.4Trigunas and color preferences. Ms. Astha Sharma
The present study brought together 2 concepts trigunas and color preferences to see their interrelationships as well their relationship with personality characteristics of individuals. The study was done on a group of 30 teachers in
Concurrent symposium 2B: Understanding cognitions and meta cognitions in health and illness.(Day 2)
1) Cognitions and meta cognitions in emotional disorders- Dr. M.P.Sharma
Cognition is the full range of processes and mechanisms that support thinking and also the content or products of these processes, namely thoughts themselves. There are 3 levels of cognitions: the Tripartite divisions of thought: beliefs, assumptions, and automatic thoughts.
The cognitive theory assumes that to survive, one needs to process information. Schemata refer to the fundamental cognitive structures about the self and the world. Also discussed was automatic thoughts also called self-verbalizations, which clients are rarely aware of unless asked to notice them.
Some of the cognitive errors are the all or none thinking, arbitrary thinking(conclusion based on incomplete information), personalization, magnification, disqualifying the positives and catastrophizing. The disenchantment over the limits of behavioral approaches led to the “revolutionary” acceptance of the idea that cognition is one of the forces driving behavior. The basic premise of cognitive theories of emotional disorder is that dysfunction arises from an individual’s interpretation of events. Flavel(1979) introduced the term “meta-cognition” which refers to any knowledge, or cognitive process that is involved in the monitoring, controlling or appraisal of cognitions.
2) Dysfunctional cognitions in medical conditions- Dr. Naveen Grover
Cognitive factors play an important role in the development and management of medical conditions in people. The way one thinks about a medical condition can influence its outcomes positively or negatively. Cognitions that were seen as functional before the onset of the illness, may be seen as dysfunctional once the illness sets in. Medical conditions can trigger dysfunctional cognitions related to the domains of loss and threat. Catastrophic interpretation of symptoms can be seen in chronic fatigue syndrome, chronic pain syndrome. Adherence to the “all or none” response in which patients either follow the doctor’s advice(adherence) or deviate from it in some way(non-adherence). The factors that impact dysfunctional cognitions are internal locus of control orientation in which illness is attributed to one’s own actions. External locus of control is when events are unrelated to one’s actions and are beyond one’s control. Dysfunctional cognitions can affect a person’s health in atleast 3 ways- they may hold irrational beliefs about themselves which influence illness related behavior; they might involve in maladaptive cognitive appraisals; and negative cognitions about illness may cause them to experience anxiety and depression which, in turn, may exacerbate existing illness or increase illness related distress. Another important factor is that strong self efficacy beliefs need to be promoted in the medically ill.
Mukta
Wednesday, March 3, 2010
Tuesday, March 2, 2010
Healing Horses
As a part of my research paper , i volunteered with Equine therapist Mrs. Pushpa Bopiah at her center - Healing Horses , where she does equine therapy for children with developmental disorders - mainly autism , cp etc .
She needs volunteers, so if anyone is interested you can contact her through email ; her email id is : healinghorse@hotmail.com
Also one need not know horse riding to volunteer .
CUSP-Internship Programme
CUSP @ CSCS is looking for applications for the Internship Programme in 2010-2011. Students with a background in the natural or social sciences, and having an interest in interdisciplinary work can apply for the programme. Interest and aptitude to work with questions related to integrated perspectives (integrating biological and cultural markers) on mind, mental health and well- being would be an additional advantage. The internship is envisaged for a period of 1 month. The interns will spend their time between CSCS as well as other institutional spaces that support their work, and will have to work in the libraries. Candidates will be expected, during the period of the internship, to participate in academic events, conduct formal and informal discussions with faculty and students, and to share, at the end of their tenure, a paper on their respective areas of research.
Interested Candidates can contact
Ranjini Krishnan : ranjini_k@cscs.res.in
Interested Candidates can contact
Ranjini Krishnan : ranjini_k@cscs.res.in
Thursday, February 25, 2010
Summary of the class held on 16th, 22nd and 23rd Feb 2010,
Summary of the class held on 22nd Feb 2010:
In this class, we spoke about culture and its influence in clinical psychology. Culture definitely plays an important role in the field of clinical psychology. Likewise, culture remains an ingredient submerged in this field. We came about with many culture based aspects in the class, of which some where naming the disorder and their meaning (like normal and abnormal could be culture specific), assessment (culture fair and culture free), treatment resources (involvement of family in collectivistic cultures), clash between culture of the psychologist and the client, who is an expert? ( is culturally dependent), culture based syndromes, tackling situations when the client and the therapist are from different cultural backgrounds and also other factors related to culture in this field.
Further, we also discussed about the styles used by clinical psychologists and whether they are in par with the norms written in books. Few from the class accepted that the clinical psychologists they met where following the norms as they were in books, namely:
• Firstly, the clinical psychologists conduct their sessions with the time slab in their mind. They conduct sessions for about 50 minutes and if the client comes late by about 30 minutes, the clinical psychologists start the session but stop it exactly after the remaining 20 minutes, and also advise them to be on time for the next session.
• Secondly, they follow the norm of charging their clients the entire session’s fee, if they don’t inform the clinician prior to 48 hours of their appointment about the cancellation. In other words, cancellation has to done 48 hours prior to the appointment taken with the clinician.
• Thirdly, the clinician also follows the norm of providing his client with a free session during the next appointment, if the clinician is not available during the previous fixed appointment.
Further, there was an issue also raised about the differences between the culture of the client and the clinician. Hence, lot of effort lies on the clinician to know and understand the various cultures and also analyse their clients based on the cultures they are brought up in, instead of imbibing and diagnosing their client blindly based on their personal cultural ideas and mere personal experience.
The major challenges for a clinical psychologist are
• Cultural competence, cultural awareness.
• Knowledge about diversity of cultures so as to understand client’s cultures.
The major key towards efficacy in one’s practice and experience is, understanding the client and the culture they are brought up in and are imbibed with and eventually diagnose them effectively!
In this context, there was a book referred by Sir named, “Listening to Cultures” by Nanditha Chowdhury.
Summary of the class held on 23rd Feb 2010:
This class was on the ethical code of conduct and the ethical principles. . It was discussed that there is correlation between law and ethics. There is an increase in filling of many law suits and also increase in professionals all over, which left many loose ends untied! There was no idea that a need for so many revisions would take place, but due to the above advancements, revision was imposed. Ethics is not a legal document, but it consists of few principles, followed by a group of professionals with an idea to provide the best possible help and support to your client, however there is no necessary legal mandate that the clinician will be jailed. Hence, the licensing came up in some states in a sense that if one values law, then they have to get licensing done to practice.
The Universal Declaration of Human Rights was started in the year 1948. The ethical code of conduct and the 1st APA guideline was published in the year 1953, and within 5 to 6 years, it’s revised 9 times. This needs to be given a thought as to why these intense revisions were needed, or rather the reasons. Some points came up by the class were:
• Research interest
• Laws in other field: general activism, laws in other fields
• Client becoming consumers, which refers to many insurance facilities and many law suits started.
• Sudden popularity of the field itself that is increase in the number of mental health professional, also stigma reducing and Individualisation. Survey shows that in the year 1940, there were about 20000 clinical psychologists. In 1990, there were about one lakh clinical psychologists.
In this context, the statistics given by Diana Gross (in her guest lecture on ) was taken in o consideration. She said, “Clinical psychology course happens to be the fourth- fifth popular most subject opted by students.”
In this regard, there were a number of laws and acts discussed, namely:
• Consumer Protection Act in the year 1986.
• Mental Health Act of India replaced the Indian Lunacy Act in the year 1987.
• RCI act came up in the year 1952.
• ISAP considered the Ethical Code of Conduct in the year 1993.
• Policy statement of ethical consideration by Indian council of Medical Reserach in the year 1994.
• Persons of Disability Act in the year 1995.
The APA code of conduct mentions two parts as the general principles, namely: Aspirational part and Enforceable part.
Aspirational part: There is an internal aspiration to follow books but however there is no need to follow t 100% of the times. Further, the norms in the book are very general and broad as what to what had to be done.
Enforceable part: Ethics is important and as such, there will have a member committee in APA and meetings go on to analyse the intensity and the degree of violation. Later, this case is referred to local court to judge if the clinician can continue practice or not. But most cases licence is cancelled.
In this regards, there was a case study discussed: In the early 1970’s there was a case related to ethical violation in California. There was a Bengali guy, who was undergoing this doctorate program and was taking therapy under a clinical psychologist. In the course of the session, the clinician learnt that his client was sexually drawn towards a lady named Tara scoff, who refused it. As such, he wanted o revenge her to an extent that he was even ready to kill her. This aspect was noted by the clinician during the session and he immediately informed the local police about his client and cautioned them, thinking he was helping out his client from falling a trap to law. This was his first step towards breaking his ethical issue that is, he breached the client’s confidentiality. After few months, the client managed to harm the lady and this brought the lady’s parents to the court of law. They filled a case against all involved in this, including the clinical psychologist. This case went on for a few months – years. The court found out evidence that the clinician failed to inform Tara about the harm involving her, of rather refused to caution her family about the harm, so that they could take necessary precautions.
After this case, there were many cases which came up in this context. And since then, there are many laws in this area. The client fills a case in the court of law, when they feel dissatisfied with their clinician. And many a times, majority of these cases are false. In spite of tightening the loose ends, the number of ethical violations is increasing. Further, in order to upgrade one’s license and also to pass through a master’s degree, it’s important to educate oneself about the ethical code of conduct and advancements in this area.
Many surveys were conducted in this regard. In the year 1987, a survey was conducted on 460 practising clinical psychologists, who efficiently responded to the survey. There were 83 separate behaviours given to them, through the case details and asked what they would do and not do in these situations. Only few clinicians had a very clear idea about answering ‘yes’ and ‘no’ to the questions, but majority answered that it was based on the context and depended on the situation they were in. Thus, there was a major dilemma in their responses on what to do and not to do. (Page 87 of Pomerantz)
If we replicate the same survey today, we can see many cases in grey area and the ethical dilemma still persistent in them. This may be because of unclear ethical codes presented by APA and however, the revisions made are not that that clear to solve the dilemma in the clinician’s mind.
There was an OHP put up on the revised version of the ethical code of conduct, the APA guidelines.
ETHICAL PRINCIPLES OF PSYCHOLOGISTS AND CODE OF CONDUCT (2002):
CONTENTS:
• Introduction and applicability
• Preamble
• General principles
• A beneficence and non-mal beneficence
• Fidelity and responsibility
• Integrity
• Justice
• Respect for people’s rights and dignity
• ETHICAL STANDARDS
1. Resolving ethical issues. Some sub-categories are Misuse of psychologists work, improper complaints, informal resolution of ethical violations, cooperating with ethics committees, conflicts between ethics and organizational demands, conflicts between ethics and law/regulations/other, improper complaints.
2. Competence. Some sub-categories are boundaries of competence, bases for scientific and professional judgements, maintaining competence, personal problems and conflicts, delegation of work to others, providing service in emergency.
3. Human relations. Some sub-categories are avoiding harm, unfair discriminations, sexual harassment, other harassment, conflict of interest, informed consent, interruption of psychological services, conflict of interest, third party requests for services, exploitative relationships, co-operation with other professionals.
4. Privacy and confidentiality. Some sub-categories are maintaining confidentiality, recording, disclosure, consultants, use of confidential information for didactic of other purpose, discuss the limits of confidentiality.
5. Advertising and other public statements. Some examples are fees and financial arrangements, referrals and fees, barter with clients, withholding records for payments.
6. Education and training. Some sub-categories are assessing student and supervisor performance, accuracy in teaching, student disclosure of personal information, mandatory individual or group therapy.
8. Research and publication. Some sub-categories are institutional approval, debriefing, plagiarism, reviewers.
9. Assessments. Some sub-categories are bases for assessments, release of test data, use of assessments, test construction, interpreting assessment results, maintaining test security, obsolete tests and outdated test results, assessment by unqualified persons, test scoring and interpretation services.
10. Therapy. Some sub-categories are group therapy, informed consent to therapy, terminating therapy, therapy involving couples or families, interruption of therapy.
The latter half of the class was spent by studying and analysing a few case studies, which were on the violation lines. The class was divided into groups and different case studies were given and the groups had to identify whether there was violation taking place, by referring to the ETHICAL PRINCIPLES OF PSYCHOLOGISTS AND CODE OF CONDUCT (2002) and also come out with different solutions to the said violation in each case.
Summary of the class held on 16th Feb 2010:
There was a debate held in this class on the topic, “whether prescribing rights should be given to clinical psychologists or not”. The class was divided in to groups to discus on the above said topic. This topic initially began by referring to two states in the United States namely New Mexico and Louisuana, where the clinical psychologists are given the prescription rights and initially this license is supervised by professionals for two years.
The arguments for the prescribing rights were:
• Shortage of psychiatrists (which is not very true in India)
• Non- physician professionals (dentists, ayurvedic doctors who have prescribing rights)
• Convenience for clients
• Professional autonomy
• Professional identification
• Substantial increase of Revenue for psychologists
• Enable clinical psychologists to provide a wide variety of treatments and conduct tests on wider spectrum.
• Potential increase in efficacy and cost effectiveness, which is in the benefit of the client, who are in need of both psychotherapy and medication- psychopharmacology.
• Prescribing rights will give the clinical psychologist a competitive advancement in health care market place.
• Less confusion for clients as to whom they have to approach, as the clinical psychologist can give the whole picture.
• Natural progression in clinical psychology quests towards becoming a ‘fully fledged’ health care professional.
• Clinical psychologist would know when to use medication and when to use psychotherapy, rather than one sided approach.
Arguments against prescribing rights for clinical psychologists:
• Effect of drug on multiple bodily systems can never be estimated without long term medical training/inclination.
• Focus on psychotherapy eventually will get diluted (this point was argued saying that the clinical psychologist has an internal inclination of practising psychotherapy)
• Identity confusion – exact roles of psychologist and psychiatrist are befuddled.
• Decrease in the potential influence of pharmaceutical industry.
• May lead to de- emphasis of psychological form of treatment because medications are often faster acting and potentially more profitable than psychotherapy.
• A conceptual shift may occur, with biological explanation taking precedents over the psychological ones.
• May damage the clinician’s relation with psychiatry and general medicine which my lead to financially excessive law suits and general feelings of animosity.
• The students who are pursuing their masters do not have a background of biology in their graduate programs, which eventually emphasis on the aspect that, the clinical psychologists lack the ability to identify which drug plays on which part of the body and further, any side effect caused to the client can be trusted on the drug itself.
• If prescribing rights are given, this would result in very little difference between psychiatrist and psychologist.
Implications on training:
If we gain prescribing rights, basic pharmacology training will be required and mastery in the medication strategies used for treatment as well as the knowledge of the substance abuse are very important for the clinician to know. Probably, one semester course on psychopharmacology is recommended. Collaborative practice must also be given importance in psychopharmacology, diagnostic assessment, physical assessment, drug interaction. A strong background in biology classes, 2 years graded training in psychopharmacology and post doctoral psychopharmacology residency is recommended.
The reference given in class was Pomerantz and Wikipedia.
There were many other possibilities and assumptions discussed in class. The debate was concluded with a very thought provoking and a probably considerable idea, that is:
“Can there be an integration of training programs for all mental health professionals in future? “
In this class, we spoke about culture and its influence in clinical psychology. Culture definitely plays an important role in the field of clinical psychology. Likewise, culture remains an ingredient submerged in this field. We came about with many culture based aspects in the class, of which some where naming the disorder and their meaning (like normal and abnormal could be culture specific), assessment (culture fair and culture free), treatment resources (involvement of family in collectivistic cultures), clash between culture of the psychologist and the client, who is an expert? ( is culturally dependent), culture based syndromes, tackling situations when the client and the therapist are from different cultural backgrounds and also other factors related to culture in this field.
Further, we also discussed about the styles used by clinical psychologists and whether they are in par with the norms written in books. Few from the class accepted that the clinical psychologists they met where following the norms as they were in books, namely:
• Firstly, the clinical psychologists conduct their sessions with the time slab in their mind. They conduct sessions for about 50 minutes and if the client comes late by about 30 minutes, the clinical psychologists start the session but stop it exactly after the remaining 20 minutes, and also advise them to be on time for the next session.
• Secondly, they follow the norm of charging their clients the entire session’s fee, if they don’t inform the clinician prior to 48 hours of their appointment about the cancellation. In other words, cancellation has to done 48 hours prior to the appointment taken with the clinician.
• Thirdly, the clinician also follows the norm of providing his client with a free session during the next appointment, if the clinician is not available during the previous fixed appointment.
Further, there was an issue also raised about the differences between the culture of the client and the clinician. Hence, lot of effort lies on the clinician to know and understand the various cultures and also analyse their clients based on the cultures they are brought up in, instead of imbibing and diagnosing their client blindly based on their personal cultural ideas and mere personal experience.
The major challenges for a clinical psychologist are
• Cultural competence, cultural awareness.
• Knowledge about diversity of cultures so as to understand client’s cultures.
The major key towards efficacy in one’s practice and experience is, understanding the client and the culture they are brought up in and are imbibed with and eventually diagnose them effectively!
In this context, there was a book referred by Sir named, “Listening to Cultures” by Nanditha Chowdhury.
Summary of the class held on 23rd Feb 2010:
This class was on the ethical code of conduct and the ethical principles. . It was discussed that there is correlation between law and ethics. There is an increase in filling of many law suits and also increase in professionals all over, which left many loose ends untied! There was no idea that a need for so many revisions would take place, but due to the above advancements, revision was imposed. Ethics is not a legal document, but it consists of few principles, followed by a group of professionals with an idea to provide the best possible help and support to your client, however there is no necessary legal mandate that the clinician will be jailed. Hence, the licensing came up in some states in a sense that if one values law, then they have to get licensing done to practice.
The Universal Declaration of Human Rights was started in the year 1948. The ethical code of conduct and the 1st APA guideline was published in the year 1953, and within 5 to 6 years, it’s revised 9 times. This needs to be given a thought as to why these intense revisions were needed, or rather the reasons. Some points came up by the class were:
• Research interest
• Laws in other field: general activism, laws in other fields
• Client becoming consumers, which refers to many insurance facilities and many law suits started.
• Sudden popularity of the field itself that is increase in the number of mental health professional, also stigma reducing and Individualisation. Survey shows that in the year 1940, there were about 20000 clinical psychologists. In 1990, there were about one lakh clinical psychologists.
In this context, the statistics given by Diana Gross (in her guest lecture on ) was taken in o consideration. She said, “Clinical psychology course happens to be the fourth- fifth popular most subject opted by students.”
In this regard, there were a number of laws and acts discussed, namely:
• Consumer Protection Act in the year 1986.
• Mental Health Act of India replaced the Indian Lunacy Act in the year 1987.
• RCI act came up in the year 1952.
• ISAP considered the Ethical Code of Conduct in the year 1993.
• Policy statement of ethical consideration by Indian council of Medical Reserach in the year 1994.
• Persons of Disability Act in the year 1995.
The APA code of conduct mentions two parts as the general principles, namely: Aspirational part and Enforceable part.
Aspirational part: There is an internal aspiration to follow books but however there is no need to follow t 100% of the times. Further, the norms in the book are very general and broad as what to what had to be done.
Enforceable part: Ethics is important and as such, there will have a member committee in APA and meetings go on to analyse the intensity and the degree of violation. Later, this case is referred to local court to judge if the clinician can continue practice or not. But most cases licence is cancelled.
In this regards, there was a case study discussed: In the early 1970’s there was a case related to ethical violation in California. There was a Bengali guy, who was undergoing this doctorate program and was taking therapy under a clinical psychologist. In the course of the session, the clinician learnt that his client was sexually drawn towards a lady named Tara scoff, who refused it. As such, he wanted o revenge her to an extent that he was even ready to kill her. This aspect was noted by the clinician during the session and he immediately informed the local police about his client and cautioned them, thinking he was helping out his client from falling a trap to law. This was his first step towards breaking his ethical issue that is, he breached the client’s confidentiality. After few months, the client managed to harm the lady and this brought the lady’s parents to the court of law. They filled a case against all involved in this, including the clinical psychologist. This case went on for a few months – years. The court found out evidence that the clinician failed to inform Tara about the harm involving her, of rather refused to caution her family about the harm, so that they could take necessary precautions.
After this case, there were many cases which came up in this context. And since then, there are many laws in this area. The client fills a case in the court of law, when they feel dissatisfied with their clinician. And many a times, majority of these cases are false. In spite of tightening the loose ends, the number of ethical violations is increasing. Further, in order to upgrade one’s license and also to pass through a master’s degree, it’s important to educate oneself about the ethical code of conduct and advancements in this area.
Many surveys were conducted in this regard. In the year 1987, a survey was conducted on 460 practising clinical psychologists, who efficiently responded to the survey. There were 83 separate behaviours given to them, through the case details and asked what they would do and not do in these situations. Only few clinicians had a very clear idea about answering ‘yes’ and ‘no’ to the questions, but majority answered that it was based on the context and depended on the situation they were in. Thus, there was a major dilemma in their responses on what to do and not to do. (Page 87 of Pomerantz)
If we replicate the same survey today, we can see many cases in grey area and the ethical dilemma still persistent in them. This may be because of unclear ethical codes presented by APA and however, the revisions made are not that that clear to solve the dilemma in the clinician’s mind.
There was an OHP put up on the revised version of the ethical code of conduct, the APA guidelines.
ETHICAL PRINCIPLES OF PSYCHOLOGISTS AND CODE OF CONDUCT (2002):
CONTENTS:
• Introduction and applicability
• Preamble
• General principles
• A beneficence and non-mal beneficence
• Fidelity and responsibility
• Integrity
• Justice
• Respect for people’s rights and dignity
• ETHICAL STANDARDS
1. Resolving ethical issues. Some sub-categories are Misuse of psychologists work, improper complaints, informal resolution of ethical violations, cooperating with ethics committees, conflicts between ethics and organizational demands, conflicts between ethics and law/regulations/other, improper complaints.
2. Competence. Some sub-categories are boundaries of competence, bases for scientific and professional judgements, maintaining competence, personal problems and conflicts, delegation of work to others, providing service in emergency.
3. Human relations. Some sub-categories are avoiding harm, unfair discriminations, sexual harassment, other harassment, conflict of interest, informed consent, interruption of psychological services, conflict of interest, third party requests for services, exploitative relationships, co-operation with other professionals.
4. Privacy and confidentiality. Some sub-categories are maintaining confidentiality, recording, disclosure, consultants, use of confidential information for didactic of other purpose, discuss the limits of confidentiality.
5. Advertising and other public statements. Some examples are fees and financial arrangements, referrals and fees, barter with clients, withholding records for payments.
6. Education and training. Some sub-categories are assessing student and supervisor performance, accuracy in teaching, student disclosure of personal information, mandatory individual or group therapy.
8. Research and publication. Some sub-categories are institutional approval, debriefing, plagiarism, reviewers.
9. Assessments. Some sub-categories are bases for assessments, release of test data, use of assessments, test construction, interpreting assessment results, maintaining test security, obsolete tests and outdated test results, assessment by unqualified persons, test scoring and interpretation services.
10. Therapy. Some sub-categories are group therapy, informed consent to therapy, terminating therapy, therapy involving couples or families, interruption of therapy.
The latter half of the class was spent by studying and analysing a few case studies, which were on the violation lines. The class was divided into groups and different case studies were given and the groups had to identify whether there was violation taking place, by referring to the ETHICAL PRINCIPLES OF PSYCHOLOGISTS AND CODE OF CONDUCT (2002) and also come out with different solutions to the said violation in each case.
Summary of the class held on 16th Feb 2010:
There was a debate held in this class on the topic, “whether prescribing rights should be given to clinical psychologists or not”. The class was divided in to groups to discus on the above said topic. This topic initially began by referring to two states in the United States namely New Mexico and Louisuana, where the clinical psychologists are given the prescription rights and initially this license is supervised by professionals for two years.
The arguments for the prescribing rights were:
• Shortage of psychiatrists (which is not very true in India)
• Non- physician professionals (dentists, ayurvedic doctors who have prescribing rights)
• Convenience for clients
• Professional autonomy
• Professional identification
• Substantial increase of Revenue for psychologists
• Enable clinical psychologists to provide a wide variety of treatments and conduct tests on wider spectrum.
• Potential increase in efficacy and cost effectiveness, which is in the benefit of the client, who are in need of both psychotherapy and medication- psychopharmacology.
• Prescribing rights will give the clinical psychologist a competitive advancement in health care market place.
• Less confusion for clients as to whom they have to approach, as the clinical psychologist can give the whole picture.
• Natural progression in clinical psychology quests towards becoming a ‘fully fledged’ health care professional.
• Clinical psychologist would know when to use medication and when to use psychotherapy, rather than one sided approach.
Arguments against prescribing rights for clinical psychologists:
• Effect of drug on multiple bodily systems can never be estimated without long term medical training/inclination.
• Focus on psychotherapy eventually will get diluted (this point was argued saying that the clinical psychologist has an internal inclination of practising psychotherapy)
• Identity confusion – exact roles of psychologist and psychiatrist are befuddled.
• Decrease in the potential influence of pharmaceutical industry.
• May lead to de- emphasis of psychological form of treatment because medications are often faster acting and potentially more profitable than psychotherapy.
• A conceptual shift may occur, with biological explanation taking precedents over the psychological ones.
• May damage the clinician’s relation with psychiatry and general medicine which my lead to financially excessive law suits and general feelings of animosity.
• The students who are pursuing their masters do not have a background of biology in their graduate programs, which eventually emphasis on the aspect that, the clinical psychologists lack the ability to identify which drug plays on which part of the body and further, any side effect caused to the client can be trusted on the drug itself.
• If prescribing rights are given, this would result in very little difference between psychiatrist and psychologist.
Implications on training:
If we gain prescribing rights, basic pharmacology training will be required and mastery in the medication strategies used for treatment as well as the knowledge of the substance abuse are very important for the clinician to know. Probably, one semester course on psychopharmacology is recommended. Collaborative practice must also be given importance in psychopharmacology, diagnostic assessment, physical assessment, drug interaction. A strong background in biology classes, 2 years graded training in psychopharmacology and post doctoral psychopharmacology residency is recommended.
The reference given in class was Pomerantz and Wikipedia.
There were many other possibilities and assumptions discussed in class. The debate was concluded with a very thought provoking and a probably considerable idea, that is:
“Can there be an integration of training programs for all mental health professionals in future? “
Tuesday, February 16, 2010
Suummary of Bidisha Chatterjee's guest lecture
Autonomy in Psychotherapy from a Feminist Point of View
Bidisha Chatterjee, nee Mukherjee
18th December, 2009
Most of classic -and some of modern- psychology has been somewhat steeped in the values of the patriarchal mode of thinking. You may observe such bias, for instance, in the different theories of moral development put forth by Kohlberg, Freud and Piaget. Each of them takes a linear approach. Kohlberg and Piaget take similar identical approaches, in which they suggest that girls can at best achieve only a slightly lesser level o achievement.
As (in)famous as Freud's theories were, the criticisms leveled against them by the feminists are also equally well-known. Perhaps one of his most controversial ideas were around the Oedipus and Elektra complexes. The point at which a boy is free fromthis complex is when he starts developing autonomy, rationality, etc. As an adult, he reflects this impartiality and his emotions are kept leashed. Girls, according to Freud, lack in development because they never clearly resolve their Elektra complex. Feminists, on the contrary, don't see this as a lack, but believe this is rather a one sided way of explaining away the use of emotions in problem solving.
The feminists have taken up issue with the structure of the self in mainstream psychology, as well:
>>Mainstream: By morality, what is generally meant is equality.
Feminists: They are critical of this, and insist that it would be ignorant to treat everyone the same because differences DO exist!
>>Mainstream: Ideas of reason and decision-making emphasize impartiality, a sort of neutrality, detached from context.
Feminists: They wonder if such a view from nowhere is even possible. They believe in open ended decisions.
>>Feminists do not believe that responsibility equals being answerable for one's actions, but that it should go beyond 'duty'.
>>Mainstream: relationships are defined in terms of give-and-take, of needs, and of “contractuality”. Solution of problems is based on what is just, on impartiality. Private emotions are not aired in public and relationships are kept at arm's length.
Feminists: Their perspective is all about “connectivity”.
>>Mainstream: An autonomous person sees hierarchy in nearly every relationship. Psychotherapists with this sort of training often believe they have power over the client. A man would supposedly not understand a woman client because to him an objective relationship is important. Subjective involvement is almost nil.
Feminists: Although they agree that too much emotional involvement can be detrimental in practice, they believe the mindet to understand the other's emotions is important.
In fact, feminists deny that autonomous development of the self is possible, because human beings are social animals. To understand what a man is, you also have to understand what he is not. In this respect, Carol Gilligan has made a remarkable contribution, and helped formulate the requirements of a healthy, care-based relationship between therapist and client.
And thus, the feminist version of self development is as follows:
>>The self develops amidst associations and connections
>>Self prefers care over reason (although feminsts haven't gone so far as to deny the importance of reason).
>>The primary moral imperative is caring for others, not just equality
>>Responsibility ought to mean care and respect at a personal level
>>The self perceives relationships as interconnectivity and wmotional bonding and not just contractual relationships.
>>The self arrives at decisions in the context of relationships. The question is, “How to respond?” not simply, “What is just?” as in mainstream belief. Mrs Chatterjee then wound up her lecture and drove home her point with reference to the Heinz dilemma.
Tissy ma'am then had some interesting comments to make. She pointed out that there lies dangers in over-generalization. This patriarchal psychiatric model comes from the West, and that Ayurveda does consider everything the feminists are saying. So, culture must not be forgotten as a major influence. The humanistic school also talks about individual uniueness and relationships. To this, Mrs Chatterjee added that therapist-client situations ought to conider species survival. Needs must be met, but in a way that transcends the give-and-take policy. Power relationships do exist, but should be viewed as power WITH power and not power OVER power.
Someone in the audience then raised the question of professionality. Would it then not be better to go to a friend, who would be just as caring, maybe more? Mrs Chatterjee responded that feminists criticize the modern concept of empathy. They assert that therapists should maintain professionality, but should keep it at a human-to-human level. Co-feeling, and not empathy, and interconnectivity instead of inter-involvement are emphasized.
“But isn't the concept of co-feeling a little presumptious?” another member of the audience wanted to know. For instance, how can the therapist really know EXACTLY what a rape-victim is going through unless (s)he has experienced it for him/herself? Mrs Chatterjee clarified her stance, saying that feminists believe today's concept of empathy to be a limited, insufficient form of sympathy. The therapist shold try to “extend beyond his/her area of thought” and cultivate the mindset to accommodate what the client says into hs/her framework. Consider various possibilities of suffering and think about what best can be done.
With this, the session was wrapped up. Being as thought-provoking as it was, this lecture still left some questions unanswered in the minds of some of the audience members. For instance, how possible and plausible is co-feeling? How can a therapist possible understand the world of, say, a schizophrenic? Also, some of us felt it was unfair that the 'onus of emotionality' should always fall on the woman's shoulders. Why can't women also be rational and autonomous? Isn't the concept of the emotional woman a stereotype?
Bidisha Chatterjee, nee Mukherjee
18th December, 2009
Most of classic -and some of modern- psychology has been somewhat steeped in the values of the patriarchal mode of thinking. You may observe such bias, for instance, in the different theories of moral development put forth by Kohlberg, Freud and Piaget. Each of them takes a linear approach. Kohlberg and Piaget take similar identical approaches, in which they suggest that girls can at best achieve only a slightly lesser level o achievement.
As (in)famous as Freud's theories were, the criticisms leveled against them by the feminists are also equally well-known. Perhaps one of his most controversial ideas were around the Oedipus and Elektra complexes. The point at which a boy is free fromthis complex is when he starts developing autonomy, rationality, etc. As an adult, he reflects this impartiality and his emotions are kept leashed. Girls, according to Freud, lack in development because they never clearly resolve their Elektra complex. Feminists, on the contrary, don't see this as a lack, but believe this is rather a one sided way of explaining away the use of emotions in problem solving.
The feminists have taken up issue with the structure of the self in mainstream psychology, as well:
>>Mainstream: By morality, what is generally meant is equality.
Feminists: They are critical of this, and insist that it would be ignorant to treat everyone the same because differences DO exist!
>>Mainstream: Ideas of reason and decision-making emphasize impartiality, a sort of neutrality, detached from context.
Feminists: They wonder if such a view from nowhere is even possible. They believe in open ended decisions.
>>Feminists do not believe that responsibility equals being answerable for one's actions, but that it should go beyond 'duty'.
>>Mainstream: relationships are defined in terms of give-and-take, of needs, and of “contractuality”. Solution of problems is based on what is just, on impartiality. Private emotions are not aired in public and relationships are kept at arm's length.
Feminists: Their perspective is all about “connectivity”.
>>Mainstream: An autonomous person sees hierarchy in nearly every relationship. Psychotherapists with this sort of training often believe they have power over the client. A man would supposedly not understand a woman client because to him an objective relationship is important. Subjective involvement is almost nil.
Feminists: Although they agree that too much emotional involvement can be detrimental in practice, they believe the mindet to understand the other's emotions is important.
In fact, feminists deny that autonomous development of the self is possible, because human beings are social animals. To understand what a man is, you also have to understand what he is not. In this respect, Carol Gilligan has made a remarkable contribution, and helped formulate the requirements of a healthy, care-based relationship between therapist and client.
And thus, the feminist version of self development is as follows:
>>The self develops amidst associations and connections
>>Self prefers care over reason (although feminsts haven't gone so far as to deny the importance of reason).
>>The primary moral imperative is caring for others, not just equality
>>Responsibility ought to mean care and respect at a personal level
>>The self perceives relationships as interconnectivity and wmotional bonding and not just contractual relationships.
>>The self arrives at decisions in the context of relationships. The question is, “How to respond?” not simply, “What is just?” as in mainstream belief. Mrs Chatterjee then wound up her lecture and drove home her point with reference to the Heinz dilemma.
Tissy ma'am then had some interesting comments to make. She pointed out that there lies dangers in over-generalization. This patriarchal psychiatric model comes from the West, and that Ayurveda does consider everything the feminists are saying. So, culture must not be forgotten as a major influence. The humanistic school also talks about individual uniueness and relationships. To this, Mrs Chatterjee added that therapist-client situations ought to conider species survival. Needs must be met, but in a way that transcends the give-and-take policy. Power relationships do exist, but should be viewed as power WITH power and not power OVER power.
Someone in the audience then raised the question of professionality. Would it then not be better to go to a friend, who would be just as caring, maybe more? Mrs Chatterjee responded that feminists criticize the modern concept of empathy. They assert that therapists should maintain professionality, but should keep it at a human-to-human level. Co-feeling, and not empathy, and interconnectivity instead of inter-involvement are emphasized.
“But isn't the concept of co-feeling a little presumptious?” another member of the audience wanted to know. For instance, how can the therapist really know EXACTLY what a rape-victim is going through unless (s)he has experienced it for him/herself? Mrs Chatterjee clarified her stance, saying that feminists believe today's concept of empathy to be a limited, insufficient form of sympathy. The therapist shold try to “extend beyond his/her area of thought” and cultivate the mindset to accommodate what the client says into hs/her framework. Consider various possibilities of suffering and think about what best can be done.
With this, the session was wrapped up. Being as thought-provoking as it was, this lecture still left some questions unanswered in the minds of some of the audience members. For instance, how possible and plausible is co-feeling? How can a therapist possible understand the world of, say, a schizophrenic? Also, some of us felt it was unfair that the 'onus of emotionality' should always fall on the woman's shoulders. Why can't women also be rational and autonomous? Isn't the concept of the emotional woman a stereotype?
Monday, February 15, 2010
REPORT ON THE GUEST LECTURE BY DR. KAKLI GUPTA
On the 12th of January 2010, the MPCL II batch got to interact with a practitioner who we could not only relate to but who had also been confronted by the same dilemmas we face now as students having to make life altering choices.
It was very evident that the class greatly appreciated the opportunity to have her answer any doubts, queries or reservations they might have and be part of an open discussion wherein pressing issues from the field were discussed.
Dr. Gupta opened the session by telling us why exactly she pursued psychology after wanting to become a doctor and how it was her experience with psychologists that changed her mind as a teenager. She then traced the path that her education had taken through Lady Shri Ram College and Delhi University where she was exposed to the different but very strong views in favour of and opposing psychoanalysis. Following this she gave us a few excerpts from her internship at a government hospital where she was supervised by psychiatrists. It was surprising to learn that in certain situations sessions were taken while sitting with the client on a staircase due to the dearth of consultation rooms. She was very candid about the fact that a patient coming back for further consultation was very gratifying and also gave her an ego boost.
Moving on to her experience while doing her Psy.D at the California School of Professional Psychology, Dr. Gupta shared with us the fact that due to the syllabus she had covered in India, she was given the option of dropping some of her first year courses like Observation and Interviewing, Principles of Psychotherapy, Systems and History of Psychology, Social Psychology and Cognitive and Affective Psychology. She also warned us that while this opportunity seemed very tempting, as she could then complete some of the second year courses in her first year, it may not have been the best decision as her exposure to these areas was very limited and by not taking them she had not received any formal training in some key areas which in retrospect would have been an asset. She also shared with us the experience of being utterly lost in a class like African American Psychology, which was taught by a lawyer and a psychologist, where she had no knowledge about certain aspects that were taken for granted due to her foreign education.
From a practitioner’s perspective, she advocated that a psychologist should have a basic understanding of law proceedings as it is required in cases such a child abuse, domestic violence, etc. Her practical opinion regarding assessment was initially negative as she was against the concept of labeling people according to their prowess or proficiency on a particular test.
For her second practicum which consisted of 700 hours, she worked in a clinic for 3 days a week. The clinic was one which laid a heavy emphasis on psychoanalysis and on her first day there she thrown into the deep end by being assigned ten cases, all with very severe conditions. For every 10 clients she dealt with, she got one hour of individual supervision while group supervision sessions were for one and a half hours per week. Her process group focused on the dynamics of her relationship with her colleagues.
One client in particular, she said, had taught her the most about how practice and theory differ. She recounted her experience with an American man of Chinese descent who always asked for a consult with an Asian, female intern. He had had so much exposure to psychotherapy that he could manipulate and intimidate the intern and revel in it. On the first day he arrived with a rose and a painting as a gift for her which she flatly refused to accept which in retrospect was exactly what he had wanted. It never struck her to look at the painting and analyze why he had chosen that ver painting to give to her.
In the context of therapy for therapists, she firmly supported it and told us how she unexpectedly felt more at ease with a male therapist than she had with female ones. She said that her first year of therapy was geared more towards being in touch with oneself and accepting oneself.
She often felt the burden of being representative of the true Indian but later came to feel that she was not representative of Indians due to their diversity. In relation to her ethnicity she told us about a child who once commented on her accent which made her feel that the girl did not want to work with her. Her supervisor instead told her that it was the girl who was uncomfortable with her disability and needed someone who themselves were different. It was merely a manifestation of transference.
In response to one of the questions put forward by the class Dr. Gupta assured us that the APA does not discriminate between a PhD and a Psy.D but a PhD tends to carry more weight due to the fact that the number of people to obtain a PhD is far lower than that of those who obtain a Psy.D. She clarified that most Ivy League schools would require a PhD qualification for faculty members but professional schools would accept Psy.D holders as well. In the Indian context, people have been quite receptive to the Psy.D and accept any form of doctoral qualification. As far as recognition is concerned, she informed us that the IACP recognizes a Psy.D but the RCI does not.
One of the other questions that she had been requested to address was the competence of a therapist who had been educated abroad and was practicing in India. She completely supported the fact that she could practice as well as anyone else here even though she was educated abroad. She said that feeling incompetent and inadequate is something every young psychologist goes through and it has nothing to do with the location of one’s education.
Another query was the difference in practice in the East and West to which her answer was that they are not starkly different and that certain core processes remained the same such as connecting with a patient took approximately half a week, parents were met every month, if extended family had to be met, the child’s permission had to be taken, etc.
In response to the question of whether a client’s staunch religious beliefs can sometimes be detrimental to the progress made by psychotherapy, she disagreed. Her view on it was very interesting as she believed that it was easier for someone who believed in God to believe in a therapist. A therapist is not supposed to alter or impose religious belief. She also believed that religion helped people cope and if ever confronted with a similar situation we should attempt to work with the religious beliefs and not against them.
When asked what she would do if faced with the ethical dilemma of treating a friend or family member, her advice was not to agree to being their therapist but to offer them any help she could as a friend.
Her take on the question of further education in India or abroad tipped the scales slightly in favour of western education as she believed that in India Psychology was still not getting the recognition it deserved and while it was moving in that direction, it was not there yet.
One of the questions most people shied away from was the question of fees. Dr. Gupta categorically told us that one of the most difficult things in initial practice was to ask for fees which she said one just got used to. She said that in the case of under privileged clients, she had a particular number of slots she kept free when she would deal with clients at a lower fee.
I think it was an exceptionally informative session that allayed some of our fears and cleared up some of the foggy impressions we had about clinical practice.
Given below is the link to the book that she suggested in relation to the cultural aspects of practice.
http://openlibrary.org/b/OL14893883M/Psychotherapy_and_religion
It was very evident that the class greatly appreciated the opportunity to have her answer any doubts, queries or reservations they might have and be part of an open discussion wherein pressing issues from the field were discussed.
Dr. Gupta opened the session by telling us why exactly she pursued psychology after wanting to become a doctor and how it was her experience with psychologists that changed her mind as a teenager. She then traced the path that her education had taken through Lady Shri Ram College and Delhi University where she was exposed to the different but very strong views in favour of and opposing psychoanalysis. Following this she gave us a few excerpts from her internship at a government hospital where she was supervised by psychiatrists. It was surprising to learn that in certain situations sessions were taken while sitting with the client on a staircase due to the dearth of consultation rooms. She was very candid about the fact that a patient coming back for further consultation was very gratifying and also gave her an ego boost.
Moving on to her experience while doing her Psy.D at the California School of Professional Psychology, Dr. Gupta shared with us the fact that due to the syllabus she had covered in India, she was given the option of dropping some of her first year courses like Observation and Interviewing, Principles of Psychotherapy, Systems and History of Psychology, Social Psychology and Cognitive and Affective Psychology. She also warned us that while this opportunity seemed very tempting, as she could then complete some of the second year courses in her first year, it may not have been the best decision as her exposure to these areas was very limited and by not taking them she had not received any formal training in some key areas which in retrospect would have been an asset. She also shared with us the experience of being utterly lost in a class like African American Psychology, which was taught by a lawyer and a psychologist, where she had no knowledge about certain aspects that were taken for granted due to her foreign education.
From a practitioner’s perspective, she advocated that a psychologist should have a basic understanding of law proceedings as it is required in cases such a child abuse, domestic violence, etc. Her practical opinion regarding assessment was initially negative as she was against the concept of labeling people according to their prowess or proficiency on a particular test.
For her second practicum which consisted of 700 hours, she worked in a clinic for 3 days a week. The clinic was one which laid a heavy emphasis on psychoanalysis and on her first day there she thrown into the deep end by being assigned ten cases, all with very severe conditions. For every 10 clients she dealt with, she got one hour of individual supervision while group supervision sessions were for one and a half hours per week. Her process group focused on the dynamics of her relationship with her colleagues.
One client in particular, she said, had taught her the most about how practice and theory differ. She recounted her experience with an American man of Chinese descent who always asked for a consult with an Asian, female intern. He had had so much exposure to psychotherapy that he could manipulate and intimidate the intern and revel in it. On the first day he arrived with a rose and a painting as a gift for her which she flatly refused to accept which in retrospect was exactly what he had wanted. It never struck her to look at the painting and analyze why he had chosen that ver painting to give to her.
In the context of therapy for therapists, she firmly supported it and told us how she unexpectedly felt more at ease with a male therapist than she had with female ones. She said that her first year of therapy was geared more towards being in touch with oneself and accepting oneself.
She often felt the burden of being representative of the true Indian but later came to feel that she was not representative of Indians due to their diversity. In relation to her ethnicity she told us about a child who once commented on her accent which made her feel that the girl did not want to work with her. Her supervisor instead told her that it was the girl who was uncomfortable with her disability and needed someone who themselves were different. It was merely a manifestation of transference.
In response to one of the questions put forward by the class Dr. Gupta assured us that the APA does not discriminate between a PhD and a Psy.D but a PhD tends to carry more weight due to the fact that the number of people to obtain a PhD is far lower than that of those who obtain a Psy.D. She clarified that most Ivy League schools would require a PhD qualification for faculty members but professional schools would accept Psy.D holders as well. In the Indian context, people have been quite receptive to the Psy.D and accept any form of doctoral qualification. As far as recognition is concerned, she informed us that the IACP recognizes a Psy.D but the RCI does not.
One of the other questions that she had been requested to address was the competence of a therapist who had been educated abroad and was practicing in India. She completely supported the fact that she could practice as well as anyone else here even though she was educated abroad. She said that feeling incompetent and inadequate is something every young psychologist goes through and it has nothing to do with the location of one’s education.
Another query was the difference in practice in the East and West to which her answer was that they are not starkly different and that certain core processes remained the same such as connecting with a patient took approximately half a week, parents were met every month, if extended family had to be met, the child’s permission had to be taken, etc.
In response to the question of whether a client’s staunch religious beliefs can sometimes be detrimental to the progress made by psychotherapy, she disagreed. Her view on it was very interesting as she believed that it was easier for someone who believed in God to believe in a therapist. A therapist is not supposed to alter or impose religious belief. She also believed that religion helped people cope and if ever confronted with a similar situation we should attempt to work with the religious beliefs and not against them.
When asked what she would do if faced with the ethical dilemma of treating a friend or family member, her advice was not to agree to being their therapist but to offer them any help she could as a friend.
Her take on the question of further education in India or abroad tipped the scales slightly in favour of western education as she believed that in India Psychology was still not getting the recognition it deserved and while it was moving in that direction, it was not there yet.
One of the questions most people shied away from was the question of fees. Dr. Gupta categorically told us that one of the most difficult things in initial practice was to ask for fees which she said one just got used to. She said that in the case of under privileged clients, she had a particular number of slots she kept free when she would deal with clients at a lower fee.
I think it was an exceptionally informative session that allayed some of our fears and cleared up some of the foggy impressions we had about clinical practice.
Given below is the link to the book that she suggested in relation to the cultural aspects of practice.
http://openlibrary.org/b/OL14893883M/Psychotherapy_and_religion
Friday, January 29, 2010
CIA option: IACP Conference 2010 through my eyes
For those of you who wanted to, but could not attend DC sir's meeting with Subbu and me today, here's the gist:
All students willing to take up the assignment- 'IACP Conference 2010 through my eyes' should select one of the main sessions and one of the Paper or Poster sessions.
To see the see the lists of topics for the conference click HERE for main sessions, HERE for oral presentations and HERE for poster presentations.
You can put up their choice as a comment to this blog posting. Also, write your name and topics chosen on the list put up on the noticeboard in class. Try and make sure your topics don't coincide with another person's. If there are any such overlap issues to solve, please meet DC sir tomorrow after the exam.
The submitted report should have two parts:
a) Brief summary of the 2 sessions that I attended- why I choose those two- who the resource persons were- what they said (1000 words max.)
b) Student's reaction to the sessions- what you liked/disliked about the session- questions provoked in the mind- questions remained unanswered- any follow-up of the sessions by personally talking to one/two of the speakers later on- how is the session topics related to our course (1000 words max.)
You can be as innovative as possible, fulfilling the basic requirements as stated above.
DC sir would like us to enjoy the whole process rather than taking this CIA as a burden. And, of course, do not miss the lunch and the banquet ;-)
All students willing to take up the assignment- 'IACP Conference 2010 through my eyes' should select one of the main sessions and one of the Paper or Poster sessions.
To see the see the lists of topics for the conference click HERE for main sessions, HERE for oral presentations and HERE for poster presentations.
You can put up their choice as a comment to this blog posting. Also, write your name and topics chosen on the list put up on the noticeboard in class. Try and make sure your topics don't coincide with another person's. If there are any such overlap issues to solve, please meet DC sir tomorrow after the exam.
The submitted report should have two parts:
a) Brief summary of the 2 sessions that I attended- why I choose those two- who the resource persons were- what they said (1000 words max.)
b) Student's reaction to the sessions- what you liked/disliked about the session- questions provoked in the mind- questions remained unanswered- any follow-up of the sessions by personally talking to one/two of the speakers later on- how is the session topics related to our course (1000 words max.)
You can be as innovative as possible, fulfilling the basic requirements as stated above.
DC sir would like us to enjoy the whole process rather than taking this CIA as a burden. And, of course, do not miss the lunch and the banquet ;-)
Wednesday, January 20, 2010
CLASS SUMMARY: 8th , 11th, and 18th JAN.’10
GENERAL ISSUES IN PSYCHOTHERAPY
• DOES PSYCHOTHERAPY WORK?
Hans Eysenck after reviewing some of the early empirical studies on psychotherapy outcome, concluded that’s most clients got better without therapy and is of little benefit.
He was criticized for his claim and inspired thousands of subsequent empirical studies since then.
In 1970s and 1980s meta-analysis was the method of research. It statistically combines the results of many- in some cases, hundreds-separate studies to create numerical representation of the effects of psychotherapy as tested across massive number of settings, therapists and clients.
There are two types of psychotherapy research:
1. OUTCOME – comparing with other types of therapies
2. PROCESS- what actually happens at a micro-level in the session.
• WHO, WHEN AND HOW SHOULD RESEARCHER ASK?
As different people have different view points on the result of the therapy, the researcher has to decide on whom to consider. HANS STRUPP gave the tripartite model according to which there are three parties to be taken in account .
1. The first is the client
2. The second is the therapist
3. The third is the “society” i.e. any outsider to the therapy process who has an interest in how the therapy progresses.
As to when to ask one can ask question just after a session when the memory is fresh or after some time lapse after a week or month to test the effectiveness of therapy over time.
• EFFICACY V/S EFFECTIVENESS
Efficacy studies typically feature well-defined groups of patients usually meeting diagnostic criteria for a chosen disorder but no others; manualized treatment guidelines to minimize variability between therapists and random assignment to control and treatment groups.
It is more homogeneous and thus internal validity is high
Effectiveness studies tend to include a wider range of clients, including those with complex diagnostic profiles: allow for greater variability between therapists’ methods and may or may not include control group for comparison to treatment group. Thus internal validity is low and external validity is high and is more a heterogeneous group.
• WHICH THERAPY IS BEST?
Though there are many schools of psychotherapy each one is competent enough as all of the have some similar characteristics thus in psychotherapy the “dodo bird verdict” applies perfectly. Some of the common characteristics common among are as follows:
1. Relation between therapists and client
2. Support to client
? Affective experiencing
? Cognitive mastery
? Behavioral regulation
3. Some kind of learning
4. Action orientation- something to be done
UNCOMMON FACTORS:
? Patient/client’s characteristics
? Therapist’s characteristics
? Interaction/relationship between the therapists and clients
EXPERT’S ROLE
? Release of emotion
? Therapeutic alliance/relationship building
CLIENT’S/PATIENT’S CHARACTERISTICS
? The degree of patient’s distress
? Intelligence includes emotional intelligence, insight, willing to change, connecting things, verbal processes etc.
? Age – young adulthood
? Motivation
? Openness i.e. psychological mindedness
? Race, ethnicity and social class
THERAPIST’S CHARACTERISTICS
? Gender, age, and ethnicity
? Personality
? Empathy, warmth & genuineness
? Freedom from personal problems
? Experience & professional identification
According to Wolberg following are the desirable traits of a therapist
? Therapeutic personality
? Objective – less neurotic
? Flexible
? Level of ego strength
Undesirable traits are:
? Emotionally detached
? Excessive hostility
? Professional ego
• PSYCHOTHERAPEUTIC RELATION
? Background/Context (rf-encyclopedia of psychotherapy)
Therapeutic factors in the total range of psychotherapeutic intervention.
1. Non-specific : a. Affective Experiencing
b. Cognitive Mastery
c. Behavioral Regulation
2. Specific: a. Analytical Schools
b. Behavioral Schools
c. Experiential Schools
3. The Relationship As Therapeutic Factor: Psychotherapeutic changes always occur in the context of an interpersonal relationship and are to some extent extricable from it.
Simultaneous occurrence in different combination and emphasis.
? Transferential Relationship & Working Alliance
-special relationship between the therapist and the patient. Constitute both the subject and object of analysis
-primary stance: (original Freudian Room) transferential relations (therapist as a deliberate dispassionate observer and reflector of the patients feelings)* which many of us would not agree with.
-assymetrical therapeutic relationship
-secondary (more recent) stance: working or therapeutic alliance (holding the env., corrective relationship, empathic relationship)
Therapist aims at forming a real and mature (more satisfying) alliance with the conscious adult ego of the patient and encourages him/her to be a scientist partner in the exploration of difficulties (transference, resistance etc.)
? Teacher-Pupil Relationship
-used in behavior therapy
-deliberately structured
-therapist directly and systematically manipulates, shapes and inserts individual values in the therapeutic alliance (like a learning technician/social reinforcement machine)
-deliberately doesn’t dwell on the therapist-patient relationship. Secondarily done as relationship skill. *(this makes it easy for the behavioral therapist to leave the patient and transfer him to another’s care which is not so easy in any psychodynamic form of therapy, which is basically based on feelings and runs on time schedule)
-cognitive therapy : collaborative empiricism – tutorial approach
- patients share elements of both psychodynamic and cognitive approaches
? Person-to-Person Relationship (No power hierarchy)
-Rogerian/Expirential Approach
-here-and-now therapeutic dialogue or mutual encounter
-Egalitarian treatment model: alliance of human being to human being
“ I ENTER THE RELATIONSHIP NOT AS A SCIENTIST, NOR AS A PHYSICIAN WHO CAN ACCURATELY DIAGNOSE AND CURE, BUT AS A PERSON ENTERING INTO AN INTERPERSONAL RELATIONSHIP.”
• COURSE OF PSYCHOTHERAPY
? Initial Contact known as INTAKE
? ASSESSMENT PLAN both formal and informal. (first few sessions is to figure out what is the area of concern and major problems)
? TREATMENT PLAN that is GOAL SETTING. (every school has specific goal setting method)
? ACTUAL WORKING
? EVALUATION (home work, feedback etc). it is continuous in all session
? TERMINATION & FOLLOW UP
Even after termination the client will always has the right to come back.
Norcross has done research on the subject and has given changes of steps
? Precontemplation
? Contemplation
? Preparation
? Transformation/Action
? Maintenance
? Termination
• DOES PSYCHOTHERAPY WORK?
Hans Eysenck after reviewing some of the early empirical studies on psychotherapy outcome, concluded that’s most clients got better without therapy and is of little benefit.
He was criticized for his claim and inspired thousands of subsequent empirical studies since then.
In 1970s and 1980s meta-analysis was the method of research. It statistically combines the results of many- in some cases, hundreds-separate studies to create numerical representation of the effects of psychotherapy as tested across massive number of settings, therapists and clients.
There are two types of psychotherapy research:
1. OUTCOME – comparing with other types of therapies
2. PROCESS- what actually happens at a micro-level in the session.
• WHO, WHEN AND HOW SHOULD RESEARCHER ASK?
As different people have different view points on the result of the therapy, the researcher has to decide on whom to consider. HANS STRUPP gave the tripartite model according to which there are three parties to be taken in account .
1. The first is the client
2. The second is the therapist
3. The third is the “society” i.e. any outsider to the therapy process who has an interest in how the therapy progresses.
As to when to ask one can ask question just after a session when the memory is fresh or after some time lapse after a week or month to test the effectiveness of therapy over time.
• EFFICACY V/S EFFECTIVENESS
Efficacy studies typically feature well-defined groups of patients usually meeting diagnostic criteria for a chosen disorder but no others; manualized treatment guidelines to minimize variability between therapists and random assignment to control and treatment groups.
It is more homogeneous and thus internal validity is high
Effectiveness studies tend to include a wider range of clients, including those with complex diagnostic profiles: allow for greater variability between therapists’ methods and may or may not include control group for comparison to treatment group. Thus internal validity is low and external validity is high and is more a heterogeneous group.
• WHICH THERAPY IS BEST?
Though there are many schools of psychotherapy each one is competent enough as all of the have some similar characteristics thus in psychotherapy the “dodo bird verdict” applies perfectly. Some of the common characteristics common among are as follows:
1. Relation between therapists and client
2. Support to client
? Affective experiencing
? Cognitive mastery
? Behavioral regulation
3. Some kind of learning
4. Action orientation- something to be done
UNCOMMON FACTORS:
? Patient/client’s characteristics
? Therapist’s characteristics
? Interaction/relationship between the therapists and clients
EXPERT’S ROLE
? Release of emotion
? Therapeutic alliance/relationship building
CLIENT’S/PATIENT’S CHARACTERISTICS
? The degree of patient’s distress
? Intelligence includes emotional intelligence, insight, willing to change, connecting things, verbal processes etc.
? Age – young adulthood
? Motivation
? Openness i.e. psychological mindedness
? Race, ethnicity and social class
THERAPIST’S CHARACTERISTICS
? Gender, age, and ethnicity
? Personality
? Empathy, warmth & genuineness
? Freedom from personal problems
? Experience & professional identification
According to Wolberg following are the desirable traits of a therapist
? Therapeutic personality
? Objective – less neurotic
? Flexible
? Level of ego strength
Undesirable traits are:
? Emotionally detached
? Excessive hostility
? Professional ego
• PSYCHOTHERAPEUTIC RELATION
? Background/Context (rf-encyclopedia of psychotherapy)
Therapeutic factors in the total range of psychotherapeutic intervention.
1. Non-specific : a. Affective Experiencing
b. Cognitive Mastery
c. Behavioral Regulation
2. Specific: a. Analytical Schools
b. Behavioral Schools
c. Experiential Schools
3. The Relationship As Therapeutic Factor: Psychotherapeutic changes always occur in the context of an interpersonal relationship and are to some extent extricable from it.
Simultaneous occurrence in different combination and emphasis.
? Transferential Relationship & Working Alliance
-special relationship between the therapist and the patient. Constitute both the subject and object of analysis
-primary stance: (original Freudian Room) transferential relations (therapist as a deliberate dispassionate observer and reflector of the patients feelings)* which many of us would not agree with.
-assymetrical therapeutic relationship
-secondary (more recent) stance: working or therapeutic alliance (holding the env., corrective relationship, empathic relationship)
Therapist aims at forming a real and mature (more satisfying) alliance with the conscious adult ego of the patient and encourages him/her to be a scientist partner in the exploration of difficulties (transference, resistance etc.)
? Teacher-Pupil Relationship
-used in behavior therapy
-deliberately structured
-therapist directly and systematically manipulates, shapes and inserts individual values in the therapeutic alliance (like a learning technician/social reinforcement machine)
-deliberately doesn’t dwell on the therapist-patient relationship. Secondarily done as relationship skill. *(this makes it easy for the behavioral therapist to leave the patient and transfer him to another’s care which is not so easy in any psychodynamic form of therapy, which is basically based on feelings and runs on time schedule)
-cognitive therapy : collaborative empiricism – tutorial approach
- patients share elements of both psychodynamic and cognitive approaches
? Person-to-Person Relationship (No power hierarchy)
-Rogerian/Expirential Approach
-here-and-now therapeutic dialogue or mutual encounter
-Egalitarian treatment model: alliance of human being to human being
“ I ENTER THE RELATIONSHIP NOT AS A SCIENTIST, NOR AS A PHYSICIAN WHO CAN ACCURATELY DIAGNOSE AND CURE, BUT AS A PERSON ENTERING INTO AN INTERPERSONAL RELATIONSHIP.”
• COURSE OF PSYCHOTHERAPY
? Initial Contact known as INTAKE
? ASSESSMENT PLAN both formal and informal. (first few sessions is to figure out what is the area of concern and major problems)
? TREATMENT PLAN that is GOAL SETTING. (every school has specific goal setting method)
? ACTUAL WORKING
? EVALUATION (home work, feedback etc). it is continuous in all session
? TERMINATION & FOLLOW UP
Even after termination the client will always has the right to come back.
Norcross has done research on the subject and has given changes of steps
? Precontemplation
? Contemplation
? Preparation
? Transformation/Action
? Maintenance
? Termination
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