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.

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.

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?"

Thursday, March 11, 2010

Integration Paper

To read Malvika, Sarah and Nesmita's integration paper, click HERE.

Wednesday, March 10, 2010

THE FUTURE OF CLINICAL PSYCHOLOGY

To read my write-up, click HERE.

Integration Paper

To read Ninad, Disha and Urvita's integration paper, click HERE.

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)

Tuesday, March 9, 2010

iacp conference report by Sebastian Varun

To read it, click HERE

Animal Assisted Therapy

To check Seema's article Here .

ALCOHOLICS ANONYMOUS: CULT OR CURE?

To read Akriti's articke click Here

Monday, March 8, 2010

IACP report

To read the next part of Harish's IACP report, click HERE.

Saturday, March 6, 2010

Integration Paper

To read Rehna and Sister's integration paper, click HERE

Integration Paper

To read Firozna and Jinu's integration paper, click HERE

IACP report

Click HERE to read Sheeba's NAC IACP report.

Integration Paper: Exploratory Study on Animal Assisted Therapy and its Applicability in India

Click HERE to read Seema's integration paper.

NAC IACP report

Click HERE to read Mridu's NAC IACP report.

Integration Paper

Click HERE for Kiran'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

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 India. It is a very old system of healing the body physically and mentally. But very few studies have studied the effect of Yoga on schizophrenic patients. In this study 30 chronic schizophrenic patients were randomly assigned to either an experimental group (Yoga therapy along with pharmacotherapy) and to a control group (pharmacotherapy alone). Two scales were used for assessment. They are the PGI General Well Being Measure(GWBG), and the Checklist for Basic Living Skills and Indian Disability Evaluation and Assessment Scale(IDEAS). The experimental group attended Yoga therapy everyday for about one and a half hours and they also received motivational and feedback sessions. After this chi-square test was used to analyze and evaluate the data. When the results were compared after a month it was found that the experimental group were functioning better in terms of their self care, were more involved in their work , had a higher sense of well being etc. The contribution of Yoga on mental health practice has been acknowledged worldwide and is used as an adjunct to therapy in many countries.

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 Lucknow (Hindus and Muslims). The 2 scales used were the Vedic Personality Inventory and the Luscher Color Test. The data was analyzed both using the t-test and the chi square test. It was found that people choose colors according to their attitude towards life and their emotions. The personality characteristics associated with the trigunas are: Sattvic personality is truthful, lawful, stable etc., the Rajasic personality is angry, jealous, proud etc., and the tamasic personality is lazy, inactive, and reckless etc. The main ways of gaining happiness are: by the Sattvic personality are through meditation, helping others and serving society, by the Rajasic personality are by focusing on gaining worldly pleasures, by the Tamasic personality are by excessively eating and drinking etc. Those with Sattvic personalities sleep 4-6 hours and prefer colors like blue, yellow, and white, whereas those with Rajasic personalities sleep 7-9 hours and prefer colors like red, green and violet, and those with Tamasic personalities sleep 12-15 hours and prefer black and other colors having a high percentage of black. On the basis of the means a predominance of Sattva guna was seen in the whole sample. The influence of religion was not evident as far as dominance of gunas was concerned and religion may have played a role in the choice of colors. Two limitations of this study were that firstly a small sample was used, and secondly the presence of external factors, individual differences, and aesthetic factors were not considered.

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. Meta cognition is a multi-faceted concept. In other words it is a “feeling of knowing”. There are 3 types of meta cognitions- meta cognitions of knowledge- beliefs about one’s own cognitions, meta cognitions of experience- appraisal of meaning to specific mental events, meta cognitions of control strategies- responses to control activities of the cognitive system. Also discussed were the 2 types of worry: type 1 worry is the concern about external things, type 2 worry is the worry about worry. Recent models of psychopathology, particularly OCD, have begun to emphasize the role of beliefs about one’s thoughts and appraisal of thoughts themselves in the development and persistence of the disorder and this emphasis has proven valuable in the advancing our understanding and treatment of emotional disorders.

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

IACP report

To read Harish's IACP report, click HERE.

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