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? “
Showing posts with label Class Summaries. Show all posts
Showing posts with label Class Summaries. Show all posts
Thursday, February 25, 2010
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?
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
Wednesday, January 6, 2010
Summary of the class of 5th January, 2010
In a discussion of the ideal definition of psychotherapy on Monday (4.1.10), we had read Wolberg’s (1995) definition, being one of the most accepted ones. According to Lewis Wolberg "Psychotherapy is the treatment, by psychological means, of problems of an emotional nature in which a trained person deliberately establishes a professional relationship with the patient with the object of (1) removing, modifying, or retarding existing symptoms, (2) mediating disturbed patterns of behaviour, and (3) promoting positive personality growth and development."
A request to react to this definition brought forth several interesting comments from the class:
• We see that point (3) (“promoting positive…”) is not always the average psychotherapist’s primary concern. Perhaps this is not so strange: focusing on the immediate problems (symptoms) seems to do be a way to do away with the “road blocks” in the process of positive personality growth.
• Some may not be comfortable with the term “treatment” because it rings rather medical and dominant. We tried to understand why, by exploring the etymological roots of the term and found that, as a term used in medicine, it only meant “behaviour or conduct”. The term “therapy” was used much later, and in medicine, meant to “heal or to cure”. However, some of us in class felt that to discuss etymology did not seem so relevant to a discussion of the word’s present-day usage. Language is a tool. The fact remains that sometimes it may take on some borrowed power from its usage (sir used the example of “gay”).
• Most of us preferred the term “assistance” instead, which Ninad had mentioned in his definition in Monday’s class. Interestingly, we seemed to find Ninad’s definition more satisfactory than Wolberg’s one: Psychotherapy is defined as the process in which an expert viz. the psychotherapist assesses the client or patient in reviewing, reinterpreting and reconstructing his/her concerns, consistent with the psychological school of thought in which (s)he has received training. [Perhaps we will hold sir to his promise to grant us full marks for writing Ninad’s definition of psychotherapy in the exam. ;) ]
• It lays rather too much stress on the emotional side of problems than others.
• “Psychological means” is an ambiguous term, and has no mention of theoretical backing-up.
• Positive personality growth is something that may differ from culture to culture.
Another definition we finally found satisfactory was the one given by Sommers-Flanagan and Sommers-Flanagan (2004): Psychotherapy is a process that involves a trained person who practices the artful application of scientifically derived principles for establishing professional helping relationships with persons who seek assistance in resolving large or small psychological or relational problems. This is accomplished through ethically defined means and involves, in the broadest sense, some form of learning or human development.
Moving on to the differentiation of psychotherapy from psychotherapeutics (a term coined by Tuke), we agreed that psychotherapy is ideally supposed to be generally helpful to anyone, whereas psychotherapeutics aids psychotherapy but may work for some and not for others (e.g. psychodrama, dance, music, etc).
The “ideal” patient/client for psychotherapy has the following characteristics (remembered by the mnemonic YAVIS): Young, Attractive, Vital/verbose, Intelligent and SuccessfulIn fact, it has been jocularly suggested that the most ideal client for psychotherapy is the one who doesn’t need it at all! Incidentally, there also exists an acronym for those qualities that make a “bad” client: HOUND, which stands for Homely, Old, Unsuccessful, Non-verbal and Dumb.
The primary stakeholders of psychotherapy are the therapist and the client. Several intervening factors that affect psychotherapy are qualities around these stakeholders, i.e client variables, therapist variables (like age, sex, etc) and the relationship between the two (which can sometimes be dictated by the school of thought the therapist belongs to).
The class was wound down with an interesting study by Farber et al (2005) who listed out 12 themes in finding out the reasons for why people become psychotherapists, most of which we could identify with. These reasons have implications for practice, which will be discussed next class.
A request to react to this definition brought forth several interesting comments from the class:
• We see that point (3) (“promoting positive…”) is not always the average psychotherapist’s primary concern. Perhaps this is not so strange: focusing on the immediate problems (symptoms) seems to do be a way to do away with the “road blocks” in the process of positive personality growth.
• Some may not be comfortable with the term “treatment” because it rings rather medical and dominant. We tried to understand why, by exploring the etymological roots of the term and found that, as a term used in medicine, it only meant “behaviour or conduct”. The term “therapy” was used much later, and in medicine, meant to “heal or to cure”. However, some of us in class felt that to discuss etymology did not seem so relevant to a discussion of the word’s present-day usage. Language is a tool. The fact remains that sometimes it may take on some borrowed power from its usage (sir used the example of “gay”).
• Most of us preferred the term “assistance” instead, which Ninad had mentioned in his definition in Monday’s class. Interestingly, we seemed to find Ninad’s definition more satisfactory than Wolberg’s one: Psychotherapy is defined as the process in which an expert viz. the psychotherapist assesses the client or patient in reviewing, reinterpreting and reconstructing his/her concerns, consistent with the psychological school of thought in which (s)he has received training. [Perhaps we will hold sir to his promise to grant us full marks for writing Ninad’s definition of psychotherapy in the exam. ;) ]
• It lays rather too much stress on the emotional side of problems than others.
• “Psychological means” is an ambiguous term, and has no mention of theoretical backing-up.
• Positive personality growth is something that may differ from culture to culture.
Another definition we finally found satisfactory was the one given by Sommers-Flanagan and Sommers-Flanagan (2004): Psychotherapy is a process that involves a trained person who practices the artful application of scientifically derived principles for establishing professional helping relationships with persons who seek assistance in resolving large or small psychological or relational problems. This is accomplished through ethically defined means and involves, in the broadest sense, some form of learning or human development.
Moving on to the differentiation of psychotherapy from psychotherapeutics (a term coined by Tuke), we agreed that psychotherapy is ideally supposed to be generally helpful to anyone, whereas psychotherapeutics aids psychotherapy but may work for some and not for others (e.g. psychodrama, dance, music, etc).
The “ideal” patient/client for psychotherapy has the following characteristics (remembered by the mnemonic YAVIS): Young, Attractive, Vital/verbose, Intelligent and SuccessfulIn fact, it has been jocularly suggested that the most ideal client for psychotherapy is the one who doesn’t need it at all! Incidentally, there also exists an acronym for those qualities that make a “bad” client: HOUND, which stands for Homely, Old, Unsuccessful, Non-verbal and Dumb.
The primary stakeholders of psychotherapy are the therapist and the client. Several intervening factors that affect psychotherapy are qualities around these stakeholders, i.e client variables, therapist variables (like age, sex, etc) and the relationship between the two (which can sometimes be dictated by the school of thought the therapist belongs to).
The class was wound down with an interesting study by Farber et al (2005) who listed out 12 themes in finding out the reasons for why people become psychotherapists, most of which we could identify with. These reasons have implications for practice, which will be discussed next class.
Wednesday, December 16, 2009
Summary of the class of 15th of December, 2010
Summary of the class of 15th of December, 2010
Of all those times we psychology students have had to, time and again, study the importance and the nuances of the clinical interview, I do believe yesterday’s CP class was one of the most entertaining sessions on the topic!
The class was begun in the expectation (!) that the class had read chapters 7 and 8 from Pomerantz. The opening discussion was on the prerequisites of conducting a clinical interview. Pomerantz had listed the following 3 prerequisites:
• “Quieting” of the mind
• Self awareness
• Positive working Relationship/ Rapport
However, the class saw fit to add more items to his list:
• Active listening skills
• Attending skills (eye contact, body posture, paralinguistic qualities)
• Communication skills
• Adequate training
• Genuineness
• Openness
• Non-judgemental attitude
Sir pointed out that whatever the interview is intended to accomplish (Intake, assessment, intervention, etc), a comfortable professional relationship will smooth the way. Several factors determine how tough or easy it would be to build such a relationship with the client. One obvious factor is the personality of the therapist, and another is the level of self awareness in him/her.
Things took an interesting turn at this point: It is obviously essential it is for clinical psychologists, to appreciate how absolutely indispensable and difficult to achieve self awareness can be. And what better place to hear that than straight from the horse’s mouth? DC sir sportingly shared with the class his own moments of uncertainty and doubt- and had some of us in class sharing our own experiences, too…!
Moving onto questioning skills, sir mentioned it is very important to strike a balance in the proportion of open-ended to close ended questions. He also talked about listening responses, which include clarification, paraphrasing, reflection (of content and of feeling) and summarizing.
The purpose of interviews, he said, generally lie on a continuum with assessment at one end and intervention at the other, and depends on specific populations and objectives. The importance of setting and its relation to the referral question was stressed.
In enumerating the various types of interviews, 3 criteria are kept in mind:
• Role (directive / non-directive)
• Structure of interview (structured / semi-structured/ unstructured)
• Purpose (Intake interview, case history interview, MSE, crisis interview, diagnostic/clinical interview and collateral interviews).
Of course, it is usually the case that more than one type of interview is rolled into one.
The class ended on a most hilarious note- with mimicry, music and holiday spirit, although the holidays were (technically) a week away. Altogether, those who missed this class are to be pitied! :D
Of all those times we psychology students have had to, time and again, study the importance and the nuances of the clinical interview, I do believe yesterday’s CP class was one of the most entertaining sessions on the topic!
The class was begun in the expectation (!) that the class had read chapters 7 and 8 from Pomerantz. The opening discussion was on the prerequisites of conducting a clinical interview. Pomerantz had listed the following 3 prerequisites:
• “Quieting” of the mind
• Self awareness
• Positive working Relationship/ Rapport
However, the class saw fit to add more items to his list:
• Active listening skills
• Attending skills (eye contact, body posture, paralinguistic qualities)
• Communication skills
• Adequate training
• Genuineness
• Openness
• Non-judgemental attitude
Sir pointed out that whatever the interview is intended to accomplish (Intake, assessment, intervention, etc), a comfortable professional relationship will smooth the way. Several factors determine how tough or easy it would be to build such a relationship with the client. One obvious factor is the personality of the therapist, and another is the level of self awareness in him/her.
Things took an interesting turn at this point: It is obviously essential it is for clinical psychologists, to appreciate how absolutely indispensable and difficult to achieve self awareness can be. And what better place to hear that than straight from the horse’s mouth? DC sir sportingly shared with the class his own moments of uncertainty and doubt- and had some of us in class sharing our own experiences, too…!
Moving onto questioning skills, sir mentioned it is very important to strike a balance in the proportion of open-ended to close ended questions. He also talked about listening responses, which include clarification, paraphrasing, reflection (of content and of feeling) and summarizing.
The purpose of interviews, he said, generally lie on a continuum with assessment at one end and intervention at the other, and depends on specific populations and objectives. The importance of setting and its relation to the referral question was stressed.
In enumerating the various types of interviews, 3 criteria are kept in mind:
• Role (directive / non-directive)
• Structure of interview (structured / semi-structured/ unstructured)
• Purpose (Intake interview, case history interview, MSE, crisis interview, diagnostic/clinical interview and collateral interviews).
Of course, it is usually the case that more than one type of interview is rolled into one.
The class ended on a most hilarious note- with mimicry, music and holiday spirit, although the holidays were (technically) a week away. Altogether, those who missed this class are to be pitied! :D
Wednesday, December 2, 2009
Class Summary
Class of Tuesday, the 24th of November
This class began with a recap of the Nature of Clinical Psychology which had been discussed the class before. It was agreed that the following are the major descriptive characteristics of the field of clinical psychology:
1) Scientificity/scientific approach
2) Idiograpihc approach
3) Focus on abnormality/pathology
4) Designed to answer the question, "How can I help?"
5) Diversity, and
6) More focus on assessment and diagnosis than on intervention (as per today's state of affairs).
Although these are the "generally agreed upon" characteristics of clinical psychology, some experts in the field feel differently about one or more of these points. For instance, sir highlighted, with reference to 2 books (namely, Science and Pseudoscience in Clinical Psychology by Lilienfeld, Lynn and Lohr and Introduction to Clinical Psychology by Hecker and Thorpe), how some parts of clinical practice may border on pseudoscience. What do clinical psychologists have against graphology, for example, which seems to work on the same principles as projective tests?
This is where further discussion on the merits and pit-falls of sticking to evidence based practice began. On the one hand, using EBP gives one the confidence of a tried and tested method, with sufficient scientific proof of its efficiency. On the other hand, what does one do if validation by empirical evidence is not possible for a certain practice? As DC sir said, "Do we then throw psychoanalysis out of the window, provided we have a large enough window?" Also, if one never tries new methods, how is the science of clinical psychology ever to grow? This is the age-old problem of Professional development vs. Creativity that Carl Rogers (1950) also alludes to, in his article "Where Are We Going In Clinical Psychology?"
Proceeding on to the development of clinical psychology in India, the question was raised: "Has it been exactly as in the West? Or has the Indian history of clinical psychology varied in some way?" Summarizing the lively debate that followed is a challenging task; but in essence, some of us felt that insofar as India has been using the "photocopy approach" in the words of Ramalingaswamy (a historian of Indian psychology), yes: The development of Indian clinical psychology may have been the same- but only to an extent. Things may soon change, as awareness of an Indian psychology is on the rise. But others in class were of the opinion that one cannot say the development has been exactly the same, because, after all, India is no stranger to psychology. Ancient seers and sages of India have long since contemplated on human nature, and that the difference lies in our not having enough written records of what they had discovered, albeit cloaked in philosophy and mysticism. Other factors such as the focus on the family, and the ever-present element of religiousness cannot, too, be ignored.
Traces of Indian psychology and psychotherapy has undeniably been found in the Vedas, in Siddha and Ayurveda, in the writings of Charaka and Sushruta. And although the Mughals later brought with them a different cultural tinge, it is nevertheless considered Indian. The British brought with them, along with allopathy, a whole new psychology that was influenced by what was initiated in the West by those like Tuke, Pinel and so on. The first asylum (for the British, not yet for the Indians) was established in 1787 in Calcutta: but not much in the way of treatment was offered to the unfortunate "madmen" (and alleged adultresses!). They were just waiting to be shipped away to Britain. Later, on being questioned, the British started admitting Indians as well into these asylums. Gradually, asylums were opened in Bangalore, Agra and an important one in Ranchi, all of which are now called hospitals.
On the academic side of things, as we know, the first University that taught psychology was Calcutta University, around 1916, facilitated by Sri Brajendra Nath Seal (who taught Psychology as part of Philosophy masters course way back in 1905 in CU). Mysore University soon followed (1924). The articles written by Sanjeev Jain and by G.G.Prabhu (GGP, as he seems to be fondly known) shed much light on the development of Mental Health Services/ clinical psychology in India, Specifically around NIMHANS in Bangalore. According to GGP, the 3 Gs responsible for bringing this feat about were Dr. Girindrasekhar Bose (psychologist/psychiatrist), Prof. M.V. Gopalaswamy (psychologist) and Dr. Govindaswamy (psychiatrist/psychologist, student of Gopalaswamy). It is GGP's opinion that when Gopalaswamy and Govindaswamy together started clinical psychology in NIMHANS, their conceptualization of clinical psychology was very different from what it has turned out to be today, and that if at all there was a Golden Era for Indian clinical psychology, it was till 1960 (this is debatable!).
Other courses in clinical psychology soon cropped up in CIP (estbd in Ranchi by Berkeley Hill), BHU (Varanasi), Ahmedabad, and so on. The path of development of CP in India has not by any means been smooth. The courses at Varanasi and Ahmendabad were not popular for long. The name of the course at NIMHANS has changed nearly half a dozen times, recently because of their disagreements with the RCI: Diploma in Medical Psychology -> Diploma in Medical and Social Psychology -> MPhil in Medical and Social Psychology -> MPhil in Clinical Psychology -> MPhil in Mental Health and Social Psychology->->??.
The class was wound down with one provocative question for those who wished to write an integration paper: WHY has there been no truce declared between NIMHANS and the RCI? Is a truce forthcoming at all?
Major Reading Resources:
• A bunch of 4 articles on Clin Psych in India- (Janak Pandeys entry on ‘India’ in Encyclopedia of Psychology, S K Verma’s article in CCP, GGP’s book Ch in Mental Health: An Indian Perspective(1946-2003), GGP’s article in NACIACP-06 Souvenir- ESSENTAIL READING)
• Plus some other articles on the same topic (Clin Psych in India) mainly published in IJCP from time to time, available with DC (Supplementary reading)
• Hecker & Thorpe (Ch 1- Characteristics of Clin Psych)
• Other regularly referred textbooks for general overview (Trull & Phares, Pomerantz, Plante, etc)
• Lilienfeld’s book (see the text above)
This class began with a recap of the Nature of Clinical Psychology which had been discussed the class before. It was agreed that the following are the major descriptive characteristics of the field of clinical psychology:
1) Scientificity/scientific approach
2) Idiograpihc approach
3) Focus on abnormality/pathology
4) Designed to answer the question, "How can I help?"
5) Diversity, and
6) More focus on assessment and diagnosis than on intervention (as per today's state of affairs).
Although these are the "generally agreed upon" characteristics of clinical psychology, some experts in the field feel differently about one or more of these points. For instance, sir highlighted, with reference to 2 books (namely, Science and Pseudoscience in Clinical Psychology by Lilienfeld, Lynn and Lohr and Introduction to Clinical Psychology by Hecker and Thorpe), how some parts of clinical practice may border on pseudoscience. What do clinical psychologists have against graphology, for example, which seems to work on the same principles as projective tests?
This is where further discussion on the merits and pit-falls of sticking to evidence based practice began. On the one hand, using EBP gives one the confidence of a tried and tested method, with sufficient scientific proof of its efficiency. On the other hand, what does one do if validation by empirical evidence is not possible for a certain practice? As DC sir said, "Do we then throw psychoanalysis out of the window, provided we have a large enough window?" Also, if one never tries new methods, how is the science of clinical psychology ever to grow? This is the age-old problem of Professional development vs. Creativity that Carl Rogers (1950) also alludes to, in his article "Where Are We Going In Clinical Psychology?"
Proceeding on to the development of clinical psychology in India, the question was raised: "Has it been exactly as in the West? Or has the Indian history of clinical psychology varied in some way?" Summarizing the lively debate that followed is a challenging task; but in essence, some of us felt that insofar as India has been using the "photocopy approach" in the words of Ramalingaswamy (a historian of Indian psychology), yes: The development of Indian clinical psychology may have been the same- but only to an extent. Things may soon change, as awareness of an Indian psychology is on the rise. But others in class were of the opinion that one cannot say the development has been exactly the same, because, after all, India is no stranger to psychology. Ancient seers and sages of India have long since contemplated on human nature, and that the difference lies in our not having enough written records of what they had discovered, albeit cloaked in philosophy and mysticism. Other factors such as the focus on the family, and the ever-present element of religiousness cannot, too, be ignored.
Traces of Indian psychology and psychotherapy has undeniably been found in the Vedas, in Siddha and Ayurveda, in the writings of Charaka and Sushruta. And although the Mughals later brought with them a different cultural tinge, it is nevertheless considered Indian. The British brought with them, along with allopathy, a whole new psychology that was influenced by what was initiated in the West by those like Tuke, Pinel and so on. The first asylum (for the British, not yet for the Indians) was established in 1787 in Calcutta: but not much in the way of treatment was offered to the unfortunate "madmen" (and alleged adultresses!). They were just waiting to be shipped away to Britain. Later, on being questioned, the British started admitting Indians as well into these asylums. Gradually, asylums were opened in Bangalore, Agra and an important one in Ranchi, all of which are now called hospitals.
On the academic side of things, as we know, the first University that taught psychology was Calcutta University, around 1916, facilitated by Sri Brajendra Nath Seal (who taught Psychology as part of Philosophy masters course way back in 1905 in CU). Mysore University soon followed (1924). The articles written by Sanjeev Jain and by G.G.Prabhu (GGP, as he seems to be fondly known) shed much light on the development of Mental Health Services/ clinical psychology in India, Specifically around NIMHANS in Bangalore. According to GGP, the 3 Gs responsible for bringing this feat about were Dr. Girindrasekhar Bose (psychologist/psychiatrist), Prof. M.V. Gopalaswamy (psychologist) and Dr. Govindaswamy (psychiatrist/psychologist, student of Gopalaswamy). It is GGP's opinion that when Gopalaswamy and Govindaswamy together started clinical psychology in NIMHANS, their conceptualization of clinical psychology was very different from what it has turned out to be today, and that if at all there was a Golden Era for Indian clinical psychology, it was till 1960 (this is debatable!).
Other courses in clinical psychology soon cropped up in CIP (estbd in Ranchi by Berkeley Hill), BHU (Varanasi), Ahmedabad, and so on. The path of development of CP in India has not by any means been smooth. The courses at Varanasi and Ahmendabad were not popular for long. The name of the course at NIMHANS has changed nearly half a dozen times, recently because of their disagreements with the RCI: Diploma in Medical Psychology -> Diploma in Medical and Social Psychology -> MPhil in Medical and Social Psychology -> MPhil in Clinical Psychology -> MPhil in Mental Health and Social Psychology->->??.
The class was wound down with one provocative question for those who wished to write an integration paper: WHY has there been no truce declared between NIMHANS and the RCI? Is a truce forthcoming at all?
Major Reading Resources:
• A bunch of 4 articles on Clin Psych in India- (Janak Pandeys entry on ‘India’ in Encyclopedia of Psychology, S K Verma’s article in CCP, GGP’s book Ch in Mental Health: An Indian Perspective(1946-2003), GGP’s article in NACIACP-06 Souvenir- ESSENTAIL READING)
• Plus some other articles on the same topic (Clin Psych in India) mainly published in IJCP from time to time, available with DC (Supplementary reading)
• Hecker & Thorpe (Ch 1- Characteristics of Clin Psych)
• Other regularly referred textbooks for general overview (Trull & Phares, Pomerantz, Plante, etc)
• Lilienfeld’s book (see the text above)
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