Psychological Therapies

Clinical Psychology

• Diagnose and treat mental, emotional, and behavioural disorders

• Integrates scientific research, psychological theory, and clinical knowledge to understand and alleviate psychological distress

• Sits within a broad group of mental health professionals including psychiatrists, therapists, counsellors, social workers, etc

• Clinical psychologists often specialise in different areas, such as child and adolescent psychology, forensic psychology, neuropsychology, or health psychology.

• Work settings include private practice, hospitals, community mental health centers, rehabilitation facilities, and academic institutions.

Role of Psychologists

• It focuses on psychological therapy, assessment, and behavioural interventions

• Assess and diagnose psychological conditions using clinical interviews, psychometric assessments, and observation.

• Develop and implement evidence-based treatments tailored to individual needs.

• Promote mental health and well-being through therapy, psychoeducation, and preventative interventions.

• Conduct research to improve psychological treatments and understand mental health disorders.

• Provide consultation and supervision to other professionals in clinical and academic settings.

• Use standardized psychological tools, such as MMPI (Minnesota Multiphasic Personality Inventory), WAIS (Wechsler Adult Intelligence Scale), and Beck Depression Inventory.

• Collaborate with other healthcare professionals to provide holistic care.

Why see a Clinical Psychologist?

• Clinical psychologists support individuals across various psychological and life challenges. Common reasons for seeking therapy include:

  • Mental Health Conditions

    • Mood disorders: Major Depressive Disorder (MDD), Bipolar Disorder, Dysthymia

    • Anxiety disorders: Generalized Anxiety Disorder (GAD), Panic Disorder, Social Anxiety Disorder, Phobias

    • Obsessive-Compulsive & Related Disorders: OCD, Body Dysmorphic Disorder, Hoarding Disorder

    • Trauma & Stress-Related Disorders: PTSD, Acute Stress Disorder, Adjustment Disorder

  • Developmental and Neurological Disorders

    • Autism Spectrum Disorder (ASD): Social communication difficulties, repetitive behaviors

    • Attention-Deficit/Hyperactivity Disorder (ADHD): Impulsivity, inattention, hyperactivity

    • Learning Disabilities: Dyslexia, dyscalculia, executive functioning deficits

  • Health Psychology & Psychosomatic Issues

    • Chronic illness coping: Cancer, diabetes, autoimmune disorders

    • Pain management: Fibromyalgia, migraines, chronic pain conditions

    • Stress-related physical conditions: Hypertension, irritable bowel syndrome

  • Behavioural and Emotional Issues

    • Anger management: Difficulty regulating emotions

    • Interpersonal and relationship difficulties: Family, romantic, or workplace conflicts

    • Adjustment to life changes: Divorce, job loss, relocation, grief

  • Severe and Enduring Mental Illness

    • Schizophrenia and psychotic disorders: Hallucinations, delusions, disorganized thinking

    • Personality disorders: Borderline, Antisocial, Narcissistic, Avoidant Personality Disorders

  • Support for Specific Populations

    • Children and adolescents: Emotional regulation, bullying, school stress

    • Older adults: Dementia, late-life depression, grief counseling

DSM

Diagnostic and Statistical Manual of Mental Disorders

• The DSM-5 (latest version) provides a biopsychosocial approach to diagnosing mental disorders.

• Divides disorders into 18 different classes (e.g., neurodevelopmental disorders, schizophrenia spectrum, mood disorders, anxiety disorders, etc.).

• Contains over 300 diagnoses with clearly defined criteria for diagnosis.

• Sets thresholds and rules for meeting diagnostic criteria (e.g., symptom duration, impact on daily functioning).

• Used by psychologists, psychiatrists, and mental health professionals worldwide.

Key Concepts in Diagnosis

Heterogeneity

• Two people with the same diagnosis can experience very different symptoms.

• Example: Two individuals with depression—one might have insomnia and anxiety, while another experiences lethargy and social withdrawal.

Comorbidity

• If a person has one disorder, they are more likely to have another.

• Example: Major Depressive Disorder (MDD) frequently co-occurs with Anxiety Disorders.

Psychological Therapies

Four Foundational Models of Psychological Therapy

1. Psychodynamic (Unconscious processes, early experiences)

2. Biological (Brain structure, genetics, neurotransmitters)

3. Behavioural (Learned behaviours, conditioning)

4. Cognitive-Behavioural (CBT) (Thought patterns influencing behaviour)

Psychodynamic

• Rooted in Freudian theory but evolved significantly.

  • “Two things you need to know about Feud. One is he was wrong, and the second is that he’s dead.:

• Explores unconscious processes, early childhood experiences, and internal conflicts.

Core Concepts

1. Unconscious Processes

   • Behavior, thoughts, and emotions are shaped by unconscious drives & motivations.

   • Therapy seeks to bring these hidden elements to awareness.

2. Early Childhood Experiences

   • Personality & relationship patterns are shaped by early experiences.

   • Unresolved past conflicts can manifest in current behaviors and emotional difficulties.

3. Internal Conflicts and Defense Mechanisms

   • Psychological distress stems from inner conflicts between unconscious desires & societal expectations.

   • Defense mechanisms (e.g., repression, denial, projection) help manage distress but may become maladaptive.

   • Therapy examines whether these defenses are helpful or hindering.

4. Transference and Countertransference

   • Transference: Client projects feelings from past relationships onto the therapist.

   • Countertransference: Therapist's emotional reaction to the client.

   • Exploring these dynamics reveals relational patterns and emotional blind spots.

5. Therapeutic Relationship

   • The therapist-client relationship serves as a microcosm for understanding a client’s emotional world.

6. Techniques

   • Free association (express thoughts without censorship)

   • Interpretation (analyzing themes in speech and behavior)

   • Dream analysis (examining unconscious symbolism)

Biological

• Mental disorders have biological causes (e.g., brain structure, neurotransmitters, genetics).

Key Factors

• Neurological & neurochemical: Imbalances in dopamine, serotonin, etc.

• Genetic & epigenetic: Inherited vulnerabilities, environmental triggers.

• Endocrine system: Thyroid, stress hormones affecting mood.

• Medication: Antidepressants, anxiolytics, antipsychotics, mood stabilizers.

• Other interventions: ECT (electroconvulsive therapy), TMS (transcranial magnetic stimulation), VNS (vagus nerve stimulation), DBS (deep brain stimulation), neurofeedback

  • ect and tms helps with severe depression that nothing else seems to work for

• Lifestyle factors: Diet, sleep, and exercise significantly impact mental health.

Biopsychosocial

• biological — physical health and genetics → medical interventions

• psychological and social factors interpret more broadly and inform complementary strategies

Behavioural

• Focuses on observable behaviors and how they are learned through conditioning.

Key Concepts

• Classical Conditioning (Pavlov): Learning through association.

• Operant Conditioning (Skinner): Behavior shaped by rewards and punishments.

• Social Learning (Bandura): Observing and imitating others.

Therapeutic Techniques

• Systematic Desensitization: Gradual exposure for phobias.

• Token Economies: Reward-based systems for behavior change.

Cognitive

• cognitions (thoughts) are also important — dysfunctional thinking leads to dysfunctional emotions or behaviours

• identify and challenge distorted or irrational thoughts and beliefs, and replace them with more realistic, positive ones

• Focuses on how thoughts influence emotions and behaviors.

• Developed into Cognitive-Behavioral Therapy (CBT), which combines cognitive and behavioral strategies.

• techniques include cognitive restructuring, problem-solving, and skills training

• explain the rationale for the importance of thoughts — their relationship with feelings and behaviours

Techniques

1. Cognitive Restructuring:

   • Identifying and challenging distorted thoughts.

   • Example: Changing “I’m a failure” to “I made a mistake, but I can improve.”

2. ABC model

   • “A”ctivating event

   • “B”eliefs or thoughts about that event

   • “C”onsequences — that is, your emotional, physiological and behavioural consequences

   • Example

     • **Activating event—**Partner not home from work an hour later than usual – they are rarely late and there has been no call or text

       1. **Belief—**Stuck in a meeting → **Consequences—**Maybe a bit annoyed;Maybe a bit empathetic; Maybe a bit happy; Delay dinner

       2. **Belief—**In a serious accident → **Consequences—**Worried; Increased heart rate; Call the hospital/police

       3. **Belief—**Cheating on you → **Consequences—**Angry/upset; Heart races; Short of breath; Panic/anxiety; Destroy their stuff

Evaluating Therapies

• How do we know which therapies work?

• Must be evidences based

• Must use APA guidelines

• Treatments must be evidence-based to be considered effective.

• 3 criteria:

  1. at least two independent randomised controlled trials (RCTs) that indicate that the intervention is useful in treating a particular presenting problem

  2. the active treatment must be better than either a placebo condition or an alternative active reaction

  3. the rct must be competently carried out

Randomised Controlled Trials

• should be registered on a clinical trials register

• full protocol for the trial should be outlined

• recruitment procedures plus inclusion/exclusion criteria specified

• random assignment to conditions (conditions clearly described - active intervention, a placebo or a wait list control)

• assessment before and after the intervention (plus follow-ups)

• enough participants to be able to detect a difference between conditions if such a difference exists – adequately powered

• Gold standard for research.

• Includes pre/post-assessment, randomization, control groups.

• Example: Comparing CBT for anxiety vs. medication.