Clinical Psychology

What is Clinical Psychology?

  • Definition: A branch of psychology focused on understanding, assessing, and treating mental health difficulties.

  • Scope: Works across emotional wellbeing, behaviour, cognition (thinking), and relationships.

  • Application: Applies psychological theory to real-world problems.

  • Key Point: Clinical psychologists do not only diagnose and treat but together with the individual, they seek to understand why difficulties develop and persist and what patterns are maintaining these difficulties.

  • Nadine Burke Harris- TED talk about ACE’s.

Where Do Clinical Psychologists Work?

  • NHS Sectors:
      - CAMHS (Child and Adolescent Mental Health Services)
      - Adult mental health
      - Learning disability services
      - Older adult and inpatient services

  • Hospitals:
      - Addresses the overlap between physical health and mental health, such as in cases of chronic pain, weight management, pediatric care, cancer care, and eating disorders.

  • Schools & Community:
      - Focuses on early intervention, social care, community teams, and primary care.

  • Forensic Settings:
      - Including prisons, courts, and secure units.

  • Residential schools

Compassion focused therapy. Can be sensitive when working with families and building that rapport and trust.

What Makes Clinical Psychology Unique?

  • Strong focus on formulation (creating a comprehensive understanding of how a person's presentation developed) rather than just diagnosis and treatment. How a person has got to a point/ make sense of how they got to a point. Not just a focus on treatment. Looking at all the factors that make and will continue to make you vulnerable and why they are behaving in that particular way. How they are able to function to be able to live in a certain way. Science practitioner model.

  • Utilizes multiple psychological models customized for each individual (eclectic approach).

  • Emphasis on:
      - Individualized understanding
      - Contextual factors including family, culture, environment, and systems.

  • Scientist-Practitioner Model:
      - Integrates research evidence to inform practice.

  • Key Point: Clinical psychology emphasizes understanding "not just what is the problem?" but "how did this develop — and why for this person?"

Key Theoretical Models

  • Cognitive Behavioral Therapy (CBT):
      - Theory positing that thoughts, feelings, and behaviours are interlinked.

  • Psychodynamic Theory:
      - Emphasizes the role of early experiences and unconscious processes.

  • Systemic Theory:
      - Focuses on family and relational patterns. Internal family systems- conceptualize different parts of us. Making sense of human behaviour.

  • Humanistic Theory:
      - Concentrates on meaning, self, and personal growth.

  • Neuropsychological Models:
      - Explores relationships between brain function and behaviour.

Draw up on each of the models together.

Example: The CBT Model

  • Pattern of Interaction:
      - Situation → Thought → Emotion → Behaviour → Physical Response

  • Case:
      - Child struggles with speech → thinks "I sound stupid" → feels anxious → avoids speaking → exhibits tense and withdrawn physical response.

  • Key Point: Communication difficulties can lead to profound impacts on thoughts, emotions, and behaviours, illustrating the overlap between psychology and Speech & Language Therapy (SLT).

Learning disabilities BCT- behaviour is looked at more.

Psychological Theories - A Deeper Look

  • Covering areas such as:
      - Attachment
      - Developmental psychology
      - Social learning
      - Trauma & Adverse Childhood Experiences (ACEs)

Attachment Theory

  • Developed by John Bowlby (1950s–70s) and refined by Mary Ainsworth.

  • The Attachment Bond:
      - Children are biologically predisposed to form close bonds with caregivers; these bonds act as a 'safe base' for exploration and emotional regulation.

  • Internal Working Models:
      - Early attachment experiences create mental templates for relationships, shaping future expectations from others.

  • Separation & Loss:
      - Disruptions to early attachment can have lasting effects on emotional development, mental health, and behaviour.

  • Key Point for SLTs: A child's attachment pattern significantly influences their engagement in therapy and coping mechanisms.

The Four Attachment Styles

  • Based on Ainsworth's research (Strange Situation):
      - Secure:
        - Responsive and consistent caregivers; child explores freely, becomes distressed by separation but is easily comforted upon reunion, resulting in a positive model of self and others.
      - Anxious-Ambivalent:
        - Inconsistent caregiver response; child becomes clingy and highly distressed by separation and is difficult to soothe.
      - Avoidant:
        - Emotionally unavailable caregivers; child appears independent while suppressing emotional needs and may be inwardly distressed.
      - Disorganised:
        - Caregivers who exhibit frightening or frightened behaviours lead to a distraught child who shows no coherent strategy for coping, often linked to trauma and abuse.

  • Key Point: Disorganised attachment is associated with developmental trauma, which may manifest as challenging behaviours in children.

Developmental Psychology

  • Jean Piaget's Stages of Cognitive Development:
      - 0–2 years: Sensorimotor stage (learning through senses and actions).
      - 2–7 years: Pre-operational stage (language and egocentric thinking).
      - 7–11 years: Concrete operational stage (logical thinking about concrete objects).
      - 12+ years: Formal operational stage (abstract and hypothetical reasoning).

  • Lev Vygotsky's Social & Cultural Development:
      - Introduced the concept of the Zone of Proximal Development (ZPD), which refers to the gap between a child's current capabilities and what they can achieve with guidance.
      - Scaffolding involves providing temporary support from a skilled person, which is gradually removed as the child gains competence.
      - Language as a tool for thought emphasizes that inner speech originates from social interactions, and internalized language is critical for cognition.

  • Key Point for SLTs: Vygotsky's ZPD and scaffolding principles can directly inform SLT interventions, by working within a child’s learning zone.

Social Learning Theory — Bandura

  • Observational Learning (OL):
      - Bandura (1977) claimed that individuals learn through observation and modelling, not merely through direct experience.
      - Children learn communication behaviours, including avoidance, by observing the actions of those around them.

  • Reciprocal Determinism (RD):
      - This principle states that behaviour, cognition, and environment are interrelated; modifying one can influence the others.
      - Behaviour is not solely an intrinsic attribute of the child.

  • Self-Efficacy (SE):
      - Refers to an individual's belief in their capability to succeed, which significantly impacts their willingness to engage.
      - Low self-efficacy, especially regarding communication, can lead to avoidance and withdrawal—an important concern for SLT clients.

  • Modelling in Therapy (Mo):
      - Therapists and parents serve as key models for demonstrating effective communication, which can shape the client’s approach.

  • Key Point: Low self-efficacy in communication poses a major barrier to SLT progress; recognizing this is vital for practice.

Trauma & Adverse Childhood Experiences (ACEs)

  • Definition: ACEs encompass a range of stressful or traumatic events in childhood that can lead to profound long-term effects on health, development, and wellbeing.
      - Examples of ACEs include:
        - Physical, emotional, or sexual abuse
        - Neglect (both physical and emotional)
        - Domestic violence
        - Parental separation or divorce
        - Parental mental illness
        - Substance misuse by a parent
        - Parental imprisonment
        - Exposure to community violence or war

  • Trauma-Informed Practice:
      - This approach shifts the focus from "what's wrong with you?" to "what happened to you?"
      - Ensures safety first (Safety First: physical and emotional), promotes trustworthiness, consistency, and empowerment to help restore a sense of control.

A Critical Lens: Western Bias in Psychology

  • The WEIRD Problem (Henrich, Heine, & Norenzayan, 2010):
      - Most psychology research is concentrated on participants who are Western, Educated, Industrialized, Rich, and Democratic (WEIRD), while findings are often mistakenly portrayed as universal.

  • Assumptions:
      - Secure attachment as the optimal standard
      - Individual therapy regarded as the primary approach
      - Verbal, insight-oriented therapies (e.g., CBT) dominate the field
      - Nuclear family is assumed to be the main attachment unit
      - Self-disclosure and direct communication are prioritized therapeutically

  • Omissions:
      - Neglect of collectivist cultures, non-verbal, somatic, and spiritual healing practices.
      - Experiences relating to racism, migration, and intergenerational trauma, along with non-Western psychological frameworks.
      - Ignoring structural inequalities as underlying causes of mental distress.

  • Cultural Humility:
      - Emphasizing the importance of holding theoretical understandings lightly; valuing inquiry into a client's individual framework and maintaining a curiosity about unknowns.

  • Key Point: For SLTs, communication norms such as eye contact, turn-taking, and silences can vary across cultures—most assessment tools are normed on white Western populations.

What is Assessment in Clinical Psychology?

  • Concept:
      - Assessment is comprehensive and aims to construct a nuanced understanding of the individual, not merely generating a score.

  • Methods of Assessment Include:
      - Clinical interviews
      - Observational analysis across varying environments
      - Use of psychometric tools such as questionnaires, cognitive tests, and neuropsychological assessments
      - Input from diverse stakeholders including family members, educational settings, and allied professionals such as SLTs.

  • Key Point: The goal is to craft a comprehensive, contextualized portrait of the individual, transcending mere diagnostic categories or numerical scores.

What is Formulation?

  • Definition: Formulation serves as a psychological explanation for an individual’s difficulties by addressing- not the same as a diagnosis:
      - Why did this problem arise?
      - What keeps/ maintains the issue?
      - What interventions may assist?

  • Components of Formulation:
      - Biological factors
      - Psychological factors
      - Social or environmental dynamics

  • Key Point: Each formulation is tailored; two individuals with the same diagnosis can have fundamentally different formulations.

The 5 Ps Formulation Model

  • Breakdown of Model:
      - Predisposing Factors: What inherent vulnerabilities exist?
      - Precipitating Factors: What was the trigger at this specific moment?
      - Presenting Issues: What is the current issue faced?
      - Perpetuating Factors: What elements sustain the problem?
      - Protective Factors: Where are the individual’s strengths?

  • Key Point: Unlike mere diagnostic labels, the 5 Ps exemplify an individualized approach; identical labels can lead to divergent formulations.

Importance of how they are all linked and work together.

Formulate the client, the parent, settings, staff. Formulate in different settings and seeing how they are behaving.

Why Formulation Matters

  • Shifts emphasis away from labels (like 'anxiety disorder') toward a holistic understanding of the individual.

  • Customizes interventions specifically to cater to the individual’s needs. Individualize the therapy- bring in different models.

  • Promotes self- compassion or to others by viewing behaviour as meaningful rather than merely problematic.

  • Is collaboratively shared with the client and their family, fostering a sense of teamwork versus a purely clinical dynamic.

  • Key Point: Formulation serves as an insightful tool for understanding rather than just a classification system—emphasizing the recognition of the whole person.

Interventions Used by Clinical Psychologists

  • Main Categories of Interventions:
      - Talking Therapies: Including CBT, systemic therapy, psychodynamic work, Dialectical Behavioural Therapy (DBT), and Compassion Focused Therapy (CFT).
      - Behavioural Interventions: Techniques such as graded exposure and positive reinforcement strategies.
      - Parent & Family Work: Training, psychoeducation, systemic sessions designed for supporting families.
      - Team Consultation: Offering support to various systems such as schools, CAMHS teams, and learning disability services.

  • Key Point: Clinical psychologists often engage indirectly through consultation, training, and advisory roles, rather than exclusively focusing on one-on-one therapeutic encounters.

  • Mix of direct and indirect work.

Compassion Focused Therapy (CFT)

  • Development: Introduced by Paul Gilbert in the 2000s, CFT draws from evolutionary psychology, attachment theory, and mindfulness principles.

  • Core Premise: Many mental health issues stem from shame and self-criticism rather than just weakness.

  • Model of conceptualizing your own and others difficulties.

  • Components of CFT:
      - Threat System: Alerts the individual to dangers and provokes anxiety, anger, and disgust. It is an evolved response intended for protection but can dominate when tied to trauma, shame, or chronic stress (Example: "I sound stupid" leading to avoidance).
      - Drive System: Motivates achievement and pursuit of goals; however, can lead to self-criticism if goals are not achieved (Example: "I must speak perfectly").
      - Soothing System: Generates calmness, safety, and contentment; activated through experiences of compassion, connection, and care. CFT aims to enhance this system through training focused on compassion (Example: "I’m doing my best" fostering a sense of safety).

  • Affects daily living and tasks e.g. going to work, making friends due to their sense of threat is sensitive. By cultivating a strong soothing system, individuals can improve their emotional regulation, leading to better interpersonal relationships and overall well-being.

  • CFT Goal: To fortify the Soothing System—particularly when the Threat System predominates due to trauma or shame.

  • Key Point for SLTs: Clients with communication difficulties such as stammering or selective mutism often operate within their Threat System—CFT offers a compassionate and sensitive framework for practice.

Overlap with Speech & Language Therapy

  • Clinical psychologists and SLTs frequently collaborate and share client demographics related to:
      - Autism
      - Learning Disabilities
      - Developmental Trauma
      - Social Communication Difficulties
      - Selective Mutism (overlap in both). Gold standard- joint working. Considered as a psychological disorder but SLTs have the skills in the condition.

How Clinical Psychologists Work with SLTs

  • Joint Work Encompasses:
      - Shared assessments focusing on both communication and emotional needs.
      - Joint formulations that integrate the SLT's communication profile with the psychologist’s formulation of the individual.
      - Support in managing:
        - Emotional impacts stemming from communication difficulties.
        - Behaviours linked with frustration or barriers to communication.
        - Families navigating services and systems concurrently.

  • Key Point: Effective collaboration thrives when both disciplines appreciate each other’s frameworks; this session aims to foster such understanding.

Case Study: Collaboration in Action

  • Scenario: A child presenting with language delay and concurrent behavioural outbursts at school.

  • SLT Role:
      - Evaluate the child’s communication profile.
      - Provide support for expressive and receptive language skills.
      - Advise families and schools with communication strategies.

  • Clinical Psychologist Role:
      - Investigate factors related to frustration and anxiety, focusing on attachment mechanisms.
      - Create a formulation of the behaviours exhibited.
      - Offer suggestions for behavioural strategy implementation within the family and school settings.
      - Assist the child in utilizing alternative strategies and regulating their Threat System.

  • Key Point: Combined insights foster a shared understanding that facilitates targeted and effective interventions for the child and family.

  • CFT- build their self-esteem and what they think of themselves.

Communication Difficulties & Mental Health

  • Key Insight for SLT Students:
    Communication challenges can:
      - Increase anxiety and fear surrounding social interaction.
      - Negatively influence peer, family, and teacher relationships.
      - Result in behavioural problems rooted in frustration.
      - Impact overall self-esteem and identity development.

  • Key Point: As an SLT, your observation of psychological distress is crucial; it is an essential aspect of your role.

Working Systemically

  • Both clinical psychology and SLT recognize that individuals reside within larger systems.

  • Approaches Include:
      - Working with families instead of solely focusing on the individual.
      - Collaborating within multidisciplinary teams (MDTs) across health, education, and social care.
      - Modifying environments to shift from changing the individual to adapting surrounding contexts.

Key Differences Between Clinical Psychologists and SLTs

  • Clinical Psychologists:
      - Concentrate on mental health and conceptual formulation.
      - Employ psychological therapy models in practice.
      - Engage with neurodevelopmental issues, trauma, and mental health challenges.
      - Require Doctoral-level training (DClinPsy).

  • Speech & Language Therapists:
      - Focus on communication difficulties and swallowing challenges.
      - Implement structured communication interventions.
      - Work with individuals across the lifespan—from pediatric to adult populations.
      - Require a Bachelor’s or Master’s degree (BSc/MSc).

  • Key Point: The overlap between the two professions is increasing, especially evident in neurodevelopmental services, CAMHS, and learning disability teams.

Importance for SLT Students

  • Engaging with clinical psychologists enhances your competency as a colleague and advocate for clients.

  • A comprehensive understanding of formulation improves your clinical reasoning and assessment skills.

  • Recognizing behaviour as a form of communication rather than simply viewing it as problematic aligns with both fields’ values.

  • Knowing how and when to refer to psychology is a vital clinical skill.

  • Key Point: You don’t have to be a psychologist, but it’s essential to think alongside psychologists and collaborate by leveraging each other's proficiencies.

Key Takeaways

  1. Clinical psychology involves understanding and elucidating psychological distress beyond mere treatment.

  2. Formulation is a crucial component—individualized, collaborative, and richer than a mere diagnosis.

  3. There exists considerable overlap between SLT and clinical psychology within real-world practice.

  4. Collaborative efforts between both professions enhance outcomes for clients and their families.

Speech difficulties- impact on mental health- for assignment.