Evolving Formulations:sharing complex information with clients

Psychological formulations are central to cognitive behavioural approaches. The use of such formulations presents a number of difficulties when working with clients with psychotic problems. Despite this, sophisticated psychological formulations can be collaboratively developed with psychotic clients. This paper presents one method of developing such formulations through an evolutionary process. Early in the therapeutic process, simple formulations involving straightforward theoretical models are presented, which are systematically elaborated as therapy proceeds. This involves developing, collaboratively with clients, successive layers of formulation. Each of these layers builds on and incorporates the previous one, yet involves an incremental increase in complexity, depth and informational content. The evolutionary process is illustrated with a case example

Interpreting in Palliative Care: A Continuing Education Workshop

Offers a curriculum for a daylong course for interpreters about palliative care, including lesson plans, handouts, presentation slides, and videos

Mental health law and incapacity: The role of the Clinical Psychologist

From an academic clinical psychological perspective, mental health problems are seen as existing on a number of continua with normal functioning, rather than being explicable in terms of categorical diagnoses. Clinical Psychologists use clinical case formulations in their professional practice and are critical of the validity and utility of diagnosis. Psychologists also see mental health problems as stemming from disturbances in psychological processes. In turn, these processes may be disrupted by a variety of causes – biological, social and psychological. Nevertheless, we see disturbance or impairment of such psychological processes as the central issue in mental ill health.Mental health legislation should therefore reflect these perspectives in terms of the criteria for compulsory treatment and in terms of the procedures and practices governing care.To an extent this is welcome in the Government’s current proposals for mental health legislative reform. A basis of compulsion based on criteria rather than diagnosis is proposed, as are care plans rather than diagnosis and treatment. Clinical psychology, however, would go further. Since there seem to be differences between ‘well’ and ‘ill’ in terms only of the degree and nature of the disturbance of psychological process and the impact on functioning, this speaks to the nature of‘unsoundness of mind’. Clinical psychologists contend that it follows that mental health legislation is appropriate and necessary only if people are impaired in their judgement to the extent of being unable to make valid decisions for themselves.It has been proposed that Clinical Psychologists could act as ‘clinical supervisors’ (the term which is to replace ‘responsible medical officers’). If, indeed, mental ill health is the disturbance of complex, inter-related psychological processes, it makes perfect sense to employ psychologists to coordinate care and decision-making. Clinical psychologists are ready to take their place as partners with lawyers and psychiatrists

Psychological Processes Mediate the Impact of Familial Risk, Social Circumstances and Life Events on Mental Health

<p>Results of a structural equation model testing the mediating effects of the psychological processes of response style and self-blame on the contribution of familial mental health history, relationship status, income and education, social inclusion and life events on mental health problems and well-being, with S-B χ² (3,199, N = 27,397) = 126,654·8, p<·001; RCFI = ·97; RMSEA = ·04 (·038–·039). The path diagram shows completely standardised robust parameter estimates which represent the relative contribution of each latent factor to the model. All coefficients are statistically significant, p<·001. Latent factors are represented by ovals. The double headed arrow between mental health problems and well-being represents the correlations between these latent constructs.</p

Imagine there's no diagnosis, it's easy if you try

The recent discussions over the reliability, validity, utility, humanity and epistemology of psychiatric diagnosis have had wider implications than might at first sight be apparent. Diagnosis is, for many people, both the entry-point to services and the starting-point for public debate. Challenges to the scientific and professional basis for diagnosis, therefore, can have profound implications. Such is the dominance of traditional diagnostic thinking about mental health care that it is often wrongly assumed that there is little alternative – or that any possible alternatives would require lengthy and expensive periods of development. In fact, there is no present impediment to the development of new ways of thinking and delivering services, and especially no impediment to practical and scientifically valid alternatives to diagnosis. </jats:p

Knots and black holes: why we’re all prone to madness and what we can do about it

AbstractPeople from all walks of life can suffer from mental health problems such as low mood, anxiety, obsessive-compulsive problems, even hearing voices. In extreme circumstances, people can begin to fear that other people are plotting to harm them, and some of us even take our own lives. While it is overwhelmingly true that traumatic experiences or on-going deprivation or abuse are possible factors that contribute to psychological problems, there remains an apparent capriciousness to mental health problems. Some people seem to rise above trauma; other people are plagued by great misery without obvious external causes. There is a tendency to explain these differences as reflecting personal, even biological, vulnerabilities. This article is published as part of a collection entitled “On balance: lifestyle, mental health and wellbeing”.</jats:p

“But what about real mental illnesses?” Alternatives to the disease model approach to ‘schizophrenia’

The old dichotomy between ‘neurosis’ and ‘psychosis’ appears to be alive and well in the debate about psychiatric diagnosis. It is often suggested that while diagnostic alternatives may be appropriate for the relatively common forms of distress with which we can all identify such as anxiety and depression, psychiatric diagnoses remain vital for experiences such as hearing voices, holding beliefs that others find strange, or appearing out of touch with reality–experiences that are traditionally thought of as symptoms of psychosis. Such experiences are often assumed to be symptoms of underlying brain pathology or ‘real mental illnesses’ that need to be diagnosed or ‘excluded’ (in the medical sense of ruling out particular explanations of problems) before deciding on the appropriate intervention. This paper argues that this belief is misguided, and that far from being essential, psychiatric diagnosis has the potential to be particularly damaging when applied to such experiences. It describes an alternative perspective outlined in a recent consensus report by the British Psychological Society Division of Clinical Psychology (Understanding Psychosis and Schizophrenia [Cooke, 2014]) which has attracted significant attention in the UK and internationally. The report argues that even the most severe distress and the most puzzling behavior can often be understood psychologically, and that psychological approaches to helping can be very effective. It exhorts professionals not to insist that people accept any one particular framework of understanding, for example that their experiences are symptoms of an illness. This paper outlines that report’s main findings, together with their implications for how professionals can best help

Beethoven the Pianist by Tilman Skowroneck

William Kinderman discusses and reviews Skowrowneck\u27s 2010 work. Skowroneck, Tilman. Beethoven the Pianist. Cambridge: Cambridge University Press, 2010. ISBN 978-0-521-11959-7