Clinical and Health Psychology Course - PDF

Clinical and Health Psychology Session 1: Introduction to Course & Clinical Psychology Dr Dom Willmott Adjunct Professor - SWPS Psychology in English [email protected] @DrDomWillmott Dominic Willmott  W...

Clinical and Health Psychology Session 1: Introduction to Course & Clinical Psychology Dr Dom Willmott Adjunct Professor - SWPS Psychology in English [email protected] @DrDomWillmott Dominic Willmott  What we will cover this session Introduction Attendance Assessment (MCQ Exam) Course content Module Overview What is the focus and purpose of this module? Designed to give you an insight into the sub-disciplines of Clinical (& Health) Psychology What Clinical Psychology is What Clinical Psychology Researchers & Practitioners do By drawing on early and contemporary Psychological Theory & Research this module will help you to understand; Some of the Key Priorities of Contemporary Clinical (& Health) Psychology; Reduce suffering and improve patients mental health & wellbeing Conduct/engage with latest research to advance & enhance practice Deliver evidence-based treatment and interventions Community engagement and public health Influence policy and systems change Hughes, Lavender & Latchford (2018) 3 Course Learning Outcomes Be able to critically evaluate psychological research and theory applied to clinical and health issues Scrutinize competing empirical arguments & therapeutic approaches to determine likely best course of treatment available for patients Engage in critical thinking when evaluating theory and research 4  What is Clinical Psychology? What does a Clinical Psychologist Do? 5 What is Clinical Psychology? What we mean by Clinical Psychology differs slightly over time & place Though usually involves assessing and treating mental ill health and managing behaviour They apply psychological principals to therapeutic practice BUT it’s important to know that this can also be done by different types of psychologists… Counsellor Therapist Life Coach Clinical Psychologist Assess, diagnose and treat mental illness and behavioural manifestations 6 Historical Background of CP Ancient Greek, Chinese & Egyptian philosophers refer to link between mental wellbeing and physical health Though ‘modern’ roots of Clinical Psychology as we know it traced back to the late 19th century Early theorists developed psychotherapies including Wilhelm Wundt, Sigmund Freud and Carl Rogers These modern era theorists laid the groundwork for CP’s understanding & treatment of mental illness today They also established different therapeutic traditions for treating mental illness and behavioural difficulties What is Clinical Psychology, today? How are Clinical Psychologists different to other Psychologists or therapists? They can be distinguished by; 1. Education & Training Typically have many years (10+) of academic study and clinical practice experience Also usually have PhD and/or PsyD (US) or DClinPsy (UK) qualification 2. Assessment, Diagnosis & Treatment They often have specific training that means they can conduct clinical assessments and diagnose illness (and appropriate treatments/interventions) Typically use psychotherapy treatments, instead of prescribing medication (Psychiatrist) Triangulation: 1. Clinical Interviews, 2. Psych Assessments, 3. Patients Case History 8 What do Clinical Psychologist’s (CP) Treat? Wide-ranging mental health and behavioural problems across the human life-course Type of Issues CP’s treat… Adjustment issues (e.g. trauma or stress responses) Emotional & Psychological Difficulties (e.g. coping with serious illness, death of child) Interpersonal or Social Dysfunction (e.g. personality disorders, anxiety disorders) Behavioral Difficulties (e.g. substance abuse, impulse control, sexual deviance) Intellectual, Cognitive & Neurological Conditions (e.g. Autism, life after a stroke) APA (2022) 9 Who do Clinical Psychologist’s (CP) Treat? Groups & Individuals CP’s work with Individuals (most common) Couples (e.g. private therapy) Families (e.g. helping them to cope/manage symptomology) How are CP’s expertise consulted? Depends on the region of the world Health Settings (e.g. hospitals, secure units) Private Practice (e.g. private consultancy) Less common > Crisis Response Settings (e.g. war zones, aftermath of terror incidents) 10  What will we cover on this Clinical & Health Psych course… …and in what order? 11 Teaching Timetable Order Course Content / Classes 1. Introduction to Course & Foundations of Clinical Psychology 2. Clinical Assessment & Clinical Diagnosis 3. Health & Disease in Clinical Psychology 4th – 8th November 4. Different Approaches to Treatment 2024 5. The Role of a Clinical Psychologist 6. Types of Psychological and Health Issues 7. Application Workshop Break: Wider Reading & Learning Consolidation until December 8. Foundations of Health Psychology and Disease-Stress Link 17th – 20th December 9. Health Promotion and Disease Prevention 2024 10. Clinical Psychology in Practice: Different Applications End of Module - Assessment 13  Dr Dom Willmott (Please call me Dom!) Associate Professor in Legal Psychology, UK Adjunct Professor of Psychology, SWPS Chartered Psychologist & Associate Fellow of BPS Editor-in-Chief: Journal of Criminal Psychology Education BSc (Hons) Psychology with Criminology (2008 – 2011) MSc Investigative Psychology (2011 – 2012) PhD Legal Psychology (2014 – 2018) Research Psychologist & Legal Psychology Consultant Consult with UK & US Gov. on Rape Trial Decision Making 14 Conduct Research on Varied Legal Psych Topics ▪ Courtroom Psychology: Court decision-making, Lawyer practice & bias; Victim-Survivor Experiences, EWT ▪ Gender-based Violence: Sexual Violence, RMA, CAN; IPV, Male Rape ▪ Research with Prisoners & Offenders: Rioting, Sexual & Serial Homicide, Psychopathy, Criminal Social Identity ▪ Main job = to get you enthusiastic about the psychological methods and stats! ---------------------------------------------------------------------------- ▪ Email: [email protected] ▪ SWPS Profile: https://www.swps.pl/nauka-i-badania/pracownicy-naukowi/17902-willmott-dominic ▪ On campus for 4 weeks per year ▪ 4th – 8th Nov 2024 ▪ 16th – 20th Dec 2024 ▪ 2025 dates 2BC  Module components The module consists of: 30 contact hours in the form of lectures (Lecturer: Dr Dom Willmott) 24 contact hours in the form of workshops (Tutor: Magdalena Witkowicz)  Assessment Information (Exam) How to demonstrate you have met the learning outcomes? – MCQ test (Multiple Choice Question) - written exam where student needs to choose one correct answer from (usually 4) options provided – The MCQ will consist of 30 questions – Likely to be 23rd Jan 2025 (2bc) – PLEASE also engage with in-class exercises Example MCQ Type Questions The Exam… PLEASE DON’T PANIC We Will Come Back To The Exam Later in The Course! 19  How do I get an A? Come to class ☺ – (attendance min. 80%) Ask questions if you’re unsure! Do the readings What if you have questions about the module or assessment? In the first instance (unless it’s confidential), please ask your question in class as other students may have the same question as you or may wish to follow up (we have time built in for discussion) For personal/private issues, ask me at the end of class or directly via email [email protected] Availability I’ll do my best to respond asap via email but be aware I also teach/research full-time in the UK Quickest response = in/after class whilst I’m in Poland ☺ 21 Learning outside of these sessions What should you be doing? You must read widely beyond lecture slides Relevant Key textbooks for this module include > Read journal articles on research topics related to each week's learning A range of Book Chapters, Research Articles, Podcasts & Video Clips are recommended across different sessions 22 Required Reading… Additional Reading & Tasks Try to engage with at least Books & Book Chapter one chapter for each Davey, Laek & Whittington (2021) Clinical Psychology. [3rd Ed] session we Chapter 1 – What does a Clinical Psychologist do? cover Journal Article – Applied Example Sigurdardóttir, T.D., West, A. and Gudjonsson, G.H. (2024), "The current role and contribution of ‘forensic clinical psychologists’ (FCPs) to criminal 2 hours class investigation in the United Kingdom", Journal of Criminal Psychology, Vol. content 14 No. 3, pp. 217-239. = Around 5 hours of independent study 24  FEEDBACK Please share any feedback you have for me about the content & teaching as we go… Good or bad – I like feedback! Let me know if I am talking or going through the content too quickly! Don’t wait until the end of the course when it’s too late to make changes ☺  FEEDBACK Do you prefer… 1. Plenty of breaks during a session… 2. Or to work through the content and finish early?  Thanks for listening! Any Questions? Email: [email protected] Staff Page: https://www.swps.pl/nauka-i-badania/pracownicy- naukowi/17902-willmott-dominic Social Media: @DrDomWillmott  Clinical and Health Psychology Session 3: Health and Disease in Clinical Psychology Dr Dom Willmott Adjunct Professor - SWPS Psychology in English [email protected] @DrDomWillmott Dominic Willmott  What we will cover this session Theories Underpinning MH Theories Underpinning CP Therapy The Role of a Clinical Psychologist – Professional Responsibilities – Ethics & Negligence – Cultural Competence Tech Treatment Advancements  Clinical Psychology A closer look at theory underpinning the therapy…  A History of Mental Health (and Treatment) Jones & Tyson, 2014 Core Theories Underpinning Clinical Practice Core theories underpin treatment approaches in clinical psychology These include; Psychodynamic approachs Behaviourist approachs Cognitive approaches Biological approaches Understanding these concepts is essential for effective practice and research. Each approach offers a different understanding of how best to understand disordered human behaviour And informs treatment strategies tailored to individual needs Core Theories Underpinning Clinical Practice These different theories* offer a unique perspective on how to interpret human behavior and mental processes Psychodynamic theory dives deep into unconscious influences Behavioural theory offers insights through the lens of observable actions and their modification Cognitive theory brings attention to the profound impact of thought patterns on emotional health Biological theory refer to genetics (and thus brain chemistry) to explain ‘abnormal’ behavior These frameworks collectively inform assessment and treatment, leading to deeper insights into the patient experience (Jones & Tyson, 2014) *Not an exhaustive list of theories Psychoanalytic Theory Founded by Sigmund Freud, psychoanalysis explores… How unconscious motivations, early childhood experiences, and developmental stages impact mental health. This theory emphasizes the role of repressed thoughts and unresolved conflicts Unresolved conflicts are addressed through techniques like free association and dream analysis. Psychoanalytic Theory Psychodynamic Therapy - a derivative of psychoanalysis, remains widely used Psychodynamic approach to treating psychological disorders has 3 key priorities; 1. Gain access to repressed thoughts & feelings 2. Resolve conflicts that arose in childhood 3. Assist clients in gaining awareness of their unconscious desires/motivations Techniques include: Free association, Analysis of resistance, Transference Dream analysis Biological Theories Biological theories suggest that; Genetics have an important influence on behaviour Brain anatomy and chemistry linked to ‘abnormal behaviour’ Fast developing area of epigenetics shows how environment can cause genetic changes and mutations to brains / DNA (Intergenerational) trauma evidenced in some males involved in violent acts (casual? contributor?) Biological ‘Interventions’ Biological treatments often include pharmacotherapy (medication) aimed at ‘correcting’ neurotransmitter imbalances & addressing biological abnormalities Additionally, lifestyle interventions such as healthy diets and lifestyles are deemed important in influencing brain and wider mental health Jones & Tyson, 2014 Behavioural Theory Behaviourist theory suggests that; Mental health issues arise from learned behaviours rather than unconscious conflicts or biological factors ‘Abnormal’ behaviours are viewed as maladaptive responses developed through faulty learning processes As such, phobias may develop as a learnt response to a negative experience of some kind Behavioural Therapy Behavioural therapies center around conditioning techniques used to modify maladaptive behaviors through reinforcement and exposure strategies Therapeutic techniques help patients to confront fears gradually, re-conditioning anxiety responses using relaxation techniques to recondition fear responses Common methods of behavioral therapies include; Systematic desensitization and exposure therapy Commonly used to treat phobias, anxiety, and other disorders Based upon idea that gradually exposing clients to stressors in controlled ways can help them to overcome them Cogntive Theory Cognitive approaches prioritise; Identifying and altering dysfunctional thought patterns to improve emotional and behavioral responses Key frameworks used in this way Aaron Beck’s Cognitive Therapy Albert Ellis’s Rational Emotive Behavior Therapy (REBT) Cogntive Therapies Cognitive Behavioral Therapy (CBT) is an application of cognitive theory in MH treatment focused on identifying and restructuring negative thought patterns to alleviate emotional distress CBT techniques include: Cognitive Restructuring: Challenging and changing distorted thoughts. Behavioral Activation: Encouraging engagement in activities that improve mood. CBT’s highly effective for various conditions, including depression and anxiety; People with depression often exhibit biased cognitive processing e.g. focusing excessively on negative information while neglecting positive experiences. This cognitive bias can exacerbate feelings of sadness and hopelessness, creating a cycle that is difficult to break without intervention Assessment Methods Clinical psychologists employ various assessment methods such as interviews, questionnaires, and psychological testing. These methods help clinicians gather essential information to formulate accurate diagnoses and effective treatment plans. Therapeutic Approaches Different therapeutic approaches exist within Clinical Psychology, including Cognitive Behaviour Therapy (CBT), Psychodynamic Therapy, and Humanistic Therapy. Each approach has its unique techniques and philosophies. Role of Clinical Psychologists A clinical psychologist's role extends beyond therapy; they also engage in assessment, research and consultation. Their expertise is essential in various settings, including hospitals, schools, prisons, secure unit’s and private practices. Ethical Considerations Ethics play a crucial role in Clinical Psychology. Practitioners must adhere to principles such as; Confidentiality (where possible) Informed Consent (where possible) Professional integrity All of which are designed to prioritise client welfare and maintain trust Patient Trust - in the treatment Public Trust - in the profession Cultural Competence Cultural competence is vital in clinical psychology Practitioners must understand and respect diverse cultural backgrounds to; Provide effective and sensitive care Address specific needs and beliefs of their clients Be prepared for challenging situations Maintain professional bias-free judgements What situations may you face? Cultural Considerations in Therapy The type of society and culture we live in impacts the beliefs we have about physical and mental illness As such, the support that is available and considered worthwhile/effective is also influence by culture Examples of cultural considerations for practitioners are therefore vast – e.g. Male patients likely to face more stigma and receive less support if off work with their mental health Brest Cancer, AIDS, Depression may cause shame/stigma In some cultures, physical and mental health difficulties may be seen as punishment for bad religious dedication Patients/families may reject a diagnosis or treatment based on shame or belief in supernatural forces Therapists should therefore, consider how these factors may impact a patient's ability to cope after a diagnosis and the available support needed Cultural Competence in Clinical & Health Practice South African Case Study In some deprived/remote areas in in South Africa, Zulu people now live somewhat urban lives As their people grow older they start to struggle with mental and physical health disorders that many elderly people suffer One example includes Dementia where symptoms can manifest as confusion, hallucinations and behaviour that is generally ‘out of character’ This can include leaving their home at night naked and in a confused state, wondering around However, in Zulu culture, some believe that this is evidence of the patient a witch and in many cases the community may attack or kill the person to ‘save the community from the witchcraft’ Cultural Competence in Clinical & Health Practice South African Case Study What could a clinical or health psychologist do here to intervene in a way that helps treat the patient but remains culturally competent? Are there limits to cultural sensitivity that need to be considered? Psychoeducation – Try to educate director carer, other community stakeholders on symptoms, triggers, and early warning signs. Helps patients and families recognize and manage symptoms. Family-Focused Therapy (FFT) - Involve family members in the treatment process. Key Components: Communication training, problem-solving skills, and education on disorder management. Consult & Establish Multi-agency Partnerships – cannot/should not be expected to do it alone Social Services, Police, Health professionals, Legal Professionals if in extreme circumstances patient needed removing for own safety (right to life) Cultural Competence Cultural competence in clinical psychology involves the therapist's ability to understand, respect, and integrate the cultural contexts of clients in the therapeutic process. It requires continuous learning to adapt to various cultural perspectives. Core Components: It involves three main elements: Cultural Awareness Cultural Knowledge Cultural Skill These help clinicians identify and respond effectively to cultural differences, making the therapeutic process more inclusive and effective for diverse populations. Importance of Cultural Competence in Therapy 1. Effective Communication: Cultural competence helps to break down barriers like language differences and stigma, which may hinder communication and client engagement. Techniques such as using interpreters or providing translated materials can improve understanding. 2. Client Engagement: Acknowledging and validating clients' cultural values—such as incorporating rituals or beliefs important to them This serves to enhance therapeutic rapport and trust, leading to more effective outcomes. Importance of Cultural Competence in Therapy 3. Evidence-Based Adaptations: Tailoring evidence-based practices to specific patients For example, adapting CBT to include cultural elements, has shown improved effectiveness for specific populations 4. Cultural Competence Models and Tools Multicultural Competence Model: This model promotes active learning in cultural awareness and skills development, encouraging therapists to reflect on personal biases and build culturally relevant strategies. Cultural Competency Tools: Tools like the Cultural Competence Continuum and Cultural Formulation Interview guide therapists in assessing clients' cultural contexts systematically. This is essential for developing a deeper understanding of each client's unique background.  Professional Negligence and External Scrutiny BUT must appreciate the responsibility of professional opinion & actions Do not offer an opinion outside your area of expertise sounds obvious but can be pressure/leading questions via instructions or when giving oral evidence Do not offer an opinion if there is insufficient evidence on which to base an opinion. Say this is the case or seek additional information. Carry out a full and thorough investigation into the facts Take all reasonable steps to meet the client AND their family, partner, care givers (+ community) Always consider other possibilities/alternatives to the diagnosis you arrive at Do seek second opinion from experienced colleagues where necessary e.g. with similar cases in past Current ‘Tech’ Trends Several Tech trends emerging in CP used as Integration of technology in assessment and treatment Current trends in Clinical Psychology include the integration of technology, such as; Teletherapy Mental health apps These innovations; 1. Enhance accessibility 2. Provide new avenues for treatment and support BUT (THERE IS ALWAYS A BUT…!) DO THEY WORK? Teletherapy (sometimes called telepsychology) Refers to provision of mental health counselling and therapeutic services through digital platforms primarily via; Video conferencing Phone calls Instant messaging (sometimes bots!) Designed to allow clients to engage with licensed psychologists and therapists and from the comfort of their own home And to make mental health care more accessible and convenient Who likes this concept? Would be willing to deliver theraptutric interventions in this way? Mental Health Applications Designed to support individuals in managing their mental well-being through various features Popular due to their accessibility, affordability and growing demand for mental health resources Good apps underpinned by core principals and techniques used in clinical therapy (e.g. CBT) Types of Mental Health Apps Types of Mental Health Apps Self-Management: Allow users to track behaviours and receive feedback, medication reminders, biometric logging (e.g., heart rate), techniques to manage anxiety or stress Cognition Improvement: Targeted at individuals with cognitive challenges, these apps help improve thinking patterns through exercises and educational content Skills Training: Often employ game-like elements to teach coping skills, such as managing anxiety or stress through interactive learning methods Social Support: Designed to facilitate connections between users and peers and/or healthcare professionals, providing a platform for shared experiences and support Symptom Tracking: Users can log their moods and symptoms over time, which aid in identifying patterns and triggers that can be discussed with therapists or healthcare providers Tech Solutions to MH What are the benefits vs risks? Consider the importance of; Clinical judgement Qualification / experience of MH professionals Potential for harm and exploitation Variation in quality/accuracy Technological Developments Benefits Risks ? ? Technological Developments Benefits Risks - Only as good as the data it relies on and may + Accessibility and affordability have zero/little clinician input + For some people may be only support - Massive opportunity for incorrect diagnosis and available – anything better than nothing? thus treatment (encourages self-diagnosis?) + Allows for machine learning and greater - Lack of safeguards for patient safety based on consensus IF driven by reliable data/tech clinical judgement/experience + Has potential to allow CP’s and therapists to - Undermines and put’s at risk the profession of expand the number of patients they see psychology and importance of clinical judgement, experience and training + Necessity in a fast tech developing world - Data is open to exploitation (e.g. community help groups on SM who target vulnerable) Week 1 Content Recap… Challenges in the Field Clinical psychologists face various challenges, including; Stigma following diagnosis Funding avaliability Accessibility to care Demand for evidence-based practices Threat of tech (whilst also an opportunity) is one of these new challenges that Psychology must consider Addressing these challenges is crucial for advancing the field and improving patient outcomes.  Psychological Disorders: A Multifactorial Perspective Understanding the Complexity of Clinical Practice Biological Factors Psychological Factors Social Determinants of Health Genetic predispositions and Cognitive patterns, emotional states, The conditions in which individuals are physiological conditions play a critical and personality traits can influence born, grow, work, and live role in disease manifestation, both the onset and progression of fundamentally shape health outcomes interacting with environmental diseases, highlighting the mind-body and access to care, reflecting systemic influences to affect overall health. connection. equity issues.  Psychopathology: Understanding Mental Disorders Definition of Psychopathology Psychopathology refers to the study of mental disorders, their symptoms, etiology, and effects on individuals and society as a whole. Classification Diagnostic classifications such as DSM-5 and ICD-10 provide frameworks for understanding, diagnosing, and treating various mental health conditions. Prevalent Disorders in Clinical Psychology Commonly encountered disorders include anxiety disorders, mood disorders, personality disorders, and psychotic disorders, each requiring specific interventions. The Role of Diagnosis in Clinical Psychology Diagnostic Criteria Establishing clear diagnostic criteria enables clinicians to accurately identify and classify mental health conditions, which is critical for formulating treatment plans. DSM-5 Framework The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides a comprehensive standard for diagnosing mental disorders based on extensive research. ICD-10 Framework The International Classification of Diseases (ICD- 10) complements DSM-5 by offering a broader perspective; it is essential for international health statistics and policy-making.  Health Promotion in Clinical Settings Importance of Preventive Care Preventive care plays a critical role in mental health, reducing the onset of disorders through early intervention and education. Interventions Clinical interventions can include cognitive behavioural therapies, lifestyle modification programs, and stress management techniques aimed at improving health outcomes. Therapeutic Strategies Integrative therapeutic strategies that engage patients in their care lead to improved adherence to treatment and better overall health outcomes. Challenges in Clinical Psychological Practice Cultural Differences Cultural perspectives on health and disease can influence interpretations, access to care, and stigmatization of mental illnesses. Individual Variability Each individual’s unique background and experiences shape their understanding and experience of health, which challenges standardized definitions. Stigma Associated with Mental Illness Stigmatization continues to be a significant barrier, impacting individuals’ willingness to seek help and affecting their mental health journey. Future Directions The future of clinical psychology lies in further exploring the interconnection between health and disease. Emerging Trends Advancements in understanding health psychology reveal new approaches to treatment, such as resilience training and positive psychology practices. Integration of Technology Digital health technologies, such as telepsychology and mental health apps, are transforming access to care and patient engagement. Holistic Approaches to Treatment Future frameworks in mental health will increasingly emphasize holistic approaches, encompassing mental, physical, and social well-being. Additional Reading & Tasks Books & Book Chapter Davey, Laek & Whittington (2021) Clinical Psychology. [3rd Ed] Chapter 15 – Working with People with Physical Health Problems Journal Article – Applied Example Gallego-Alberto, L., Losada, A., Cabrera, I., Romero-Moreno, R., Pérez-Miguel, A., Pedroso-Chaparro, M. D. S., & Márquez-González, M. (2022). “I feel guilty”. Exploring guilt-related dynamics in family caregivers of people with dementia. Clinical Gerontologist, 45(5), 1294-1303. 70  Thanks for listening! Any Questions? Email: [email protected] Staff Page: https://www.swps.pl/nauka-i-badania/pracownicy- naukowi/17902-willmott-dominic Social Media: @DrDomWillmott  Clinical and Health Psychology Session 3: Clinical Assessment & Diagnosis Dr Dom Willmott Adjunct Professor - SWPS Psychology in English [email protected] @DrDomWillmott Dominic Willmott  What we will cover this session Clinical Assessment & Clinical Diagnosis – Differences between Assess & Diagnosis Types of Psychological Disorders (DSM 5 TR) - Mood Disorders - Anxiety Disorders - Psychotic Disorders - Personality Disorders - Sexual Disorders Symptomology & Treatments Between Clinical Assessment from Clinical Diagnosis Assessment & Diagnosis in Clinical Psychology (CP) Understanding the Foundations of Practice CP applies scientific knowledge to assess, diagnose psychological disorders Importance of Assessment and Diagnosis: 1. Accurate assessment and diagnosis are pivotal in clinical psychology as they guide treatment decisions 2. inform therapeutic approaches 3. Ensure that clients receive appropriate interventions tailored to their needs Understanding Clinical Assessment Definition of Clinical Assessment Clinical assessment encompasses a structured process of collecting, analyzing, and interpreting data regarding an individual's psychological state and generał functioning, resulting in comprehensive understanding of their mental health (needs). Purpose in Psychological Evaluation The primary aim of clinical assessment is to gather an in-depth profile of the individual, facilitating informed decision-making about the appropriate interventions and supports needed for effective treatment. Methods and Tools Used A variety of tools are employed in clinical assessments, including standardized psychological tests, unstructured or structured interviews, and observational techniques that help elicit a nuanced understanding of the client's experiences. Types of Clinical Assessments Psychological Tests Standardized psychological tests measure specific psychological constructs, such as intelligence, personality traits, or symptom severity, providing quantifiable data that can assist in diagnosis and treatment planning. Behavioral Observations Observing individuals in various contexts can reveal important behavioral patterns that contribute to understanding their psychological functioning, especially in cases where self-report may be limited. Interviews Clinical interviews, whether structured or unstructured, serve to explore an individual's history, symptoms, and experiences in a conversational manner, allowing for qualitative insight into their mental health. Self-Report Measures Self-report questionnaires empower clients to articulate their feelings and experiences, offering valuable insights that complement clinical assessments and enrich case conceptualization. Understanding Clinical Diagnosis Definition of Clinical Diagnosis Clinical diagnosis is the process through which mental health professionals identify and classify mental disorders based on observed symptoms, history, and standardized criteria. Relationship with Mental Disorders Diagnosis serves to categorize psychological conditions, guiding treatment approaches that are tailored to specific mental health challenges faced by individuals. Criteria for Diagnosis Diagnostic criteria are guidelines specified by standardized systems, such as DSM-5, which frame the clinical judgment and support the identification of mental disorders.  Diagnostic Criteria and Classification Systems Understanding the Frameworks for Diagnosis DSM-5 and ICD-10 Understanding Diagnostic Limitations of Classification The DSM-5 (Diagnostic and Categories While classification systems provide Statistical Manual of Mental These classification systems utility, they are not without Disorders, Fifth Edition) and ICD-10 delineate categories of mental limitations, including promoting (International Classification of disorders, facilitating a structured rigid categorizations that may Diseases) are authoritative approach to diagnosis and driving overlook individual variability frameworks providing standardized research and treatment modalities and the nuances of human diagnostic criteria for mental health within clinical psychology. experience. disorders globally.  Assessment Vs Diagnosis: Key Differences Focus: Assessment emphasizes understanding the individual's psychological makeup contextually, while diagnosis aims to classify and label specific mental disorders based on standardized criteria. Purpose: The goal of assessment is to enhance therapeutic strategies through detailed insight, whereas diagnosis functions to assign a mental health label for treatment planning. Implications for Treatment: Effective assessment allows for personalized treatment plans, whereas diagnosis requires alignment of treatment strategies with the identified disorder. What CP’s use to guide decisions? The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a comprehensive classification system for mental health disorders, published by the American Psychiatric Association (APA). Most recent edition is DSM-5 (2013) with a text revision now in operation DSM-5-TR (2022) The DSM (and ICD) is used by CP’s to help diagnose mental health disorders, providing them with a standardised framework that supports clinical practice. Its ongoing revisions reflect the dynamic nature of mental health science and practice. What CP’s use to guide decisions? Allows CP’s to make informed and consistent diagnoses based on observable symptoms and behaviours. This standardization aids in ensuring that different clinicians can arrive at similar diagnoses for the same set of symptoms, enhancing reliability in clinical practice Clinical Formulation: Psychologists use the DSM/ICD to develop clinical formulations that guide treatment planning. By understanding specific disorder classifications, CP’s can tailor interventions to meet the unique needs of their clients Assessment & Diagnosis Do CP’s have a responsibility to be statistically competent & aware of debates/evidence regarding psychometric properties of scales used? Think about the implications that scores leading to a diagnosis can have on a patients life? Moral Responsibility? Legal Responsibility? Professional Responsibility?  What is a Mental Disorder? - Term ‘Mental Disorder’ used interchangeably with ‘Mental Illness’ - WHO (2017) ‘Generally characterized by some combination of abnormal thoughts, emotions, behaviour and relationships with others… Many disorders can be successfully treated’ (with medication and/or psychotherapies)  Anxiety Sexual Affective Disorders Disorders Personality Disorders Schizophrenia Disorders Delusional Autistic Disorders Disorders Spectrum caused by Conditions Delirium Learning Substance Misuse Disability Dementia Behavioural Eating and Emotional Disorders Disorders in Phobias OCD / PTSD children and adolescents Mood Disorders Mood Disorders Overview of Mood Disorders Mood disorders are mental health conditions characterised by extreme changes in mood that impact daily functioning. Mood disorders affect millions worldwide and can have a significant impact on quality of life. Examples of such disorders include: Major Depressive Disorder (MDD) Bipolar Disorder (Types I and II) Key Symptoms of Major Depressive Disorder (MDD) Core Symptoms (lasting at least 2 weeks): Depressed mood, almost every day Loss of interest or pleasure in most activities Additional Symptoms (at least 5 in total): Significant weight change or appetite disturbance Insomnia or hypersomnia Fatigue or low energy Feelings of worthlessness or excessive guilt Difficulty concentrating Recurrent thoughts of death or suicide Key Symptoms of Bipolar Disorder Manic Episode (for Bipolar Type I Disorder): Elevated or irritable mood lasting at least 1 week Symptoms (at least 3): Increased self-esteem, decreased need for sleep, talkativeness, racing thoughts, distractibility, increased goal-directed activity, impulsive behaviour. Hypomanic Episode (for Bipolar Type II Disorder): Similar to mania, but less intense and lasting at least 4 days Depressive Episodes: Symptoms similar to MDD during depressive phases. Treatments Cognitive-behavioural therapy (CBT) Identify and change negative thought patterns. For Depression: Address negative self-beliefs and encourage behavioural activation. For Bipolar Disorder: Useful for depressive symptoms and managing mood stability. Interpersonal Therapy (IPT) Improve relationships and social functioning. For Depression: Address grief, role transitions, and social conflicts. For Bipolar Disorder: Sometimes used to manage relationship challenges and improve social support. Anxiety Disorders Introduction to Anxiety Disorders Definition: Anxiety disorders are mental health conditions characterised by excessive fear, worry, or related behaviours Examples of Anxiety Disorders: Obsessive-Compulsive Disorder (OCD) Post-Traumatic Stress Disorder (PTSD) Prevalence: Anxiety disorders are among the most common mental health issues, affecting millions globally. Key Symptoms of Obsessive-Compulsive Disorder (OCD) Core Features: Obsessions: Persistent, unwanted thoughts, urges, or images that cause distress Compulsions: Repetitive behaviors or mental acts driven by an urge to reduce anxiety or prevent feared outcomes. Diagnostic Criteria (DSM-5): Obsessions and/or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause significant distress or impairment. Symptoms are not due to substance use, another medical condition, or another mental disorder. Key Symptoms of Post-Traumatic Stress Disorder (PTSD) Core Features: Occurs following exposure to actual or threatened death, serious injury, or sexual violence etc. Diagnostic Criteria (DSM-5): Intrusive Symptoms: Recurrent, distressing memories, flashbacks, or nightmares. Avoidance: Efforts to avoid distressing memories, thoughts, feelings, or reminders of the trauma. Negative Changes in Mood and Cognition: Memory gaps about the trauma, negative beliefs, or a persistent negative emotional state. Arousal and Reactivity: Irritability, hypervigilance, exaggerated startle response, Symptoms must persist for more than one month and cause significant distress or impairment. Who might suffer with PTSD? Service Personnel: Primary & Secondary (Vicarious) Trauma Treatment Overview for Anxiety Disorders Cognitive-behavioural therapy (CBT) Focus: Change unhelpful thoughts and behaviours. Exposure and Response Prevention (ERP) Method: Expose patients to obsessional triggers while preventing the compulsion. Goal: Reduce reliance on compulsions and decrease anxiety related to obsessions. Outcome: Over time, patients learn to tolerate anxiety and experience a reduction In OCD symptoms. Collaborative Care and Medication Management Role of Clinical Psychologists: Provide therapeutic support and work with psychiatrists for medication when necessary. Medication for OCD and PTSD: Selective Serotonin Reuptake Inhibitors (SSRIs) are commonly prescribed. Psychologists help support treatment adherence and address any side effects. Crisis Management and Relapse Prevention Crisis Planning: Identify triggers and warning signs of relapse. Create an action plan for high-stress periods. Relapse Prevention: Develop coping skills and regular check-ins to maintain treatment gains. Treatment Overview for Anxiety Disorders Eye Movement Desensitization and Reprocessing (EMDR) Focus: Process traumatic memories through guided eye movements. Method: Patients recall distressing experiences while following guided eye movements, helping to integrate and reduce the emotional I ntensity of memories. Effectiveness: Shown to be effective in reducing PTSD symptoms.  EMDR Efficacy in Forensic- Clinical Settings?  Schizophrenic and Psychotic Disorders v Introduction to Psychotic Disorders Psychotic disorders are mental health conditions involving distorted thinking, perceptions, and loss of touch with reality Examples of Psychotic Disorders Schizophrenia Schizoaffective Disorder Brief Psychotic Disorder Delusional Disorder Key Symptoms of Psychotic Disorders (DSM-5) Core Symptoms: Delusions: Fixed, false beliefs resistant to logic (e.g., paranoia, grandiosity). Hallucinations: Sensory experiences without external stimuli (commonly auditory). Disorganized Thinking: Speech may be incoherent, tangential, or illogical. Grossly Disorganized or Abnormal Motor Behavior: Ranges from agitation to catatonia. Negative Symptoms: Reduced emotional expression, lack of motivation, social withdrawal. DSM-5 Criteria for Schizophrenia 2+ of the following, present for a sig portion of time (more than one-month) with at least one being delusions, hallucinations, or disorganized speech: Delusions Hallucinations Disorganized Speech Grossly Disorganized or Catatonic Behavior Negative Symptoms Duration: Continuous signs for at least 6 months. Impairment: Sig functional impairment in work, relationships, or self-care. Diagnosing Schizophrenia Clinical Interviews: Assess symptom history, duration, and impact on daily functioning. Mental Status Exam: Evaluate thought processes, perceptions, and behavior. Rule Out Other Conditions: Differentiate from mood disorders, substance use, or medical conditions. Functional Assessment: Examine daily functioning, personal history, and social relationships. Treatment Overview Cognitive-Behavioral Therapy (CBT) - Identify and challenge delusional beliefs and maladaptive thoughts. Family Therapy - Involves family in treatment to improve communication and support. Psychoeducation - Educates patients and families about psychotic disorders. Social Skills Training (SST) - Improve interpersonal skills and social functioning. Collaborative Care and Medication Management Role of Clinical Psychologists: Provide psychotherapy and coordinate care with psychiatrists. Medications: Antipsychotics: First-line treatment for psychotic symptoms. Psychologists assist in monitoring symptoms and promoting adherence to medication plans. Outcome: Combined therapy and medication can improve symptom control and functional outcomes. Relapse Prevention and Crisis Management Recognize early warning signs and triggers. Establish coping strategies and crisis intervention plans. Develop a support network and emergency contacts. Promote consistent follow-up and check-ins to monitor well-being. Personality Disorders Introduction to Personality Disorders Personality disorders involve enduring patterns of behavior, cognition, and inner experience that deviate from cultural expectations. Clusters of Personality Disorders: Cluster A: Odd or eccentric (e.g., Paranoid, Schizoid) Cluster B: Dramatic or erratic (e.g., Borderline, Narcissistic) Cluster C: Anxious or fearful (e.g., Avoidant, Dependent) Key Symptoms of Narcissistic Personality Disorder (NPD) Core Features: Grandiosity, need for admiration, and lack of empathy. Specific Symptoms (at least 5): Exaggerated sense of self-importance Preoccupation with fantasies of success, power, or beauty Belief in being "special" and unique Need for excessive admiration Sense of entitlement Interpersonal exploitation Lack of empathy Envy of others or belief that others are envious of them Arrogant or haughty behaviors Key Symptoms of Borderline Personality Disorder (BPD) Core Features: Instability in relationships, self-image, and emotions; impulsivity. Specific Symptoms (at least 5): Fear of abandonment Unstable and intense relationships Distorted self-image or sense of identity Impulsivity in areas like spending, sex, or substance use Recurrent suicidal behavior or self-harm Emotional instability or rapid mood swings Chronic feelings of emptiness Intense or inappropriate anger Stress-related paranoia or dissociation Diagnostic Approach for Personality Disorders Methods Used by Clinical Psychologists: Clinical Interviews: Assess long-term patterns of thoughts, feelings, and behaviors. Self-Report Questionnaires: Tools like the Personality Assessment Inventory (PAI) or Millon Clinical Multiaxial Inventory (MCMI). Observation of Behavior: Evaluate interpersonal interactions and emotional regulation. Functional Impairment: Determine impact on work, relationships, and daily life. Treating Narcissistic Personality Disorder (NPD) Primary Approaches: Psychodynamic Therapy: Focus on underlying self-esteem issues and interpersonal functioning. Cognitive-Behavioral Therapy (CBT): Identify and modify dysfunctional beliefs about self-importance and entitlement. Goals: Increase empathy and improve interpersonal skills. Challenge grandiosity and unrealistic self-perceptions. Develop a healthier sense of self-worth. Treating Borderline Personality Disorder (BPD) Primary Approach: Dialectical Behavior Therapy (DBT) Focus: Enhance emotional regulation, interpersonal effectiveness, and distress tolerance. Core Components: Mindfulness to improve awareness of thoughts and emotions. Emotion Regulation to reduce mood swings. Interpersonal Effectiveness to manage relationships. Distress Tolerance to cope with crisis situations. Cognitive-Behavioral Therapy (CBT) for PD’s Focus: Restructure maladaptive thoughts and challenge dysfunctional beliefs. CBT Techniques: Identify and modify thought patterns driving behavior. Behavioral strategies for impulse control. Improve problem-solving and interpersonal skills. Psychodynamic Therapy for PD’s Goal: Explore and resolve unconscious conflicts that influence behavior. Key Method: Focus on Early Relationships: Helps patients understand how past experiences shape current thoughts and behaviors. Outcome: Increased self-awareness and improved relational functioning. Schema Therapy for Personality Disorders Goal: Identify and modify deep-seated schemas (core beliefs) that contribute to dysfunctional behavior. Methods: Cognitive Techniques: Identify and challenge negative core beliefs. Experiential Techniques: Role-playing to re-experience and reprocess traumatic events. Outcome: Schema therapy is particularly effective for long-standing patterns seen in personality disorders (BUT not always applied in crisis)  Sexual Disorders Introduction to Sexual Disorders Sexual disorders include a range of conditions involving abnormal sexual desires, behaviors, or thoughts that cause distress or harm. Categories of Sexual Disorders: Paraphilic Disorders: Involving sexual interests that deviate from normative interests and can cause harm or distress (e.g., pedophilic disorder). Sexual Dysfunction: Issues related to the sexual response cycle, causing distress (e.g., erectile disorder). Key Symptoms of Pedophilic Disorder Core Features: Recurrent, intense sexual fantasies, urges, or behaviors involving prepubescent children (generally age 13 or younger). Duration: Symptoms persist for at least 6 months. Distress or Acting Out: Causes distress or impairment in functioning, or the person has acted on these urges. Age Requirements: The individual must be at least 16 years old and at least 5 years older than the child involved. Impact: This disorder can lead to legal issues, social stigma, and severe personal distress. Assessment & Diagnosis Should people with paedophilic disorders receive the same level of care/treatment as other client groups? Should CP’s be allowed to opt out of working with these client groups exclusively? Moral Responsibility to treat? Legal Responsibility to treat? Professional Responsibility to treat? Treatment Overview for Sexual Disorders Goal: Manage symptoms, reduce risk, improve personal control, and enhance social functioning (in theory…) Challenges in Treatment: Stigma and Shame: Individuals may feel isolated, which can hinder seeking treatment. Risk Management: Some disorders involve urges that pose a risk to others, requiring specialized therapeutic oversight. Cognitive-Behavioral Therapy (CBT) for SD’s Address cognitive distortions, beliefs, and behaviors contributing to deviant sexual thoughts. CBT Techniques: Cognitive Restructuring: Challenge and replace distorted beliefs (e.g., minimizing harm). Impulse Control Techniques: Build skills to manage urges and avoid risky situations. Relapse Prevention: Develop coping strategies for high-risk situations. Outcome: Can help individuals gain greater control over thoughts and behaviors. Psychodynamic Therapy for SD’s (Freud would be happy!) Explore underlying emotional conflicts that may contribute to paraphilic interests. Techniques: Insight-Oriented Therapy: ‘Address’ early life experiences and unconscious conflicts (easy as it sounds?) Attachment-Focused Interventions: Work through issues related to attachment and intimacy. Outcome: Greater self-awareness and insight into how past experiences influence current behaviors. Pharmacotherapy Types of Medication: SSRIs (Selective Serotonin Reuptake Inhibitors): Often used to reduce sexual urges and manage symptoms of OCD. Anti-Androgens: Medications to lower testosterone levels and decrease sexual drive (e.g., medroxyprogesterone acetate). Role of Clinical Psychologists: Work collaboratively with psychiatrists to (CLOSELY) monitor medication effects and support therapeutic goals. Group Therapy – Circles of Accountability Provide support and accountability in a controlled, supervised setting. Benefits: Peer support helps reduce isolation and shame. Group discussions can encourage honest dialogue and coping skills. Facilitates responsibility through shared experiences and perspectives. Considerations: Requires careful group composition and strong facilitation to ensure safety (risk’s of creating such a group?)  Efficacy? Ruth Mann et al (2017) Victim Empathy < Effective Interventions The good news is that SO Risk Assessment tools found to accurately predict risk of recivisism Psychotherapy Specific to Pedophilic Disorder Multi-Component Approach: CBT and Relapse Prevention: Identify triggers, build coping mechanisms, and challenge distorted thinking. Motivational Interviewing (MI): Enhance motivation for change by addressing ambivalence and resistance (very popular) Self-Regulation Training: Focus on building self-discipline to manage urges and impulses effectively. The Role of Psychoeducation for Pedophilic Disorders Education: Provide patients and families with knowledge about the disorder, treatment options, and triggers. Community Resources: Guide individuals to support services, advocacy groups, and specialized treatment centers. Empowerment: Educate individuals on managing symptoms and reducing stigma through understanding. Risks? Role of Clinical Assessment in Diagnosis Connecting Assessment to Diagnostic Outcomes How Assessment Informs Diagnosis: Clinical assessments yield critical data that feed into the diagnostic process, allowing clinicians to synthesize extensive information and draw informed conclusions about a client's mental health. Integration of Findings: The integration of findings from diverse assessment methods creates a comprehensive picture that aids in precise diagnosis, enhancing understanding of the client's condition and needs. Case Conceptualization: Assessment guides diagnostic considerations and treatment planning by offering clarity and understanding of the client's context. The Role of Clinical Judgment Clinical judgment plays a pivotal role in both assessment and diagnosis. Clinicians must integrate their with the collected data to make informed decisions. Thi s ski ll is essential for accurate identification and effective intervention. Think about Cultural Competence! Integration of Assessment and Diagnosis The integration of clinical assessment and diagnosis is crucial for effective treatment. A thorough assessment informs the diagnostic process, leading to more accurate and personalized that address the patient's specific needs.  Ethical Considerations in Assessment and Diagnosis Navigating the Ethical Landscape Accuracy of Assessment Techniques Ethical practice demands rigor in utilizing valid and reliable assessment instruments to avoid misdiagnosis, which could lead to unnecessary or harmful interventions. Diagnosis Stigma Addressing the stigma associated with diagnosis is crucial; clinicians must be sensitive to the implications a label may carry and work to mitigate its effects on client self-perception. Challenges in Assessment and Diagnosis Variability in Symptom Presentation: The manifestation of psychological symptoms can vary widely; thus, clinicians must remain vigilant to avoid misdiagnosis based on atypical presentations of common disorders. Diagnostic Overshadowing: Diagnostic overshadowing occurs when a clinician attributes all symptoms to existing diagnoses rather than recognizing co-occurring conditions, complicating treatment. Future Considerations & Dilemmas? Emerging Technologies: Technological advancements pave the way for novel assessment tools that enhance diagnostic accuracy and therapeutic intervention, assisting practitioners in delivering data-driven care. Integration of AI: Artificial Intelligence is becoming an integral part of assessment and diagnosis, providing sophisticated analysis of patterns and trends that augment clinical decision- making. Personalized Assessment Tools: The evolution of personalized assessment tools allows for tailored evaluations that align with individual needs, enhancing both diagnostic accuracy and treatment tailoredness. Additional Reading & Tasks Books & Book Chapter Davey, Laek & Whittington (2021) Clinical Psychology. [3rd Ed] Chapter 2 – The Art and Science of Psychological Practice Journal Article – Applied Example Mihura, J. L., Roy, M., & Graceffo, R. A. (2017). Psychological assessment training in clinical psychology doctoral programs. Journal of Personality assessment, 99(2), 153-164. 142  Conclusion Summary of Key Differences Importance of Integrating Recommendations for Clinical Assessment and Diagnosis Practice Clinicians must recognize that clinical assessment focuses on holistic Integrating comprehensive It is vital for practitioners to utilize a understanding whereas diagnosis assessment data with diagnostic balanced approach that leverages centers on classification and criteria can significantly enhance both assessment and diagnosis to treatment assignment. client outcomes and therapeutic inform and enrich treatment strategies. methodologies.  Thanks for listening! Any Questions? Email: [email protected] Staff Page: https://www.swps.pl/nauka-i-badania/pracownicy- naukowi/17902-willmott-dominic Social Media: @DrDomWillmott  Application Workshop: Reviewing and applying what we have covered so far… In small groups (approx. 4-5) pick one of the case examples on the next slide (or select case you know well) 1. Review available case info and details 2. Review/apply theory attempting to explain the offending 3. Conduct clinical assessment on the details 4. Attempt to diagnose psychological disorder causing offending 5. Identify and plan (feasible!) tailored clinical treatment/intervention 145 Lucy Letby 146  Lucy Letby: Lucy Letby, a former neonatal nurse, was convicted of committing heinous crimes against vulnerable infants under her care at Chester Hospital in England. Her offenses include the murder of 7 babies and the attempted murder of 6 others between 2015 and 2016. This case has is one of the most shocking instances of child killing in UK history. Victim Selection: Letby murdered 5 boys and 2 girls, with victims being particularly vulnerable premature infants. Criminal Acts: Her MO = administering excess milk, air, insulin, or fluids into the infants. The prosecution described Letby as a "malevolent presence" in the neonatal unit. Handwritten notes found in her home included confessions of feeling like a "horrible evil person" and contradictory statements claiming her innocence. Colleagues testified to observing unusual behavior from Letby during critical moments leading up to the deaths of several infants. For instance, she spent excessive time with certain babies not assigned to her care that ultimately died. 147 Andrei Chikatilo 148  Andrei Chikatilo: Andrei Chikatilo, infamously known as the "Rostov Ripper," was a Soviet serial killer responsible for the brutal murders of at least 53 individuals, primarily women and children, between 1978 and 1990. His crimes took place across various regions, including the Russia and Ukraine. Victim Selection: Chikatilo typically targeted young victims, luring them to secluded areas such as forests or abandoned buildings. Many of his victims were approached at train or bus stations. Criminal Acts: His offenses included sexual assault, murder, and mutilation. Chikatilo would often rape his victims before killing them, using knives and other weapons. He derived sexual gratification from the act of killing, often achieving orgasm during the murders. Dismemberment and Cannibalism: Chikatilo dismembered some of his victims and even engaged in cannibalistic acts, keeping body parts as trophies 149  Relevant Sources Previous Session Slides DSM-5-IV - google is your friend! Lots of media reports on these cases Journal articles below relevant to each case… Willmott, D., Boduszek, D., & Robinson, R. (2018). A psychodynamic-behaviourist investigation of Russian sexual serial killer Andrei Chikatilo. The Journal of Forensic Psychiatry & Psychology, 29(3), 498-507. Ryan, S., Willmott, D., Sherretts, N., & Kielkiewicz, K. (2017). A psycho-legal analysis and criminal trajectory of female child serial killer Beverley Allitt. European Journal of Current Legal Issues, 23(2). 150  Remember to recap and apply hat we have covered so far… 1. Search, review and summarise available case info and details 2. Review/apply theory attempting to explain the offending 3. Conduct clinical assessment based on the available details 4. Attempt to diagnose psychological disorder causing offending 5. Identify and plan (feasible!) tailored clinical treatment/intervention You will present this back to the class either once complete ☺ 151 Offender Assessment and Treatment Forensic Risk Assessment: Dr Dom Willmott Session Overview Risk Assessment Static vs Dynamic Risk vs Protective factors Types of RA Offender Treatment & Intervention What works? Strength Based Models of Rehab - GML - RNR Learning Outcomes Understand how an offender’s risk of reoffending is assessed and the ’science’ of risk assessment Understand the relationship between risk/protective factors and likely future offending Understanding the psychological processes (& treatments) that underpin offender rehabilitation Key Reading for todays session… Crighton & Towl (2021) Forensic Psych Chapter 8 – Risk Assessment Wider Reading linked to todays session…  If only we had a crystal ball to predict the future! As we don’t, how can we assess (estimate) likely risk… What is Violent Offending? What are the psychological underpinnings? Before establishing future risk of violent offending, first we must operationally define Play first 7 mins Approaches to risk assessment Clinical Vs Actuarial RA Represent two distinct approaches to evaluating risks and making predictions in forensic settings. Actuarial Risk Assessment: This method relies on statistical models that use historical data to predict future outcomes. It involves quantifying risk through established tools, which are based on empirical relationships between various risk factors and the likelihood of specific events, such as recidivism or violent behavior. The actuarial approach minimizes human bias by relying on data- driven insights. Clinical Vs Actuarial RA Clinical Assessment: In contrast, clinical judgment involves subjective decision-making where professionals assess individuals based on their training, experience, and intuition. This method often incorporates qualitative factors that may not be easily quantifiable, such as personal interviews or observations of behavior during assessments. ALL Risk Assessment is a Skill Set… Psychological assessment is a skill. It involves: Selection of the right tools and tests for the presenting problem Administration and scoring of tests. Interpretation of test scores in the context of other relevant information Identifying practical recommendations for risk management and rehabilitation 163 Assessment Methods Questionnaires (clinician and self report) Practical tests (of aptitude, ability, attitude, risk) Observation (for objective evidence) Interview (to gain the client’s perspective) Liaison with family members/professionals Informant information (other perspective) File search (historical and clinical info) 164 Multiple Sources of Information Test scores should not be used in isolation - a single score is rarely informative Score patterns across a range of measures and tests are more useful than single sources Test scores are used to complement rather than replace other sources of information; the interview and file search are essential 165  Static and dynamic Risk Factors Offender characteristics that are Characteristics of an offender that are predictive of re-offending but cannot predictive of re-offending and can be be changed are considered static changed are considered dynamic  Static and dynamic risk factors Offender characteristics that are Characteristics of an offender that are predictive of re-offending but cannot be predictive of re-offending and can be changed changed are considered static are considered dynamic These include: These include: Adult criminal history (prior offending record) Deviant companions Pre-adult history of ASB / deviance Interpersonal conflict (& tendencies) Family criminality, Family ties / relationshsips Criminogenic ’needs’ (social-cog factors) Poor family rearing practices (neglect) Antisocial cognitions, Low socio-economic status Values and behaviours, Demo factors e.g. Age, Gender, Personal distress and anxiety Low intellectual functioning Low social achievement, Psychological Disorders Substance abuse Symptomology of Psychological Disorders Personality Disorders as Risk Factors Category of mental disorders characterized by maladaptive patterns of behaviour, cognition, and emotions. Consistent across different contexts Deviation from social norms. Roughly 1 in 10 Cluster A Cluster B Cluster C Paranoid, Schizoid, Narcissistic, Avoidant, Dependant Schizotypal Antisocial, Borderline O-C Protective Factors Protective Factors  These static vs dynamic factors can provide a useful basis by which we can begin to formulate an assessment of risk Various psychometric tools developed to aid Clinincal- Forensic Psychologists in this task…  Risk Matric 2000 (RM2000) Structured Assessment Violence Examples Juvinile Sex Offender Protocol Risk in Youth (SAVRY) Historical Clinical Risk (HCR-20) (J-SOAP-II) Sexual Violence Risk-20 (SVR-20) Psychopathy Checklist-Revised (PCL-R) Offender Assessment System (OASys) and AssetPlus Level of Service Inventory- Spousal Assault Risk Assessment Revised (LSI-R) (SARA) Sex Offender Risk Appraisal Estimate of Risk of Adolescent Guide (SORAG) Sexual Offense Recidivism (ERASOR) Violence Risk Appraisal Guide (VRAG)  Limitations of Psychometrics Self report scales can be faked, falsified, or unconsciously self-serving Self and clinician report scales are subjective, not objective Scales may be biased (gender, culture, language) The scales measure constructs - theories not facts Test scores are open to misuse, misinterpretation etc Psychometric measures have limitations, such as measurement error. Don’t take the numbers too literally, interpret and use the data wisely 173  Forensic Risk Assessment Aim: to differentiate higher risk offenders from lower risk offenders Important for the police, courts, correctional workers, and the general public. Forensic risk assessments answer two general concerns. How likely is an offender to commit a new offence? What can be done to decrease this likelihood? Although perfect prediction is an unattainable goal, the serious consequences of incorrect risk decisions justify careful attention When Risk Assessment goes wrong (John Warboys) Evidence Based Risk Assessment Basis by which we can… Provide staff with information of what needs should be targeted in through interventions The same measure can be used to reassess offenders risk after an intervention or period of time Evidence Based Risk Assessment Limitations: Can be lengthy and time consuming to complete. Require access to a variety of supporting documentation Require staff to attend specific training in the administration and scoring of the risk assessment  The HCR-20 is a 20-item checklist to assess the risk for future violent behaviour in criminal and psychiatric populations Responsibility for the assessment may be divided among several different professionals It includes three sub-scales: Historical factors (10 items), Clinical factors (5 items), and Risk-management factors (items) HCR-20 The final judgment regarding risk for future violence (Low, Moderate, High) should be based on a careful analysis of the 20 risk factor items. (Webster et al. The assessor rates each item according to three levels of certainty (i.e., 1997) Absent, Possibly Present, Definitely Present) It has a risk scenario plan added to the end to assist with treatment recommendations and risk management The current HCR-20 is Version 3 Violence in the HCR-20 is defined as "actual, attempted, or threatened harm to a person or persons."  HCR-20: Step 1 Risk Factors Step 1: Determine Presence and Relevance of Risk Factors Historical (H) Items: These are mainly static in nature and are therefore unlikely to fluctuate over time. Clinical (C) items: These items refer to an individuals current mental, emotional and psychiatric status and includes risk markers that are dynamic and are, therefore, likely to change over time. Risk management items (R): These items are concerned with forecasting the future social, living and treatment circumstances, as well as anticipating the persons reaction to those conditions.  Historical Items Clinical Items Risk Items Previous Violence Major mental illness Lack of insight Plans lack feasibility HCR-20 Young age at first violent Psychopathy conviction Relationship instability Early Maladjustment Negative attitudes Active symptoms Exposure to destabilisers Lack of personal Items of mental Illness Support Employment problems Personality Impulsivity Non compliance Disorder with remediation attempts Substance use problems Prior Supervision Unresponsive to Stress Failure treatment HCR-20 The HCR-20 provides psychologistss with an estimate of the likelihood of violence, and should be presented in terms of low, moderate, or high probability of violence. Ultimately, HCR-20 results are intended to provide information for decision-makers, so that criminal and mental health-related decisions can be based on the best available estimates of risk of violence.  Trained by an approved trainer 2 day training program Training for It is always important to read the manual to ensure accuracy of rating administering Early assessments should be supervised by an the experience assessor HCR-20 One can become a certified trainer Today we are going to skip all of this and you guys are going to do it on a real recent case example Treatment and Intervention in Forensic Settings SETTING THE SCENE: REHABILITATION WITHIN PRISONS Nothing Works: Martinson 1974 Seminal Review: What works? Questions and Answers about Prison Reform Lead to shift from primarily rehabilitation focus to more punitive approaches Risk, Need and Responsivity: Developed in North America – Andrews & Bonta (2006)​ Played a central role in discrediting ‘nothing works’ and revitalizing the rehabilitation movement Targets individual criminogenic factors – deficit based (Ward & Laws, 2011) Effective? (Mews et al., 2017) What’s missing? 184  Risk, Need and “The Risk-Need-Responsivity (RNR) model is Responsivity Model perhaps the most influential model for the assessment and treatment of offenders (RNR) (Blanchette & Brown, 2006; Ward, Mesler & Yates, 2007)” (www.publicsafety.gc.ca)  Background (cited from www.publicsafety.gc.ca): Developed in the 1980s and first formalized in 1990 (Andrews, Bonta & Hoge, 1990). RNR Model Used to assess and rehabilitate offenders. Since 1990, a number of principles have been added to the core theoretical principles to enhance and strengthen the design and implementation of effective interventions. For example: - For staff to establish collaborative and respectful working relationships with clients. - For correctional agencies and managers providing policies and leadership to facilitate and enable effective interventions (Andrews, 2001; Andrews & Bonta, 2006). Is based on three principles: risk, need and reponsivity  Risk principle: Match the level of service to the offender's risk RNR Model of reoffending. The risk principle asserts that offender recidivism can be - Risk Principle reduced if the level of treatment provided to the offender is proportional to the offender's risk to re-offend, with treatment focusing on the higher risk offenders. The principle has two parts to it: 1) level of treatment and, 2) offender's risk to re-offend.  Need principle: assess criminogenic needs and targets RNR Model them in treatment. The need principle highlights the importance of -Need Principle criminogenic needs in the design and delivery of treatment; Criminogenic needs are dynamic risk factors that are directly linked to criminal behaviour that can come, and are responsive to treatment (Ward and Stewart, 2003).  Responsivity principle: describes how the treatment should be provided. RNR Model – The Responsivity Principle seeks to maximize the offender's ability to learn from a rehabilitative intervention by treatment; and tailoring - Responsivity the intervention to the offenders learning style, motivation, abilities and strengths Principle There are two parts to the responsivity principle: general and specific responsivity.  General responsivity calls for the use of cognitive social learning methods to influence behaviour.  Specific responsivity is a "fine tuning" of the cognitive behavioural intervention, taking into account the strengths, learning style, personality, motivation, and bio-social (e.g., gender, race) characteristics of the individual. what do we know about desistance Setting the Scene: Desistance HMPPS (2019) – Desistance is: How people abstain from crime. Desistance is a journey. It’s an ongoing process. Tensions between desistance and risk (McNeill, 2019) Desistance-based practice (at its best) Risk-based practice (at its worst) Realism (expects and manages lapses) Demand compliance Individualises De-individualises Works in, with, and through relationships Works on the individual, uses relationships to manage risk Builds and sustains hope Manages fear Builds strengths Address deficits Supports agency Applies external controls/interventions Develops social capital / integration Manages external controls/interventions Provides positive recognition Reinforces negative labelling Strengths Based Approaches Strength Based Approaches Focus on an individuals strengths Holistic and multidisciplinary Works to promote wellbeing Outcome led Department of Health and Social Care “It's about emphasising the use of professional engagement and judgement, as opposed to procedural approaches, with a focus on the individual, taking a holistic and co-productive approach to keeping the person at the centre of all decisions, identifying what matters to them and how best outcomes can be achieved. It is about enabling people to find the best solutions for themselves, to support them in making independent decisions about how they live…” 195 The Good Lives Model – Primary Goods All 11 primary goods are necessary for a “good life” But the weightings placed on these reflect an individual’s values and life experience This weighting is associated with the sense of personal identity or life- meaning  Good Life Interventions: The Five Phases 1. Identify the social, psychological and environmental aspects of an individual’s offending 2. Consider the function of the offending (what primary goals are directly or indirectly linked?) 3. Understand the person’s core practical identities (What is a good life to you? What does ‘new me’ look like?) 4. Identify what secondary goods will assist them in attaining their primary goals (SMART) 5. Develop a detailed intervention plan (identifying specific steps) Laws and Ward 2010; Ward, Mann & Gannon 2007; Ward and Maruna 2007 Offending Behaviour Programmes Horizon and Kaizen Thinking Skills Programme (TSP) Therapeutic Communities Plus (TC+) Alcohol Dependence Treatment Programme (ADTP) Challenge to Change (C2C) Healthy Identity Intervention (HII) Building Better Relationships (BBR) Control of Violence for Angry Impulsive Drinkers (COVAID) Research and decide which of these are likely to be a good choice for your offender! Building Recovery Capital What is Recovery Recovery principles and support approaches Idea that offending popualtions often have to recover from trauma they have personally experience AND inflicted on others Evidence suggests that recovery can be supported when a whole systems approach is adopted to support the individual. This reflects the principle of focusing on: - The individual’s strengths and needs - Developing and using their social networks (Best, 2019) - Developing, supporting and using their community Limits with this appraoch? Think about victim families and recividism rates…  Recovery Capital is described as the internal and external strengths and resources that a person has which may support them in their recovery (Granfield & Cloud, 2008). Recovery Four types of Recovery Capital: approaches 1. Personal 2. Family/Social 3. Community 4. Cultural Behaviour Change Theory Behaviour Change Can you think of a big change you have made so far in your life? What made you make the change in the first place? What helped you when the change was tough to carry on with? Have you ever gone back to the way before? Did anything get you back to the change? What is motivational interviewing? Motivational interviewing (MI) is a client-centered counseling approach increasingly utilized in forensic psychology to facilitate behavior change among individuals involved in the criminal justice system. This method is particularly effective for engaging clients who may be resistant or ambivalent about changing their behaviors, such as substance abuse or criminal activities. Motivational interviewing (MI) Miller and Rollnick (1991, 2013) define MI as: “a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence” Or more recently as… “a collaborative conversation style for strengthening a person’s own motivation and commitment to change” What is motivational interviewing? Motivational interviewing (MI) is a client-centered counseling approach increasingly utilized in forensic psychology to facilitate behavior change among individuals involved in the criminal justice system. This method is particularly effective for engaging clients who may be resistant or ambivalent about changing their behaviors, such as substance abuse or criminal activities.  What is motivational interviewing? 1.Express Empathy: Practitioners actively listen and convey understanding of the client’s perspective, fostering a supportive environment. 2.Develop Discrepancy: MI encourages clients to recognize the gap between their current behaviors and their personal goals or values, which can motivate change. 3.Avoid Argumentation: Instead of confronting clients, practitioners work collaboratively with them, promoting a non-judgmental dialogue that respects the client's autonomy. 4.Roll with Resistance: When clients express resistance or ambivalence, practitioners adapt their approach rather than pushing back, allowing the conversation to flow in a way that respects the client's feelings. 5.Support Self-Efficacy: MI emphasizes the client's ability to change by highlighting their strengths and past successes, thereby enhancing their confidence in making changes.  What is motivational interviewing? In forensic psychology, MI is applied to various populations, including offenders with substance abuse issues, domestic violence perpetrators, and those with mental health disorders. The technique is effective in: Enhancing Motivation: MI helps clients articulate their reasons for change and resolve ambivalence, which is crucial for those who may be coerced into treatment. Improving Engagement: By fostering a trusting relationship, MI increases clients' willingness to participate in treatment programs and adhere to treatment plans. Facilitating Behavioral Change: The approach has been shown to be particularly beneficial for high-risk individuals who may otherwise be unresponsive to traditional interventions Prochaska & DiClemente, 1983; Prochaska, DiClemente, & Norcross, 1992  Autonomy Spirit Collaboration Evaluation Roll with Resistance Express Empathy Principles Develop discrepancy Support self-efficacy Open ended questions Micro Affirm Skills Reflections Summaries Desires Ability Change Commitment (Intention, decision) Reason Talk Commitment Activation (Ready, prepared) Need Taking Steps Behaviour Change The Framework of Motivational Interviewing Schema Therapy (Young, 1990) An integrative therapy: Cognitive behaviour, psychodynamic, experiential and interpersonal techniques. Different from CBT. Greater focus on: Problematic emotional reactions Childhood experiences Therapeutic relationship To understand Schema Therapy (ST), we must first understand what Schemas are. Schema Theory Summed up Problematic Maladaptive Adverse views of self coping childhood and others methods Early Maladaptive Schemas (EMS) From childhood, we develop mental frameworks that help us make sense of ourselves and others, and problem solve. Problematic childhood experiences can lead to the development of EMS. Sometimes as a coping method Can be problematic in adulthood because they are dysfunctional, inaccurate and limiting. Individuals with these maladaptive schemas are rarely aware that they hold such dysfunctional beliefs (Young et al., 2003) Maladaptive Schemas Among PD Patients PD patients show signs maladaptive schemas Do not develop positive self image Inaccurately interpret the actions of others’ and their own behaviours (intentions) Dysfunctional coping methods Many report problematic childhoods. E.g: Bad parenting styles Traumatic experiences Individual temperament EMS are developed from problematic childhoods. But why? Young et al. (2003) The link between childhood problems and EMS Young et al. (2003) said the following emotional needs need to be met: Secure attachment (think Bowlby’s attachment theory) Autonomy and independence Limits and boundaries Validation of needs and feelings Spontaneity and play Traumatic and problematic childhood prevent the formation of these needs and subsequently initiate/strengthen the formation of EMSs Domain Schemas Core Emotional Needs Disconnection & Rejection Mistrust/Abuse Secure attachment Abandonment/Instability Acceptance Emotional Deprivation Care Defectiveness/Shame Social isolation/Alienation Impaired Autonomy & Performance Dependence/Incompetence Autonomy Vulnerability to Harm Competence Enmeshment Sense of identity Failure Impaired Limits Entitlement Realistic limits Insufficient Self-Control/Self Discipline Self-control Other Directedness Subjugation Free expression of needs and emotions Self-Sacrifice Approval Seeking/Recognition Seeking Over-vigilance and Inhibition Negativity/Pessimism Spontaneity Emotional inhibition Playfulness Unrelenting standard/Hypocriticalness Punitiveness Individuals develop maladaptive coping methods 1) Surrender = Individual surrenders to their activated schemas and adapts their thoughts and behaviours in line with them. This only leads to re-experiencing the emotional pain as well as reinforcing it. 2) Avoidance = Individual tries to avoid any situation that might trigger the schema. This doesn’t fix the core issue though. 3) Overcompensation = individual acts in what they perceive to be the complete opposite direction of the schema. This might sound like it would be good but it can lead to underestimating the issue or acting in a way that is aggressive (e.g., acting aggressively) – we will see an example. (Young et al., 2005) Schema Therapy Early Maladaptive Problematic Maladaptive coping childhood Schemas methods Emotional needs unmet Schema Modes Not all maladaptive schemas are active at the same time. Individuals will express different combinations of schemas in different scenarios. We refer to these and Schema Modes. Essentially different patterns of behaviour that are triggered by different situations. Common Maladaptive Schema modes: Child Modes: Feeling, thinking and acting in a childlike manner (Dysfunctional) parent mode: self-directed criticisms or demands that reflect internalised parent behaviours. (Dysfunctional) Coping mode: Trying to protect oneself from pain by engaging in maladaptive coping methods. Healthy modes = health self-reflection and associated feelings of pleasure and happiness. Any Questions? Time for you to try it out…  Forensic Application Workshop 2: Reviewing and applying what we have covered so far… In small groups (approx. 4-5) using a real case example on the next slide… 1. Review available case info and details 2. Attempt to re-diagnose psychological disorder causing offending 1. Review previous slides to confirm you agree with original diagnosis 3. Conduct HCR-20 Violent Risk Assessment (or alternative RA test) drawing on the details 4. Identify and plan (feasible!) tailored treatments intervention 1. Either from risk or strengths based perspective (express your preference) 222 Danny W. 223  Danny W. Danny W (31) was recently convicted for a serious knife attack in a supermarket carpark after a minor confrontation. Fleeing the scene he ran into a nearby pub where he held those inside hostage for a short period of time before stabbing a number of people in a seemingly unprovked attack. During sentencing the trial judge described him "dangerous" and gave him a life sentence. However, he was told he could be released in just four years' time (2026) if he shows evidence of responding to treatment in custody. Danny suffers with a severe personality disorder which causes him to experience psychosis when he does not take his medication. At the time of the offence, he was reported hearing voices and feeling paranoid. 224  Relevant Sources Previous Session Slides Media reports about the case Prison Letter HCR-20 Formulate a brief ‘report’ (bullet points are fine) concerning…. 1. What MH diagnosis may be driving his offending behaviour 2. Do you agree with the original diagnosis? If not, why? 3. His score on the HCR-20 providing your opinion on his level of risk 4. Identify his risk and protective factors (if any)? 5. What treatment do you recommend for treating/managing the MH disorder 6. A clinical opinion to the court about the treatment you recommend whilst in custody You will present this back to the class either once complete ☺ 225  Relevant Sources Previous Session