Clinical Psychology: Different Approaches & Roles PDF

Clinical psychology is not everything! Megan Phillips Generalist Psychologist Behaviour Support Practitioner Disability Sector, Forensic Sector Trigger warning Some content in this presentation may be triggering for some. Please leave the session and seek support should you experience a...

Clinical psychology is not everything! Megan Phillips Generalist Psychologist Behaviour Support Practitioner Disability Sector, Forensic Sector Trigger warning Some content in this presentation may be triggering for some. Please leave the session and seek support should you experience a negative reaction. Please reach out to support services such as lifeline and psychiatric triage should you need further support. Clinical psychology is not everything! You can apply psychological theory in many different roles. Cognitive Behavioural Theory Behaviourist Theory Humanistic theory Education theories Social theory Developmental theory And many others!  You can apply psychological theories to how we Clinical psychology respond to our environment, managing our emotions, changing ways of thinking, how we is not everything! interact with others, influencing behaviours and how we cope with difficult events.  Disability sector – Support Worker, Behaviour Support Practitioner, Social Worker, OT, Generalist Psychologist Skill building Clinical Psychology is behaviour not Build relationships everything! Build community connections Increase community inclusion Clinical psychology is not everything!  We use applied behaviour analysis (ABA) to identify the function of the persons behaviour Setting – what are the biopsychosocial factors Functional that contribute to the behaviour? What is it behaviour about the persons environment that might be contributing to the behaviour occurring? assessment Antecedent – what happened just before the behaviour occurred Behaviour – what did the person do? Consequence – what happened after this?  Based on 2 assumptions: The cause of human behaviour is something in the environment Skinner – The consequence of the behaviour determines the possibility of it being repeated operant conditioning Reinforcers – responses from the environment that increase the likelihood of the behaviour – apetitive stimulus theory Punisher – negative operants that decrease the likelihood of the behaviour – it weakens the behaviour – aversive stimulus Disability support When we work with people with a disability, we are there to teach them skills so that they can live more independently, or change their behaviour so that they can be a part of our community. We break the skills down into smaller tasks. We use behaviorist theory in how we teach these skills. Disability support We don’t do things for the person – they don’t learn the skills if we do it for them. We do things with the person. Think about how you learned to tie your shoelaces? Disability support When teaching skills, we break them down into smaller tasks. For example teaching someone to make a cup of coffee We develop a program that outlines the steps to completing the task, how to teach the skill, and how and when to reinforce the learning. We need to teach these steps one at a time. Disability support Depending on the persons cognitive ability we might teach one step at a time. For example the first step might be to get all the equipment and ingredients ready. We might do this through a visual aide that has pictures of each of the components first. We also need to think about if the client knows where these things are, and do they know to go and get them? We call these prompts. Instead of telling them directly, we might prompt the person by saying “John what do you need to make yourself a cup of coffee?” or “john where do you find these items that you need to make a cup of coffee?” This is called person centered active support Disability support When John asks for a coffee, When John collects all the staff will show him the visual items, staff will provide aid and verbally prompt him Example: verbal praise “ well done by saying “John what things John, now we can make you do we need to make a a coffee”. coffee?” When John has successfully Staff will then model how to completed step 1 three make a coffee with John, times, John will move onto telling him each step as they step 2 – putting a teaspoon do it. of coffee into the cup.  Similar roles, but with a forensic focus Skill building as well as changing behaviour People use behaviour for a reason! They are generally trying to communicate something or meet a need eg ‘im thirsty’ or ‘I don’t like that Forensic noise’ disability For example people with a disability are more likely to come from a background of trauma and abuse, their behaviour is telling you they don’t like something or they are feeling unsafe. There are many reasons why people use behaviour to communicate  Behaviour is often a way that people with a disability communicate to meet their needs. Forensic The Good Lives Model (Ward 2002) uses a strengths based approach to teach individuals the skills they Disability need to meet their needs in socially appropriate ways. The Good Lives Model (GLM) talks about how we as human beings seek to secure ‘human goods’ to be functioning human beings and achieve higher wellbeing. Good Lives Model Strengths based approach to offender rehabilitation Develop the persons capability and strengths to reduce their risk of reoffending People offend because they are trying to secure a valued outcome in their life. Offending is the product of a desire for something that is inherently human and normal. Due to deficits with the person and their environment this manifests as harmful and antisocial behaviour. These deficits prevent the person for meeting these outcomes in pro-social ways. Good Lives Model EG: instead of locking someone in prison, give them the skills to Intervention aims to develop meet their needs. Teach them the individual's personal to problem solve rather than functioning rather than becoming frustrated. Teach removing a problem them emotional regulation skills rather than becoming violent. Good Lives Model primary goods Skills in play Healthy living and Skills in work Knowledge (recreation, functioning (mastery) hobbies) Skills in agency Freedom from Community (autonomy, self emotional turmoil Relationships (belonging) directedness) and stress Creativity Spirituality Pleasure (expressing (purpose in life) yourself)  Good Lives Model secondary goods How we secure primary goods Eg: completing university to satisfy the primary good of knowledge and excellence in work The way of living refers to how a person is currently living their life and reflects their values and attitudes. A life plan is about how the person lives their life now and in the future Good Lives Model Capacity There are 4 types of Scope problems evident in a person’s ways of living Means and planning their life: Coherance  People with a disability have the same needs as you and I. We all seek to have meaningful friendships and to be social beings. Forensic People with a disability often don’t have Disability friends other than paid supports. Think about friendships and relationships in terms of the GLM One of the areas that I work in is sexualized behaviours. Forensic Disability Why do people with a disability sometimes use inappropriate sexualized behaviour? There are generally 2 reasons why people use inappropriate behaviours They are learned They are sexually deviant Today I will talk about the behaviours (cognitive deviancy) learned behaviours  Behaviour may be deviant but it is Inappropriate precipitated by the person having poor social skills, lack of sexual sexualised knowledge, limited opportunity for behaviour in intimate relationships, and poor impulse control. people with an This is known as counterfeit deviance theory (Luiselli 2000) intellectual disability It is important to note that people with an ID are statistically more likely to be victims of sexual assault Inappropriate sexualised behaviour in people with an intellectual disability A number of assessment tools have been developed to assess people with an ID Assessment – assessment of understanding and knowledge sexual knowledge. of sex. This includes body parts, intimacy, relationships, safe sex and rules of sex. Inappropriate Once assessed, a treatment program is developed to address sexualised the deficits identified. behaviour in people Often peoples understanding of relationships is gained from their own experience (eg abuse) lack of skills (attitudes that with an intellectual people with an ID are not sexual beings) observations of others (role models) and what they see on tv! disability Home and Away, social media, Instagram, music videos… What do you think? Rhianna S&M video https://youtu.be/KdS6HFQ_LUc?si=rgbz-RQxDB6OFCMp Where were you in 2011? This video was banned in 11 countries What were kids in schools talking about when this video was released? What might people with a disability take from this?  We have programs which work to assist people to develop these Inappropriate skills and knowledge. sexualised Support workers can support this learning by role modelling behaviour in people appropriate social behaviour, and implementing and programs that people like myself develop. Such as skill development, with an intellectual reinforcement schedules and cognitive behavioural programs. Behaviour Support Practitioners and other allied health will work to disability change behaviour, through skill development, challenge distorted thinking, challenging thinking  Forensic Risk Assessment assesses the likelihood that the person will reoffend (recidivism) They are based on static factors and dynamic factors identified Assessment of through research. Risk Static Factors are things that don’t change such as age at first offence, age of victims, sex of victims, number of times person has been charged, number of times the person has been to prison. Dynamic factors are factors that can change such as mental health, alcohol and substance use, coping skills, emotional regulation, engagement with supports, employment, So where does the Good Lives Model Fit? As we said earlier, the GLM is about developing a persons skills so that they can live a good life Assessment of risk identifies the risk factors we need to manage to keep people safe, while we develop the persons skills. For example, providing the person with increased support work hours, engaging them with allied health services, engaging them in fulfilling purposeful activities (such as education and employment) securing stable accommodation So that the persons skills can be developed to decrease the risk of recidivism Risk management and skill development We cant just stop a person from meeting their sexual What psychological needs – we need to teach theories are linked to this them to meet their needs work? in socially appropriate ways. Psychological theories Social theory (what is Cognitive behavioural Offending risk theory accepted socially? theory (cognitive (what are offending What is appropriate to distortions) risk factors?) fit in with society?) Developmental theory Operant conditioning Good lives model (what developmental (how to change (people are inherently stage is the person at behaviour and driven to meet needs) eg: adolescence) reinforce behaviour)  CBT has been found to be a successful treatment modality for offender treatment. When we use CBT with people with a cognitive impairment it needs to be Cognitive modified to be responsive to their needs. Behavioural Lambrick and Glasser (2004) developed a treatment model that was CBT based for forensic disability clients. Its known as “old me new me” Therapy (CBT) The old me is based on the negative automatic thinking patterns that lead them to offend. The new me is based on the replacement thoughts identified to help them to not reoffend and to stay out of trouble (eg: prison). Cognitive Behavioural Therapy  The CBT framework of old me new me is based on : Thoughts/cognitions Feelings: emotions and physiological Old Me New Behaviour: how thoughts and Me feelings influence behaviour  Support worker Support worker - – outreach accommodation Behaviour Support support What roles are practitioner coordinator involved in this line Psychologist of work? Corrections (generalist, officer forensic) Occupational Social workers Therapists Thanks!! Megan Phillips [email protected] linkedin.com/in/megan-Phillips-83