CLINICAL
Psychology
MGR. RENATA JARDIN
COURSE: 5-6/12/2020
CLINICAL PSYCHOLOGY aim of course
BASIC ORIENTATION IN
PSYCHOLOGICAL TERMINOLOGY.
PRACTICAL APPLICATION OF
KNOWLEDGE .
GROUP WORK AND CLINICAL
CASES.
COURSE REQUIREMENTS
PRESENTATION
FINAL ESSAY AND EXAM
- group presentation – 12min time limit
- individual assignment
- 3-5 members
- chose one of the suggested topics from
Health or Clinical psychology and elaborate a
presentation
- choose one famous person or literary
person and develop analysis of his mental
issues, diagnostic hypothesis and
therapeutic plan
- present some examples or studies on the
topic
- requirements: minimum 3 pages,
maximum 5 pages
- deadline: one hour before last lesson
DAY 1: 5/12/2020 – Program
TIMETABLE:
Morning: 9:00 to 10:30, 15min break, 10:45 to 12:00
Noon break: 12:00 to 13:00
Afternoon: 13:00 to 14:30, 15min break, 14:45 to 16:15, 15min break, 16:30 to 18:00
TOPICS
➢What is clinical psychology?
➢Abnormal Behaviour versus normal behaviour, assessment
➢Diagnosis and Classification of Psychological Problems according to the DSM IV
➢Introduction into therapeutic intervention
➢Psychotherapy: General Issues; Psychoanalytic; Client-Centered; Gestalt, Behavioural; Cognitive;
Contemplative (Mindfulness), Community; Group/Family.
What is clinical psychology?
➢- empiric (research based) approach towards
the psyche
➢- includes psychological assessment,
evaluation of disorders
➢- differential diagnostic in cooperation with
other health professionals
➢ applying of scientific knowledge for
relieving, healing and preventing mental
health issues
➢Rules differ from country to country
Normal versus abnormal
- before defining anormality, we must define the sense of “normality”
- normality is culturally defined
- normality is conditioned by family culture
AS A THERAPIST/CLINICAL PSYCHOLOGIST YOU MUST HAVE A NOTION OF NORMALITY AND
UNDERSTAND THE NOTION OF NORMALITY OF THE PATIENT!
E.g. abused, traumatized, tortured patients do not necessarily know what is normal!
TOPIC: abnormal behaviour
DEFINING WHAT IS NORMAL
PERCEPTION OF NORMALITY
➢ DEPENDANT ON HISTORICAL PERIOD
➢ POWERFUL TOOL FOR MANIPULATION
➢ EDUCATION OF CHILDREN, GENDER
ROLES, ACCEPTED BEHAVIOUR IN
COUPLES
➢ SADIC, PSYCHOPATHIC, NARCISSTIC
PERVERT PERSONALITIES USE IT
EFFECTIVELY TO MANIPULATE
➢ DEPENDANT ON SOCIETAL EVENTS –
CURRENT SOCIAL REPRESENTATIONS,
CORONAVIRUS PERFECT EXAMPLE
➢ DOUBTS ABOUT THE TRUTH OF ONE´S
PERCEPTION OF NORMALITY CAN LEAD TO
MENTAL HEALTH ISSUES
BREAKOUT ROOM BRAINSTORM
DEFINE
WHO IS NORMAL?
- As a clinical psychologist you see a
patient for the first time
https://www.youtube.com/watch?v=prUFZIc
gZiQ
WHAT WILL YOU BE LOOKING FOR?
HOW CAN YOU SAY THAT THIS PERSON IS
ACTING “ABNORMALLY?
HOW CAN YOU DISTINGUISH BETWEEN
NORMAL AND ABNORMAL?
TOPIC: abnormal behavior
CLASSIFICATION OF ABNORMAL
BEHAVIOUR
CRITERIA FOR CLINICAL INTERVIEW
DEVIATION FROM:
❖ SUFFERING
❖ STATISTICAL NORMS
❖ SOCIETAL NORMS
❖ BEHAVIOURS THAT ARE
DESTRUCTIVE/CONTRAPRODUCTIVE
❖ MALADAPTATION TO LIFE, CHALLENGES,
SITUATIONS
❖ IRATIONALITY, DELUSIONAL
COMMUNICATION
❖ PERSONAL DISTRESS, MENTAL
DISORDER
❖ UNPREDICTABILITY – PUTTING MYSELF
OR OTHERS IN DANGER
TOPIC: abnormal behaviour
WHAT DOES THAT MEAN?
- notions of a hypothesis of continuity
- mental pathology is not that different from
normal functioning
- the difference is the quantity and length
➢ long-lasting
➢ consequences on “normal” life
➢ insomnia, loss of weight, pathologic thoughts,
suicidal thoughts, break of social relations
TOPIC: abnormal behavior
- notions of a hypothesis of
dysfunctionalism
- discontinuity does not mean that it
cannot be repaired
- change of state continuity of humour,
mood, social relations, interactions
➢ maniac - depression, bi-polar mood,
hyperactivity, positivism
WE ONLY HAVE HYPOTHESIS OF
ABNORMAL BEHAVIOUR AND HIS
FREQUENCY
What we own:
➢ possible risk factors
➢ genetic factors
➢ factors of probability
THEY ARE NOT THE SAME!!!
ABNORMAL BEHAVIOUR
- we start to speak about disorders, psychopathology BUT
* in order to remain “mentally healthy” one must go crazy sometimes
* in order to function and perform well, one must sometimes feel stress, anxiety
* in order to protect oneself from danger, one must feel fear
* in order to live in a fulfilled way one must experience extreme happiness
* to be grateful for what you have in life you must know depression to some extent
PSYCHOPATHOLOGY
200 YEARS behind medicine
- trying to find an internationally recognized way of qualification
➢ DSM V used mainly in USA but also in France
➢ MKN 10 used in Europe and also CZ
WHAT IS THE AIM?
▪ regroup and describe what we observe – symptoms
▪ a minimum, group of symptoms that are typical and could indicate a certain diagnosis
PSYCHOPATHOLOGY
•Psychiatrists, clinical psychologists,
therapists etc. can communicate
internationally in a standardized way and
classify by using:
•Categories – distinguishes between types of
phenomena that differ in a clearly defined
way
•Dimensions – defines to which extent a
person is expressing a certain symptom
What does “differential diagnosis” mean?
• supposes a comparison of other psychopathologies and tries to eliminate those in a logical and
argumented matter form the “most probable” to the “most unlikely” diagnosis.
• start to eliminate and distinguish between “psychotic” and “neurotic” elements
• GAIN AS MUCH INFORMATION AS POSSIBLE
• clinical interview is not a therapeutic interview!!!
• ANAMNESIS: what does an anamnesis must contain?
Basic information: name, age, marital status, sex, race,
occupation, previous admissions, family composition
PATIENT
ANAMNESIS
Reason for consultation/referral: actual symptoms,
problems, recurrent, new? Own perception, opinion of
other professionals.
History and severity of present symptoms/disorder: dvlp of
symptoms, behavioural changes, life impact, length of
duration, perception of intensity (scale, comparison to
other life events).
Psychiatric and medical history: family history, genetic and
organic factors, treatment history in the family
Maping of family history and nature of relations
Reconstruction of patients history: birth, school, education,
social relations, work
DURING THE INTERVIEW OBSERVATION OF PATIENT, NON
VERBAL COMMUNICATION, PHYSICAL BEHAVIOUR,
POSTURE, TICKS, HINTS FOR ANXIETY, DISSOCIATION…
What else to
keep in mind?
Specification of severity
The specifications can only be applied when
the criteria of evaluation of the particular
disorder are fulfilled:
❖ mild
❖ intermediate
❖ severe
❖ partial remission
❖ complete remission
STAGES OF MENTAL ILLNESS 1
• Good constitution,
functionality, hobbies,
normal life
• Characteristic traits of
personality
Period of
health
Premorbid
symptoms
• Before the actual apparition
of the disease
• Certain psychosomatic
factors appear
• We cannot define whether it
is a mental illness
• Onset of mental illness with
specific traits among non
specific traits
• Differentiation between
psychotic and neurotic
symptoms and
neurovegetative symptoms
Prodromal
stage
STAGES OF MENTAL ILLNESS 2
• Specific traits are dominant and
provide the possibility to
confirm diagnosis – specific
therapy
• Manic or depressive episodes
manifest, hallucinatory
symptoms
Manifestation of
mental illness
Symptom fading
• The symptoms are starting to
become less intensive and the
non specific symptoms are
dominant again
• The premorbid personality is
coming back
• Specific symptoms have
disappeared
• The therapy has shown it´s
effect
• Non specific symptoms
(tiredness, weakness)
• Sociability regained
Reconvalescence
and normal health
Causes of mental disorder
What are the main causes of psychological disorders?
Main causes still unknown
Main factors that can influence their development:
❖chemical imbalances in the brain – neurotransmitters or hormones
❖childhood experiences
❖Genetic and organic factors
❖prenatal exposures, and stress but also nutrition
BRAINSTORM BREAKOUT ROOMS
WHAT DO YOU KNOW ABOUT PSYCHOSIS AND NEUROSIS?
https://www.youtube.com/watch?v=s8cIjhBPPiY
PSYCHOSIS AND NEUROSIS
Lit: the catastrophes of perception, René
Thom
CATASTOPHY OF
SUBORDINATION/CONFORMISM/FOLDING
- to obey to societal rules is necessary
NEUROSIS: simple catastrophe, the person
can be “unfolded”, a mark of the folding or
the scrunch will remain, even after therapy.
It is not a traumatism, no severe interruption
of continuity. Very common, person is mostly
aware of the symptoms!!!
PSYCHOSIS AND NEUROSIS
The nature of the “catastrophe” must be
determined. The line between severe neurosis
and psychosis can be very vague.
PSYCHOSIS: torn apart, ripped up. The cracks,
fissure have conducted to loss of continuity,
separation, dissociation, destruction.
Destructive elements are present, defences
are gone, emotions and representations do
not collide.
The therapeutic work is not only unfolding
issues but exploring puzzle pieces and fixing
them back together.
What can be neurotic?
➢- mild functional neuro-psychical disorders with specific clinical phenomena
- anxiety, obsession, certain types of depression
➢- causing factors: biological factors, socio-psychic climate, economic factors, cultural factors
or climate factors (SAD)
➢- In Cultural psychology: the neurotic east coast (USA)
➢- genetic, organic factors less dominant
➢- functionality is affected but not thought, language, communication
➢- PERSONALITY IS NOT AFFECTED, CONTACT WITH REALITY MAINTAINED
What can be psychotic?
➢ loss of relation to reality
➢ hallucinations, audio, visual, internal
➢ difficult to treat but not impossible
➢ unawareness of my own actions, feelings, behaviours
➢ impression that others are strange, I am okay
➢ prevalence of organic or genetic factors
➢ PERSONALITY IS AFFECTED, PERSON CAN SEEM FUNCTIONAL
Psychotic and neurotic disorders
In clinical practice it can be difficult to distinguish neurosis and psychosis in some cases. Strict
clinical methodology and evaluation is necessary!!!
➢ which types of tests do you know?
➢ MMPI
➢ PANSS, SANS
➢ ROR, TAT
➢ complementary: Hamilton anxiety/depression scale, Columbia Suicide severity rating scale
Classification of disorders from
neurosis/psychosis view – clin case
Anxiety disorders
- Phobia
- OCD
- PTSD
- Stress, panic
Eating disorders
- bulimia or anorexia
Affective disorders
- Postpartum depression
- Unipolar/bipolar depression
- SAD
NEUROSIS
Psychotic disorders
- paranoia
- schizophrenia
- manic depression
Personality disorders
PSYCHOSIS
TOPIC: Diagnosis and classification of
psychologic problems
BASIC CATEGORIES
1.
Disorders diagnosed in childhood or
adolescence
7.
Anxiety disorders
8.
Somatoform disorders
9.
Dissociative disorders
2.
Delirium, dementia, amnesia, cognitive
disorders
10. Disorders of sexual identity
3.
Mental disorders due to general medical states
11. Eating disorders, Sleeping disorders
4.
Mental disorders linked to substance abuse
12. Personality disorders
5.
Schizophrenia and psychotic disorders
13. Adaptation disorders
6.
Mood disorders
14. Other disorders worth clinical examination
1. Disorders diagnosed in childhood or
adolescence
MENTAL RETARDATION
From light, medium, severe to profound
LEARNING DISABILITIES
Reading disorder – dyslexia
Calculation disorder – dyscalculia
Writing disorder – dysgraphia
Learning disorder – dyspraxia
COMMUNICATION DISORDER
Expressive disorder, phonologic disorder,
stuttering, communication disorder
1. Disorders diagnosed in childhood or
adolescence
PERVASIVE DEVELOPMENTAL DISORDERS
-
Asperger syndrome
autism disorder
atypic autism disorder
the Rett syndrome
disintegrative childhood disorder
invasive developmental disorder
TICS
- Gilles de la Tourette
- motor or vocal tics
- transitory tics
1. Disorders diagnosed in childhood or
adolescence
ATTENTION DEFICIT DISORDERS OR
DISTURBING BEHAVIOUR
-
ADHD, ADD (no hyperactivity)
conduct disorder
ODD (oppositional)
oppositional behaviour with provocation
disturbing behaviour NS
DISORDERS RELATED TO SHPINCTER
CONTROL
- enuresis, encopresis
OTHER: attachment anxiety, selective mutism,
stereotypical movements (automutilation)
ADHD
6 SYMPTOMS that have to prevail for at
least 6month:
- Inattention (does not pay attention to
details, cannot stay focused
- hyperactivity, physical and mental
- cannot get his job done, stick to the
instructions, gets distracted
- difficulties to get organized
- jumping from one to the other
- impulsivity (emotional, social in class)
CLINICAL CASE
- ADHD among adults also exists
- LET´S DO A CLINICAL CASE
AND THEN BRAINSTORM ABOUT IT
A word on attachment
Theory developed by John Bowlby and Mary
Ainsworth.
- supposes that for a healthy development,
emotional stability and being able to create
healthy relationships a stable attachment to
a care figure (ideally the mother) is
primordial.
https://www.youtube.com/watch?v=WjOow
WxOXCg
2. Delirium, dementia, amnesia, cognitive
disorders
Delirium: due to medical condition, intoxication or detoxication, NS. Change of conscience,
cognitive functioning, disorganized language, memory deficit, can last several hours, leave come
back.
Dementia: Alzheimer type, Parkinson, Huntington after stroke, other medical conditions,
substance abuse. Deficit of cognitive functions, change of memory (cannot remember or cannot
memorize), alteration of language, motricity, change of executive functions, cannot recognize
objects, faces, change of behaviour.
Amnesia: alteration of memory (cannot remember anything or only puzzlepieces of the past),
incapacity to learn new information. Transitory or chronic.
Other cognitive troubles:
Alzheimer versus Parkinson
3. Mental disorders due to general medical
states
- Catatonic disorder due to…(not due to
mental disease)
(immobility, negativity, strange movements,
echolalia, echopraxia)
- modification of personality due to…
- mental disorder due to…
Specifications:
- lability, disinhibition, aggressivity, apathy,
paranoia, combined, non specified
4. Mental disorders linked to substance
abuse
ALCOHOL
- dependency (…), abuse, intoxication, detoxication, delirium, dementia, amnesia, anxiety, sexual
dysfunction, sleeping troubles, psychotic symptoms, mood swings.
Let´s define dependency: unadapted substance use that leads to alteration of functions, clinically
significant suffering, presence of 3 or more symptoms:
1.
2.
3.
4.
5.
tolerance (the need of higher and higher doses of the substance to obtain the desired effect).
withdrawal symptoms when substance is not used
permanent present desire to lower the consumption of the substance
social, professional activities affected by substance use
longterm, excessive use of substance
4. Mental disorders linked to substance abuse
Other substances:
“I take ONLY cocaine” the sexy drug
- amphetamines: euphoria, extreme emotions,
hypervigilance, sensitivity or anger, tension
- caffeine: nervousness, excitation, insomnia
- cannabis: alteration of coordination,
euphoria or anxiety, slow down of time,
alteration of judgement
- cocaine: tachycardie, hyperawakeness,
psychomotor agitation, convulsions
- hallucinogens: depersonalization,
derealisation, illusions, hallucinations
-opiates: somnolence, coma, alteration of
memory, attention, behaviour
https://www.youtube.com/watch?v=vxI7PTVRf
hQ
5. Schizophrenia and psychotic disorders
- very serious mental condition, abnormal
behaviour, affects emotions and cognition,
lack of motivation and engagement in
social interaction.
IS NOT MULTIPLE OR SPLIT PERSONALITY
POSITIVE SYMPTOMS
hallucinations (auditory, visual, sensory)
delusional or disorganized thinking
agitated behaviour
TYPES
NEGATIVE SYMPTOMS
apathy, flat effect, robotic speech
lack of emotion, anhedonia
lack of social engagement
-
paranoid
disorganized (hebephrenic)
catatonic
undifferentiated
5. SCHIZOPRHENIA and psychotic
disorders
What is it
CATATONIC SCHIZOPHRENIA
https://www.youtube.com/watch?v=yhwbkB3iYM
https://www.youtube.com/watch?v=IehtMYl
OuIk
- look for negative or positive symptoms
while watching these videos
PARANOID SCHIZOPHRENIA
https://www.youtube.com/watch?v=PcMJ98
sNZOk
Differential diagnosis
schizophrenia
of
Other psychotic disorders
SCHIZOPHRENIFORM DISORDER – takes at least 1month but less than 6
SCHIZO-AFFECTIVE DISORDER – maniac or depressive episode, delusions present for at least
2weeks
DELUSIONAL DISORDER – delusions without alteration of functioning
BRIEF PSYCHOSIS EPISODE (DISORDER) – due to life stress, disapears usually
MOOD DISORDER WITH PSYCHOSIS
PSYCHOTIC DISORDER DUE TO SUBSTANCE ABUSE OR MEDICAL CONDITION
6. Mood disorders
DEPRESSION
-
major depressive disorder
isolated episode
recurrent depression
Dysthemia/anhedonia
differential diagnostic must be done
carefully!!!
- exclude schizo-affective disorder,
schizophrenia, delusional disorder
- track for maniac, hypomaniac or mixted
episodes
BRAINSTORM ON DEPRESSION
- DEPRESSION IS ON THE RISE – WHY?
◦ Find actual health data about depression
◦ What could be the causes for the rise?
◦ Factors?
◦ Could it be that it is “overdiagnosed”?
◦ In which cases and how come?
◦ WHEN CAN WE ACTUALLY DIAGNOSE
DEPRESSION?
DEPRESSION CLINICAL DATA
SPECIFICATIONS:
- mild, average, severe, with or without
psychotic characteristics
- isolated, chronical
- catatonic, melancholic, atypic, post
partum
Differential diagnostic:
adolescent, instable feelings
hormonal changes (taking the pill), menopausal
changes
CRITERIA OF EVALUATION:
- frequency of depressive humour (episode
at least 2weeks, major one year or more)
- feelings of guilt (unjustified)
- low selfesteem
- basic needs altered to which extent?
- presence of suicidal thoughts
- evaluate depression and reactive
depression (reaction to some life event)
Bipolar disorder
- at least one affective episode (maniac or
depressive) has already been diagnosed in
the past
- mainly diagnosed during the age of 20 to
30 but can also be present among children
attention to periods of unstable hormons!
SEVERAL FACTORS CAN BE THE CAUSE
- family events, infectious diseases, post
partum start, hereditary, metabolism
7. Anxiety disorders
-
panic disorder
panic with or without agoraphobia
specific phobias
OCD
PTSD
generalized anxiety disorder GAD
intense stress
anxiety due to…
Types of phobia
SIGNIFICANT PHOBIAS FOR COMPLEX
PSYCHOTHERAPY
-
fear
fear
fear
fear
fear
fear
of
of
of
of
of
of
commitment
abandonment
separation
loss
death
social interaction/people
8. Somatoform disorders
- main criteria are repeated expressions of physical symptoms and the need (excessive) for
physical examination, consultation with specialists – examinations reveal negative
- physical symptoms are present but cannot explain the patient´s distress
- start of symptoms can be related to a life situation or conflict – patient refuses to accept
psychological cause of problems
◦ DIFFERENTIAL DIAGNOSTIC: histrionic personality, schizophrenia, GAD, depressive episode
TRANSFER OF NEUROTIC SYMPTOMS INTO SOMATIC SYMPTOMS – beginning of 19th century, Freud
◦ Somatisation disorder
◦ Hypochondriac disorder
◦ Fear of physical dysmorphia – preoccupation by a self defined physical default
9. Dissociative disorders
DISSOCIATIVE
DISORDERS
DISSOCIATIVE
AMNESIA
DISSOCIATIVE FUGUE
DEPERSONALIZATION
DISSOCIATIVE
IDENTITY DISORDER
Loss of memory of a
traumatic event
Loss of identity,
escape to another
reality
Feeling of being
detached
Two or more distinct
personalities
9. Dissociative disorders
MAIN CHARACTERISTIC:
FACTORS:
- partial or total absence of normal
integration between memories of the past,
consciousness of identity, actual emotions
and capability to control ones body
- can occur promptly with no trigger
- can last for several weeks, rarely years
- previously referred to as hysteria
(Charcot, Freud, Breuer)
- psychogenic origin
- traumatic life events, toxic or
unfunctional relationships
EMOTIONS:
- lack of self-realization and attention
- unresolved family issues, relations
10. Disorders of sexual identity
SEXUAL DYSFUNCTIONS
- diminution of sexual desire
- aversion towards sexuality
- excitation, erection disorder
- orgasm disorder – man/woman
- praecox erection
- dyspareunia, vaginism
- sexual disorder due to general medical
condition
PARAPHILIA, PARAPHILIC DISORDERS
❑Exhibitionism
❑Fetichism
❑Paedophilia
❑Masochism/sadism
❑Voyeurism
❑frotteurism
MIND LEGAL ASPECTS OF OBTAINED INFORMATION IN THERAPY
DISORDERS OF SEXUAL IDENTITY
SEXUAL IDENTITY DISORDER
Intense and persistent identification with
the other sex or the desire to obtain
cultural benefits attributed to the other
gender.
◦ Among children
◦ Among adolescents
GENDER DYSPHORIA
◦ Discomfort and unhappiness of one´s gender
11. Eating disorders, sleeping disorders
EATING DISORDERS
Anorexia nervosa
Bulimia nervosa
Binge eating disorder
(others, non classified in DSM: Pica (eating non alimentary
substances) Rumination (swallowing, regurgitating, chewing
again) Avoidant food intake
CAUSES:
➢personality traits such as impulsivity, perfectionism,
neuroticism
➢https://www.youtube.com/watch?v=QqNI9aRUb3k - Diana
11. Eating disorders, sleeping disorders
FIRST DEGREE SLEEPING DISORDERS
DYSSOMNIAS
- primary insomnia – difficulty falling asleep
- primary hypersomnia – more than 8-10h
- narcolepsia – excessive daytime
sleepiness
- sleeping disorder due to respiratory
factors
- sleeping disorder due to cardiac factors
PARASOMNIA
- nightmares
- night terrors
- somnambulia
- parasomnia NS
3 CATEGORIES of personality disorder
Paranoid,
distrustful nature,
doubts loyalty,
easily offended
GROUP A – BIZARRE AND EXCENTRIC
❑paranoic personalities
❑ schizoid personalities
❑ schizotypal personalities
- Defense mecanisms applied : imagination,
projection. Way of thinking shows psychotic traits,
vulnerability and stress cause cognitive
desorganisation
Negative
symptoms of
schizophrenia
Schizotypal,
distorted reality,
odd ideas,
eccentric, unusual
experiences,
superstition,
religiosity
Schizoid, socially
withdrawn,
uninterested in
others, solitary,
unaffected by
praise or criticism
3 CATEGORIES of personality disorder
GROUP B – DRAMATIC, UNPREDICTABLE
AND EMOTIVE
❑ histrionic personalities
❑ narcistic personalities
❑ antisocial personalities
❑ border line personalities
- Defense mecanisms applied: denial,
dissociation, clivage, acting out. Mood
swings, dramatization, instability, emotivity.
GROUP C – ANXIOUS, FEARFUL
❑ DEPENDANT PERSONALITY
❑ AVOIDANT PERSONALITY
❑ OCD
- Defense mecanisms: withdrawal dominant,
isolation, avoidance, passive aggressivity,
hypochondric, anxiety, mood swings, doubtful
12. Personality disorders – breakout rooms
OCD
https://www.youtube.com/watch?v=_GT-qKTp9L0
Borderline
https://www.youtube.com/watch?v=rZdjbLFPr5k
Antisocial
https://www.youtube.com/watch?v=y6VLuieUsDI
Schizotypal, schizoid, schizophrenia
https://www.youtube.com/watch?v=Nt9A8OTb-Is
The triangle of our psychological functioning
What is
personality?
Thoughts
Behaviours
Emotions
13. Adjustment disorders
Adjustment DISORDER
* with depression
* depressive humour
* with anxiety
* with conduct disorder
* with emotional disturbances
Maladaptive reaction to life stress, acculturation, change of work/school within 3 month onset of
the stressor. Subjective distress or emotional disturbance.
•CLINICAL CASE: CHILDREN OF DIPLOMATS, EXPATS
•Depending on culture, personality and coping mecanisms
14. Other disorders worth clinical
examination
- relational problems
- neglect or abuse
- simulation
- professional problem
- acculturation problems
- problem connected with life period
- religious issues
- problems related to modern lifestyle
(screen, workaholism, consumerism)
Models of psychologic disorders
BEHAVIORAL MODEL
BIOMEDICINAL MODEL
• First half of 19th century
(Pinel, Tuke) moral model –
punishment for bad
behaviour.
• CURRENTLY: learned
disturbed behaviour – focus
on restructuring the
behaviour – thanks to +feedback (Pavlov).
• Considers the person as sick,
attributes a diagnosis
related to a brain
dysfunction.
• Treatment consists of
psychiatric medication,
hospitalization.
• Patriarchal approach – the
doctor knows
• REPLACE THE MORAL
MODEL
BIOPSYCHOSOCIAL MODEL
• Introduced in the 1970ties
(Engel)
• Attributed mainly in
psychosomatic diseases
• Enriched by the dimensions
of:
• Psychological and social
aspects in etiology and
pathogenesis
• Therapy, prevention and
rehabilitation
Models of psychologic disorders
PSYCHOANALYTIC MODEL
• Psychiatric disorder as a
result of unconscious
conflict
• Uniqueness of disorder –
INDIVIDUAL ETIOLOGY
• Distinction from the
parternalistic model
INTERACTIVE FAMILY
MODEL
• Based on examination of
the communication in
the family of the patient
• Supposed factor:
defective family
functions, where one
individual is catalogued
as psychologically ill
• SYSTEMIC APPROACHES
Other models
• More recent
• Social model
• Conspirative model
(Chromý)
• Psychedelic modeltranspersonal
psychology (Stanislav
Grof)
ROLE OF PSYCHOLOGIST
* to be there
* listen emphatically
* give the support, understanding and encouragement that the person needs at a particular
moment in his life or that he has lacked for a long time – substitute
* play roles – saying
* but also help to structure, sometimes the need to be directive!
* you are not a friend but a expert in your field!
Diagnostic interview versus Therapy
Focused on gaining as much data and
information as possible from the patient.
Focused on letting the patient express,
name, find his issues himself and
consciously process emotions.
➢let patient explain what he is struggling
with in his own words
➢ patient names and you act like a mirror
➢move on to directive questions that will
guide you in your differential diagnostic
➢ help to analyse and concretise but stand
away from interpretation
➢Establish diagnostic hypothesis and
treatment plan – recommend cooperation
with other specialists!
➢ give patient space to access his own
unconscious information through cognitions
or emotions
BRAINSTORM – which therapies do you
know?
https://www.youtube.com/watch?v=M1iev0zph3o
Psychoanalytic currents – 1 - Freud
SIGMUND FREUD 1856-1939
- criticized but broadly used, repeated,
cited, build upon
- first structured approach towards mental
illness, explanation of intrapsychic dynamics
- ahead of his time where lobotomy was
still considered a valid practice
Psychoanalytic currents – 1 - Freud
BASIC THEORY – first matter (Lit.: Freud, interpretation of dreams)
- still plays an important role
In psychotherapy, especially
In trauma therapy, in projective
METAPSYCHIC
Unconscious - primary
Tests (ROR, TAT)
- capacity to reveal secondary
mecanisms
Preconscious - primary
Conscious - secondary
Psychoanalytic currents – 1 - Freud
BASIC THEORY – second matter – the identities
• SUPEREGO
The id – reserve of pulsions
The Super ego – parents, norms, societal constraints
EGO
ID
The ego – myself, my personality, what I reveal in the real world
Freud was persuaded that the super ego is represented by
tension
The father – contested by Melanie Klein
In some theories you will find the distinction between the father and the mother super ego.
Psychoanalytic currents – 1 - Freud
BASIC THEORY – the defence mechanisms (later redefined by several authors, Peary)
- extremely useful in everyday psychological practice to help the patient access deeper
contents/ blocks and trauma
- when the therapist is able to define and name the defence mechanism CAREFULLY and in the
right time – this is actually the foundation of a good psychotherapy!!!
- to be distinguished from dissociation!
https://www.youtube.com/watch?v=9bHm8_kq3DA
Psychoanalytic currents – 1 - Freud
CODING AND THE FREUD DEFINITIONS : E (espace psychique, psychic space)
E = (I, O, P)
I: the pulsions, i1: sexual pulsion (Sexualtrieb), i2: life pulsion (Lebenstrieb), i3: the instinct of death (Todestrieb – from
Greek mythology Thanatos), i4: the instinct of autoconservation (Selbsterhaltungstrieb), i5: the pulsion of power
(Bemächtigungstrieb) – beginning of love stories (adolescence), i6: the pulsion of destruction (personality disorder), i7:
pulsion of aggression, i8: the pulsion of cannibalism (still present in sexual practice), i9: the pulsion of knowledge, i10:
the pulsion of the ego
O: ontogenic forces, parents, siblings, religion, taboos, holding back, controlling oneself, forces of disgust and shame
P: phylogenic forces, the interdiction of the incest, prescolarity and scolarity, police, justice, codes, norms, repressive
economy
The forces of “encrage”, socialization, should be applied in the family (ontogenic forces), if they are not the phylogenic
forces must take the responsibility.
Reference to psychosis and neurosis
If rules are too much repressive, strict
families, religious taboos, effort based
education, forces cannot be sublimed.
NEUROSIS – pulsions cannot be expressed,
they are trapped -OCD - superobedience
……….ontogeneties
………….
………….
SUBLIMATION
If rules are not respected the phylogenetic
forces must “frame” the individual.
Psychosis, antisocial behavior: the stress
tensions are not working, absence of
“framing” can be dangerous!
…….ontogeneties
…………………………………
PULSIONS
……………….
NO SUBLIMATION
PULSIONS
1. Psychoanalytic currents: JUNG
CARL GUSTAV JUNG (1875 – 1961)
- swiss doctor and psychotherapist, founder of analytic psychotherapy
- met with Freud in 1907
- enlarged the Freudian perspective with:
◦ Understanding psychology in relation to mythology, religion
◦ Art, symbols, archetypes
◦ Dreams and the connection to the unconscious
◦ Definition of the term of collective unconscious
JUNGIAN THERAPY
- PARTICULAR WAY OF THERAPY – psychodynamic and psychoanalytic but not only
- helps the patient to understand his experience, feelings and dreams in the context of the
Jungian theory
- abstract, mythologic, philosophic theory
- it implies the knowledge of this theory from both sides
- Jung believed that all symptoms (anxiety, depression etc.) are linked to an issue of the ego –
some message of the unconscious – not always the case (environmental, biological base too)
JUNG VERSUS FREUD
Jung broke with Freud about the theory of personality and the theory of the collective
unconscious. Jung prepared the ground for the humanistic currents of psychology.
They also differed in their concept of perception of the different parts of a personality:
LIBIDO: for Freud psychic energy for sexual gratification, for JUNG a source that motivates
certain behaviours.
CONSCIOUSNESS: Freud: repressed desires, JUNG: repressed memories and our ancestral past.
BEHAVIOUR: Freud: past experiences and trauma, JUNG past experiences in addition to future
aspirations.
EGO: Freud: the Ego is a mediator of the ID, Jung:how one sees oneself, selfregulation
https://www.youtube.com/watch?v=dL0TvdiVN38
1. Psychoanalytic current: LACAN
- French psychoanalytic
- not that known in anglosaxon environment
because of difficulty to translate his “neologismes”
Jacques Lacan (1901-1981)
- called “surrealistic psychoanalysis” inspired by
artists (André Breton, Mallarmé)
- was using automatic techniques that were
supposed to enable immediate access to
unconscious content
MOST FAMOUS CONCEPTS:
- the mirror phase
- our own loneliness and nonunderstanding
- his approach to love and partnership
https://www.youtube.com/watch?v=5OnhOXq7m4w
Lacan as a superstar 18:50
https://www.youtube.com/watch?v=byNaVrE0KrA
2. Client centred therapy : Rogers
1951 – Carl Rogers, Client centered therapy
1968 – Dunod, the development of a person
CARL ROGERS (1902-1987)
- psychotherapist that defended human value in alterity
and the respect that it deserves
- studied clincal psychopedagogics at NY University
- therapist experience for over 30years
CLIENT CENTERED THERAPY
ELABORATION OF A THEORY OF
-
psychotherapy
personality
interpersonal relations
the maxima functionality
BASIS
WHAT DOES EMPATIC ATTITUDE ACTUALLY
MEAN?
- dive into the subjective universe of the
patient
- learn the cognitive and emotional aspects
of his experiencing of others
- verbal and non verbal communication
- empathic attitude of the therapist
GIVE SPACE AND INSCITE TO THE GROWTH
PROCESS.
WHAT IS EMPATHY and what it is not?
NOT
- feeling for the patient
- taking on the symptoms of the patient
- IDENTIFICATION WITH THE PATIENT
YES
- therapeutic empathy takes place in the context of separation!!!
- in the individuality of 2 individuals that communicate
- I AM NOT THE OTHER AND THE OTHER IS NOT ME
- learn to understand the patient´s reality from his perspective not from mine – in a sense of
normality
https://www.youtube.com/watch?v=iMi7uY83z-U – the power of listening - Rogers
Principles of client centered therapy
NON DIRECTIVITY
- don´t show off – unlike the patriarchal
perspective
ATTITUDE OF POSITIVE UNCONDITIONAL
UNDERSTANDING AND CONSIDERATION
❖ considering the other as capable
➢ absence of judgement
❖ therapist is just there to help him find his
way
➢ absence of interventional directivity
❖ GOODWILLED NEUTRALITY
➢ THE MORE THE THERAPIST SEEMS
COMPETENT, THE MORE THE PATIENT
CANNOT ACTIVATE HIS COMPETENCE
➢Does not mean indifference!!!
❖ bring resources to consciousness
❖ enable to understand the origin of
difficulties
❖ find capability to resolve them
5 imperatives of Rogers
Attitude of receptivity,
welcoming, like you
welcome a guest –not
initiative
Focus on what the person
has lived, experienced and
not only on the facts – how
you feel – we are not
journalists
Respect the person and
show that you really care
and consider, show that you
respect his way of life and
his “filter”
Be interested in the person
and not in the problem
itself – the existential
problem – the person not
the pathology is the center
Facilitate communication
without making revelations.
One should not listen to the
patient in order to classify
his speech into
preestablished categories.
HOW?
- ECHO REFORMULTATION
echo response, simple repetition
can also come from the psychologist: is it hard? Yes it is hard for me…
- ECHO REFLECTION
reflect the communication of the patient
retake his idea and reformulate in another way
thinking with the client
- REFORMULATION CLARIFICATION
So if I understand you correctly?...
It is not only something simple it is.... According to you?
HOW?
- RERORMULATION RESUME
focuses on the essential that the client said and explains it to him – take notes
supposes that you have captured the essential that the client wanted to say
reformulates what is essential for the client himself
SPACE FOR REVELATIONS
◦ PROPOSE TO THE CLIENT A REVELATION OF LATENT CONTENT
◦ SUPPOSED EXPLICATIONS OF TRUTH ABOUT HIS “UNCONSCIOUS MECANISMS”
◦ https://www.youtube.com/watch?v=r_yGBnZXFFA - Rogers
◦ https://www.youtube.com/watch?v=4wTVbzvBH0k – role play
3. Gestalt therapy
USES REFORMULATION AS A RE-INVERSION OF THE RELATION FIGURE AND BACKGROUND
- the white, image of a vase, the black – profile
- the figure is detaching from the background
APPEARING OF LATENT CONTENT
https://www.youtube.com/watch?v=GBl14hIqDwc
- explanation
GESTALT THERAPY PRINCIPLES
https://www.youtube.com/watch?v=yJHpnIKM7D4 – the empty chair technique
4. Cognitive -Behavioural therapy
- CBT
- type of psychotherapy that helps people learn how to identify and change destructive or
disturbing thought patterns
◦ Overthinking
◦ Black and white thinking
◦ Catastrophizing
◦ Focusing on negative content
◦ Old, toxic believes
◦ TRIANGLE EMOTIONS, THOUGTHS, BEHAVIORS
Old believes, challenges, new believes
Old believes and situations
Challenges
New believes
Other therapeutic interventions – when to
use what
- techniques of mindfulness
- systemic therapy
- couple therapy
- group therapy
- playtherapy
- sandtray therapy
- art therapy, clay therapy, dance therapy