| Week |
Subject |
Related Preparation |
| 1) |
INTRODUCTION TO CLINICAL INTERVIEW SKILLS
|
-WHILE STARTING:
- In many of the psychotherapy cases, mistakes are made, a deadlock is entered or a failure is made because the suitability and motivation of the patient for treatment are not properly evaluated.
-Some psychotherapists even brag about starting psychotherapy without warming up to interviewing the patient, that is, without properly assessing the patient's psychopathology, self-efficacy and psychological mindset.
PROFESSIONAL RELATIONSHIP:
A professional relationship requires explicit consent from one party to the other party or other person to provide services.
Consensus in counseling or psychotherapy often corresponds to informed consent.
-Professional relationship can also be described as a process in which the service provided is subject to a fee.
PROFESSIONAL AND ETHICAL ISSUES:
-Presenting Yourself: Personal Care and Dressing
-Time: -Start the session on time
-Finish the session on time
-Note taking/Privacy
-Fee
CLINICAL INTERVIEW:
There is a professional relationship between the therapist and the patient.
The therapist has the motivation to achieve a result, albeit minimal, by communicating with the patient.
In this professional relationship, the therapist applies active listening skills and a variety of psychological techniques to assess, understand, and help the patient achieve their goals.
PHYSICAL ENVIRONMENT:
Room:
Does it allow privacy?
-Is it suitable for conversation (seating, comfort, etc.)
Are there any distractions?
-Does it affect the recording of the conversations?
-How should the seating arrangement be?
- Clutter and Order in the Office
-Note Taking
-It is important to clarify questions such as how the Audio and Video Recording Rules should be.
IN THE FIRST MINUTES OF YOUR FIRST MEETING:
You should create a comfortable and safe environment where your patient can gain as much control over the situation as possible!
- If you are meeting for the first time, introduce yourself and state the purpose of this meeting.
-What do you hope to learn?
-What information do you have?
-Tell the estimated time you expect to spend with your patient.
MUST HAVE IN A THERAPY SESSION
-Openness and honesty
-Listening
-No judgment
-don't care
-Acceptance
-Privacy
IT IS IMPORTANT TO CLEARLY EXPLAIN THE WORK EXPECTED FROM THE PATIENT DURING THE SESSION
- What I expect you to do is to be able to speak as openly as possible about the problems and difficulties that are affecting you during our sessions, or to speak as freely as possible, without censorship, about anything in your mind if there are no particular difficulties or problems affecting you at the time.
-The main complaint is the reason for seeking help expressed by the patient. It is usually the first or second sentence of the answer to the opening question:
"Describe the problem that brought you here."
"What's the problem that brought you here?"
DISCOVER PATIENT'S STRENGTHS;
-The capacity to cope with stress,
-Achievements,
-Intrinsic values,
-Friendships,
-Family support.
In addition, hobbies and interests that he uses to cope with his worries can also be considered as his strong areas.
- However, remembering that it is not possible to learn everything in the first meeting, not to shower the patient with questions,
It is also necessary not to give him the impression that he is being questioned.
FINALLY T…
-Contract for the second meeting
-One of the important goals in the first interview is to ensure that the patient comes to the second interview.
So how do we achieve this? |
| 2) |
INTERVIEW TECHNIQUES
|
Hello dear students, the topic of our lesson this week
DIFFERENCES BETWEEN INTERVIEW AND CHAT
-The main purpose of the interview is to try to help the patient by performing the problem-solving process within the framework of a positive relationship.
1- Introduction/ Beginning
2- Data Collection
3- Evaluation
4- Intervention / Therapy
5- Termination
**Steps 2, 3 and 4 form the basis of the process.
Roles:
-One person appointed as therapist and assumed responsibility for the process, and another person appointed as patient. Thus, the roles were determined.
Tasks:
The therapist's role includes clearly defined tasks. At the same time, the patient has responsibility for the implementation of certain tasks.
Responsibility:
- Another difference between interview and conversation is the therapist's responsibility.
Norms:
The social and linguistic rules that govern our daily conversations that we learn can sometimes be inappropriate for interviewing.
Reciprocity Between Participants:
- In conversations between two people, participants are allowed to ask each other many sincere questions to each other.
-In interviews, the therapist's personal identity is hidden, it is outside the boundaries of the interview.
Interruption:
-The therapist's authoritarian interruption is sometimes necessary and allowed for the effectiveness of the interview.
-CASE FORMULATION
Case formulation is a difficult task where every mental health worker has all the information they need to do.
-A good formulation should include as many non-symptoms as present.
Case formulation is a way of understanding and explaining the patient.
It provides a balance between the information we receive and our understanding of the situation.
BIOPSYCOSOCIAL MODEL
Biological dimension: There are neuropsychiatric, genetic and physiological factors that affect brain functions.
Psychological dimension: In addition to the strengths and weaknesses of the patient's psychological structure, it includes dynamic concepts such as defense mechanisms, conscious or unconscious causes of behavior, trauma response, conflict, transference and cotransference.
In the social dimension: The patient's relationships within the family, friendships, out-of-school relationships and relations with the people around him are evaluated in the context of culture, socioeconomic class, religion and ethnicity.
APPLICATION OF EFFECTIVE LISTENING SKILLS AND PSYCHOLOGICAL TECHNIQUES
- It is often assumed that the best way to listen to the patient is to ask skillful questions, but this, like all assumptions, is false.
It is important to ask questions, but this is a directive action and does not always allow the patient to express himself freely.
- In reality, your patient may want to say something very different from what your leading questions emphasize.
GUIDANCE: QUESTIONS AND ACTION SKILLS:
General Question Types
1-Open Questions:
2-Closed Questions:
3-Relaxing Questions:
4-Reflective Questions:
5-Pre-Treatment Change Questions:
6-Result-Specific or Redefinition Questions
7-Rating Questions:
8-Percentage Questions:
9-Assumption Questions:
Directing action responses encourage patients to change their way of thinking, feeling, and behaving.
1-Explanation and Psychoeducation
2-Describing the Consulting Process
3-Making Suggestions!!!
4-Recommendation !!!
5-Compromise-Non-Compromise
6-Incentive
7-Confirmation-Disapproval
8-Disclosure |
| 3) |
INTERVIEW TECHNIQUES
|
FIRST MEETING (family sample)
Therapy begins with the first relationship.
- The person who seeks/voluntarily exchanges
-Usually, the most willing person among family members contact the therapist. It is necessary to be wary of this person's active attempt to win the sympathy of the therapist.
First Interview Stages in the Family
1. Meet
2. Introducing yourself
3. What are the reasons leading to treatment?
4. Each family member's description of the current problem
5. Learning about change goals
6. Reframing the scenario told by the family
7. Making the therapeutic agreement
Observation areas in the family
1-Appearance
2-cognitive process
3-Repetitive behavioral patterns
4-Emotional state
5-What are the defense mechanisms used in the family?
6-How are the existing subsystems and relations in the family?
7-How is the power distribution in the family?
8-How are the boundaries and relationship types in the family?
9-How are the coalition and rules?
FOR A GOOD RELATIONSHIP IN THERAPY
1. Being able to put ourselves in the patient's shoes
2. Accepting that the patient's reactions may not be in line with our understanding
3. Knowing that the patient will misunderstand us and prejudice
4. Not to forget that some of our reactions may be related to our own characteristics.
5. Playing a tolerant leadership role in the relationship
6. Believing that people are fundamentally good and that every person has the potential for personal growth and maturation.
SUICIDE/SUICIDE
Listening to a patient talking about suicide, the therapist must maintain an attitude of calm, non-judgmental seriousness, and patience.
How should suicidal tendencies be investigated?
It would be appropriate to ask questions in an orderly manner by approaching the subject.
What could these questions be?
-How bad do you feel?
Have you thought about harming yourself?
Have you thought about killing yourself?
SUITABLE AND UNSUITABLE ATTITUDES DURING THE INTERVIEW:
Avoid being confused…
-Patient: I want to hurt people who are close to me”
-???
Example of inappropriate attitude:
- How come?
- This is a very bad situation.
– What nonsense?
Appropriate answers:
– “You want to harm close people”?
– What do you mean by the desire to harm?
– what do you mean by harm?
WEEK 4: STORY TAKING
Hello dear students, the subject of our lesson this week is history taking in clinical practice.
The purpose of the psychiatric interview is to try to get to know and understand the individual.
- The purpose of the first interview, aimed at getting to know and understanding the individual, is to collect information on 15 topics:
1. Description of data:
2. The main complaint:
3. Information sources:
4. Reason for application or consultation:
5. Disease history:
6. Healed disorders:
7. Medical history:
8. Social history and premorbid personality:
9. Family history:
10. Mental status examination:
11. Diagnostic formulation:
12. Differential diagnosis:
13. Multiaxial psychiatric diagnosis:
14. Skills and activities:
15. Treatment plan and termination:
Under these headings, the most important points to be considered during the interview (the relationship with the patient, the characteristics of the interview, the problems that may be experienced in the interview and our attitudes towards them, the correct questioning techniques in some disorders) will be among our learning objectives. |
| 4) |
STORY TAKING
|
The purpose of the psychiatric interview is to try to get to know and understand the individual.
- The purpose of the first interview, aimed at getting to know and understanding the individual, is to collect information on 15 topics:
1. Description of data:
2. The main complaint:
3. Information sources:
4. Reason for application or consultation:
5. Disease history:
6. Healed disorders:
7. Medical history:
8. Social history and premorbid personality:
9. Family history:
10. Mental status examination:
11. Diagnostic formulation:
12. Differential diagnosis:
13. Multiaxial psychiatric diagnosis:
14. Skills and activities:
15. Treatment plan and termination:
Under these headings, the most important points to be considered during the interview (the relationship with the patient, the characteristics of the interview, the problems that may be experienced in the interview and our attitudes towards them, the correct questioning techniques in some disorders) will be among our learning objectives. |
| 5) |
MENTAL STATUS EXAMINATION-1
|
Hello dear students, the subject of this course is Mental Status Examination in clinical practice. This lesson is about the patient.
-General appearance and behavior
-Cognitive functions:
-Experience and expression of emotions
-Psychomotor behaviors,
-Idea
-How to observe and obtain information on subjects such as perception will be covered in detail.
In the mental examination, 4 risks should be evaluated for the safety of the patient and others:
1. S (Suicidality-Suicide): Suicide and murder, sudden aggression, harmful dangerous behaviors,
2. O (Organic disturbances):
3. A (Alcohol-Alcohol): Alcohol and substance use disorders:
4. P (Psychotic features): There is impairment of the ability to evaluate reality, delusions, hallucinations, illogical thinking and speech, catatonia. What to do if any.
-Mental status assessment is formed as a result of observations and inquiries regarding this area.
Sometimes these observations are supported by psychological tests.
-Physical observation, findings, formulation, treatments, termination:
All the factors that are thought to play a role in the emergence of the disorder, their interaction with each other, and positive findings are considered together and how the disorder arises is explained.
-Treatment plan, methods,
- Opinions about the departure and the ending, what are the factors that can affect them.
-How is mood, cognitive skills, thinking and perception, cognitions, consciousness, orientation, attention, affect, mood. The way he expresses them and what to pay attention to are important issues. And topics such as how we will use the information we have obtained are among our learning goals. |
| 6) |
MENTAL STATUS EXAMINATION-2
|
Students, we will continue the subject of this lesson, Mental Status Examination. In this lesson, we will learn the basic concepts. So what are these:
- SENSE: People get to know their own bodies and their environment through their sense organs.
PERCEPTION: Characteristics and principles of the perception process.
Perception disorders: Although it is generally accepted that the perception process shows an objective functioning, this is not an absolute objectivity. Error in the perception process and perceptions
and misconceptions may occur. Misconceptions can happen to anyone.
MEMORY (MEMORY):
-It is the function of evaluating, processing, coding, storing in the mind and remembering the learned information and experiences when necessary.'
-Memory is not a single function, but a set of functions.
-What are the features, functions, types and disorders of memory?
THINKING DISORDERS:
The formation, flow, content and control disorders of thought will be discussed.
SPEECH DISORDERS:
Speech is a motor function determined by the thinking process. Conditions that affect motor function in terms of frequency and intensity also affect speech.
- It can be difficult to distinguish speech disorders due to diseases that impair verbal expression and thinking process disorders.
-The formation, flow, content and control disorders of speech will be discussed.
MOVEMENT DISORDERS:
-Man's mental behavior is reflected in his motor behavior.
Behaviors are nonverbal communication tools.
Behaviors can be either voluntary or involuntary.
Behaviors are generally considered to be increased, decreased, or slowed.
Topics such as these are among our learning objectives. |
| 7) |
PSYCHOTHERAPUTIC INTERVIEW-case formulation
|
- Therapist needs vs Client needs:
Whose needs are met in therapy?
The points where we are blind, where we distort the truth?
Our demonstrations of strength that patients pay for?
Our personal conflicts?
THE THERAPIST NEEDS:
1-The need to control
2-The need to show your strength
3- The need to help others
4-The need to direct the values he has
5-The need for respect and appreciation
6-The need for validation of qualification
DEEP INDIVIDUAL SATISFACTION IS NOT BAD, BUT THE PATIENT IS ALSO
MUST BENEFIT FROM THIS
Limits of privacy:
Where should it start and where should it end?
Patient Multiple Relationship Format:
-Conditions to avoid:
-Why inconvenient?
Misuse of power
Patient abuse
Blocking the lens
Set clear policy (boundaries-framework)
Getting supervision if you're in a dilemma
Talking to and informing the patient and obtaining consent
Psychotherapeutic Formulation:
-Psychiatric Case Formulations are the clinician's compass to guide treatment.
It is a recommended method for organizing data about a psychiatric patient and treatment recommendations according to some principles.
AN EFFECTIVE PSYCHIATRIC FORMULATION HAS 3 COMPONENTS.
1-Descriptive Component:
It covers the nature, severity and causative factors of the individual's psychiatric picture.
-The patient's table is basically;
-Is he psychotic?
-Is it characterological?
-Is he psychoneurotic?
Etiologically;
-Is it organic?
-Is it psychogenic?
2-Explanatory Component: “Why did this happen?” answers the question.
3-Treatment-Course Component: The treatment component is “What can be done for this situation?” To the question, the Navigation component is “What is the probability of this happening?” seeks an answer to the question.
CLASSIFICATION:
• Axis I: Clinical Disorders
Other conditions that may be the focus of clinical attention
• Axis II: Personality disorders
mental retardation
• Axis III: General medical conditions
• Axis IV: Psychosocial and environmental problems
• Axis V : General evaluation of functionality
GUIDE TO BIOPSYCHOSOCIAL FORMULATION:
1- Biological Formulation
2- Psychological Formulation
3- Social Formulation
4- Differential Diagnosis
5- Risk Assessment
6- Biopsychosocial Treatment Plan
7- Prognosis
• Case study:
• X lady: Role Play |
| 8) |
FORMULATION IN PERSONALITY DISORDERS
|
Individuals with personality disorders are more likely to refuse to seek psychiatric help than other individuals with psychiatric diagnoses and often deny their problems.
-Symptoms are usually egosyntonic and alloplastic (adaptation by trying to change the external environment)
PERSONALITY: It can be defined as the continuous characteristics and tendencies that determine the differences in the psychological reactions of individuals such as thoughts, emotions and behaviors and cannot be explained by the living moment, biological situation or social environment.
It includes the relatively important and persistent aspects of psychological responses.
CHARACTER: It is defined as a person's way of seeing and perceiving the world and coping with life. Learning and social environment play an important role in character development.
TEMPERATURE: It is behavioral tendencies that are based on innate, more biologically based predispositions.
PERSONALITY DISORDER:
-According to many theorists, personality encompasses almost everything related to the individual mentally, emotionally, socially and physically.
Personality disorder, on the other hand, is a permanent and continuous departure from expected norms in these psychological characteristics.
DSM5: Personality disorder is defined as the presence of long-term adjustment disorder and rigid tendencies, which manifests itself with subjective distress and/or socio-occupational dysfunction in the individual.
DYNAMIC INTERVIEW IN PERSONALITY DISORDERS:
- Two dimensions are always considered together in a dynamic interview; events and feelings. Emotions do not mean much without stating the events, and events do not have much meaning without expressing the feelings.
The therapist is as concerned with what the patient's story is as with how he tells it.
TRANSFER AND FORMULATION:
-Transmission begins even before coming to therapy, so it is necessary to carefully monitor the patient's transference reactions in order to aid formulation.
- Transference: Emotional responses and attitudes based on the patient's experiences in relationships with significant people in his past life and now directed towards the therapist
- In order to maintain the originality of the transfer, the patient should be able to convey his negative feelings easily. |
| 9) |
FORMULATION IN PERSONALITY DISORDERS
|
- Paranoid Personality Disorder
- Schizoid Personality Disorder
- Schizotypal Personality Disorder
- Antisocial Personality Disorder
- Borderline Personality Disorder
- Histrionic Personality Disorder
- Narcissistic Personality Disorder
- Avoidant Personality Disorder
- Dependent Personality Disorder
- Detailed information about the self, defense mechanisms, object relations, and emotions related to Obsessive-Compulsive Personality Disorder are among the learning objectives. |
| 10) |
CASE PRESENTATION / ROLE PLAY
|
The subject of our course is clinical practice.
|
| 11) |
DEFENSE MECHANISMS
|
-Defense mechanisms: are defined as “the mechanisms that are unconsciously used without bringing the problem to the fore in order to cope with anxiety situations caused by unsatisfied needs through inhibition or conflict”.
-The individual develops some behavioral mechanisms in order to keep his existence in balance.
- Suppression (repression) :
-Suppression (repulsion) is the automatic throwing of a thought into the unconscious mind, which may lead to a disintegration in the personality, and which is contrary to the person's mental structure, attitudes and moral values.
-“Remembering”, “unwillingness”, “stagnation” and “distraction”
- Demands pushed to the subconscious by suppression may manifest themselves as “sublimation” (sublimation), “rationalization” and “reflection” (projection) at later stages.
-Only if the suppression is constant (that is, if the person fears that every behavior arising from his motives will cause anxiety) and suppresses them, mental stagnation, dullness and distress will eventually occur.
DENIAL (ignore; denial):
rationalization:
DIRECTION (replacement):
REFLECTION:
IDENTIFICATION (identification):
Learning many defense mechanisms are among the learning objectives of the course. |
| 12) |
PSYCOEDUCATION IN MENTAL DISEASES
|
-Goldman psychoeducation;
-“Educate or develop a person with a psychiatric illness to serve the purpose of treatment and rehabilitation; for example, to enable the person to accept their illness, to promote active cooperation for treatment and rehabilitation, and to strengthen their coping abilities to make up for the losses caused by the illness”
defined as (Goldman, 1988).
The first of the obstacles to psychological intervention is the tendency of patients to deny their illness.
At this point, psychoeducation aims to make patients accept their illness.
-Psychoeducation; to patients with psychiatric disorders and their families; It is used to mean that they are informed about the nature of the disease, its course, treatment options, and how to reach hospital and community-based services, as well as gaining the ability to cope with the disease and related problems (Alataş, Kurt, Alataş, Bilgiç, & Karatepe, 2007).
THE MAIN OBJECTIVES OF PSYCOEDUCATION GIVEN TO PATIENTS;
1-Increased drug compliance and ability to manage the disease,
2- Early recognition of recurrences,
3-Development of effective coping methods with symptoms,
4-Reducing the risk of suicide,
5-It is the development of social and professional cooperation and quality of life.
- By using theoretical and practical information, it is tried to create a feeling of being “responsible” rather than guilty for the consequences of the disease (Çakır & Özerdem, 2010)
PSYCOEDUCATIONAL PROGRAMS CONTAIN THE FOLLOWING STEPS IN BRIEF;
- 1- Giving information on the biological nature of the disease,
- 2-Determining the patient's susceptibility to stress,
- 3-Recognition of the patient's natural coping mechanisms,
- 4-Activating existing support mechanisms,
- 5-Making families an assistant in the treatment process,
- 6-Making new arrangements according to individual differences,
- 7- Putting the patient's priorities and goals at the center of the treatment (Alataş, Kurt, Alataş, Bilgiç, & Karatepe, 2007).
-PSYCO-EDUCATION TO THE RELATIVES OF PATIENTS TO PREVENT SUICIDE
-PSYCHOEDUCATION IN SCHIZOPHRENIA
-BIPOLAR DISORDER PSYCOEDUCATION
-PSYCHOEDUCATION IN ANXIETY DISORDER
-PSYCHOEDUCATION IN PANIC DISORDER
-OCD (OBSESSIVE COMPULSORY DISORDER)
-SOCIAL PHOBIA PSYCOEDUCATION
- EATING DISORDERS PSYCHOEDUCATION
-POST TRAUMA STRESS DISORDER PSYCOEDUCATION
How to give psychoeducation in diseases such as diseases is among the learning objectives. |
| 13) |
ETHICS IN CLINICAL INTERVIEWS
|
ETHICS CONCEPT:
The concept of ethics refers to the internal.
It is related to what emerges after passing through a filter that is closely related to our character and values.
Ethics in its broadest sense is "the doctrine of right action".
- The ethical rules of any profession should give rise to the "motive of good and right action".
ETHICS OF PSYCHOLOGY:
-Psychological ethics; It is based on the basic principles necessary to ensure that the work of psychologists operating in all fields of psychology is applied at the highest level of scientific and quality.
Ethical Understanding in Psychology;
- Adopting the basic principles and why they are important,
- Ability to reflect deeply on challenging specific situations encountered,
-To use an internalized evaluation logic easily,
It includes making ethical principles a part of professional life.
REASONS UNDER ETHICAL VIOLATION
1- Not having learned the ethical rules,
2- Not having competence in the service offered,
3- Not being aware of the violation due to lack of education and mental problems,
4- Insensitivity to the rights and needs of patients, colleagues and students,
5-Exploitative attitude towards service recipients,
RESPONSIBILITY:
Psychologists adopt the principles of honesty, honesty and impartiality in their scientific, educational or practical work.
1. Ethical Responsibility
2. Responsibility to Protect Privacy
3. Confidentiality of Obtained Information
4. Education of Private Information etc. Use for Purposes
5. Responsibility for Accurate Information
The privacy policy can be ignored if:
- If the service provider has caused and/or will cause harm to himself, the psychologist and other people.
- In all cases of abuse of the service recipient, in which the child or adolescent under the age of 18, the non-criminal and the elderly or the disabled.
-Psychologist; does not discriminate against age, identity, gender, sexual identity, sexual orientation, ethnic origin, religion, sect, socio-economic level and disability.
Questions the psychologist may ask the client to minimize the breach of confidentiality:
How can I prevent you from hurting a person?
- Will it help if I get him to stay away from you?
- Can you talk to the person you want to hurt?
Interventions that the psychologist can take to minimize the breach of confidentiality:
- Voluntary hospitalization,
- Determining the duration of outpatient treatment,
- Solutions can be used, such as bringing a family member to prevent harm |
| 14) |
CASE PRESENTATION/ ROLE PLAY
|
The subject of this course is clinical practice.
|
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