|
|
concept of observation in clinical psychology.
VARIOUS
DEFINITIONS OF
“CLINICAL
PSYCHOLOGY”
Clinical
psychology is an exciting and growing field that encompasses both research and practice related to psychopathology and to mental and physical
health. Understanding, treating and preventing mental health problems and their
associate effect is the business of clinical psychology.
Clinical
psychologists play a central role in the assessment, diagnosis, treatment and
prevention of mental health problems.
Through
the use of psychological tests, interviews, observations of behavior, various
forms of psychological treatment (e.g. cognitive behavioral therapy,
interpersonal psychotherapy, marital and family therapy) clinical psychologists
are on the front line in the treatment of mental health problems.
They
are increasingly involved in the treatment of behavioral and psychological
factors that are related to physical diseases, including cancer, heart disease,
diabetes, asthma and chronic pain etc. They are also involved in the delivery
of programs to prevent mental health problems and to promote positive mental
and physical health.
As
a result, clinical psychologists engage in work in which the stakes are high
and the opportunities are great to bring meaningful changes in the lives of
others.
The
word “Clinical”, derived from the Latin and Greek words for Bed, suggests the
treatment of individuals who are ill. But clinical psychology has come to mean a
broader area than just mental illness of individuals. Among the ultimate aims
of clinical psychology are the psychological well-being and beneficial behavior
of persons; therefore, it focuses on internal psychobiological conditions and
on external social and physical environments within which individuals function.
Clinical
psychology is the largest single speciality within psychology that deals with
principles and skills applied outside the laboratory, it is by no means all of
applied psychology, which includes industrial, educational, organizational,
military and several other specialties.
OTHER DEFINITIONS OF
CLINICAL PSYCHOLOGY
·
Clinical
Psychology is a branch of psychology devoted to the study, diagnosis, and
treatment of people with mental illnesses and other psychological disorders.
·
Clinical psychology is the scientific study, diagnosis, and treatment
of people who have psychological problems adjusting to themselves and the
environment. Clinical psychologists deal with both normal and abnormal behaviors.
They administer and interpret psychological tests, and assist in the diagnosis
and treatment of mental disorders. They also study the structure and
development of personality.
·
Clinical psychology is a broad field of
practice and research within the discipline of psychology, which applies
psychological principles to the assessment, prevention, amelioration, and
rehabilitation of psychological distress, disability, dysfunctional behaviors,
and health-risk behaviors, and to the enhancement of psychological and physical
well-being.
·
Clinical
psychology includes both scientific research, focusing on the search for
general principles, and clinical service, focusing on the study and care of
clients, and information gathered from each of these activities influences
practice and research.
·
Clinical
psychology is a broad approach to human problems (both individual and
interpersonal) consisting of assessment,
diagnosis, consultation, treatment, program development, administration,
and research with regard to numerous populations, including children,
adolescents, adults, the elderly, families, groups, and disadvantaged persons.
·
Clinical
psychology focuses on the assessment, treatment, and understanding of
psychological and behavioral problems and disorders. In fact, clinical
psychology focuses its efforts on the ways in which the human psyche interacts
with physical, emotional, and social aspects of health and dysfunction.
·
According
to the American Psychological Association, clinical psychology attempts to use
the principles of psychology to better understand, predict, and alleviate
"intellectual, emotional, psychological, and behavioral disability and
discomfort" (American Psychological Association, 1981).
·
Clinical psychology is "the aspect
of psychological science and practice concerned with the analysis, treatment,
and prevention of human psychological disabilities and with the enhancing of
personal adjustment and effectiveness" (Rodnick, 1985).
Thus,
clinical psychology uses what is known about the principles of human behavior
to help people with the numerous troubles and concerns they experience during
the course of life in their relationships, emotions, and physical selves. For
example, a clinical psychologist might evaluate a child using intellectual and
educational tests to determine if the child has a learning disability or an
attentional problem that might contribute to poor school performance. Another
example includes a psychologist who treats an adult experiencing severe
depression following a recent divorce. People experiencing alcohol addiction,
hallucinations, compulsive eating, sexual dysfunctions, physical abuse,
suicidal impulses, and head injuries are a few of the many problem areas that
are of interest to clinical psychologists.
Clinical Observation:
Domains
Clinicians
assess the physical aspects such as the appearance of a patient, including
apparent age, height, weight, and manner of dress and grooming. Colorful or
bizarre clothing might suggest mania,
while unkempt, dirty clothes might suggest schizophrenia or depression. If the patient appears much older
than his or her chronological age this can suggest chronic poor self-care or
ill-health. Clothing and accessories of a particular subculture, body modifications, or clothing not typical of the
patient's gender, might give clues to personality. Observations of physical
appearance might include the physical features of alcoholism or drug abuse, such as signs of malnutrition, nicotine stains, dental erosion, a
rash around the mouth from inhalant abuse, or needle track marks from
intravenous drug abuse. Observations can also include any odor which might
suggest poor personal hygiene due to extreme self-neglect, or
intoxication with alcohol.
Attitude,
also known as rapport, refers to the patient's approach
to the interview process and the interaction with the examiner. The patient's
attitude may be described for example as cooperative, uncooperative, hostile,
guarded, suspicious or regressed.
Interpersonal
Characteristics and Approach to Evaluation (oppositional/resistant, submissive,
defensive, open and friendly, candid and cooperative, showed subdued mistrust
and hostility, excessive shyness)
Behavioral
Approach (distant, indifferent, unconcerned, evasive, negative, irritable,
depressive, anxious, sullen, angry, assaultive, exhibitionistic, seductive,
frightened, alert, agitated)
Expressive
Language (no problems expressing self, circumstantial and tangential responses,
anomia, difficulties finding words, misuse of words in a low-vocabulary-skills
way, misuse of words in a bizarre-thinking-processes way, echolalia, mumbling)
Receptive
Language (normal, able to comprehend questions, difficulty understanding
questions)
Gait and
Motor Coordination (awkward, staggering, shuffling, rigid, trembling with
intentional movement or at rest), posture (slouched, erect), work speed, any
noteworthy mannerisms or gestures.
Eye Contact
(makes, avoids, seems hesitant to make eye contact)
Abnormalities
of behaviour, also called abnormalities of activity, include observations of
specific abnormal movements, as well as more general observations of the
patient's level of activity and arousal, and observations of the patient's eye contact and gait. Abnormal movements, for example
choreiform or athetoid movements may indicate a neurological disorder. A tremor
may indicate a neurological condition or the side effects of antipsychotic medication. The patient may have tics
(involuntary movements or vocalizations) which may be a symptom of Tourette's
syndrome. There are
a range of abnormalities of movement which are typical of catatonia, such as echopraxia, catalepsy, waxy flexibility and paratonia. Stereotypies (repetitive purposeless movements
such a rocking or head banging) or mannerisms (repetitive quasi-purposeful abnormal
movements such as a gesture or abnormal gait) may be a feature of chronic
schizophrenia or autism. More global behavioural
abnormalities may be noted, such as an increase in arousal and movement
(described as psychomotor
agitation or hyperactivity) which might reflect mania
or delirium. An inability to sit still might
represent akathisia, a side effect of antipsychotic
medication. Similarly a global decrease in arousal and movement (described as psychomotor
retardation, akinesia or stupor)
might indicate depression or a medical condition such as Parkinson's
disease, dementia or delirium. The examiner would
also comment on eye movements (repeatedly glancing to one side can suggest that
the patient is experiencing hallucinations), and the quality of eye contact
(which can provide clues to the patient's emotional state). Lack of eye contact
may suggest autism.
d) Speech
Speech
(normal rate and volume, pressured, slow, accent, loud, quiet, impoverished)
When observing the patient's spontaneous speech, the
interviewer will note paralinguistic features such as the loudness,
rhythm, intonation, pitch, articulation, quantity, rate, spontaneity and
latency of speech.
Language
assessment will allow the recognition of medical conditions presenting with aphonia or dysarthria, neurological conditions such as stroke
or dementia presenting with aphasia, and specific language disorders such
as stuttering, cluttering or mutism.
People with autism may have abnormalities in paralinguistic aspects of their
speech. Echolalia (repetition of another person's
words) and palilalia (repetition of the subject's own
words) can be heard with patients with autism,
schizophrenia or Alzheimer's
disease. A person
with schizophrenia might use neologisms, which are made-up words which have
a specific meaning to the person using them. Speech assessment also contributes
to assessment of mood, for example people with mania or anxiety may have rapid, loud and pressured speech; on the other hand depressed patients will typically have a
prolonged speech latency and speak in a slow, quiet and hesitant manner.
e)
Mood and Affect
Affect
is the patient's immediate expression of emotion; mood refers to the more
sustained emotional makeup of the patient's personality.
Affect or
how they felt a given moment (comments can include range of emotions like
broad, restricted, blunted, flat, inappropriate, labile, consistent with the
content of the conversation and facial expressions, pessimistic, optimistic) as
well as inappropriate signs (began dancing in the office, verbally threatened
examiner, cried while discussing recent happy event and unable to explain why).
Rapport
(easy to establish, initially difficult but easier over time, difficult to
establish, tenuous, easily upset)
Facial and
Emotional Expressions (relaxed, tense, smiled, laughed, became insulting,
yelled, happy, sad, alert, day-dreamy, angry, smiling, distrustful/suspicious,
tearful when discussing such and such)
Response to
Failure on Test Items (unaware, frustrated, anxious, obsessed, unaffected)
Impulsivity
(low medium, high, effected by substance use)
Patients display a range of affect that may be
described as broad, restricted, labile, or flat. Affect is inappropriate when
there is no consonance between what the patient is experiencing or describing
and the emotion he is showing at the same time (e.g., laughing when relating
the recent death of a loved one). Both affect and mood can be described as
dysphoric (depression, anxiety, guilt), euthymic (normal), or euphoric
(implying a pathologically elevated sense of well-being).
For
example, someone who shows a bland affect when describing a very distressing
experience would be described as showing incongruent affect, which might
suggest schizophrenia. The intensity of the affect may be described as normal,
blunted, exaggerated, flat, heightened or overly dramatic. A flat or blunted affect is associated with schizophrenia, depression or post-traumatic
stress disorder;
heightened affect might suggest mania, and an overly dramatic or exaggerated
affect might suggest certain personality
disorders.
Alexithymic individuals may be unable to
describe their subjective mood state. An individual who is unable to experience
any pleasure may be suffering from anhedonia.
f)
Thought processes
Thought
Processes (could/could not recall the plot of a favorite movie or book
logically, difficult to understand line of reasoning, showed loose
associations, flight of ideas, ideas of reference, illogical thinking,
grandiosity, magical thinking, obsessions, delusions, reports of experiences of
depersonalization, Hallucinations ( visual, olfactory and auditory).
Thought process refers to the quantity,
tempo (rate of flow) and form (or logical coherence) of thought. Thought
process cannot be directly observed but can only be described by the patient,
or inferred from a patient's speech. Regarding the tempo of thought, some people
may experience flight of ideas, when their thoughts are so rapid that their
speech seems incoherent, although a careful observer can discern a chain of
poetic associations in the patient's speech. Alternatively an individual may be
described as having retarded or inhibited thinking, in which thoughts seem to
progress slowly with few associations. Poverty of thought is a global reduction
in the quantity of thought. A pattern of interruption or disorganization of
thought processes is broadly referred to as formal
thought disorder,
and might be described more specifically as thought blocking, fusion, loosening
of associations.
Flight
of ideas is typical of mania. Conversely, patients with depression may have
retarded or inhibited thinking. Poverty of thought is one of the negative symptoms of schizophrenia, and might also be
a feature of severe depression or dementia. Formal thought disorder is a
common feature of schizophrenia. Circumstantial thinking might be observed in anxiety disorders or certain kinds of personality
disorders.
g)
Cognition
Covers
the patient's level of alertness, orientation, sensorium,attention, memory.
Orientation
(person, place, time, presidents, your name)
Alertness
(sleepy, alert, tired for working late, dull and uninterested, highly
distractible)
Coherence
(responses were coherent and easy to understand, simplistic and concrete,
lacking in necessary detail, overly detailed and difficult to follow)
Mild
impairment of attention and concentration may occur in any mental illness where people are anxious and
distractible, but more extensive cognitive abnormalities are likely to indicate
a gross disturbance of brain functioning such as delirium,
dementia or intoxication.
Body
Language interpretation
What people
say could often be very different from what they're thinking or feeling. It's
very easy to say something untrue or insincere, so we can never rely on words
alone.
Fortunately,
there's a proven way to accurately decode people's thoughts, emotions or mood -
and that's by reading their body language. People may lie, but their body
silently and unconsciously speaks the truth.
Examples:
a)
Depressed people tend not to put as much effort into their appearance, body
language and mannerisms, and their communication style tends to be negative.
The following are some other body
forms that indicate frustration:
c) Anxiety is one of the body's
language that can not be identified by one gesture or the other; you have to
combine more than one signal to know whether that person's anxious or not. The
presence of three or more signs of the below shows that this person is anxious:
d)
Lie detection
2: Naturalistic
Observation
Naturalistic
observation is a method of observation, commonly used by psychologists, behavioral scientists
and social scientists,
that involves observing subjects in their natural habitats. Objectively, studying events as
they occur naturally, without intervention. It usually involves observing
humans or animals as they go about their activities in real life settings. The
psychologist looks for cause-and-effect relationships between events and for
broad patterns of behaviour.
Naturalistic observation is a technique used to collect behavioral data in
real-life situations as opposed to laboratory or other controlled settings.
This technique is most useful when little is known about the matter under
consideration. Underlying the interpretation of data obtained through this
procedure is the assumption that the investigator did not interfere with the
natural order of the situation. This type of
research is often utilized in situations where conducting lab research is
unrealistic, cost prohibitive or would unduly affect the subject's behavior.
The researcher simply records what occurs and does not intervene
in the situation. Psychologists use naturalistic observation to study the
interactions between parents and children, doctors and patients, police and
citizens, and managers and workers.
Naturalistic
observation is also common among developmental psychologists who study social
play, parent-child attachments, and other aspects of child development. These
researchers observe children at home, in school, on the playground, and in
other settings.
Procedure:
Usually involves careful observation of participants in their
natural surroundings.
Observational
methods involve an investigator viewing users as they work and taking notes on
the activity which takes place. Observation may be either direct, where the
investigator is actually present during the task, or indirect, where the task
is viewed by some other means such as through use of a video camera.
For example, I might have an interest in the eating
habits of humans. My school has a cafeteria, so I could just sit at a table,
enjoy my lunch with a notebook, and make observations of the eating habits of
my fellow students and teachers. You should pick a behaviour that you do not
have a predetermined theory or even opinion about, though this is difficult to
do.
Examples
1) As an example of
naturalistic observation, the study of parent-child interaction may involve
videotaping the parent and child in their home either as they go about their
daily routine or as they perform an activity given to them by the researcher.
These videotaped interactions can then be taken back to the laboratory and
analyzed using a variety of techniques in order to extract the desired
information from them. This particular research technique has the advantage of
making it easier for research participants to be involved in the study.
2) Sex
Differences in Children's Risk-Taking Behavior
Popular
belief has it that males are bigger risk takers than females. Is this true?
Because
of a lack of empirical evidence on this, Ginsburg and Miller (1982) set out to
find out if young boys or girls are more willing to take risks. They chose the
naturalistic observation method because they wanted to study this behavior in
the real world rather than the laboratory.
The
setting they chose was the San Antonio Zoo. They operationally defined
risk-taking and measured it in four ways:
riding an elephant
petting a burro
feeding animals
climbing a steep wooden
bridge.
The
investigators recorded the number of boys and girls engaging in these
"risky" behaviors. They found that boys engaged in risk-taking
behaviors more frequently than girls.
Benefits
A
main strength of observational studies is that they get to see how participants
actually behave rather than what they say they do. It allows researchers
to observe behavior in the setting in which it normally occurs rather than the
artificial and limited setting of the laboratory. It Enables the study of situations that cannot be
artificially set up. Allows
the observer to view what users actually do in context. Direct observation
allows the investigator to focus attention on specific areas of interest.
Indirect observation captures activity that would otherwise have gone
unrecorded or unnoticed. More natural behaviour occurs if people are unaware of
observation.
A further strength of
observational studies is that they offer ways of studying behaviour when there
are ethical problems with manipulating variables. For example there will be
less ethical issues with carry out a naturalistic observation of school
children compared to carrying out experiments on school children.
Observational studies
are also useful as a starting point in research. For example the researchers
may be investigating a new area of research in order to produce hypotheses for
future investigations such as experiments.
Limitations
Observations do not
provide information about what participants are thinking or feeling.
Observing can be obtrusive and
subjects may alter their behaviour due to the presence of an observer. Co
operation of users is vital and so the interpersonal skills of the observer are
important. Notes and video tape need to be analyzed by the note-taker which can
be time consuming and prevents the task being split up for analysis by a number
of people.
There is little or no
control of extraneous variables in observational studies therefore we can not
make cause and effect statements.
There is also the
problem of observer bias with observational studies. This occurs if the
observers ‘see’ what they expect to see.
A number of ethical
issues can arise with observational studies including problems with a lack of
informed consent and invasion of privacy.
Observations
can also be very time consuming, one may have to wait for
some time to observe the behavior of interest. It requires careful
preparation and possibly training for the observers.
Types
of observations
Naturalistic
observation, can be divided into two main sections, overt and
covert(undisclosed observation).
Overt,
when participant are aware they are being observed. And in covert or
undisclosed observation the participants do not know they are being observed.
That
advantages of using overt naturalistic observation is that you see your
participants in their natural everyday environment, going about their daily
lives as they would normally, however, this can cause demand characteristics in
the participants as they may behave how they think the researcher wants them
to.
The
advantages of using Covert naturalistic observation is that your results will
be extremely high in ecological validity, and there will be very few if none
strange behaviours, however, covert observation of any kind can bring about
numerous ethical issues.
DEFECNCE MECHANISM
These unconscious behavioral or psychological maneuvers enable the individual to minimize or avoid anxiety, affects or impulses arising out of conflict.
denial | distortion | projection
acting out | blocking | hypochondriasis | introjection | passive aggression | projection | regression | schizoid fantasy | somatization
controlling | displacement | dissociation | externalization | inhibition | intellectualization | isolation of affect | rationalization | reaction formation | repression | sexualization
altruism | anticipation | asceticism | humor | sublimation | suppression
affiliation | aim inhibition | autistic fantasy | avoidance | compartmentalization | compensation | conversion | counterphobia | deflection | devaluation | fixation | help-rejecting complaining | idealization | identification | identification with the aggressor | incorporation | instinctualization | introjective identification | moralization | omnipotence | projective identification | resistance | restitution | reversal | restitution | self-assertion | self-observation | splitting | substitution | symbolization | turning against the self | undoing | withdrawal
Also: avoidance mechanism, defence, escape mechanism, mechanism of defense
The use of defence mechanisms can indicate problem areas for a person as a defence mechanism gives some relief from anxiety producing thoughts and actions at the expense of distorting the real world. Defense mechanisms protect us from being consciously aware of a thought or feeling which we cannot tolerate. The defense only allows the unconscious thought or feeling to be expressed indirectly in a disguised form. Let's say you are angry with a professor because he is very critical of you. Here's how the various defenses might hide and/or transform that anger:
Denial: You completely reject the thought or feeling. "I'm not
angry with him!"
Suppression: You are vaguely aware of the thought or feeling, but try to hide it. "I'm going to try to be nice to him."
Reaction Formation: You turn the feeling into its opposite. "I think he's really great!"
Projection: You think someone else has your
thought or feeling. "That professor hates me."
Displacement: You redirect your feelings to another target."I hate
that secretary."
Rationalization: You come up with various explanations to justify the situation (while denying your feelings). "He's so critical because he's trying to help us do our best."
Intellectualization: A type of rationalization, only more intellectualized. "This situation reminds me of how Nietzsche said that anger is ontological despair."
Undoing: You try to reverse or undo your feeling by DOING something that indicates the opposite feeling. It may be an "apology" for the feeling you find unacceptable within yourself. "I think I'll give that professor an apple."
Isolation of affect: You "think" the feeling but don't really feel it. "I guess I'm angry with him, sort of."
Regression: You revert to an old, usually immature behavior to ventilate your feeling or return to a less mature, anxiety reducing behaviour. "Let's shoot spitballs at people!"
Sublimation: You redirect the feeling into a socially productive activity. "I'm going to write a poem about anger.
Repression: the removal of threatening
thoughts from awareness;
Displacement: substituting a less threatening
object for impulses;