Clinical Skills: Developmental Psychology – Lecture 1 (UNIVERSITY OF AMSTERDAM)

There are several characteristics of early adolescence (i.e. 10 – 14):

• Heightened emotionalism; more sensitive reactions.
• Very focused on satisfying immediate needs; acting impulsively; here and now focus.
• Separation from parents; peers become very important.
• Do not want to stand out; want to belong to the group; sensitive to peer pressure.

There are several characteristics of middle adolescence (i.e. 14 – 16):

• Inclined to take risks and experiment; sensation seeking.
• Pay little attention to consequences of behaviour.
• More individualization.
• Mood swings.

There are several characteristics of late adolescence: (i.e. 16 – 22)

• Increasingly self-aware.
• More of an identity; less susceptible to peer pressure.
• More responsible for themselves and others.
• Thinking more often wins from feelings; more future-oriented.
• Increasingly good at self-reflection.
• Sometimes for a brief moment very immature.

Resistance of treatment often stems from the fear that the meaning of behaviour (e.g. undesirable behaviour) will not be recognized. The clinician needs to name what one observes (1), switch off judgement (2), ask how one can help (3) and state that the opinion of the client matters (4).

Observation uses a person as an instrument and can serve as a diagnostic technique when observation is used with the aim of drawing conclusions. There are several benefits of observation:

• It can offer explanations.
• Current behaviour is the best predictor of future behaviour.
• It provides a relationship between research data and help-seeking parents.

There are also several problems with observation:

• Selectivity
• Subjectivity
• Determining what is abnormal.
• Instability of perception.

There are several types of observation:

• Participatory observation.
• Self-observation.
• Systematic observation.
• Descriptive observation.

Treatment effects are determined by:

• Technique and model factors (25%).
• Client variables and extra-therapeutic events (40%).
• Expectancy and placebo effects (15%)
• Therapeutic relationship (30%).

A scientist-practitioner works as a clinician and uses conversation skills (1), psychodiagnostics (2) and treatment (3) based on science.

The regulatory cycle focuses on decision making and change. It is purposeful and directional and includes problem-solving. There are several steps:

1. Problem recognition
   This includes recognizing the problem and this is a big part of the intake.
2. Problem definition
   This includes defining the problem and includes theory and diagnostics.
3. Opportunities for intervention
   This includes making an inventory of opportunities for intervention.
4. Make a plan
   This includes determining what steps the treatment will take.
5. Implementing a plan (i.e. intervention)
   This includes conducting the intervention.
6. Evaluation
   This includes evaluating the effect of the treatment.

The regulatory cycle aims to achieve goals to solve a problem while the empirical cycle aims to test whether a hypothesis is correct. Each step in the regulatory cycle involves going through the whole empirical cycle. The empirical cycle should be used to guide the decision-making process. It has several steps:

• Observation (i.e. intake)
• Induction (i.e. formulate hypotheses)
• Deduction (i.e. testable predictions)
• Operationalization (i.e. assessment battery)
• Testing (i.e. questionnaires; tests; treatments)
• Evaluation

The intake refers to the first meeting and has several goals:

• Get to know each other and build a working relationship.
• Get insight into complaints and referral question.
• Formulate goals.
• Provide information about what to expect.

An intake should start by introducing yourself. Afterwards, it is important to provide structure by giving clarity on what a parent is there for (1), how long the conversation will take (2) and what they can expect from you (3). During the intake, it is important to obtain information about:

• General aspects
  This includes what you want to know about a person. This includes:
  • Age of the child.
  • Family composition.
  • Relationship with the parents.
  • Key events.
  • General information regarding the school.
  • Description of the child (e.g. character traits; ecological strengths).
• Complaint-specific aspects
  This includes what you want to know about a specific client or complaint. This includes:
  
  • Situations where the complaint occurs.
  • Consequences of the complaint.
  • Distress caused by the complaint.
  • Onset of complaint.
  • Course of the complaint.
  • Previous treatments.
  • Triggers.
  • School functioning.
  • Influence on friends and family.
  • The person’s health and possible use of medication.
  • Alcohol and drug use.
  • Sexual development, activity or relationship.
• Setting-specific aspects (i.e. what is important in the setting in which you work).
  This is about what is important in the setting in which you work.

It is important to provide a summary when you are ending the consult (i.e. interview). It is important to not bring up new issues (1), postpone issues by the client when raised in an understanding way (2), provide clarity on how to proceed (3), make an appointment for next time (4) and ask whether you have understood everything (5).

The following information should be included in the intake report:

• Personal details.
• Reason for referral.
• What was discussed during the intake.
• Timeline.
• Protective factors.
• Theory of the individual.
• Research questions.
• Impressions and observations.
• Establishing hypotheses for diagnostics.

Diagnostics refers to acquiring and processing information to support decisions to be made in the counselling process in order to arrive at a complete and detailed picture of a problem to treat a client who is seeking help for a problem. It includes a detailed description of the problem (1), the situation in which problems exist (2), the emergence theory (3) and is focused on treatment and assessment for intervention.

Good assessment has several characteristics:

• Proper interpretation and integration of scores and observations.
• Feasible assessment for intervention.
• In consultation with colleagues, child, and parents.

A good assessment requires taking into account the request for help (1), taking into account what tests are appropriate for children (2) and make a proper use of tests (3).

There are several expectations of psychologist-diagnosticians:

• Professional knowledge and skills needed to analyse problems and contribute to the solution.
• Methodical working method and objective.
• Being able to justify choices.
• Professionalism.
• Following the professional code of conduct (i.e. NIP)

The consultation is used to tell the child and/or parents the results of the assessment. It has several characteristics:

• It includes a summary of what you did.
• It includes an answer to the help question.
• It includes information on your conclusions.
• It includes information on a follow-up or course of action.
• It is given within a good working relationship.