HEALTH/

HOSPI
TALSETTI
NG
COUNSELI
NG

 Thepr of
ess i
onalassist
anc einc opi
ngwi thpersonalproblems ,i
ncludingemot ional
,
behavioral,voc
at i
onal,mar it
al,educati
onal,rehabil
it
ation,andl i
fe-
stage(e.
g.,ret
irement
)
problems.Thec li
nicalpsyc hol
ogistmakesus eofs uc
ht echniquesasac ti
veli
stening,
guidance,advice,dis
cus s
ion,clarif
icat
ion,andt headmi ni
strati
onoft est
s.

 Counseli
ngworkswithc l
ientsf
rom c
hil
dhoodt
hrought ool
dage,focusi
ngon
“devel
opmental(
li
fespan),envi
ronment
alandcul
turalpers
pec
tives,
”includi
ng(
Amer
ican
Psychol
ogic
alAss
ociati
on,2008):

 Is
suesandc oncernsineduc at
ionandc areer
 Deci
sionsregardingschool,work,andr etirementtr
ansit
ions
 Marit
alandf amilyrel
ationshipdiff
iculti
es
 Managingstressf
ulli
feevent s
 Copi
ngwi thillheal
thandphys i
caldisabili
ty
 Mentaldis
or ders
 Ongoingdiff
icult
ieswithgetti
ngalongwi thpeopleingeneral

Thepot
ent
ialout
comesofc
ouns
ell
ingc
anbeunder
stoodasf
all
ingi
ntot
hreebr
oadc
ategor
ies
:

1Re s
oluti
onoft heor
iginalprobl
em inl
ivi
ng.Resoluti
onc anincl
ude:ac
hievingan
under s
tandi
ngorper spect
iveontheprobl
em,ar r
ivingataper s
onalaccept
anc eoft
he
problem ordil
emmaandt akingact
iontochangethesituati
oninwhichthepr obl
em ar
ose.

2Learning.Engagementwi
thcounsel
li
ngmayenabl
ethepersontoac
qui
renew
underst
andings,ski
ll
sandst
rategi
est
hatmaket
hem bet
terablet
ohandl
esi
milarpr
obl
emsi
n
fut
ure.

3Soc
iali
ncl
usion.Counsel
li
ngsti
mul at
est
heener
gyandcapacit
yoftheper
sonass
omeone
whocancontr
ibutetothewell
-beingofot
her
sandthes
ocialgood.

FUNCTI
ONSOFTHECLI
NICALPSYCHOLOGI
STI
NCOUNSELI
NG

1.Topr
ovi
dec
ouns
ell
ings
ervi
cest
ocl
ient
s/pat
ient
sinneedi
nthehos
pit
als
ett
ing.

2.Tof
oll
ow at
ime-
tabl
eforc
ouns
ell
ingandr
egul
arf
oll
ow upofc
lient
s/pat
ient
s.

3.Toadher
etopr
ofes
sionalet
hic
swhenpr
ovi
dingc
ouns
ell
ings
ervi
ces
.

4.Tokeepal
linf
ormat
ionont
hec
lient
/pat
ientc
onf
ident
ial
.

5.Todevelopasyst
em ofdoc
ument
ati
onandr
epor
tingt
hati
sregul
arl
yupdat
edandr
epor
ted
tohospi
talmanagement.

6.Toc
oll
abor
atewi
thot
herc
ouns
ell
orsandpr
ofes
sional
sint
hehos
pit
alandwor
kasat
eam.

7.Tosensi
ti
zet
hehos
pit
alc
ommuni
tyonc
ouns
ell
ingandt
opr
omot
ecouns
ell
ingi
nthe
hospi
tal
.

8.Todevel
opanet
wor
kingandr
efer
rals
yst
em i
ncol
labor
ati
onwi
thhos
pit
almanagement
.

9.Toprovi
deont
hej
obt
rai
ningonc
ouns
ell
ingt
ocouns
ell
ingt
rai
neesandot
her
prof
ess
ionals
.
10.Tos
ett
imef
ors
uper
vis
ionf
orbot
hpeergr
oupandver
tic
als
uper
vis
ion.

11.Tobear
esour
ceper
sonf
ort
hehos
pit
alandt
eac
hingi
nst
itut
ionsat
tac
hedt
othehos
pit
al.

12.Tocar
ryoutanyot
herj
obr
elat
edt
ocouns
ell
ingt
hatmaybegi
venbyhos
pit
al
management.

CONSULTATI
ON

 Consultat
ionistheprocesswherebyani ndividual(theconsul
tee)whohasrespons
ibil
it
y
forprovidingaservic
etoothers(t
hec l
ients)voluntaril
yconsult
sanotherpers
on(the
consult
ant)whoi sbeli
evedtoposses
ss omes pecialexperti
sewhi c
hwi l
lhel
ptheconsult
ee
provideabet t
erservi
cetohisorherclients
.

 Inconsul
tat
ion,t
hegoali
stoi
nc r
eas
etheef
fect
ivenessoft
hos
etowhom one’
sef
for
tsar
e
dir
ectedbyimparti
ngtot
hem somedegr
eeofexperti
se.

 Agrowingnumberofc li
nicalpsychologis
tsserveasconsul
tantst
ophysic
ianswhodeliver
pri
marycareservi
cesinhos pi
tals(helpi
ngaphys ic
iantobettermanagepati
entnon-
compl
iancewithunpleasantmedi calprocedur
es).

 Cli
ni c
alps ychologist
sinhos pital
sof tenengageinconsul
tat
iontointegratepsychologi
c al
servicesseaml essl
yintomedi c
alc are.Theywor kal
ongsi
dephys i
cians,nurses,andother
healthcarepr oviderstoaddr esstheps ychol
ogic
alaspect
sofil
lness,painmanagement ,and
copings t
rategies.Thiscol
labor ati
veappr oachfost
ersaholi
sti
cunder standi
ngoft he
patient,l
eadingt omor eeffectivetreatmentplans.

 Onekeyas pectofc ons

ult
ationi nahos pitalset
tingisthepsychologic
alas s
essmentand
diagnosisc onduct edbycli
nic alpsychologist
s.Theyut i
li
zetheirexpertis
etoeval uat
e
patients
'c ogniti
ve,emot i
onal ,andbehavi oralfuncti
oning,providi
ngval uableinfor
mat i
on
fortreatmentpl anni ngandi nterventi
on.Thi sprocessaidsinidenti
fyingment alhealt
h
disorders,c ogni
tiveimpairment s,andps ychosoc i
alfact
orsinfl
uencingheal t
h.

Phas
es

I
nmos
tcas
es,t
hec
ons
ult
ati
onpr
oces
swi
llpas
sthr
ought
hef
oll
owi
ngphas
es:

1.Theent
ryorpre
par
atoryphas
e.Inthei
nit
ialphas
e,t
heexac
tnat
ureoft
hec
ons
ult
ant
rel
ati
onshipandmut
ualobli
gat
ionsareworkedout
.

2.Thebe
ginni
ngorwar
ming-
upphas
e.I
nthi
sphas
e,t
hewor
kingr
elat
ions
hipi
ses
tabl
ished.

3.Theal
ternat
iveacti
onphase
.Thisphaseenc
ompas s
esthedevel
opmentofs
pec
ifi
c,
alt
ernat
ivesol
utionsandst
rategi
esofpr
oblem s
olvi
ng.

4.Ter
minati
on.Wheniti
smut
ual
lyagr
eedt
hatf
urt
herc
ons
ult
ati
oni
sunnec
ess
ary,
ter
minati
onfoll
ows.

St
andar
dsofet
hic
s

1.Respectf
orAut
onomy:Res
pec
tingi
ndi
vidual
s'r
ightt
omaket
hei
rowndec
isi
onsand
choi
ces.

2.Benef
icence:Pr
omot
ingwel
l-
bei
ng,doi
nggood,andens
uri
ngt
hewel
far
eofi
ndi
vidual
s.
3.Non-
Malefi
cence:"
Donohar
m"-avoi
dingac
tionst
hatmayc
aus
ehar
m ornegat
ive
cons
equenc
es.

4.J
ust
ice:Fai
randequi
tabl
etr
eat
mentf
oral
lindi
vidual
s,avoi
dingdi
scr
imi
nat
ion.

5.Fi
del
ity:Honor
ingc
ommi
tment
s,bei
ngt
rus
twor
thy,andmai
ntai
ningl
oyal
ty.

6.I
ntegri
ty:Uphol
dinghones
tyandt
rut
hful
nes
sinal
lint
erac
tionsandpr
ofes
sionalac
tivi
ti
es.

7.Pri
vacyandConfi
dential
ity:Respec
tingandprot
ecti
ngi
ndi
vidual
s'pr
ivac
yand
maintai
ningt
heconf
ident
ial
it
yofs ensi
tivei
nfor
mation.

8.Profes
sionalCompetence:Maint
aini
ngandenhanc
ingt
hes
kil
lsandknowl
edgenec
ess
ary
foreff
ect
iveandethi
calpract
ice.

9.CulturalCompet
ence:Ac
knowl
edgi
ngandr
espec
tingdi
ver
sec
ult
uralbac
kgr
oundsand
values
.

10.Soci
alResponsibil
ity:Acknowledgi
ngthebroaderi
mpactofpr
ofes
sionalac
tivi
ti
eson
soci
etyandac
tivel
yc ontribut
ingtothewel
fareofcommunit
ies.

Thus
,cons
ult
ati
onmi ghti
nvolveaninformaldi
scus
sion,abriefr
eport
,oramoreongoing
andfor
malconsul
tat
ionarrangement.I
ttakesi
nnumer abl
eforms,i
nmanydiff
erentset
tings
.

BI
OPSYCHOSOCI
ALMODEL

THERI
SEOFBI
OPSYCHOSOCI
ALMODEL

 Thebiomedic
alviewpoi
ntbegant
oc hangewi t
ht heri
seofmodernpsychol
ogy,
part
icul
arl
ywi t
hSigmundFreud’
s(1856–1939)earl
ywor konconversi
onhysteri
a.

 Accordi
ngt oFreud,speci
ficunc
onsciousconfl
ict
scanproducephysic
aldis
turbancest
hat
symboli
zer epr
essedps ychol
ogi
calconfl
ict
s.Al
thoughthi
sviewpointisnolongerc
entralt
o
healt
hps yc
hology,itgaveris
etothefiel
dofpsychosomati
cmedicine.

Ps
ychos
omat
icMedi
cine

 Thei deathatspec i
fici
ll
ness
esareproducedbypeople’sint
ernalc
onfli
ctswasper petuat
ed
inthewor kofFl andersDunbarinthe1930s(Dunbar,1943)andFranzAlexanderi nthe
1940s( Al
exander ,1950)
.Forexample,Al
exanderdevelopedaprofi
leoftheulcer
-pr one
personali
tyass omeonewi thexces
siveneedsfordependencyandlove.

 DunbarandAlexandermaintainedthatconfl
ict
sproduc
eanxiety,whic
hbec omes
unconsc
iousandtakesaphysiologi
calt
ollonthebodyviatheautonomicnervoussys
tem.
Theconti
nuousphysiol
ogi
calchangeseventuall
yproduceanorganicdist
urbance.

 Inthecaseoftheulcerpatient
,forexampl
e,repres
sedemotionsresulti
ngf rom f
rustrat
ed
dependencyandlove-seekingneedswerethoughttoi
ncreas
et hesecreti
onofac idinthe
st
omac h,event
uall
yer odingthestomachl
iningandproduci
ngul cer
s( Alexander,1950)
.

 Dunbar ’
sandAl exander
’swor khelpeds hapetheemer gingfieldofpsychosomatic
medi ci
nebyof feri
ngprofi
lesofpar ti
culardisorder
sbel i
evedt obepsychosomati
cin
ori
gin,thatis,causedbyemot ionalconfli
cts.Thesedis
or der
si ncl
udeul c
ers
,
hyperthyroidism,rheumatoidar t
hr i
ti
s,essenti
alhypertensi
on,neur odermati
ti
s(aski
n
dis
order )
,colit
is,andbronchialasthma.

 Wenow know t
hatal
lil
lnes
sesr
ais
eps
ychol
ogi
cali
ssues
.Mor
eover
,res
ear
cher
snow
 bel
ievet
hatapar
tic
ularc
onf
li
ctorper
sonal
it
ytypei
snots
uff
ici
entt
opr
oduc
eil
lnes
s.

 Rather
,theonsetofdiseaseisusual
lyduetos ever
alf actorsworki
ngt oget
her,whi chmay
incl
udeabiologi
calpathogen(suchasaviralorbac terialinf
ect
ion)coupledwi t
hs oci
al
andpsychol
ogicalf
actors,suchashighst
ress,low socialsuppor
t,andl ow s
ocioeconomic
stat
us.

 Theideathatthemi ndandt hebodyt ogetherdet

erminehealthandillnes
slogical
ly
impliesamodelf orst
udyingthesei s
s ues.Thismodeliscal
ledthebiopsychosocialmodel
.
It
sfundament alassumpti
oni sthatheal thandill
nessareconsequencesoftheinterpl
ayof
biol
ogical
,psychologi
cal
,ands ocialfactors

Advant
agesoft
heBi
ops
ychos
oci
alModel

 Thebi opsychosoc ialmodelmaintai

nsthatbiol
ogic
al,psychologi
cal,ands ocialfact
orsare
alli
mpor t
antdet er minant
sofhealt
handi l
lness
.Bothmac rolevelproc ess
es(suc hasthe
exist
enc eofsocials upportort
hepr es
enceofdepressi
on)andmi crolevelproc es
ses(suc
h
ascellulardis
or der sorchemic
alimbalances)c
ontinuall
yinteracttoi nfl
uenc ehealt
hand
il
lnessandt heirc ourse.

 Thebiopsychosocialmodelemphas i
zesbothhealthandill
ness.From t
hisvi
ewpoi
nt,
heal
thbec omess omethingthatoneachievest
hroughattenti
ont obi
ologi
cal
,ps
ychol
ogi
cal
,
andsocialneeds,ratherthansomethingthati
stakenforgranted.

Cl
ini
calI
mpl
icat
ionsoft
heBi
ops
ychos
oci
alModel

 Thebi opsychosoci
almodeli susef
ulforpeopl
etreatingpatient
saswel l.Fir
s t
,thepr
oces
s
ofdiagnos i
scanbenef i
tf r
om underst
andingt
hei nterac
tingroleofbiological
,
psychological
,ands oci
alfactor
sinassess
ingaper s
on’shealthorill
ness .
Recommendat ionsfortreatmentcanfoc
usonallthr eeset
soffactors.

 Thebiopsyc
hosocialmodelmakesexplic
itthesignif
icanceoftherelat
ionshi
pbetween
pati
entandpracti
tioner.Anef
fecti
vepati
ent-pr
ac t
iti
onerrelat
ionshipcanimprovea
pati
ent’
suseofservices
,theef
fic
acyoftreatment,andt herapi
ditywithwhichil
lnes
sis
res
olved.