SS4707: Counselling and Therapeutic Psychology

Week 5: 20 February 2024

Announcement

Term Paper
- Due on 19 Feb 2024 by 1700
- Deducted 1 sub-grade for late submission for 1 day
- Submission after 7 days will be given a zero mark
- Mitigation
Mock Short Answer Question

Chris is considering using a randomised controlled trial or a

quasi-experimental design to evaluate the use of interpersonal https://padlet.com/4ryvz
psychotherapy versus psychoeducation on treating adults with gj5zt/SS4707
depression in a community outpatient clinic. Based on your
learning in SS4707, suggest 1 strength and 1 limitation of each of
the two designs and conclude with your recommendation to
Chris.
Mock MCQ

What is the advantage of having multiple raters

in evaluating an individual mental health
condition? https://padlet.com/4ryvz
gj5zt/SS4707
A) Decreased Type-I error
B) More flexible time management
C) Improved measurement validity
D) More representative sampling
 Clinical Psychological
Assessment and Formulation
 Title to go here
Why are we talking about Assessment and
Formulation?
Subtitle to go here
Clinical Psychologist: Assessments
Clinical Ax / Psychological Ax
- Psychological factors contributing to presenting problems
Neurodevelopmental Ax
- Intellectual disability, specific learning disability, ADHD
Neuropsychological Ax
- pre/post surgical assessment, post-injury neuropsychological evaluation
Personality Ax
- Personnel selection, training and development
Forensic Ax
- Psychological factors contributing to presenting problems
- Attendance of psychological services
Clinical Psychologist: Assessments
• Suspected mental disorders and psychological formulation

• Suicidal risk

• Psychological factors affecting medical conditions (e.g. compliance

with medical treatment)

• Pre/post procedure psychological evaluation (e.g. organ transplant)

 https://padlet.com/4r
Assessment Exercise yvzgj5zt/SS4707

James (Male/30s) recently lost his job and had

stressful relationship
Title to go here with his partner. At times, he
thought of ending his life and he found it meaningless.
Such thought is strongest
Subtitle to go here
at night when he felt lonely
with difficulty falling asleep. He has seen his GP for
low mood and referred to you for suicidal assessment.
Form a group of 3-5, come up with a list of
factors you will include in a suicidal risk
assessment for James
Suicidal Risk Assessment

Risk Factors Protective Factors

What guide our practice in assessment?
Title to go here
- Research evidence
- Theoretical model
Subtitle to go here
Suicide and Life-Threatening Behavior, 30(1), 18-33.
Psychological factors affecting medical condition
Common Referral Questions
• ? Excessive response to medical condition/treatment
• Crying; anxious
• Compliance problem with medical procedures
• Refuse treatment
• Carer stress; Grief and loss
• Medically unexplained symptoms
• Health anxiety, body dysmorphic
• Psychological problems
• Intellectual functioning, dementia/delirium
 Case Sharing – Mrs. G

Referral from Obstetrics and Gynaecology Ward

Referred for mood assessment after miscarriage
• Female in 30s, married
• Admitted after threatened miscarriage,
miscarriage at last, minimal interaction with
hospital staff, noted quarrel with spouse
• No psychiatric history
• Relevant info: Planned and wanted pregnancy,
husband supportive, clear reason for miscarriage
could not be determined
 Case Sharing – Mrs. G (Service delivered)

• Individual consultation with Mrs. G first,

understanding preference for consultation setting
(physical environment, presence of family
members)
• Provide space and platform for Mrs. G to process
and express current needs; Validation and
Expectation management
• Mood and suicidality assessment
• Liaison work with medical team
• Plan for further services (e.g. out-patient services)
Announcement

Next week 27 Feb 2024 (12-2pm) https://padlet.com/4ryvz

gj5zt/SS4707
- Guest Speaker - Dr. Charles PAU, Director, Hong Kong
Institute of Clinical Psychologists
- Tentative Topic: Professional issues among clinical
psychologists in Hong Kong
- Let me know if you have any questions to ask Dr. Pau (Padlet,
Email)
Psychological assessment for mental disorder
Intake Interview
- Presenting concern (relationship problem? Work stress? Sleep problem?)
- History of development (6W)
- Personal background information (relevant to presenting concern)
- Psychometric assessment (rating forms, neuropsychological tests)
- Clinical impression (suspected mental disorders?)
- Psychological formulation (hypotheses of the different factors contributing
to the presenting concern)
- Management plan (further ax, psychological treatment, further referral)
Case Sharing – Ms A
Inpatient psychiatric referral
Referred for psychological assessment and treatment
• Female in 30s, married with 2 children
• Admitted after suicidal attempt, drug overdose, frequent
crying at ward
• Psychiatrist diagnosis: Borderline Personality Disorder,
depression
• Relevant info: Borderline IQ, suspected domestic violence;
limited family support
 Case Sharing – Ms A (Service delivered)

• Understand and advocate for patient’s need at

ward (Borderline IQ, Borderline Personality
Disorder); aware of stigma and misconception
• Intervention for depressed mood and
suicidality (evidence-based approaches)
• Family meeting and family work
• Close collaboration with Social worker for
suspected domestic violence
• Liaised with community service for borderline
personality disorder treatment and follow-up
What to ask and how to start with a psychological
assessment?
Title to go here
Are there any guiding
Subtitle to go here
approaches/models?
Common approaches in psychological formulation
Generic Approach
- PPP models – predisposing, precipitating, perpetuating factors
- ABC model – antecedent, behavior, consequence

Disorder specific approach

- Cognitive model for OCD (appraisal of the intrusion)

Transdiagnostic Approach
- Emotional dysregulation for mental disorders
Generic approach – PPP model
Predisposing factors doesn’t cause it, but increase the chance
- vulnerability: genes, heredity, congenital/acquired impairment
- Family history, attachment, abuse
- Intellectual disability, pervasive problem
Precipitating factors
- Relationship breakdown, finance stress, work stress, new change in life
Perpetuating factors
- Coping behaviours: substance-use, avoidance behaviours,
perception/appraisal of the problem, treatment compliance, family support
Formulation Exercise https://padlet.com/4r
yvzgj5zt/SS4707

After an accident at work, Jo is currently on sick leave,

spending most of her time at home. Her mood is low. She is
distressed handling litigation and compensation issues
Title to go here
against her employer. She does not want to see her friends.
She is not interested in the things she used to like. Her sleep
is disrupted, appetite
Subtitle is low. She can hardly concentrate with
to go here

low energy level. She often thinks if she could just die
peacefully during sleep
Form a group of 3-5, use the 3Ps model to formulate the
psychological causes of Jo’s presenting concern
Generic approach – ABC model
Antecedent
- Precipitating factors

Behaviour/belief
- Responses / thoughts following the antecedent

Consequence
- What happened after the behaviours was performed / the belief was
activated (emotion, further behaviours, thought about thought)
Disorder-specific model
- Built upon research evidence
- More structured approach: targeted factors
- Indicative for treatment planning (some approaches)

Example
- Cognitive appraisal model for
obsessive-compulsive disorders
• Problem is not the initial intrusive thoughts
• *** But appraisal and response to them
Transdiagnostic approach to mental disorders
- Focus on common pathological processes encompassing a range of menta
disorders
↓ number of protocols for treatment/training
↑ dissemination of evidence-based treatment

- Examples
- Barlow’s Unified protocol for emotional disorders
- Harvey’s transdiagnostic approach to sleep problem (Trans-C)
- Fairburn’s transdiagnostic protocol to eating disorders
 Barlow’s Unified
protocol for
emotional disorder

U don’t have to remember this

In-class reflection
Title to go here
Is a diagnosis not good enough?
Subtitle to go here
https://padlet.com/4ryvz
Why do we need psychological formulation? gj5zt/SS4707
 Two people with depression, Same/Different?
After an accident at work, Jo is
currently on sick leave, spending
most of her time at home. Her mood
is low. She is distressed handling
litigation and compensation issues
against her employer. She does not
want to see her friends. She does
not feel interested In the things she
used to like. Her sleep is disrupted,
appetite is low. She can hardly
concentrate with low energy level.
She often thinks if she could just die
peacefully during sleep
Peter’s brother recently passed away
after being hit by a car. Peter felt
heartbroken and he missed his
brother a lot. He is no longer
interested in what he used to like. His
sleep and appetite are disrupted. He
feels highly guilty for the brother’s
death, thinking he could have saved
the brother if he has driven the
brother home instead of letting the
brother drive. Peter is angry at
himself. Peter often has suicidal
ideation
Questions, Feedbacks, Suggested Quiz Items

You are welcome to email me

Lawrence.wong@cityu.edu.hk

or use the class Padlet

https://padlet.com/4ryvz
gj5zt/SS4707