The phrase ‘help them to help themselves’ cannot be more appropriate anywhere than in the mental healthcare profession. This is because the direct influence of the mental health professional or the psychologist in producing a desired treatment outcome independently, is considerably limited and much depends on the patient’s ability to cooperate with the treatment. As mental diseases are understood by the observation of behavioral pattern of an individual, technological intervention cannot aid these professionals, like that in physical health care, where X-rays, blood tests and other sophisticated scan systems and analysis conclusively pin point the diseases which are then appropriately followed up for treatment. Specialists in other areas of medicine have benefited from the development in biological sciences, where disease progress mechanisms have been more detailed and specific. Mental health professionals including psychologists do not presently benefit from laboratory testing to confirm the presence or absence of psychopathology. This is mainly because, the underlying processes associated with mental disorders in still unknown.
Mental health professionals cannot benefit by prescribing tests for genetic defects or brain lesions, for evaluating a mental disorder. Clinical psychologists depend on the observations of an individual’s behavior, personal experience and history of make diagnosis and treatment decisions. However, their services related to clinical inference is increasingly sought in both, the medical setting and in the non medical setting. Psychologists diagnose the problems of their clients and accordingly opt for interventions which are more likely to treat those conditions.
Mental health professionals make clinical inferences including diagnosis, treatment choice, violence prediction etc. All these inferences are drawn from independent observation of symptoms and information gathered, which cannot be scientifically confirmed. They seek to develop desirable outcomes in their clients through critical thinking using appropriate skills and strategies. The desirable outcomes in clinical practice include accurate diagnosis, effective treatments and exact predictions on future behavior and acts. When the clinical inferences are right, they improve the lives of people and when these are incorrect, they prolong the psychological distress. Psychologists must analyze critically the decisions they make at all stages of interaction with their clients, including information collection, interpretation of information, treatment selection and treatment evaluation. The psychologists need to form their assessments and decisions using the most and best available evidences. Mental health professionals, thus base the foundations of their diagnosis and treatment on their observation and provided information. The effectiveness of the treatment is directly associated with the validity of the data provided.
The role of mental health professionals also require them to view the perception of illness from the cultural point of view of the effected individual and his circle. The psychologist needs to emphasize to the patient, the role of his culture in the occurrence of the problem, perception of the problem and effective treatments to it. The patient must be advised appropriately of the ways to overcome such effects. This is because within a particular culture, illness has a psychological, social and moral angle. In several under developed societies, health is perceived as a balanced relationship involving people, nature and the mystical powers. Any change in this equilibrium state is perceived to trigger adversities resulting in physical or emotional signs of ill health. Thus some consider backaches as inevitable and part of life and some may consider their ailing children as being normal if the child can walk and play normally. The psychologist by identifying the cultural effects on ill health, can raise awareness. In modern medicine, the placebo effect where the ultimate drug effect is achieved without the use of drugs or by just using sugar pills, is highly culture based. Although placebo and their effectiveness are widely reported, not much is known of its mechanism. However placebos suitable for one cultural group may not be suitable for another group.
A relationship of mutual trust, confidence and understanding between the psychologist and the patient contributes to the placebo effect. The perception of illness and treatment expectations of the patient should be inline with the prescriber’s therapy approach. Belief, expectations and healer-patient relationship also have its own therapeutic effects, which have been utilized in every culture throughout history. Such efforts by the psychologists are effective only when their expectations from the patients are inline. The patients are made to be sensitive to the influences of their culture and family in their treatment and recovery, and their cooperation is sought appropriately. The families of patients do also play a crucial role in their treatment and its success. When a loved one with addiction and mental health problems is to be cared, the family experiences emotional and physical exertion apart from sadness and hopelessness. They are overcome by feelings of guilt, anger and resentment while becoming extremely preoccupied with the affected one’s health and safety (Skinner, 2007). Due to their influential role in aiding and facilitating recovery, psychologists emphasize on the role of the family in the care and treatment of affected patients. Family counseling is an important aspect of treatment criteria for psychologists.
For psychotherapy to be more effective, the client and psychotherapist need to be honest with each other. The client needs to be honest with himself or herself, in the first place. The honesty of the client in therapeutic relationships is the ability of the client to openly express the inner experiences at the moment, completely. The client needs to set aside all psychological defenses associated with the inner experience, and come to terms with the emotional pain. The emotional pain may be associated with parental or social interactions at some point in childhood. Even in their adult life, they continue to experience these painful feelings in all their social interactions. Therefore, the client is likely to experience these feelings even in their interactions with the psychotherapist. Healing and transformation of painful feelings can be achieved only when it is attacked directly in psychotherapy, without shying away from it. Most people seek psychotherapy, with certain dark aspects of their life shrouded in secrecy (Richmond, 2007). They hide such episodes from the psychotherapist, either intentionally or unintentionally, and present themselves in better light. It doesn’t seem to them that their secretive fantasies are the core of their problems and thus the treatment. It is sometimes possible for a chance encounter in psychotherapy to open up the Pandora’s box. Skilled and experienced psychotherapists can infer from frustrations or obstacles occurring in the course of the treatments, which could lead to breaking up of the lid, and real therapeutic work would begin. However when such chance findings are missed and the client prefers to hold on to his secrets, fear and anxiety are only heightened leading to a worsening of the situation, apart from a failure of the therapy.
Physicians complain that about two-thirds of their time is directed to patients whose complaints are more psychological than medical. Such non medical complaints are more associated with anxiety and depression; as stress and its emotional responses create several physical symptoms in people, who turn more to health services. Psychological disorders like anxiety and depression are associated with several physical symptoms. Diarrhea, stomach upset, sweating hands, sleeping difficulties, poor concentration and general agitation are normally associated with anxiety. Depression can lead to fatigue, loss of appetite, difficulties in performing normal activities. Symptoms associated with mood disorders may be thought of as a medical problem, pushing them to seek a physician’s care. The psychologists relate the symptoms to the emotional responses, and offer techniques and exercises to put off anxiety and depression. Stress, anxiety and depression cannot be overcome without the effort of the affected individual to bring changes.
Psychologists often emphasize the importance of social support to well being. The individual’s ability to seek and sustain social support, contributes immensely to healthy life. Social support is perhaps the most important resource against stress. Social ties and relationships have shown to suppress the effects of stress and help individuals to cope up with stressful events, which would otherwise lead to poor health. Studies have shown that social support alleviates psychological problems (Haines et. al.,1996), . Having no social support may itself may be a cause of worry leading to stress development, particularly among people having needs for social support, but not receiving it. Social support reduces psychological and neuroendocrine response to stress. Psychologists study these conditions to evaluate their sympathetic and HPA axis responses to stress. These biotic responses are more apparent when a companion is absent, and is significantly subdued when a companion is present. It has been established by research that positive social experiences effect a series of biological systems which contribute positively to resist occurrence of several chronic diseases in later life (Seeman et. al, 2002). Psychologists have generally advocated development of social contacts, as the effects of social relationships having a profound effect towards physical well being is seen in diverse settings.
It has been established that social support extended via video can also play a supportive role (Thorsteinsson et al., 1998). People experiencing a high quantity or a high quality of social relationships experience lower mortality rates, while isolation can be a major risk factor for death in humans and animals (House et. al, 1988). Social support was also seen to be associated with pregnancy and childbirth. People experiencing higher levels of social support had fewer complications in the course of their pregnancy and delivery. The beneficial effects of social support on cardiovascular, endocrine, immune systems, cancer, respiratory illness and blood pressure has been increasingly perceived. The ability of social support to have moderating effect on stress is explained by the direct effects hypothesis and the buffering hypothesis. The direct effect hypothesis suggests that social support is beneficial during non stressful times as well as highly stressful times. The buffering holds that physical and mental health benefits due to social support are maximum during periods of high stress; while being less during less stress period.
Psychologists associate the ordeal of somaticizers to requiring considerable understanding and cooperation for therapy success. Somaticizers or people who express their distress and emotional conflict through body symptoms, are among the inappropriate users of healthcare. Such people convince themselves that they are ill and seek treatment when they experience a threat to their self-esteem or achievements. Polysymptomatic somaticizers are those patients who present themselves with multiple physical symptoms that generally don’t respond to treatment, and remain chronic and unexplained (Interian, et al, 2004). . There are sufficient grounds however to link somaticization and related hypochondriasis to interpersonal disorders. Hypochondriacs may be more related with insecure attachment, that pushes one to seek care from others. Thus they seek support and reassurance through medical attention (Noyes et al., 2003). It would be surprising to know that post surgery recovery is closely associated with the state of mind. Psychologists are of the opinion that better preparation of patients by providing all information before hand, keeps them more comfortable to the needs and requirements of post surgery recovery. Psychologist Irving Janis conducted a major study on the preparation of patients for surgery in 1958. Janis observed that patients couldn’t cope well with surgery without any anticipatory concerns.
They were seen to experience worry and loss of control associated with surgery, before they were able to come to terms with it. Patients who were highly scared of surgery were seen to be equally feared after their procedure, thus developing negative side effects. Patients who had little to fear before surgery also exhibited unfavorable attitudes like complaining or becoming angry, after the surgery. It was the patients who were moderately fearful, who coped effectively with post operative stress. Most researchers now believe that post surgery recovery is very closely associated with information shared in pre-surgery discussion (Taylor, 2006). Patients who are better informed of the pre-surgery and post-surgery effects would respond better during post operative stages. Patients need to be told before hand about all aspects of normal post operative pain, and breathing exercises that would relieve them of pain. Such patients showed better adaptations to post operative requirements than those who had received very little or no information. Patients well prepared by counseling were less prone to emotional distress and regained their functioning very quickly. Another study found that a post operative roommate can influence post operative recovery by conveying information. Patients were less anxious before surgery and more ambulatory after surgery, when they had a post operative roommate (Kulik et al, 1993).
It is interesting to note the role of psychologists in pain alleviation. Cooperation and efforts by the patient are necessary for getting the intended results. There are several nondrug treatments for pain, including meditation, hypnosis, biofeedback, relaxation training and behavior modification. Such treatments are based on the philosophy that pain can be managed, by the patients themselves doing something about it. By helping the patients change their perception, behavior and attitude associated with pain, they would be able to better cope with pain. Psychotherapy enables patients to benefit from individual or group counseling. Experienced professionals can help patients with chronic pain to adopt crucial coping skills. The patients are also provided psychological and emotional support for dealing with pain. The mental state of people suffering pain is altered through relaxation and meditation therapies, which helps to relax tense muscles and reduce anxiety (About, 2008). A state of relaxed but alert awareness is produced through meditation, which when coupled with other therapies can help people to alleviate pain, by considering pain as being remote and separate from the individual. Behavior modification, sometimes called operant conditioning is directed at changing habits and attitudes, developing in patients experiencing chronic pain. Pain relief through behavior modification is obtained by changing an individual’s lifestyle. With the full cooperation of the patient and his family, mobility and independence are increased through exercising, diet and other related activities. The treatment intends to reduce pain medication and positive efforts of the patients are rewarded and praised. Through biofeedback, patients learn to control certain body functions, when they are provided information related to it. By providing biofeedback through visual and audio cues, patients begin to control relevant body activities through imagery. For instance when temperature of the hands need to be raised, they imagine a warm tropical beach. For pains, biofeedback is a logical attempt, though its method of working is not fully understood.
Adolescent rehabilitation is perhaps more associated with the phrase ‘helping them to help themselves’. Adolescents place on a small demand on the health services compared to the younger children. However, the major health problems associated with adolescents is in the behavioral and social spheres. The adolescent period in the time when the young person strives to become independent from his or her family, takes major decisions on life and enters into relationships with opposites sex members. Adolescence has been traditionally conceived as a period of storm and stress. Incidence of rarer psychiatric disorders like schizophrenia, maniac depressive psychosis and obsessional compulsive states are also associated with the adolescent period. Traditionally clinically psychologists specializing with adolescent problems had worked for psychiatric settings like residential adolescent units. However, it has now been established that clinical psychology services for the adolescents must be administered in close association with a wider network of health education and social services agencies. Although clinical psychologists have been working with adolescents for a long period of time, no separate psychology services exclusively for adolescents have been formed. In the child and adolescents psychiatric setups, the psychologists mainly have an assessment role. For instance, the psychologists would be assigned to carry out psychometric assessments of an adolescent. In the last 10 to 15 years, the responsibility considerably changed for the psychologists with the evolution of sophisticated assessment procedures, often involving direct observation of behavior.
Many psychologists adopt a scientific approach to the clinical problems. The problem is first carefully and objectively described followed by the detailed formulation of the problem, where hypothesis is set up on the origin and sustenance of the problem. Finally the hypothesis are tested though treatment interventions, which are closely monitored. The problems associated with adolescents are diverse in nature including drugs, alcohol, sexual problems, delinquent behavior and attempted suicide. Adolescents strive to gain independence from their family. Thus a fundamental aim of the therapy is to help them gain independence by helping them develop their problem solving skills, so that they can avoid psychological distress. Treatment of young offenders often require ‘training in problem solving skills’ to be imparted as part of the treatment. Delinquent behavior in some youth is mainly because they have not learnt to address social situation in appropriate ways. For example an adolescent may use violent behavior to achieve his intentions, simply because there was no other alternative behavior strategy. To treat delinquent behavior, psychologists carry out social skills training programmes in a community settings. These programmes emphasize eye contact and head movements to more complex interactive skills like interviewing techniques, dealing with teasing, bulling and criticism. The main aim of treatment is to establish behavioral competence in social, educational, vocational and self care skills through modeling and instruction.
In the treatment of alcohol dependents, some basic guidelines are helpful in the treatment of patients with comorbid alcohol use and associated anxiety disorders. The clinical psychologist need to primarily establish a rapport with the patient and emphasize treatment as a common goal. The treatment goal of alcohol dependent patients is abstinence, leading to restoration of all normal functioning. The clinician should initiate efforts to enhance motivation for recovery. Relapse prevention efforts can be initiated when detoxification and motivation are adequate and complete. As abstinence is associated with psychiatric symptoms, the patients need to learn skills to effectively handle high risk situations and craving, together with help in managing anxiety and depression. Although chronic alcoholics may find Alcoholics Anonymous meetings useful, they need considerable encouragement to get initiated and continue with attendance to these meetings. Alcoholics with antisocial personality disorder (ASPD) are extremely uncooperative and disrupt group treatment programmes. Problematic behaviors by such patients include intimidation, stealing, general aggression and even questioning the credibility of the programme. Such behaviors can be restricted by asking the patient sign a contract at the time of admission. The contract should mention rules and the consequences of breaking them, which should be strictly adhered to.
The behavior and social science sectors have begun to be increasingly sought by governmental agencies to advice on policy formations, with regard to health issues. The National Research Council’s Division of Behavioral and Social Sciences and Education (DBASSE) have released over three hundred publications in the last ten years, which are directly or indirectly related to health concerns. These include children, education, family, employment and training. At the individual level, these studies provide knowledge and understanding of health issues like drug, obesity, alcohol abuse, violent behavior, smoking, stress management, illness coping and health decision making. Such knowledge helps in promoting good health attitudes like well-being, distributing healthcare across geographical, sociological and economical boundaries, use and misuse of healthcare institutions and monitoring health provider’s behavior. The behavioral and social sciences knowledge also help in transferring belief through generations, analyze economics involved in alternate healthcare systems and track social and psychological effects on treatment and recovery (NRC, 2005). It has now been widely acknowledged that certain diseases like heart and lung disease, tuberculosis, malaria etc., hitherto considered a realm of biomedical research, cannot be fully understood and treated without support of behavior and social research.
The psychologists of today are increasingly sought in the medical setting, for several reasons. The importance of the mind-body relationship in management of physical illness has been increasingly recognized. Also in the last couple of decades, the increase in stress related disorders were on the increase, requiring stress management techniques and better coping styles. The role of the psychologists has broadened to include to the roles of diagnostician, therapist, teacher, researcher and administrator. Their increasing role in the hospital setting have also been justified by their contributions in most fields of medicine including cardiovascular disorders, pediatrics, gastroenteric disorders etc. Clinical psychologists evaluate cases and plan intervention programmes in medical settings, based on certain vital concepts. The quality of life, coping styles and significant life events are among the crucial parameters that would be assessed for clients with the hospital settings. The quality of life or a sense of well being in the hospital settings, particularly with regard to the medical problem, can result in a change in the level of satisfaction for the patient. Coping styles too contribute to the development and maintaining of the illness. Significant life events may be associated with stress which can affect the psychological functioning of the individual.
In the treatment of cardiac patients, psychologists work with patients to help them deal with the negative or maladaptive defenses like denial, anxiety or depression associated with cardiac ailments. They provide explanations and reassurance which often has a negating effect on the patient’s anxiety. Formal and informal group therapy, behavior therapy including relaxation and coping skills, training and individual psychotherapy are sought by the clinical psychologists. In oncology centers, psychological assessment is a continuous process which help the psychologists to understand the patient, the patient’s strength and weaknesses, environment of the patient, and the coping skills being used. The psychologists plan the intervention to help the patient to function at the highest level physically, emotionally and socially. Here the psychologists educate the patient on cancer, provides individual psychotherapy to strengthen defenses, enhance coping skills and reduce fear. In pediatrics, psychologists attempt to address several issues including learning disabilities, mental retardation, fears, phobias, emotional disorders, etc,. Here the psychological intervention mainly consists of behavior modification, individual counseling, social skills training and rehabilitation counseling. Similarly in obstetrics and gynecology, the importance to psychological aspects is increasing. Premenstrual syndrome has been associated with tension, anxiety, irritability and depression, among others. Even menopause in women is associated with emotional aspects, having symptoms like disease spells, palpitations, night sweat, insomnia etc. Counseling and relaxation techniques are used to help these women.
Autogenics training has been shown to be more effective than Progressive Muscle Relaxation (PMR), although it requires considerable effort and patience to learn. Autogenics training involves a series of exercises which has to be mastered over the course of time. Autogenics training helps to create a sense of warmth physical relaxation and mental peace. Once an individual is proficient with the use of autogenics, it can be used to fight addictions like gambling, smoking etc. It can also be used to overcome unwanted behaviors like nail biting and do away with unexplained fears like the fear of flying. Autogenics training can only be mastered by faithful, long and hard practices. The benefits of these exercises would be appropriate to the efforts, intelligence and desire to produce results.
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