Helping aspiring Psychologists be aware of what is important for a person accessing Psychological Services

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A really important post this week for all aspiring Psychologists and, for all aspiring mental health clinicians. TAKE NOTE and read this eye-opening piece.

What to do / what not to do. The important aspects to make people feel understood.  How best the psychologist can support a person in distress. Skills and tips.

By Aine

Background

In 2010, when I finally got to see a clinical psychologist, I was very sedated and traumatised by the system itself and the experience of sectioning.  I have complex Post Traumatic Stress connected to that time in August 2008.  Trust in others is low.  I had lost all confidence in myself. Due to “the Frozen present”, where past trauma can get frozen in time, I found it hard to let go of the difficulties of the past and to live in the present.

I was sectioned after an adverse reaction to the antidepressant Citalopram prescribed for panic attacks.  There were 10 people on my doorstep when an Open Dialogue approach would have been appropriate and less traumatic.  That would have involved me in the decision-making process at the time.  Instead, I experienced coercive ‘’care’’.  It felt more like torture.

I ended up locked into an Acute Psych unit for three weeks and on heavy duty tranquilizers for three years.  This is the same building in which the clinical psychologist administered his tests a few years later.  That may have impacted my test results as going back into that building brought back memories.  In hindsight, I would have preferred a different location. The clinical psychologist was also from a different background and culture which also may have had some impact on how I interacted with him.

After contact with the mental health system, I ended up drifting without direction in life. I had lost my career. Relationships had been fractured by the sectioning process and broken down. Siblings and uncles should not be involved in this process.  An independent mental health advocate should be used.

Writing reports

Write reports as if the person you are writing about will read it at some stage in the future.

Try to write a few positive things.  In all the notes I received from my records there is nothing really positive other than the initial letter of referral by my GP who refers to me as genuine and pleasant.  Most of the notes feel judgemental and on some level a bit soul destroying to read.  Accessing and reading my notes via Freedom of Information was traumatic in itself.

Some of what was written about me felt irrelevant ‘’Co-operative, casually dressed, oriented in time and in person.  Eye contact appropriate, rapport was good.  A little anxious and worried about the timing as she had to take the bus’’.

I would have highlighted that my appointment time needed to fit in with the public transport from my town to where the psychologist was based.

When assessing a person be aware that the drugs they are on can be very sedating and affect how the person is presenting.  Some of my issues at the time included lack of motivation and lack of interest.  I had memory and concentration difficulties, felt indecisive, and lacked self-confidence. ‘’I am going blank’’ was one of my comments.

The notes highlighted that I had stopped Lithium for two days, but that was out of context and seen as a problem.  I had a valid medical reason for stopping this drug for two days, which was not included.  It can become toxic to the person if they ignore certain symptoms.

My notes highlighted that I felt hopeless, irritable, anxious, and that I sometimes cried.  I have issues around sleep and poor sleep quality.  Some of my symptoms seem to be Fibromyalgia even though it is not formally diagnosed.  I still have work to do around sleep and sleep hygiene if I want to have a better life including changing my mattress.  I hope to bring daily meditation into my life and make it a habit.

While looking into my history and picking up on some traumas, it never mentioned the extensive travel I got to enjoy in my younger days and other interests.  It almost paints me as a sad person with no life, highlighting that I attend funerals!  Try to focus in on the good parts of a person’s past and times they were happy as part of generating some Hope that there can be happier times to look forward to in the future.  This is even more relevant in the current pandemic.

Tests administered

Tests administered included Minnesota Multiphasic Personality Inventory (MMPI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Schema Mode Inventory (SMI).

In my psychological tests results, I scored Moderate on BDI and BAI.  On the MMPI test I scored below the cut-off point on three of the validity scales.

‘’Her profile indicates that she got scores on two clinical scales, that is depression above the cut-off point and on the social introversion scales.  The scores above the cut-off point on scale 2 (depression) indicates her dysphoric mode, pessimism about the future, harboured guilt feelings, slow moving, complains of weakness, has somatic complaints, prone to worry, feels useless and unable to function, and maintains psychological distance’’.

‘’The scores above the cut-off point on the social introversion scale indicate that she is socially introverted, more comfortable alone, hard to get to know, sensitive towards other things, submissive compliant, over accepting of authority, and has a slow personal tempo’’.

I do not see myself as introverted.  I like the company of others but also like my own, quiet space sometimes.  I do not feel I am hard to get to know, accepting of authority and that my personal tempo is slow.  I can be very sensitive to how others treat me and what they say.  I need more boundaries in this area.

‘’On the SMI, she has significant scores on the vulnerable child more, on the compliance surrender mode, detached self-soother mode, demanding parent mode, and on the healthy adult mode’’.

My initial reaction is, I am not in the compliance surrender mode, but when I think about recent conflict in personal relationships it makes some sense.  For years, I was helpful to a couple I thought were friends.  I did act in a submissive, subservient, and approval seeking way.  Maybe due to lack of self-confidence, but also to avoid any disagreements.  The relationship was lacking formal boundaries. 

One of the lines in my report reads ‘’The low scale scores indicate her ineffectiveness dealing with the problems of daily life’’.

I would have to ask myself am I ineffective?  I tend to get overwhelmed and distracted by minor issues or changes in routine.  I also have low energy as the day progresses which links back to sleep.

I am on top of daily chores and routines, but sometimes find it hard to manage my time and the day slips away from me.  The last decade or so has had financial implications.  I am capable of being effective with daily living, but that requires daily work.  I tend to ruminate over relationship issues.

Recommendations from the report

My history says I have bipolar disorder, however, I had high scores on depression and scores below the cut-off point on scale 9, that is mania. The plan was to have some sessions to work on my depression and some of the areas that came up in the SMI test. A person’s mood varies depending on when the assessment is done.

From what I remember, I received a lot of hand outs and I am not sure if I read them.  A recovery plan would have required a bit more structure.

In February 2012, I saw a retired psychiatrist but who was also trained as a psychotherapist. He was 83 at the time and now in his 90s.  Prof. Ivor Browne.  One hour with Ivor was intense and felt a lot more effective than my clinical psychology sessions.  Ivor came up with a 9-point plan.  My bipolar symptoms were triggered by the drug Citalopram and stress.  I have since overcome the mania and non-consensus reality, where my thinking is out of sync with so called reality.  Due to tardive dysphoria and life circumstances, I still battle low mood on a regular basis.  WRAP (Wellness Recovery Action Plan) and ASIST (Applied Suicide Intervention Skills Training) help and I occasionally make use of the Samaritans (116 123).

Tips for Psychologists

  • Try to listen without judgement.  Take some of what mainstream psychiatry write with a pinch of salt.  They are looking through a very narrow biomedical lens.
  • Try to show compassion, empathy, and understanding for the person in emotional distress.  Listen to their human story and personal narrative in an open-minded way.
  • Listing out major life events in chronological order can bring some issues to light.
  • A person may feel a sense of Hopelessness and lack of purpose so help them build some Hope into their lives.
  • A Psychologist should aim to help a person gain back some control over their Life.
  • Learn about WRAP as it can help give a structure to Recovery. The five key concepts of WRAP are Hope, Personal Responsibility, Self-advocacy, Education, and Support

    WRAP can be used to develop a wellness toolbox, help deal with triggers and can also be used to write a crisis plan.

  • Journaling can be cathartic at times and help a person process difficult emotions.
  • It may be a good idea to go back over a psychological assessment with the person to see how accurate it reflects their character and traits.  And also to help the person gain new insight into any blind spots in how they see themselves or where some of their struggles are.
  • Watch out for substance use.  For true healing a person may need to get on top of their alcohol or any drug use.  Alcohol might temporarily relieve some symptoms, but long-term cause difficulties in the person’s life.  Problems nearly always float back to the surface.
  • When finishing with a client try to have a closing session so that they do not feel abandoned.  This is something that happened recently with a therapist.

References

[1] Wellness Recovery Action Plan (WRAP): Mary Ellen Copeland et al. www.mentalhealthrecovery.com/

[2] Free WRAP App www.mentalhealthrecovery.com/wrapapp/

[3] Mental Health Matters – Wellness Recovery Action Plan (WRAP) www.youtube.com/watch?v=TnNmGyv1IHo 
[4] WRAP Crisis Plan and Working Through Hard Times (including link to pdf)
www.mentalhealthrecovery.com/info-center/crisis-plan/

I hope you found this article useful and learned some important things about working with people in distress/ struggling with their mental health. Please share the article if you found it useful, and send us any questions via Instagram or Twitter.

Comments (2)

Thank you so much for having the courage and taking the time to write this, Aine. I learnt a lot. All the best for you.

This is an excellent article for Psychologists and trainee Psychologists. Some very important issues raised.

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