Applied Clinical Psychology Services (ACPS) Ltd provide bespoke training based upon individual needs for legal and healthcare professionals.
We offer bespoke training to meet your needs in areas such as:
An Introduction to Psychological Assessments in Medico-Legal Work
Psychological assessments in a medico-legal work are different to psychological assessments in other contexts, such as NHS services.
Perhaps the first and perhaps most important difference is that a Clinical Psychologist completing a psychological assessment in a medico-legal context ultimately has a duty to The Court. In this way they act as an ‘expert’ in their specific area of experience in psychology for The Court (e.g. a Clinical Psychologist with expertise in adult mental health difficulties).
Psychologists working in a medico-legal context may work in different areas of law such as in Civil, Criminal or Family Law. Furthermore, each area of practice has their own rules that govern them. For example, in civil litigation cases all experts who prepare a report for The Court must comply with rule set out in Civil Procedure Rules (CPR) Part 35 and also associated Practice Directions to Part 35 (PD35).
The structure of a psychological assessment in a medico-legal context is similar to a psychological assessment in other settings as it would usually include several important areas of enquiry. These are likely to include such things as whether an individual being assessed has any history or pre-existing psychological difficulties, any other predisposing factors that may be considered relevant in the development of the reported psychological problem, what are the factors leading to the maintenance of the reported difficulties and what, if any, factors are preventing the individual from overcoming their psychological difficulties. This understanding of the problem can often be termed a psychological formulation. This is when a psychologist and a client arrive at a shared understanding of the problem. The formulation helps not only to understand the development of the psychological problem(s), but should also help to explain the factors contributing to the maintenance of the problem(s) and the formulation should help to guide the appropriate interventions to address the problem (these can include both psychological and other, perhaps more practical interventions).
Introduction to Cognitive-Behavioural Therapy (CBT)
CBT is a well established, evidence based psychological approach that has been found to be helpful in alleviating many types of psychological problems. CBT has been found to be especially helpful for clients suffering with different forms of anxiety based difficulties such as generalised anxiety, travel anxiety , social anxiety, post-traumatic psychological difficulties (e.g. problems following a traumatic incident); and has also been found to be helpful for mood related difficulties such as low mood / depressed mood. CBT has also been found to be helpful in lots of other different areas too.
The common model adopted in CBT is how our thoughts can influence how we feel emotionally, this in turn effects our physiological response (bodily sensations such as heart racing when we are anxious) and this then influences or behaviours. Put simply, the basic idea is that if we change the way we are thinking about a problem we can then make changes in the other areas, (such as our feelings, physiological responses and behaviours), and this can help to address the problem(s) we are experiencing.
The types of thought that can lead to psychological distress are often referred to in CBT as Negative Automatic thoughts (NATS). CBT helps an individual to identify these NATS, helps to try to understand any specific triggers to these, as NATS are more likely to lead to emotional distress, with associated uncomfortable physiological responses (e.g. heart racing) and problematic behaviours. CBT aims to understand these patterns and try to break them by ‘catching’ the NATS and by trying to objectively evaluate them, we can arrive at more ‘balanced’ thoughts (rather than just ‘positive’ thoughts) and CBT also aims to change behaviours to break any unhelpful patterns that are maintaining a problem.
Introduction to Dialectical Behaviour Therapy (DBT)
DBT is a modified cognitive-behavioural approach. It was originally developed by Marsha Linehan by observing her own work with women who repeatedly self-harm. DBT is now also used with clients with other psychological difficulties. It has a strong reliance on behavioural theory, but it also introduces ideas from Eastern meditative practices (mindfulness). There is evidence it can be helpful, especially with behavioural & emotional regulation problems that can lead to other psychological difficulties. DBT is one of the interventions recommended in NICE Guidelines for Borderline Personality Disorder (NICE, Clinical Guideline 78, 2009).
What is the difference between DBT & CBT?
- CBT emphasises change.
- DBT emphasises both acceptance (mindfulness & distress tolerance skills) & change (emotional regulation & interpersonal effectiveness skills).
- CBT is usually presented as single mode of intervention (e.g. 1-1 therapy or group therapy)
- DBT is a multi-modal intervention with:
- Weekly 1-1 therapy
- Weekly DBT Skills Group
- Telephone Coaching
- Consultation Team (therapist attends DBT consultation team meeting)
Working with Individuals Diagnosed with a Personality Disorder
The term personality disorder is a diagnostic term used to describe a number of difficulties an individual can experience. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association 2013) defines a personality disorder as: ‘an enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture.’
A personality disorder is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment. Some researchers and commentators have also spoken about the 3 P’s of personality disorder – as it is Problematic (for the individual suffering with difficulties associated with a diagnosis of personality disorder and for their family and friends also at times), it is Persistent (it is likely to have been quite a longstanding problem for the individual and it is Pervasive (as it can affect an individual across a range of different areas of their lives).
There are many different types of personality disorder diagnosis that are made in the DSM-V. However, there are three common areas that appear to be apparent in all of the different types of personality disorders:
1. Problems associated with enduring, long standing traits (thinking, feeling and behaviours).
2. Associated with difficulties regulating, managing and tolerating emotions.
3. Difficulties maintaining relationships.
Working with clients diagnosed with a personality disorder can be challenging at times, but also very rewarding. The psychological interventions implemented are more likely to be lengthy, and can be intensive in terms of resources. Psychological interventions that have been shown to be effective include Dialectical Behaviour Therapy (DBT), Mentalisation Based Therapy (MBT) and Structured Clinical Management (SCM).
It is useful to remind ourselves of the first DBT assumption: “clients are doing the best that they can” (given their experiences and the skills that they currently have). For example, clients may not have learnt how to ask for help or care and understanding in an appropriate way. Hence the only time they may have received this was when they were extremely distressed. Clients may then learn (schedules of reinforcement are important here) that the only way to receive any form of help or care and understanding from others is to present as distressed or engage in behaviours which can often present a risk to themselves (e.g. self-harm such as cutting and/or overdoses).
We need to understand the function of our client’s difficulties and therefore a formulation is crucial.
A formulation is a shared understanding, developed with the client, of how an individual’s difficulties may have begun (important aspects of their past contributing to this), what things may be keeping the difficulties in the here and now (the maintenance of the problems) and it should also guide the therapist as to what interventions are likely to be helpful and also hopefully anticipate potential difficulties in the future or help to explain any difficulties encountered in therapy.
Please contact us to discuss any of the above training further or if you have any specific requirements; as we are able to offer bespoke training packages based upon individual needs.