Core Clinical Skills

Dr. Sabahat Haqqani

Department of Psychology
Capital University of Science and Technology
Contents to covered today
Reflective Practice

1.Self-Assessment and Self-Care

2.Professionalism

3.Critical thinking and problem solving approach in clinical cases

Reflective practice is an essential competency in clinical
psychology training and practice. However, evidence is limited to
support the role of reflection in clinical practice.
 Six-stage process of reflective
practice (Gibbs, 1988)
Central to Gibb's model is the assumption that trainees and professionals can
learn from their positive and negative clinical experiences by reflecting on them
and that such feedback can benefit their performance in related situations.

(a) a description of the clinical interaction

(b) examination of one's thoughts and feelings
(c) evaluation of what went right and what went wrong
(d) analysis of the interaction
(e) conclusions, including what one might have done differently
(f) a formulation of an action plan for what to do in similar clinical interactions
Class activity
• Perform a role play (15 mins)
Who chooses to be a psychologist?
• Numerous data exist that suggest that many psychologists have
histories and vulnerabilities that place us at increased risk for
distress and impairment.
• Almost 70% of female psychologists and 33% of male psychologists
surveyed acknowledged a history of physical or sexual abuse as
children. Additionally, more than one third of those surveyed
acknowledged experiencing some form of abuse as adults.
• Compared with women from other professions, female mental
health professionals acknowledged far greater histories of childhood
abuse, parental alcoholism, and dysfunction in their family of origin,
and they were more likely to have experienced the death of a family
member and the psychiatric hospitalization of a parent.
An Ethical Imperative
• The pursuit of psychological wellness through ongoing self-care
efforts has been described as an ethical imperative (Barnett et
al., 2006).
• Its basis may be found in Principle A, Beneficence and
Nonmaleficence, of the American Psychological Association
(APA) “Ethical Principles of Psychologists and Code of
Conduct” (APA ethics code; APA, 2002), which states, in part,
“Psychologists strive to be aware of the possible effect of their
own physical and mental health on their ability to help those
with whom they work” (p. 1062). This awareness is an important
first step, but clearly much more is needed.
• Standard 2.06 (Personal Problems and Conflicts) of the APA ethics
code states the following:
(a) Psychologists refrain from initiating an activity when they know or
should know that there is a substantial likelihood that their personal
problems will prevent them from performing their work-related activities
in a competent manner.
(b) When psychologists become aware of personal problems that may
interfere with their performing work-related duties adequately, they take
appropriate measures, such as obtaining professional consultation or
assistance, and determine whether they should limit, suspend, or
terminate their work-related activities. (APA, 2002, p. 1063)
Thus self-care should be seen as an ongoing
preventive activity for all psychologists
Professionalism/ professional
competence
• Competence: The knowledge, skills, attitudes, & values
needed to practice effectively and in accordance with prevailing
professional standards and the ability to implement them
effectively for the client’s benefit.
• We can establish, maintain, expand, and lose competence.
• The goal is not exhaustive competence in every clinical area,
rather adaptation, use of resources, and awareness of strengths
and weaknesses in our professional competence.
Problems with Professional Competence
• Decline in ability to effectively utilize and implement existing
knowledge and skills.
• This decline is a gradual process with several contributing factors.
• Impairment may only be evident in hindsight.
• Self-monitoring is a poor method of assessing competence; the
most impaired individuals are often least likely to consider
themselves impaired (Kruger & Dunning, 1999).
• Declining competence or impairment will look different for each
clinician, consider a sliding scale on the continuum between
factors contributing to burnout and impairment.
Demands on psychologist
(a) clients who place great emotional demands on the psychologist
(b) clients with chronic difficulties who do not improve and who
may even relapse at times
(c) clients who attempt or complete suicide and those who
perpetrate aggressive or violent acts against themselves or
others
(d) the requirements of insurance and managed care, which
include increased paperwork demands, adverse utilization
review decisions, and difficulties with receiving payment for
services rendered
• Graduate Clinicians:
Balance classes, dissertation, internship, finances, clients, social life.
• Early Career Psychologists:
Starting a practice, a family, a job, repaying loans, growing a client base
and professional network.
• Mid-Career Psychologists:
Raising a family, running a practice, saving for retirement, supervisory
roles, seeking tenure.
• Late Career Psychologists:
Retirement planning, declining health, ongoing professional commitments.
According to research
• The data reviewed from several researchers highlight the fact that many
psychologists continue practicing without seeking assistance or taking
corrective action even though they know about the adverse impact of their
distress on client care (e.g., Guy et al., 1989; Pope et al., 1987; Sherman,
1996).
• It is also known that many psychologists who become aware of signs of
distress and possible impairment in a colleague tend not to confront or offer
assistance to the colleague (Floyd, Myszka, & Orr, 1998) but may be more
likely to ignore the situation and take no action (Good, Thoreson, &
Shaughnessy, 1995).
• Further, despite the availability of colleague, assistance committees through
many state, provincial, and territorial psychological associations (SPTPAs),
psychologists overall tend not to seek out the services they provide.
Self-Assessment and Self-Care

“ability to refill and refuel oneself in healthy

ways”

• Maintaining awareness of stressors

• Setting healthy boundaries
 Creating a Self-Care Plan (Activity)
• Write a list of the challenges, demands, difficulties and stressors in your life at present.
• Write out your warning signs of the negative effects of stress and distress you have
experienced at different times.
• Write a list of resources in your life that may be of use to you in coping with your identified
stressors -Identify current and future resources in this list. Plan ahead and remember to
make use of the people you identify.
• Write out the self-care activities you presently are using and then the additional ones you
might add. Include activities you no longer use, you may want to revisit them in the future.
• Construct a time budget of a week. Consider your fixed expenses (sleep, meals, commutes,
hours at the office, time for grocery shopping/ essential errands), use the remaining time
budget to input expenses that are optional but desirable to you (social commitments, alone
time, volunteering, religious commitments, free-time).
• Pad your time budget to remain operating around 80% capacity, this will allow you the
flexibility to handle unplanned events or emergencies that may otherwise require sacrificing
planned activities.
Collaborative care
• The ethics code emphasizes personal responsibility requiring
self-monitoring, self awareness, and ongoing self-assessment,
BUT existing literature highlights how ineffective we are at self-
monitoring and self-assessment.
• If our competence is declining, compromised, or impaired,
how are we supposed to uphold competent self-
assessment?
 We must create a collaborative culture of self-care, with a
network of competent colleagues and reliable mentors and/or
supervisors who model appropriate behavior and are invested in
our capacity to thrive.
• Consider personal psychotherapy.
• Participate in peer support groups, colleague assistance programs, and regular
consultation and/or supervision.
• Challenge your “have-to’s.”
• Get comfortable saying “no.”
• Avoid the comparison trap.
• Show yourself the empathy you show your clients. Use skills beyond session for
yourself too.
• Understand that balance is an aspirational moving target but keep working
towards it (flexibly).
• Be forgiving and be honest with yourself and your network of support.
• Understand that no human is an island, and you are a work in progress.
Key Components of Critical Thinking and
Problem-Solving:
Clinical Reasoning: apply knowledge of basic and clinical sciences to
analyze patient data, identify patterns, and form hypotheses regarding
potential diagnoses. Consider the most likely and relevant diagnoses while
ruling out less probable options.
Evidence-Based Practice: Critical thinking in clinical practice involves
the integration of the best available evidence from literature, patient
preferences, and clinical expertise. Use evidence-based guidelines and
research findings to inform decisions and ensure optimal patient outcomes.
Diagnostic Skills: Learn to gather relevant information from patient
histories, physical examinations, and diagnostic tests to arrive at accurate
and timely diagnoses. Must be able to interpret test results and assess
their implications.
Risk Assessment: Must be skilled in assessing the potential risks and
benefits of different treatment options. Consider factors such as patient
health status, comorbidities, and potential side effects to make well-
balanced decisions.
Creativity and Innovation: Critical thinking fosters creativity in
problem-solving. You may encounter complex cases with no clear
diagnosis or treatment plan. You must think innovatively and explore
alternative approaches to address such challenges effectively.
Ethical Considerations: In challenging situations, critical thinking
involves considering ethical principles and patient values when
making decisions. One must navigate morally complex scenarios,
respecting patient autonomy and preserving patient confidentiality.
Continual Assessment and Learning: Critical thinkers recognize
the need for continuous improvement. They reflect on their clinical
decisions, seeking feedback and engaging in lifelong learning to
enhance their problem-solving skills and knowledge.
What Self-Care is NOT

•Something to start after you notice difficulties arising within your practice.
•Another item on a never-ending to-do list.
•Limited to expensive, time-consuming all-day retreats.
•An optional activity done only when all other work is complete.
•An activity that must be done in private or in isolation.
•Not a social (media) obligation.
Maladaptive Coping Strategies

•Working longer hours, cutting the therapy hour to less than 50 minutes, or
seeing multiple clients with no breaks in between.
•Taking fewer vacations, working on days previously requested off, allowing
client contact at all hours.
•Sacrificing personal health needs such as sleep, exercise, or diet.
•Self-medicating: alcohol, drugs, food, caffeine, nicotine, other substances.
•Ignoring warning signs such as exhaustion, apathy, frustration, or illness in
hopes