BPS Research Digest

A newsletter-cum-blog from the British Psychological Society. Summarising a dozen psychology journal articles each month in accessible prose, the Digest is a good light read and a useful pointer to the full articles.

Unlike the American Psychological Association, the British Psychology Society does not make the members’ monthly journal available online, but does offer the BPS Research Digest: a round up of interesting and thought-provoking recent research.

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Setting homework has negative implications

Setting “homework” for clients implies that no relevant work would otherwise occur between sessions. When clients fail to do their homework but achieve positive change anyway, the focus may fall on the former rather than the latter.

Physical therapies often entail a certain amount of work on the part of the client inbetween sessions with the therapist: daily exercises may be set, weekly diet sheets may be provided, medications may be prescribed.

Psychological therapies may also require work inbetween sessions. The notion that therapeutic change occurs only within sessions, in the presence of the therapist, is disproved by the evidence: the greatest portion of therapeutic change is attributable to factors entirely outwith therapy.

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Think before you act for your client

Stop and think before you take action on behalf of your client. You may be depriving them of the opportunity to help themselves (with appropriate support).

Therapists are people who want to help. People of equivalent qualifications in other fields are usually paid more and have better conditions: we don’t do it for the money, but because we want to make a difference.

Trainees want to help. Faced with overwhelming distress or disability, you want to make a difference but have only a limited repertoire of knowledge to draw upon. You may (mistakenly) feel that you must compensate for your shortcomings and so attempt to offer more practical help where possible.

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I have to breach confidentiality – part 1

Disclosures requiring that confidentiality be breached are rare. A little preparation should permit you to focus upon supporting your client through the process, preserving your therapeutic rapport.

For UK therapists there are three occasions on which it is mandatory that confidentiality be overridden for the greater good: when the client is a risk to themselves, when the client is a risk to others and when there are children at risk; respectively, the therapist must inform the Responsible Medical Officer, the Police and the Social Services.

Particular services and professions may offer more specific guidance and place additional duties upon therapists, but it is likely that you will encounter at least one, if not all, of these eventualities.

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Give clients your full name and title

Introduce yourself with your full name and professional title. Clients can then decide how to address you as rapport builds, especially if you provide a reminder of your name (ie: a readable ID badge).

One client called me “doc” for most of our first meeting, until I felt compelled to advise him that I did not have a doctorate. He replied that he called every therapist “doc” as there were far too many of us for him to remember all our names.

In the first stage of a consultation, clients are bombarded with information, amongst which is the name and / or title of their therapist. People who are anxious or in pain usually have poor concentration and therefore poor memory, so the chances of a client remembering your original introduction are small.

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Claim your chair with your notepad

Use your notepad to claim your chair before the client enters the room. If you can sit where you need to be, there will be no unease to be misinterpreted by the client.

A prison inmate advised me that I was sitting in the “wrong place”. I wasn’t sure what he meant. He explained that I had naively given him the chair nearest the panic button. Although he had no plans to attack me or hold me to ransom, he was concerned that I might make the same error with some of his less forgiving peers.

There are many reasons why a therapist might wish to occupy a given seat in the consulting room: security (proximity to the panic button and/or the door), easy access to equipment (phone, instruments or tests), presentation (if taping the session) or simply a different view. One GP’s room I used had a skeleton in the corner! I always made sure my clients were facing away from this, particularly in discussions of bereavement and chronic illness.

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BBC Health

A source of good advice and good links to other reputable sites. BBC Health can be recommended by therapists who wish to encourage or support internet research by their clients.

Searching the internet for health related topics is a risky business. A site with a professional appearance need not have content of similar standard. BBC Health is a subsection of bbc.co.uk, the British Broadcasting Corporation’s website. The BBC has an international reputation for good journalism

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Demanding clients make legitimate requests

“Demanding” clients are often making legitimate requests. Therapists applying such a label should consider whether it is the client’s requests or the service’s lack of resources which is unrealistic.

“Demanding” is a label often applied to clients by therapists, although rarely within earshot of clients. The label influences the responsiveness of the service to the client’s stated needs by implying that their requests for assistance are in some way inappropriate or excessive.

The stereotypical demanding client is therefore one who places undue demands upon the service, seeking longer or more regular contact with their therapist than is usual or seeking access to medications and other resources which would drain the budget of the service.

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Transfer control of the session with codes

Unfamiliar co-therapists can use code phrases to transfer control of the session. Both they and the client can then focus on the client’s issues rather than the dynamics between the therapists.

While there should be no confusion in the mind of the client as to who is leading the session, there may be some stress for the therapists. Trainees may wonder if and when their supervisor will take over (or in some cases, may wish their supervisor to rescue them!). Supervisors may wish to ask a question or reinforce a point, but hesitate to undermine the trainee by interrupting.

The client’s focus should be on the issues they bring to therapy. Any awareness of unease on the part of their therapist may distract from this focus. Transfer of control of the session from one therapist to the other should be obvious to the client, but wrangling between the therapists should not.

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APA Monitor on Psychology

The newsletter of the American Psychological Association. Discussion articles and summaries of research which will be of interest and use to any therapist, be they American, psychologist or neither.

Online resources for therapists are relatively few in number and the authority of some is questionable. The decision of the American Psychological Association to make its monthly newsletter freely available online is therefore laudable.

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