Bridge to clinical psychology. Часть I. Учебное пособие для студентов факультета клинической психологии

sume our food? Meals should be eaten slowly as chewing aids digestion. Eat your meals at your own pace but do not eat hurriedly – take your time. Try to enjoy the aroma and taste of the food. Food is used functionally to maintain metabolic processes in our bodies and prevent nutrient deficiency states, but it is also incorporated as part of our culture and social tool. Hence, you could have some of your meals together with friends, family or other people who you enjoy sharing company with preferably in a relaxed atmosphere.

6. Tips for Students in Distress

Students typically encounter a great deal of stress during their university years (i.e., academic, social, family, work, financial). While most students cope successfully with the demands of college life, for some the pressure can become overwhelming and unmanageable. Students may feel alone, isolated, helpless and even hopeless. These feelings can easily disrupt academic performance and may result in harmful behaviours such as substance abuse and attempts at suicide.

Faculty and staff members are in a unique position to identify and help students who are in crisis. This may be particularly true for students who cannot turn to family or friends. Anyone who is seen as caring and trustworthy may be a potential resource in time of trouble. Your expression of interest and concern may be a critical factor in saving students’ academic careers or even their lives.

If you choose to approach a student you’re concerned about or if a student reaches out to you for help with personal problems, here are some suggestions which might make the opportunity more comfortable for you and more helpful for the student.

TALK to the student in when both of you have the time and are not rushed or preoccupied. Give the student your undivided attention. It is possible that just a few minutes of effective listening on your part may be enough to help the student feel cared about as an individual and more confident about what to do.

If you have initiated the contact, express your concern in students behaviour, in nonjudgmental terms. For example, «I’ve noticed you’ve been absent from class lately and I’m concerned,» rather than

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«Where have you been lately? You should be more concerned about your grades.»

LISTEN to thoughts and feelings in a sensitive. Communicate understanding by repeating back the essence of what the student has told you. Try to include both content and feelings. Let the student talk.

GIVE hope. Assure the student that things can get better. It is important to help them realize there are options, and assure that things will not always seem hopeless. Suggest resources: friends, family, clergy or professionals on campus. Recognize, however that your purpose should be to provide enough hope to enable the student to consult a professional or other appropriate person and not to solve the student’s problems.

AVOID judging, evaluating, and criticizing even if the student asks your opinion. Such behaviour is apt to push the student away from you and from the help he or she needs. It is important to respect the students value system, even if you don’t agree with it.

MAINTAIN clear and consistent boundaries and expectations. It is important to maintain the professional nature of the faculty/student or staff/student relationship.

REFER. In making a referral it is important to point out that: 1) help is available and 2) seeking such help is a sign of strength and courage rather than a sign of weakness or failure. It may be helpful to point out that seeking professional help for other problems (medical, legal, car problems, etc.) is considered good judgment and an appropriate use of resources. For example, «If you can, prepare the student for what they might expect if they follow your suggestion. Tell them what you know about the referral person or service.

FOLLOW-UP. Arrange a time to meet with the student again to solidity his resolve to obtain appropriate help and to demonstrate your commitment to assist him in this process. Check later to see that the referral appointment was kept and to hear how it went. Provide support while the student takes further appropriate action or pursues another referral if needed.

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CONSULT when in doubt about the appropriateness of an intervention, call the Dean of Students Office, the University Police Department, or the University Counseling Center. A student whose behaviour has become threatening, violent, or significantly disruptive may need different kinds of approach.

In case of emergency, we should react immediately. Situations involving student psychological issues can be complex and confusing.

7. Henry Fuseli, Nightmare, and Sleep Paralysis

Henry Fuseli painted «the Nightmare» in 1781. The picture is dramatic, and it has been used to illustrate articles in professional journals. The painting has several features of sleep paralysis.

Fuseli was an Anglo-Swiss painter and author, born in Zurich, Feb 7, 1741. His father was a court painter and town clerk. Henry Fuseli was educated at the Collegium Carolinum in Zurich. He started to study theology but left home because of problems stemming from a political publication. He went to Berlin, and then in 1764 to London on the recommendation of the British ambassador. In 1770 he went to Italy to become a painter, having been encouraged by Sir Joshua Reynolds. He sent his first work to the Royal Academy in 1774, studied Michelangelo in Rome, visited Naples in 1775, went to Zurich three years later, returned to London in 1779, and two years later, painted «The Nightmare». He was elected an associate of the Royal Academy in 1788 and soon became a member. Fuseli contributed nine works to John Brydell’s Shakespeare Gallery and established his own Milton Gallery in 1799 with 40 large paintings. It met with moderate success. He was professor of painting at the Royal Academy from 1799 to 1805 and was reelected in 1810. Fuseli died on April 16, 1825, and was buried in St. Paul’s Cathedral. A three-volume edition of his life and writings was prepared by John Knowles in 1831.

Exotic, original, and sensual are adjectives used to describe Fuseli’s work. He was small in stature, witty with a biting quality, and well known in the artistic life of London. His paintings are seen as

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dream-like and apparently still influence imaginative works today. Knowles said «The Nightmare» was his most popular picture, and

that it had no equal in the originality of its conception. Knowles possessed the first drawing of this scene. It had been done chiefly in black chalk and did not show the head of the mare which is clearly seen in the painting. This head was a later development of the theme. When the painting was exhibited in 1782 it «excited, as it naturally would, an uncommon degree of interest». It was sold for 20 guineas and later was engraved. The prints were commercially successful. Knowles said Fuseli painted several pictures of «The Nightmare» at different periods, with variations from and additions to the first drawing.

«The Nightmare» represents the phenomenon known as sleep paralysis. The clue is the demoniac character squatting on the abdomen and chest of the supine woman. When some people refer to sleep paralysis they may call it a nightmare, but descriptions of it permit precise and special classification. Others who have ordinary nightmares and sleep paralysis as well can make the differentiation.

Sleep paralysis occurs when falling off to sleep or waking from it. Those who suffer from it generally have much anxiety during an episode, cannot talk or shout despite efforts to do so, may attract attention by moaning, feel half awake and half asleep, and are aware of their actual surroundings. Attacks usually seem to last a long time but may take only a minute or two. In some instances the person can break the paralysis by suddenly moving his head, arm, or leg. A person may actually try to force the body partly off the bed, as Fuseli’s painting illustrates. A touch by someone nearby frequently terminates the attack. Sleep paralysis, which varies in frequency of occurrence, is usually not accompanied by narcolepsy or cataplexy, although medical writings have long combined descriptions of them.

Terrifying hypnagogic hallucinations may be part of sleep paralysis attacks. In Fuseli’s painting the grotesque, squatting figure is an important link with reports of some sleep paralysis victims who say that «someone or something is sitting on my chest» and describe the figure. This has frightening implication for the victims, with the

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sensation of weight and constriction contributing to the feeling of suffocation and anxiety.

The inability to scream, the sleeper’s awareness of his actual location in bed, full recollection of the events of the episodes, and the invariable paralysis that does not necessarily occur in ordinary nightmares, all point up some of the differences between sleep paralysis and descriptions of sleep terror of children and the nightmare of adults. Its representation by Fuseli as a nightmare is not surprising because in a general sense it can easily be so called but in a more specific way, especially with the presence of the terrifying, squatting figure, it lends itself well to depiction on canvas.

Various aspects of medicine have long been represented in art. Fuseli‘s «The Nightmare» is a good illustration of a theme that has medical interest, a common term for hallucinatory, disturbed sleep. It actually represents a specific phenomenon, however, in this case «sleep paralysis», which long after the painting appeared was described in clinical terms and given its special name, specific description, and intensive psychological evaluation.

8. A Framework for the Consultation

The ‘consultation’ is the basic unit of activity in medical practice, whether in general practice or in hospital. General practitioners carry out between 30 and 40 each full working day. On average a consultation lasts between 5 and 10 minutes, but some are shorter and others last longer. The ‘illness’ presented may be defined as physical, psychological or social or any mix of the three. The clinical focus can be put on presenting symptoms or signs, on methods of investigation, or on patterns of diagnosis or treatment.

The first essential for any framework for the consultation must be that it is able to accommodate the fashions and beliefs of the times and to recognize that appropriate care for patients has to be placed not only in the setting of current beliefs about illness but also against the backdrop of beliefs that were once held – or may come to be held in the future. The patient’s needs may be met by the reassuring words of the general practitioner whereas another presenting with

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the same problem may need extensive (and expensive) investigation and possible referral to hospital. Thus the second requirement of a framework for the consultation is that it recognizes that no two patients are the same.

Doctors are as much individuals as are their patients. Their professional beliefs about the goodness of different approaches to health care are also influenced by their own personal experience as patients, as parents or as relatives and by their views of the interaction between medicine and society.

The conduct of an individual consultation is an interaction of three components. Two are people, namely the patient and the doctor; the third is the problem under discussion, or «the illness».

Health promotion covers a broad range of activities within the setting of general practice which aim to prevent disease and to encourage wellbeing. Prevention may involve the removal of, or the avoidance of, the causes of disease. Primary prevention includes traditional public health measures such as childhood and foreign travel immunization as well as the individual’s avoidance of potentially injurious habits (e.g. smoking, excess alcohol, unhealthy diets and unsafe sex). Secondary prevention relates to the early detection of disease (e.g. hypertension and diabetes). Tertiary prevention is part of the management of established disease to minimize disability (e.g. asthma and diabetic clinics).

Infants are screened in their first few days for treatable abnormalities such as congenital dislocation of the hip. The routine immunization programme aims at protecting the child against diphtheria, tetanus, pertussis, poliomyelitis, haemophilus, mumps, measles and rubella. School-age is a healthy time and school children have a low attendance rate in general practice. The School Health Service provides routine examinations and should detect any visual and hearing defects and abnormalities that have gone previously unnoticed. The school doctor also provides further immunization including BCG (for girls only) rubella. Some adolescents need special guidance about the difficulties of this time of their lives. A great number of adults need advice from their doctor about alcohol, travel,

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employment, and the dangers of smoking. General practitioners should consider whether their records are adequate to show at-risk groups by habits, by occupation or by family history. In old age, as in infancy, the health visitor makes an important contribution to the health of this group of the practice population. Elderly patients may be at risk of poor nutrition and of hypothermia. Some may have to be helped to live with increasing disabilities. Dementia may not be preventable but its social effects may be postponed by appropriate advice and help.

At all ages accidents occur and many of these, especially those that occur at home, might have been prevented by suitable advice given by the doctor or the health visitor while on a home visit. The solution to these problems must therefore be sought not only from the medical profession but from society as a whole.

9. Communication skills

Both patients and doctors generally report high levels of satisfaction with their consultations. There is, however, considerable evidence that communication between doctors and patients is not as satisfactory as we might hope. About a fifth of patients report difficulties making an appointment to see the doctor of their choice for the time of their choice. Having made an appointment, up to a quarter of patients complain that they have to wait too long in the surgery before seeing the doctor, and a quarter of patients report that their doctor was ‘in a hurry’.

Most patients report that their doctor listens to what they say, but about 10% feel that the doctor did not appear to think that their opinions were important. About a third of patients feel that they shouldn’t raise doubts or questions, partly because they feel the doctor would think less of them, partly because they are worried about the doctor’s reaction. About a quarter of patients report that their doctor was ‘not so good’ about explaining things to them.

The effects of poor communication are, perhaps, best observed in terms of compliance rates, and the consultation task model has suggested a simple ‘rule of thirds’: about a third of patients take the

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doctor’s advice and get it right, a third take the doctors advice but get it wrong, and a third don’t even start to take the doctor’s advice.

The first important point to make is that there is no ‘right’ way to communicate or consult. What comes easily and naturally to you may be a struggle or feel out of character for me. For some people, good communication comes relatively easily whereas others do find it less easy to express themselves clearly and are less confident. The approach presented here conceives that communication is a skill as well as an attribute and that we can all improve our communication skills by becoming more aware through practice, feedback, discussion and more practice. If there is a key to good communication it is that of ‘listening’. Listening and being alert to what is said and being interested; listening to what is not being said and being observant of body language.

According to the task model the consultation is divided into four stages: (1) getting started; (2) taking a history; (3) deciding on a management plan; (4) concluding the consultation.

Getting started. Welcome the person and establish rapport by putting the person at ease, help them to feel secure, and show that you are interested in them. often this initial phase will reflects the doctor’s style and dictates the atmosphere of the consultation.

Taking a history. Defining the nature and history of the problems may seem a relatively simple matter of asking questions and listening attentively, but in practice is a little more complex. Considerable skills are required to formulate the appropriate question, in appropriate language and tone of voice. Listen carefully to what the patient is saying (and not saying) and observe their behaviour: a shrug, a smile, their eyes, their hands and body position. Be aware of your own gestures and bodily position. Possibly the most important, but frequently omitted, questions to ask the patient is – what do you think might be wrong? Many studies have shown that patients have their own ideas or ‘explanatory model’ for their symptoms. Before moving on to formulating a management plan, it can be helpful to summarize and to agree with patients what you understand to be

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their problems, their concerns and the effects of the problem on their and other people’s lives.

Deciding a management plan. The key to a healthy outcome for patients may lie in the relationship between doctor and patient. On the one hand be beware of assuming a dominant power relationship which may maintain the person’s dependence and reinforce feelings of low self-esteem. On the other hand, for some people self-esteem is maintained by their trust in the doctor. One of the dangers for the doctor is that, having identified the problem, whether physical, psychological or behavioural, there is a natural temptation to deal with that problem by giving proscriptive advice requiring the patient to change their life-style or habits.

Concluding the consultation. It is important to use time effectively. Doctors are likely to provide higher quality care if patients spend longer with their doctor. Also consider using other people who, like consultants at hospital, may have different skills from you which may be more appropriate for the patient.

Motivational interviewing is an approach developed to help patients who lead unhealthy lifestyles, especially addictive behaviours. The doctor does not put forward the ‘medical’ arguments for patients changing their behaviour because patients, in putting forward counter arguments, will reinforce their reasons for not changing. The role of the doctor is to seek any source of motivation that might lead to behavioural change and reinforce the patient’s sense of control over their health and behaviour.

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Samples of control tasks on English Grammar

Test (to be, to have, there + to be)

Variant 1.

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