Introduction to scenario:
- Example: Anna is currently on diploma program at university, training to be a nurse. Anna has a brother, Jo (short for Jonah), who has drifted since leaving school at the age of 16.
- He is currently unemployed and living with his girlfriend, Sasha, and her son, lee. Sasha is pregnant with Jo’s baby. Janice and Mark are parents to Anna and Jo.
- Mark recently retired early from his job as a grounds man because of the onset of type 2 diabetes, hypertension and angina. Janice works as a health care assistant in a local nursing home.
- Janice’s mother, Margaret, was divorced 25 years ago and lives on her own in a town not far from Janice and Mark. She was born in the West Indies and came to the United Kingdom in the 1950s, where she married Fred who was then a postman. They separated nearly 30 years ago and he died in 1989.
- Mark’s father, Ted, is a former factory worker. He is a widower whose wife died 3 years ago. He has chronic heart disease and has recently given up his home to live with Janice and Mark.
- Mark’s sister Lillian is unmarried and lives alone close by. She has been unwell and has recently been undergoing medical tests.
Applying Psychology to explain Anna’s anxiety:
Anna has lust joined the university as a student nurse and has to give her first seminar presentation to her tutor group. Although other students have all seemed a bit nervous, they have all delivered their seminars without too much fuss. Anna delayed her presentation because she was anxious about doing it. As her turn approaches, she is increasingly panic – stricken. It gets so bad that it could threaten Anna’s future career, How can Anna’ anxiety be understood, and what approaches are available to help her to overcome it?
Anxiety includes physiological responses caused by arousal of the autonomic nervous system. These include an increase in pulse and blood pressure, sweating, and the impulse to urinate or defecate. Anna’s physiological responses indicate that she is very anxious.
Cognitive approaches to Anna’s anxiety:
A cognitive scientist might be interested in making sense of Anna’s problem – solving processes. How does she interpret the demands of the task and her ability to perform it? Anna is quite capable of doing what all of her classmates have done. She may have underestimated her ability to create and present a seminar or has set herself a very high standard. A cognitive therapist would wish to help Anna change her beliefs about the demands of the task and her ability to perform it successfully. The therapist would work with Anna to encourage her to be realistic about standard of work expected at this level and to think positively about her own ability to perform the task successfully. The therapist would encourage Anna to set about the task in a more structured way. This might include something as simple as writing out a summary of the content on a series of prompt cards.
Behavioral and Social approaches to Anna’s anxiety:
Behaviorists might explain Anna’s anxiety in terms of the outcomes of past experiences in similar situation. The therapist might encourage the learning of relaxation skills to counteract feelings of anxiety and then provide Anna with opportunities to rehearse her seminar in a safe environment, while practicing relaxation. This aims to increase her confidence in her ability to undertake the task successfully (this is termed self – efficacy). First, she might watch others perform the task. Then she would rehearse it on her own, then in comfortable surroundings with the therapist or a close friend, then in an empty classroom with the same therapist or friend and then with a few friends. This would gradually increase her confidence and reduce her anxiety.
Psychodynamic approaches to Anna’s anxiety:
A psychodynamic therapist would be interested to find out why Anna is so anxious. In exploring her childhood experiences, they might find, for example, that Anna’s father had been very strict and critical and had set very high standards which she found difficult to live up to. Her mother had always wanted Anna to train as a nurse, since she herself had not had that opportunity. As a result, Anna finds herself under a lot of pressure to succeed. She is frightened of giving the seminar because she fears that it will not be up the standards she expects of herself and feels afraid of letting down the family. The psychodynamic therapist might seek to explore the origins of these feelings with her and, in so doing, seek to release her from hr feelings of anxiety.
Humanistic approaches to Anna’s anxiety:
A humanistic counselor would seek to help Anna explore the reasons for her anxiety in her own terms, and to help her resolve it in her own way. If she sees herself as less competent than others at giving seminar presentations, they would encourage her to explore why this is and might encourage her to role- play someone who is more confident. Having demonstrated that she is quite capable of accomplishing the seminar presentation in her new confident persona, her sense of self- worth and confidence are likely to improve, enabling her to give the seminar.
Social Psychological approaches to Anna’s anxiety:
A social psychologist might identify that Anna makes negative comparisons between herself and the other students, seeing herself not just as less able, but as less presentable. Giving a seminar is not just about content but about personal presentation, and much anxiety is generated because we are afraid of what other people will think of us. In this case, the social psychologist might suggest that she uses new props to help her feel more confident and attract social approval: for example, having her hair done, dressing and making up carefully, and preparing material that will entertain her audience.
Comparing Different psychological approaches to Anna’s anxiety:
It cannot be said that one is right and one is wrong. But it may be that different approaches are appropriate for different people, depending on the problems they have and the ways they prefer to deal with them. Many psychologists working in the fields of therapy or counseling use what is termed an eclectic approach. This means that they assess the nature and extent of the problem and then use whichever tools are most appropriate to assist the individual and overcome the problem.
Professionals involved in the Prevention, Management and Treatment of Psychological Problems:
It is helpful to be able to distinguish between the skills available to different types of therapists who use psychology:
1) Clinical psychologist: aims to reduce psychological distress and enhance and promote psychological well – being. They work with people with mental or physical health problems, which might include anxiety and depression, serious and enduring mental illness, adjustment to physical illness, neurological disorders, addictive behaviors, and childhood behavior disorders, personal and family relationships. They work with people throughout the lifespan, including with those with severe learning difficulties.
2) Health psychologist: applies psychological research and methods to the prevention and management of disease, the promotion and maintenance of health, the identification of psychological factors that contribute to physical illness, and the formulation of health policy. As examples, they study why and when people seek professional advice about their health, why they do or do not take preventive measures, how patients and health care professionals interact, how patient adapt to illness, and the links between perception, health behavior and physical functioning.
3) Counseling psychologist: applies psychology to work collaboratively with people across a diverse range of human problems. This includes helping people manage difficult life events such as bereavement, past and present relationships, and working with mental health issues as disorders. Counseling psychologists accept subjective experience as valid for each person, explore underlying issues and use an active collaborative relationship to empower people to consider change.
The Roles of Psychologists overlap with the Roles of other Health Care Professionals who have similar aims, including:
- Counselor: Similar to a counseling psychologist, except that anyone can describe themselves as a counselor. Training courses vary from a few days to several years. There are short courses that provide a certificate of attendance, longer courses that provide a "certificate" or "diploma" (through the academic level may be unspecified), and MSc programs that include a period of supervised training. Some training programs offer an eclectic mix of psychological approaches, through most follow a particular psychological model such as Rogerian or psychodynamic counseling.
- Psychoanalyst: someone who has trained in psychoanalysis under the supervision of an approved psychoanalyst. All approved psychoanalysts can trace the provenance of their trainers back to those who were trained directly by Freyd himself. All analysts undergo psychoanalysis themselves as part of a lengthy period of training.
- Psychodynamic psychotherapist: A therapist who has undergone a period of intensive training, including personal analysis and supervised practice, and who bases their approach on a psychodynamic model.
- Psychiatrist: A medical doctor who, since qualifying, has specialized in the diagnosis and treatment of people with mental health disorders. They may use a range of psychological therapies, but these usually include drug treatment which they have the right to prescribe. They sometimes use physical interventions such as ECT (electroconvulsive therapy). They are in charge of psychiatric beds and have the authority to admit people to hospital for treatment. They usually assume the clinical lead of a multiprofessional mental health team that normally includes clinical psychologists, mental health nurses and social workers.
- Cognitive- Behavioral Therapist: A qualified health care professional, such as a mental health nurse, who has completed undergraduate or postgraduate specialist training in cognitive behavioral therapy ( CBT) for the treatment for such disorders as depression, psychosis or obsessive – compulsive disorders. All clinical psychologists are trained to offer CBT.