Psychological Services in Primary Care

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Psychological Services in Primary Care

• the surgery and beyond!
• Dr T M Hatton Clinical Psychologist with the
  Primary Care Psychology and Families Service in
  South Birmingham

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Psychological Services in Primary Care the
surgery and beyond

• Primary Care Psychology and Families Service at
  208
• Staffed by a team of Clinical and Counselling
  Psychologists and one Counsellor
• - As a training department we have a varying
  number of Clinical and Counselling Psychology
  Trainees on placement with the service at any
  given time

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Psychological Services in Primary Care- the
surgery and beyond

• Services at 208 organisationally and
  therapeutically informed by Systemic Theory and
  Practice
• All of the Clinical Psychologists are trained to
  intermediate level in Systemic Therapy and three
  are qualified Systemic Psychotherapists

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Psychological Services in Primary Care the
surgery and beyond

• 208
• Individual Stream for 16 year olds and above
  (no upper age limit) accessed by GP referral or
  Self-referral
• Consultation (Single Session)
• Brief Therapy

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Psychological Services in Primary Care the
surgery and beyond

• 208
• Families Stream
• lifespan service - no lower or upper age limit
• Family Support Service Drop-in
• Family Support Service Consultation
• Family Therapy/Couples Therapy

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Psychological Services in Primary Care the
surgery and beyond

• The Surgery
• Patient presents with psychological difficulty
  e.g. Anxiety or Depression
• GP assesses to arrive at diagnosis and prescribe
  treatment

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Psychological Services in Primary Care the
surgery and beyond

• Some typical signs and symptoms associated with
  Anxiety
• Hyperventilation/Breathlessness
• Tingling
• Palpitations
• Difficulty Swallowing
• Avoidance etc etc

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Psychological Services in Primary Care the
surgery and beyond

• Some typical signs and symptoms associated with
  Depression
• Loss of appetite
• Sleep disturbance/early wakening
• Low mood
• Tearfulness
• Indecisiveness etc etc

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Psychological Services in Primary Care the
surgery and beyond

• Psychological difficulties do not occur in a
  vacuum rather they occur in the context of
  peoples lives
• As GPs you are uniquely placed to know your
  patients over time and in context

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Psychological Services in Primary care the
surgery and beyond

• Systemic thinking takes into account the system
  and context in which people reside
• - and offers you a way to help your patients as
  well as help you to decide when and whether to
  refer on

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Psychological Services in Primary care the
surgery and beyond

• System
• Any unit structured around feedback and made up
  of interacting parts which mutually influence one
  another and inform patterns of behaviour and
  communication
• e.g. Family, professional group, doctor/patient

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Psychological Services in primary care the
surgery and beyond

• Interaction and meaning
• When two or more people interact they are
  involved in a joint construction of action and
  meaning.
• This construction is influenced by the context in
  which each interacting individual resides and
  therefore brings to the interaction

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Psychological Services in Primary Care the
surgery and beyond

• Family or System

Father 38
Mother 37
Son 11
Daughter 8
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Psychological Services in Primary Care the
surgery and beyond

• Context in which Family Resides

Primary Healthcare
His Extended Family
Her Extended Family
Family
Employment
Hospital
Church
Education
Community
Culture
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Psychological Services in Primary Care the
surgery and beyond

• When your patient comes to see you her/his
  context and immediate system they reside in has
  an influence on their problem and their
  experience of it
• As a GP you are influenced by a different context
  (e.g. medical)
• Systemic thinking offers a way of bridging these
  two contexts by utilising the idea of
  curiosity

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Psychological Services in Primary Care the
surgery and beyond

• Systemic thinking employs a circular rather than
  linear idea of causality
• Circular questioning or curiosity in action, in
  addition to yielding information is also
  interventive

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Psychological Services in Primary Care the
surgery and beyond

• Curiosity
• The stance of curiosity is one where continuously
  new perspectives on the patients symptoms and
  predicament are generated, thus widening and
  changing the field of vision

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Psychological Services in Primary Care the
surgery and beyond

• Curiosity
• Good questions are characterised by their ability
  to open up new perspectives not only for the
  clinician but importantly for the patient.

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Psychological Services in Primary Care the
surgery and beyond

• Curiosity
• If a question triggers the patient to think
  thoughts that were previously unthinkable, then
  the process of questioning may have led the
  patient to think about their problems from a
  different angle

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Psychological Services in Primary Care the
surgery and beyond

• Curiosity
• This new perspective opens the possibility for
  new ways forward and solutions

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Psychological Services in Primary Care the
surgery and beyond

• Examples of circular questions
• Who noticed the problem first? Who next?
• What is your explanation for the problem?
• What is your partners/sons/daughters view of
  the problem?
• Do you agree with this view?
• How come X has this view?
• When you feel like this who is the first to
  notice?

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Psychological Services in Primary Care the
surgery and beyond

• Circular questions not only give you added
  information but offer a way to encourage your
  patient to reflect on their difficulties
  differently so offering the potential for change

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Psychological Services in Primary Care the
surgery and beyond

• Suggested reading
• Ten Minutes for the Family Systemic
  Interventions in Primary Care
• by Eia Asen, Dave Tomson, Venetia Young and
  Peter Tomson
• (2004) London, Routledge