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Samenvatting Inleiding tot modellen in de klinische psychologie UGent
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Inleiding tot modellen in de klinische psychologiePsychologie
Introductie .............................................................................................................................................................. 6
Modellen ............................................................................................................................................................. 6
Multiperspectivisme ............................................................................................................................................ 6
7 Kernvragen bij elk model .................................................................................................................................. 7
Competency cube ................................................................................................................................................ 7
1. Het werkveld van de klinische psychologie ................................................................................................... 8
1.1. Introductie ............................................................................................................................................... 8
1.2. Populaties en settings in de klinische psychologie .................................................................................. 8
1.3. Beroepen in de klinische psychologie ...................................................................................................... 9
2. Basismodellen in de klinische psychologie .................................................................................................. 10
2.1. Wetenschapsfilosofische achtergrond en kaders .................................................................................. 10
2.1.1. (Post-)positivisme en klinische psychologie .................................................................................. 11
2.1.2. (Sociaal-) constructivisme ............................................................................................................. 12
2.1.3. Besluit ............................................................................................................................................ 13
2.2. Metamodellen: medische vs. contextuele visie ..................................................................................... 13
2.2.1. Artikel Wamphold ......................................................................................................................... 14
2.2.2. Kenmerken medisch model ........................................................................................................... 15
2.2.3. Oorzaken medische visie ............................................................................................................... 16
2.2.4. Biopsychosociaal model ................................................................................................................ 16
2.2.5. Biologische pscyhiatrie .................................................................................................................. 16
2.2.6. Diathesis-stress model .................................................................................................................. 16
2.2.7. Kwetsbaarheid-stress model ......................................................................................................... 18
2.2.8. Commentaar op het biopsychosciaal model ................................................................................. 19
2.2.9. Conceptuele problemen van het medisch model ......................................................................... 19
2.2.10. Contextuele visie (veel varianten) ................................................................................................. 19
2.2.11. Sociale aspecten ............................................................................................................................ 19
2.2.12. Nieuwe paradigma’s ...................................................................................................................... 20
2.2.13. Evidence-based practice (EBP) model ........................................................................................... 21
2.2.14. Feedback in de klinische psychologie ............................................................................................ 23
2.2.15. Samengevat ................................................................................................................................... 23
2.3. Wetenschappelijke aanpak ................................................................................................................... 24
2.3.1. Wetenschappelijke kennis............................................................................................................. 24
3. Uitkomst- en procesonderzoek: denken over evidence-based practice ..................................................... 32
3.1. Geschiedenis: een multi-dimensionaal verhaal ..................................................................................... 32
3.1.1. ‘Vroege’ geschiedenis: klinische gevalstudies om kennis op te bouwen ...................................... 33
, 3.1.2. De ontwikkeling van systematisch onderzoek .............................................................................. 33
3.1.3. De ‘therapie-oorlogen’ .................................................................................................................. 34
3.1.4. Op weg naar methodologisch en epistemologisch pluralisme ...................................................... 35
3.1.5. Conclusie ....................................................................................................................................... 35
3.2. Uitkomstonderzoek: effectiviteit nader bekeken................................................................................... 36
3.2.1. Vraag naar uitkomsten: ................................................................................................................. 36
3.2.2. Onderzoeksbenaderingen ............................................................................................................. 38
3.2.3. Effectiviteitsonderzoek: samenvatting bevindingen ..................................................................... 43
3.2.4. Uitkomsten meten: het vraagstuk van de afhankelijke variabele ................................................. 44
3.2.5. Kwalitatieve uitkomststudies ........................................................................................................ 45
3.3. Procesonderzoek: de black box van de therapeutische situatie ............................................................ 46
3.3.1. Procesonderzoek inhoudelijk indelen ........................................................................................... 46
3.3.2. Moeilijkheden procesonderzoek ................................................................................................... 47
3.3.3. Specifieke of algemene factoren? ................................................................................................. 47
3.3.4. Therapeutfactoren ........................................................................................................................ 48
3.3.5. Cliëntfactoren ................................................................................................................................ 48
3.3.6. Helpende en niet-helpende factoren ............................................................................................ 48
3.3.7. Case-based evidence: therapeutisch proces in actie .................................................................... 49
3.4. Besluiten over onderzoek naar uitkomsten en processen ..................................................................... 50
3.5. Evidence based practice in de praktijk: de vertaling maken .................................................................. 51
3.5.1. Kloof wetenschappelijk onderzoek en praktijk ............................................................................. 51
3.5.2. Evidence based practice in de GGZ ............................................................................................... 52
4. Algemene klinische vaardigheden ............................................................................................................... 53
4.1. Situering: proces van hulpverlening ...................................................................................................... 53
4.2. Basishouding ......................................................................................................................................... 53
4.2.1. Empathie ....................................................................................................................................... 54
4.2.2. Echtheid......................................................................................................................................... 55
4.2.3. Unconditional positive regard ....................................................................................................... 57
4.3. Luistervaardigheden .............................................................................................................................. 60
4.3.1. Waarom luisteren belangrijk is ..................................................................................................... 60
4.3.2. Waarom we niet luisteren ............................................................................................................. 60
4.3.3. Hoe kan ik beter leren luisteren .................................................................................................... 61
4.4. Nuancerende vaardigheden .................................................................................................................. 67
4.5. Wederzijdse beïnvloeding...................................................................................................................... 72
4.5.1. Inleiding ......................................................................................................................................... 73
4.5.2. Expertise/Competentie ................................................................................................................. 73
4.5.3. Expertise: goede vragen ................................................................................................................ 74
4.5.4. Expertise: positionering................................................................................................................. 75
4.5.5. Attractiviteit .................................................................................................................................. 76
4.5.6. Vertrouwen ................................................................................................................................... 77
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, 4.5.7. Vertrouwenstest: informatie vragen ............................................................................................. 78
4.5.8. Vertrouwenstest: geheim vertellen .............................................................................................. 78
4.5.9. Vertrouwenstest: gunst vragen ..................................................................................................... 78
4.5.10. Vertrouwenstest: cliënt diskwalificeert zichzelf ............................................................................ 79
4.5.11. Vertrouwenstest: hulpverlener in verlegenheid ........................................................................... 79
4.5.12. vertrouwenstest: motivatie hulpverlener ..................................................................................... 79
5. Structuur van de GGz .................................................................................................................................... 80
5.1. Zorg gebaseerd op cijfers ...................................................................................................................... 80
5.2. Organisatie: klassieke visie .................................................................................................................... 83
5.3. Belangrijkste settings ............................................................................................................................ 84
5.3.1. Zorgaanbod eerste lijn .................................................................................................................. 84
5.3.2. Zorgaanbod 2e lijn ......................................................................................................................... 88
5.3.3. Zorgaanbod 3e lijn ......................................................................................................................... 91
5.3.4. Jeugdhulpverlening ....................................................................................................................... 96
5.4. Organisatie van zorg: nieuwe visies & Innovaties in de zorg............................................................... 97
5.4.1. Huidig zorgaanbod ........................................................................................................................ 97
6. Ethiek en deontologie .................................................................................................................................. 99
6.1. Intro: ethische vraagstukken ................................................................................................................. 99
6.2. Ethische begrippen ................................................................................................................................ 99
6.3. Ethische/normatieve theorieën ........................................................................................................... 100
6.3.1. Teleologische of gevolgenethiek ................................................................................................. 101
6.3.2. Deontologische of beginselethiek ............................................................................................... 101
6.3.3. Deugdenethiek ............................................................................................................................ 101
6.4. Deontologie van het beroep ................................................................................................................ 102
6.4.1. Beroepscodes .............................................................................................................................. 102
6.5. Morele dilemma’s analyseren ............................................................................................................. 107
7. Psychotherapeutische scholen (gastlessen) .............................................................................................. 108
7.1. Gastles 1: gedragstherapie.................................................................................................................. 108
7.1.1. Leertheoretisch kader ................................................................................................................. 108
7.1.2. Gedragstherapie is de toepassing van de bevindingen uit de experimentele psychologie ......... 108
7.1.3. Klassieke conditionering (Watson) .............................................................................................. 109
7.1.4. Operante conditionering (Thorndike, Skinner) ........................................................................... 109
7.1.5. Golven van cognitieve gedragstherapie ...................................................................................... 110
7.1.6. Klinische conceptualisatie: van leertheorie naar cognitieve gedragstherapie ............................ 111
7.1.7. Derde golf van CBT ...................................................................................................................... 116
7.1.8. Vierde golf van CBT ..................................................................................................................... 116
7.1.9. Toepassingen binnen de gedragstherapie .................................................................................. 116
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, 7.2. Gastles 2: ontwikkelingsgerichte therapie .......................................................................................... 117
7.2.1. Kernelementen ontwikkelingsgerichte psychotherapie.............................................................. 117
7.2.2. Toepassing: depressie bij jongeren ............................................................................................. 119
7.2.3. Hoe ontstaat een depressie?....................................................................................................... 120
7.2.4. Cognitief diathese-stress model .................................................................................................. 120
7.2.5. Behandeling depressie ................................................................................................................ 123
7.2.6. Onderzoeksresultaten ................................................................................................................. 125
7.3. Gastles 3: Introductie op de psychoanalyse ........................................................................................ 126
7.3.1. Permisse 1: de mens is een verdeeld subject .............................................................................. 126
7.3.2. Premisse 2: psychisch functioneren = een samenspel tussen 3 dimensies ................................. 127
7.3.3. Psychoanalyse vandaag (1).......................................................................................................... 129
7.3.4. Psychoanalyse vandaag (2).......................................................................................................... 131
7.3.5. Het onbewuste ............................................................................................................................ 132
7.3.6. Symptoom ................................................................................................................................... 133
7.4. Gastles 4: interpersoonlijk perspectief/systeemtherapie .................................................................... 134
7.4.1. Definitie ....................................................................................................................................... 134
7.4.2. Historiek en theoretische grondslagen ....................................................................................... 134
7.4.3. Hedendaagse theoretische uitgangspunten ............................................................................... 142
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