Chapter 11 Intervention: Overview INTRODUCTION TO CLINICAL PSYCHOLOGY 2E HUNSLEY & LEE PREPARED BY DR. CATHY CHOVAZ, KING’S COLLEGE, UWO.

Chapter 11Intervention: Overview

INTRODUCTION TO CLINICAL PSYCHOLOGY 2EHUNSLEY & LEE

PREPARED BY DR. CATHY CHOVAZ, KING’S COLLEGE, UWO

Ethics of intervention Theoretical approaches:

Short-term psychodynamic psychotherapies Interpersonal therapy (IPT) Process-experiential therapies Cognitive-behavioural therapies

Seeking psychological services Alternative forms of psychological services

Topics

Focus in the text on ‘evidence-based approaches’ to therapy

Informed consent: Client must agree to services that are being given Client should know what works best for a given

disorder as well Adult gives consent for child, but child must

assent (verbally agree) to be treated

Ethics of Intervention

Inform client of: Confidentiality and limits of confidentiality Financial arrangements What to expect in therapy Alternative treatments

Therapist must monitor whether the treatment is working

Treatment should be based on best-available evidence

Ethics of Intervention

Based on psychoanalytic theories of Freud and recent theorists. Central concepts: Unconscious: Most of what motivates an

individual is outside of awareness Assumes that individuals are prone to conflicts

between Id (impulsiveness) and Ego (planning, higher cognitive functioning)

Transference: Problematic interpersonal relationship re-enacted with therapist

Counter-transference: Therapist’s problematic interpersonal relations OR how the client makes the therapist feel

Theoretical Approaches: Short-term Psychodynamic

Psychotherapies

Some versions of this approach: Luborsky’s Supportive-Expressive Therapy Strupp’s Time-limited Dynamic Therapy

Most focus on process of:1) Bringing to awareness unconscious 2) Re-enacting problematic relationship with the

therapist3) Working through this pattern and development

of new interpersonal patterns

Short-term Psychodynamic Therapy

Additional foci of this approach: Identification of themes and central conflicts Defensive patterns in the person’s life Evoking emotions Goal-setting Termination of therapy

Strong evidence of effectiveness in depression, panic disorder, substance abuse, BPD, etc.

Short-term Psychodynamic Therapy

Much more emphasis on problems with communication and on dysfunctional relationships than dynamic therapy (although some overlap)

Clear understanding of current and past relationships central to this approach

Brief–usually 3-4 months Work on actively changing interpersonal

patterns

Interpersonal Therapy (IPT)

Focus is often on role transitions (becoming a parent, student to professional, etc.)

Originally developed for depression, but has been applied to several populations including late life, different cultures, and several disorders (including eating disorders, anxiety and substance abuse)

Interpersonal Therapy (IPT)

History in existential, humanistic and client-centered approaches (though little data on these approaches as helpful)

Focus is on Increasing awareness, reflection and expression

of emotion Enhancing emotion regulation Transforming maladaptive emotions into

adaptive emotions

Process-Experiential Therapies

Focus is on in-session experiencing of affect along with processing the emotion experience

Strong evidence for effectiveness with depression, couple distress, and adult survivors of child abuse

Process-Experiential Therapies

Behaviour Therapy is the oldest form of CBT – with a focus on operant and classical conditioning as etiology of symptoms and problems Symptom and present focused

Bandura – learning can take place by observation and imitation (self-efficacy)

Self-efficacy: person’s sense of competence to learn and perform new tasks (best predictor of Tx. success)

Cognitive Behavioural Therapies (CBT)

Ellis’s Rational-Emotive Therapy and Beck’s Cognitive Therapy are based on idea that thoughts about environment are the key to etiology and maintenance of a disorder CBT is a mixture of cognitive and behavioural

approaches CBT validated in numerous DSM disorders

Cognitive Behavioural Therapies (CBT)

Focus of treatment is on Identifying thoughts and behaviours that

might be causing problems Very active role of therapist with client Use of current research in psychopathology Didactic methods and Socratic questioning

(i.e., encouraging the client to reflect) Homework set Tailoring approach to given individual

Cognitive Behavioural Therapies (CBT)

Barlow (2004) suggested distinction be made between psychotherapy and psychological treatments Former is general and the latter is targeted to

Axis I and Axis II clinically significant disorders Anyone can refer to themselves as a

‘psychotherapist’ A license ensures the practitioner has met

educational and experience guidelines

Seeking Psychological Services

As regulated health providers, psychologist and psychological associates are required by law to deliver competent, ethical, and professional services and are accountable to the public, through the College, for their behaviour and activities…

College of Psychologists of Ontario (2004)

Evidence suggests that the overall use of mental health services has been increasing in recent decades

Duration varies, but median number of visits is 5-13 sessions

Evidence-based treatments usually are between 10-30, so some may not be receiving the full ‘dose’

General Points on Psychological Services

Women/girls are twice as likely as men/boys to consult a psychologist Most individuals consulting a psychologist are between ages of 30

and 50 yrs Those in rural areas are one-third as likely to obtain services 22% of those consulting a psychologist have university education

(compared to 13% of Canadian population) Single-parent families make up 8% of Canadian population and are

20% of those who see a psychologist People experiencing significant pain that interferes with ADL are

twice as likely as other Canadians to consult a psychologist People who receive psychological services also tend to be frequent

users of other health care services Adolescents and adults who feel so unhappy that they believe life is

not worthwhile are five times as likely as other Canadians to seek psychological services

Characteristics of Canadians Receiving Psychological Services

Couple therapy Common for all types of couples going through

various problems Family therapy

address Axis 1 disorders in one member family communication dysfunction

Group therapy (variety of orientations) Process groups: use group to explore

interpersonal dynamics Structured groups: focus on a specific problem

Alternative Forms of Psychological Services

Self-administered: Self-help books based on evidence-based care Continuum of client working on their own to

some work with a therapist Some evidence that this is effective

Computer-based treatment: Continuum of computerized aspects of evidence-based care to virtual reality

Telehealth: Range of treatments not in person (phone, email, chat, etc.)

Alternative Forms of Psychological Services

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