Download 160 Chapter 11 Power

Chapter 11 –
Intervention: Overview
Copyright © 2014 John Wiley & Sons, Inc. All
rights reserved.
Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.
Ethics of Intervention
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Focus on ‘evidence-based
approaches’ to therapy
Growing use of technology and
treatment
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
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Inform client of:
– Confidentiality and limits of confidentiality
– Financial arrangements
– What to expect in therapy
– Alternative treatments
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Therapist must monitor whether the
treatment is working
Treatment should be based on best-
available evidence
Copyright © 2014 John Wiley & Sons, Inc. All
rights reserved.
Psychotherapy
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Norcross (1990) defined
psychotherapy as:
– “…the informed and intentional application
of clinical methods and interpersonal
stances derived from established
psychological principles for the purpose of
assisting people to modify their behaviors,
cognitions, emotions, and/or other
personal characteristics in directions that
the participants deem desirable.”
Copyright © 2014 John Wiley & Sons, Inc. All
rights reserved.
Psychotherapy
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APA (2013) passed resolution
recognizing psychotherapy as effective
Intended to promote psychotherapy in
health care systems as evidence-based
care
Psychotherapy practiced by
professionals from many disciplines
(psychology, psychiatry, social work,
nursing)
Copyright © 2014 John Wiley & Sons, Inc. All
rights reserved.
Short-term Psychodynamic Therapy
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Based on psychoanalytic theories of Freud
and recent theorists. Central concepts:
– Unconscious: Most of what motivates an
individual is outside of awareness
– 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
Copyright © 2014 John Wiley & Sons, Inc. All
rights reserved.
Short-term Psychodynamic Therapy
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Some versions of this approach:
– Luborsky’s Supportive-Expressive Therapy
– Strupp’s Time-limited Dynamic Therapy
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Most all focus on process of:
– 1) Bringing to awareness unconscious
– 2) Re-enacting problematic relationship with
the therapist
– 3) Working through this pattern and
development of new interpersonal patterns
Copyright © 2014 John Wiley & Sons, Inc. All
rights reserved.
Short-term Psychodynamic Therapy
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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
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Strong evidence of effectiveness in
depression, panic disorder, substance
abuse, borderline PD, etc.
Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.
Interpersonal Therapy (IPT)
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Much more emphasis on problems with
communication and on dysfunctional
relationships than dynamic therapy
(although some overlap)
Clear understanding of current and past
relationships is central to this approach
Brief – usually 3-4 months
Work on actively changing interpersonal
patterns
Copyright © 2014 John Wiley & Sons, Inc. All
rights reserved.
Interpersonal Therapy (IPT)
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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)
Copyright © 2014 John Wiley & Sons, Inc. All
rights reserved.
Process-Experiential Therapies
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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
Copyright © 2014 John Wiley & Sons, Inc. All
rights reserved.
Process-Experiential Therapies
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Focus is also 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
Copyright © 2014 John Wiley & Sons, Inc. All
rights reserved.
Cognitive Behavioral Therapies
(CBT)
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Behavior 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
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Bandura – learning can take place by
observation and imitation
Self-efficacy: person’s sense of
competence to learn and perform new
tasks (best predictor of tx success)
Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.
Cognitive Behavioral Therapies
(CBT)
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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
behavioral approaches
CBT validated in numerous DSM disorders
Copyright © 2014 John Wiley & Sons, Inc. All
rights reserved.
Cognitive Behavioral Therapies
(CBT)
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Focus of treatment is on
– Identification of thoughts and behaviors 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
Copyright © 2014 John Wiley & Sons, Inc. All
rights reserved.
General Points on Seeking
Psychological Services
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Anyone can refer to themselves as a
‘psychotherapist’
A license ensures the practitioner has met
educational and experience guidelines
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’
Copyright © 2014 John Wiley & Sons, Inc. All
rights reserved.
Additional Forms of Psychological
Services
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Couple therapy common for all types of
couples going through various problems
Many forms of family therapy where
individual problem is thought to come
from family communication dysfunction
Group therapy (variety of orientations)
– Process groups – use group to explore
interpersonal dynamics
– Structured groups – focus on a specific
problem
Copyright © 2014 John Wiley & Sons, Inc. All
rights reserved.
Additional Forms of Psychological
Services
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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
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Computer-based treatment:
Continuum of computerized aspects of
evidence-based care to virtual reality
Telehealth: Range of treatments not in
person (phone, email, videoconferencing)
Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.