2 psychological interventions Flashcards
What are the main families of psychotherapy?
- psychodynamic therapy
- CBT
- humanistic therapy (development of personal potential, focus on direct experience, free will, self-discovery)
- systemic psychotherapy (group, interpersonal factors not intrapsychic factors)
What is the history of psychotherapy?
1896 - first psychological clinic (lightner witmer)
WW2 - PTSD - government requested psychological treatment
1947 - methods to integrate science (Frederick thorne)
1970s - general benefits of psychotherapy were established
APA - created different divisions
created first guidelines in the 90s
What is evidence-based practice in psychology?
integration of the best available research with clinical in the context of patient characteristics, culture and intervention
starts with the patient and asks what research evidence will assist the psychologist in achieving the best outcome
What are advantages and disadvantages of EBPP?
+ scientific legitimacy (research literature indicates these interventions are safe and effective, enduring compared to medication)
+ decreased reliance on clinical judgement
- threats to the psychotherapeutic relationships
- strong influence of biomedical model
What are major issues in integrating research into day-to-day practice?
(a) the relative weight to place on different research methods;
(b) the representativeness of research samples;
(c) whether research results should guide practice at the level of principles of change, intervention strategies, or specific protocols;
(d) the generalizability and transportability of treatments supported in controlled research to clinical practice settings;
(e) the extent to which judgments can be made about treatments of choice when the number and duration of treatments tested has been limited; and
(f) the degree to which the results of efficacy and effectiveness research can
be generalized from primarily White samples to minority and marginalized populations
What types of research evidence are common in psychology?
clinical observation
qualitative research
systematic case studies
single-case experimental designs
public health and ethnographic research
process-outcome studies
studies of interventions in naturalistic settings
RCTs
meta-analysis
What are general guidelines, set by the APA for psychotherapies?
- treatment efficacy - systematic evaluation
- clinical utility - applicability, feasibility, usefulness
- generalizability?
- sophisticated empirical methodologies
- controlled experiments
- systematic clinical observations
What is clinical expertise and what are the main components of it?
trained experts in clinical psychology, practicioners
(a) assessment, diagnostic judgment, systematic case formulation, and treatment planning;
(b) clinical decision making, treatment implementation, and monitoring of patient progress;
(c) interpersonal expertise;
(d) continual self-reflection and acquisition of skills;
(e) appropriate evaluation and use of research evidence in both basic and
applied psychological science;
(f) understanding the influence of individual and cultural differences on treatment;
(g) seeking available resources (e.g., consultation, adjunctive or alternative services) as needed; and
(h) having a cogent rationale for clinical strategies
sensitivity and flexibility in the administration of therapeutic interventions
understanding of the personal attributes
collaboration between researchers
How can integration of clinical expertise in practice be ensured?
- studying best outcome practices
- technical skill aquisition
- reliability and validity of clinical diagnosis
- conditions that maximise clinical expertise
- errors and biases
- develop well-normed measures
- distinguishing expertise shared among treatment strategies and specific for one type of therapy
- real-time patient feedback
What are common assessment tools used in psychological testing?
- tests
- projective tests (pictures, …)
- interviews
- mental status examination (questionnaires, …)
What are necessary characteristics of psychological assessment tools?
- clinical utility
- validity
- standardisation
- reliability
What is CBT?
based on behaviour and cognitive therapy
root -> learning theories
it assumes that problematic patterns are learned through the same processes as normal patterns
-> core beliefs, maladaptive schemas
A Activating event
B Automatic thought
C Consequences
-> emotional, behavioural, physiological
How does CBT work?
replacing maladaptive schemas with more adaptive ways of thinking, behaving, and interacting
personal and situational antecedents are identified and consequences associated with those
- restatement of patient phrases
- automatic thought catching
- socratic questioning -> clarifying questions
- behavioural activation experiments -> testing beliefs in hypothesised setting
What are common cognitive distortions?
- all-or-nothing thinkinh
- mental filter, selective abstraction
- overgeneralisation
- magnification or minimisation
- personalisation
- emotional reasoning
- discounting the positives
- mind-reading
- fortune telling (empty predictions)
- catastrophising
- labelling
- should and must statements
What is brief psychodynamic therapy?
Freud :)
Ezriels Triangle of Conflict
DAF
difficulties arise because clients have used dysfunctional psychological defence mechanisms (D) to manage inhibitory affects (A) about the expression of potentially adaptive but unacceptable feelings and impulses (F)
→ dynamic conflict between the hidden feeling (F) and the anxiety (A) about its expression
menningers triangle of person:
TCP
DAF pattern are usually long standing and have begun in childhood through interactions with past people (P)
→ maintained by significant people in current life situation (C) and re-enacted as transference with the therapist (T)
What are the suitability criteria for brief psychodynamic therapy?
- sufficient distress
- capacity to form therapeutic alliance
- psychologically minded
- capacity to tolerate strong affect
- courage to explore adaptive ways to manage conflict
- Stable life situation and some social support
- focus on therapy
- GAF score above 50
GAF score:
100 - no symptoms
90 - minimal symptoms
80 - transient symptoms (slight impairment)
70 - mild symptoms (slight impairment)
60 - moderate symptoms (panic attacks, circumstantial speech, few friends)
50 - serious symptoms (suicidal ideation, criminality, obsessions, … with serious impairment)
40 - some impairment in reality testing or communication
30 - delusions, hallucinations, inability to function in almost all areas
20 - danger in hurting themselves or others, minimal functioning, no hygiene, …
10 - persistent danger, persistent inability to do anything, expectation of death
What are the aims of brief psychodynamic therapy?
- defence restructuring
defence recognition and relinquishing - affect restructuring
affect experiencing and expression - self-other restructuring
tolerant attitude towards themselves and more accurate and compassionate
view of others, secure style of engaging in self-other attachments
What is the core conflictual relationship theme method?
(1) the client’s wish (W),
(2) the client’s anticipated response of the other person (imagined response
from the other or RO) and
(3) the client’s response in the situation (actual response of self or RS).
What is the principle of dynamic conflict?
McCullough, 2003
ppl repeatedly develop anxiety when they experience the possible occurence of a forbidden feeling and use a defence mechanism to manage and repress the feeling
Desensitisation is achieved by exposing clients gradually to increasingly stronger “doses” of forbidden feelings (F) and helping them to tolerate the anxiety (A) associated with this process until it subsides, while at the same time preventing them from using their habitual defence mechanisms (D) to escape from the anxiety-provoking situation.
→ gradual exposure and response prevention
→ forbidden feeling into consciousness
What are activating and inhibiting emotions?
A:
- anger
- sexual desire
- positive self-view
- joy
- excitement
- grief
I:
- anxiety
- guilt
- shame
What defence mechanisms exist at different levels of maturity?
high adaptive level:
anticipation
affiliation
altruism
humor
self assertion + observation
sublimation
suppression
mental inhibitions:
displacement
compromise formation level:
dissociation
intellectualisation
isolation of affect
reaction formation
repression
undoing
minor image distorting level:
devaluation
idealisation
omnipotence
disavowal level:
denial
projection
rationalisation
major image distorting level:
autistic fantasy
projective identification
splitting of self-image or others image
action level:
acting out
apathetic withdrawal
help-rejecting complaining
passive aggression
level of defensive dysregulation:
delusional projection
psychotic denial
psychotic distortion
What is the therapeutic alliance?
patient and therapist work tofether to alleviate the patient´s problems
therapeutic bond, relationship, treatment alliance, helping alliance, or working alliance
client-centered therapy
Bordin, 1979
(1) agreement of goals;
(2) assignment of tasks; and
(3) the development of a bond between patient and therapist
average correlation of the alliance and outcomes of individual psychotherapy of 0.275
prevailing measures of the alliance on average account for about 7% of psychotherapy outcomes
the average effect of the alliance is larger than the effects of other treatment
variables such as therapist adherence to treatment manual or therapist competence
What is the concept if interpersonal synchrony and how does it apply to the psychotherapeutic context?
interpersonal synchrony model of psychotherapy
→ alliance emerges from the coupling of the neuronal activity of the brains of the patient and the therapist
→ mutual coordination of the behaviour and experiences
→ adaptive emotion regulation in the patient
Level 1: perceptual-motor processes (movement, inter-brain coupling)
Level 2: complex cognition (common language, I-sharing = mutual sharing of experiences, affective co-regulation = joint regulation of affective responses and their physiological correlates)
Level 3: emotion regulation (explicit and implicit) -> self-insight, strategies
What is the dodo bird verdict?
The Dodo bird verdict (or Dodo bird conjecture) isa controversial topic in psychotherapy, referring to the claim that all empirically validated psychotherapies, regardless of their specific components, produce equivalent outcomes
Saul Rosenzweig (1930)
technique used does not matter, long as the common factors (often unspecified, empirical studies) are adhered to, such asrelationship between the patient and the therapist
What is the nomoethic approach and what is the idiographic approach?
The nomothetic approach seeks to find common patterns in people’s personalities and measures personality via psychometrics. In contrast, the idiographic approach views each person uniquely and measures personality via case studies, interviews, and observations.
-> balance needed
-> common factors approach
- identifying shared elements
- therapeutic relationship, motivation, corrective experience, insight, self-efficacy
What is the concept of integrative psychotherapy?
bridges diverse psychotherapeutic approaches and techniques/theories
What are the different ways of doing an intake assessment? (for interviews, testing, and report writing)
- voluntary attendance
- first appointments
- other appointments
- confidentiality
- anonymised case reports
- psychological reports
- consent form
- assessment form
What does an assessment form usually look like?
- questions about living situation
- questions about current concerns and problems (treatment history)
- questions about recent life stresses and challenges
- developmental history
- current family situation and family history
Explain rapport, expertise and technique.
→ Rapport - positive, comfortable relationship. Not seduction
→ Technique - tools in the CP’s toolbox
→ Expertise - proficiency and judgement acquired through clinical experience and practice
When is the assessment complete?
The assessment is complete when the presenting problem and related difficulties are clarified; related predisposing, precipitating, maintaining and protective factors have been identified; a formulation has been constructed; possible goals have been identified; options for case management or treatment have been identified; and these have been discussed with the
family
What are the case management options?
Refer back with no action
Psychoeducation periodic reassessment
Refer within team
Refer to outside team
Focal treatment
Multimodal treatment
What goes into a case formulation?
predisposing factors
protective factors
maintaining factors
precipitating factors
everything from assessment stage
What structured assessment instruments are there?
- Broad measures of general symptoms
- Brief measures of symptoms and constructs
- Structured diagnostic interviews
- Cognitive functioning tests
- Personality inventories
- Projective tests.
What types of reports, following clinical assessment and formulation exist?
- Progress notes
- Comprehensive assessment reports
- End-of-episode case summaries
- Verbal reports to clients and colleagues
- Correspondence with clients and colleagues
- Case study reports
- Annual service reports
What does a report, no matter its style, typically contain?
progress notes:
time, attendance, review, agenda, plan
comprehensive assessment report:
demographics, referral, sources, history, psychological testing, diagnosis, formulation
end-of episode case summary:
progress made as a result of implementing a case management plan
verbal reports:
* The question you aimed to answer;
* The source of your information and your confidence in its reliability and validity;
* The key pieces of information that answer the question (and no more).
correspondence with professionals:
* Has the client been placed on the waiting list or have they been assessed?
* Why is the client behaving in an unusual way and what can be done about it?
* Have you been able to help the client manage the problem?
* Should we be coordinating our input to this case?
How can psychological testing be reported?
- The tests used;
- The number and duration of testing sessions;
- The impact of cooperation, medication, physical factors (noise, cold, crowding, etc.),
extraneous psychosocial factors (e.g. exhaustion) on the validity of the results; - A list of results and an interpretation of these.
What are the aims of clinical interviews and clinical assessments?
Clinical interviews involve face-to-face interactions between a mental health professional and a client, aiming to gather information about the client’s history, symptoms, and current functioning.
Clinical assessments, on the other hand, may include standardized tests, questionnaires, and observations to systematically evaluate an individual’s mental health, cognitive abilities, and emotional well-being.
