4 Parent training Flashcards
CH4
Intro
• Treatment planning is like problem solving and decision-making
- Problem solving involves coming up with different approaches
- Decision making involves using rules to make selections among available alternatives
• Done collaboratively
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Initial steps in developing a collaborative plan for therapy
• Eg characteristics of target behaviour, characteristics of the client, social-environmental factors
• Reaching consensus on the goals of therapy
- Goals of therapy: content focus of therapy, target behaviours , best intervention
- For clients who pp in CBT useful to discuss up front the focu on current behaviours
- And the rationale for this emphasis
- More likely to accept the behavioural targets if they know their rationale
- Therapists should focus on the development of behaviours and less on the elimination of behaviours
- Lessens the frequency of the problem area and creates greater flexibility for responding
- Therapist attempts to facilitate the clients personal freedom
• Prioritising Problem Areas
CH4
Prioritizing Problem Areas
- Linehans described the Dialectical Behaviour Therapy (DBT): outlined a schema for prioritising behaviours during therapy sessions
- 4 stages
1. Life threatening behaviours
2. Therapy interfering behaviours
3. Quality of life interfering behaviours
4. Behavioural skills to increase - If the Stage 1 treatment targets are addressed, go to stage 2 targets
CH4
Deciding which interventions to select
• EST ??? is most applicable for clients with a specific problem
- Otherwise you have to combine the components of EST
- Many problem areas don’t have an EST
- When this is the case there are 4 options for the therapist
1. Don’t treat client
2. Refer to another therapist
3. Use a collection of techniques of EST
4. Employ evidence- based cognitive and behavioural principles in the development of a clients formulation
• Behavioural case formulation and treatment planning are principle-driven rather than protocol drive
Next two principle driven case formulations are both idiographic
CH4
1st approach- The role of functional analysis in the selection of interventions
• Functional analysis is ideal to identify the sequence of events that precede and follow problem behaviour
• First client and therapist identify links between antecedents and problem behaviours
• Second look for alternative response
• Evaluating the functional similarity of different forms of problematic behaviour
- Functional response classes consist of o group of behaviour that, although different, share functional relatedness as they often influences by similar environmental variables
- This awareness can help pinpoint the core processes that maintain the occurrence of problem behavioral patterns
Ch4
2nd Approach: The role of functional analysis in the selection of intervention
• More individual for the client, more considerate of the clients needs and goals
- Compared to the EST approach more flexible
• First therapist performs an assessment within a given area
• Arter this treatment approach is constructed by assembling modules that are relevant to the clients needs and with between therapeutic activities as the glue that holds the modules together
• The client only receives those components that are most appropriate for him
Ch4
Some general intervention guidelines
• Interventions for behaviors maintained by positive reinforcement.
- These problem behaviors are often addressed by interventions changing the environment.
- Therapy here includes learning to be more effective through ones behavior and to enhance behavioral skills.
• Interventions to target unhelpful thinking patterns
- Intervention focuses on developing awareness of bringing behavior more in line with goals and values and changing thinking patterns.
• Interventions to target emotional difficulties
- For people who experience anxiety, exposure-based therapies can be helpful. When clients focus on the past or future or when they wish to increase self-acceptance, mindfulness interventions are useful.
CH4
Developing a framework for a course therapy
• Deciding which therapy modes to use
- In DBT there are 4 primary treatment modalities
1. Individual outpatient therapy (focus on problem areas)
2. Skills training group
3. Telephone consultations
4. Case consultation meetings (analogous to supervision meetings)
Ch4
Discussing therapy plan with the client
- When a therapist provides a rationale he can promote a clients’ optimism about the therpy
- Next are two primary areas the therapist will review with the client before therapy
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1st area: Discussing the therapy rationale
- When client accepts the treatment rationale, associated with more therapeutic benefits
- Client is more optimistic whne they know the therapeutic approaches are widely tested and have been effective
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2nd area: Discussing between-session activities as an integral part of therapy
• CBT interventions typically involve between-session activities carried out by the client, such as self monitoring and questionnaires
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Establishing a motivation change and securing a commitment for action
• The associated level of distress with motivation for change is often a U function- Too much, too less decrease in motivation
• A strategy for facilitating motivation is motivational interviewing
- Non-confrontational and emphatic approach for discussing the effects and consequences of the problem behaviour and exploring the benefits of change
- Components of this approach include: Feedback for problem behaviour, teaching problem-solving strategies
• Low motivation for therpy is sometimes associated with psychological disorders and then a medication consultation can be necessary
• Also treatment contracts
1. Promote motivation for change
2. It’s a reminder for therapy options
3. Can provide a framework for crisis resolution
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Potential obstacles to effective therapy
• Following case formulation
- Ask client if they perceive obstacle
- Examine if the client anticipates other obstacles
- Invite clients to brainstorm on how the obstacle should be addressed
- Then can be translated into goals
CH4
Procedure for evaluating the effectiveness of therapy
• Ideally therapy goals should be measurable so you can see if there is progress being made
• Process of evaluating the therapy’s effectiveness, include the selection of an assessment framework and appropriate dependent measures
• For most clients the A-B of A-B-C schema is most effective
- A= baseline
- B= Intevention phase
- C= Period after investigation
• Nelson and Hayes provided guidelines to evaluate therapy efficacy
- measures should assess primary behaviors targeted in therapy, measures should occur frequently and if possible before treatment
- Data obtained should be graphed and regularly reviewed
Lec
Two phases in Behaviour Therapy
• Step 1
- understanding behaviour: analysing, hypothesisbased
• Step 2
- changing behaviour: interventions
