528 - DEENA'S VERSION Evidence Based Practice, Case Concept, Tx Planning Flashcards
ADDRESSING model
WHAT: Helps to fully understand a client. Helpful to see in what way the client may be in a marginalized group.
A- age
D- disability at birth
D- disability acquired
R- religion
E- ethnicity
S- sexual orientation
S- socioeconomic status
I- indigenous heritage
N- nation of origin
G- gender
WHY: This model allows for the therapist to consider a range of culture factors that influence a client’s identity and their experiences. It aids in creating relevant and effective treatment goals.
EXAMPLE: Dahlia is an 18 year old with no disabilities, she is Buddhist, Indian, a lesbian, upper class, no indigenous heritage, was born in the USA, and is a CIS gendered girl. The therapist will gather information about how aspects of her identity may be influencing her presenting problems.
adjunct treatment
WHAT: Additional (1+) interventions used in combination with the primary intervention to enhance effectiveness and address other aspects of clients’ mental health.
- adjunct tx usually done with a different practitioner than the primary one
- meds usually more common, group therapy second most common
WHY: Important to know adjunct treatments are usually a good option to best treat a client, as sometimes a single intervention does not properly address all of the client’s symptoms or challenges. They enhance overall treatment outcomes, and are apparent of a holistic approach to therapy (considers whole person, not just one aspect of their health).
EXAMPLE: A therapist is using CBT to treat a client’s anxiety. She is making progress, but often says her anxiety is overwhelming between sessions. The therapist recommends the client considering adding medication as an adjunct treatment. The therapist explains this will address the neurological aspect of her anxiety, and will bring her down to a baseline that its more responsive to the CBT.
case conceptualization/formulation
WHAT: Idiographic approach for obtaining and organizing information about a client. Formulated after first few intake sessions and can be adjusted throughout treatment.
Composed of…
1) diagnosis, symptoms, and problem list
2) info about the client’s history
3) hypothesis about the precipitants, origins, and mechanisms maintaining/causing the disorder and problems/symptoms
4) highlighting client assets
5) planning treatment + adjunct treatment
WHY: Important to create a case conceptualization as it helps the therapist deeply understand a client and disorder, beyond surface symptoms. It offers a ‘roadmap’ of the treatment and methods of measuring progress for the therapist and client to reference.
EXAMPLE: A new client has come to therapy for their depressive symptoms. Over the first two sessions, the therapist creates a case conceptualization with ideas of certain behaviors that serve to maintain their disorder, where these behaviors originated from, and what treatment(s) would be best for this individual client.
client factors
WHAT: Characteristics or resources that clients bring into the session.
- significantly influence the outcome of therapy
- impact the presentation + maintenance of their problems
- include previous experience with therapy, outcome expectancy, readiness to change, age, gender/sex, etc.
(ADDRESSING model)
WHY: Client factors are an important aspect of the therapeutic process. They can positively or negatively influence the client’s success in therapy and response to treatment. By recognizing and integrating client factors into the treatment plan, a therapist can create a more effective intervention for the client.
EXAMPLE: A client comes into therapy due to high levels of anxiety. After some conversation, the therapist learns the client is very independent and self-reliant, but lacks resilience or any deathly coping mechanisms. These client factors will be kept in consideration as the therapist plans treatment.
common factors
WHAT: Says that several types of psychotherapy all share common factors that are hypothesized to be the reason for much of the effectiveness of a tx + elicit change
4 Categories =
1) extratherapeutic
- things outside of the session (motivation, social support, client factors)
2) therapeutic relationship (necessary but not sufficient)
3) expectation (outcome, process)
4) specific techniques (compatibility of treatment chosen)
WHY: Important to identify and strengthen these factors with a client in order to provide the best possible treatment experience with a higher likelihood of positive change.
EXAMPLE: With each client, a therapist is sure to build trust and a rapport, create hope of a positive outcome, and set goals. The therapist is thorough when planning treatment to pick the most compatible treatment. The therapist is employing common factors to create the best chance for positive change in the client.
efficacy vs effectiveness research
WHAT: Aspects of psychotherapy outcomes research.
Efficacy = internal validity!
- are changes (DV) due to manipulation (IV)
Effectiveness = external validity!
- generalizability of findings
WHY: Important to understand the difference and implications of each term when consuming research. The knowledge will help to select the best treatment choice for a client.
EXAMPLE: Researchers are conducting an outcome study on ERP on substance abuse. They find that symptoms of substance abuse are reduced following treatment, indicating good efficacy. The researchers now want to investigate if this treatment plan would work in a real-world context, or the treatment’s effectiveness.
empirically supported treatments
WHAT: Treatments that have been scientifically tested and proven effective through strict, rigorous research (RCTs, longitudinal studies, or meta-analyses).
- focused on symptom reduction/a target bx
WHY: ESTs are designed to provide mental health professionals withe evidence-backed interventions. They help to ensure clients receive safe and reliable care.
Example: A therapist primarily uses CBT to treat GAD, as CBT has lots of empirical support in treating GAD. The therapist also stays up to date on new research or findings in order to best serve their clients.
evidence based practice
WHAT: A decision-making approach that integrates best available research, client characteristics, and clinician expertise to choose the best treatment option for a client.
WHY: Guide therapists in selecting and applying interventions. EBPs allow for therapists to create personalized treatment plans for each client by combining ESTs and client factors.
EXAMPLE: A therapist using EBPP chooses CBT to treat a client with depression. The client comes from a non-Western culture, so the therapist uses a multicultural approach in tailoring treatment. The therapist using a EST and adapting the treatment to the client creates the best possible outcomes.
failure to respond
WHAT: When a client is not seeing positive change or meeting goals within treatment, and stops coming to therapy.
- can occur due to mismatch between therapist/tx and client
- progress monitoring can show a lack of progress + initiate treatment or diagnosis reevaluation
WHY: Important to be aware of signs that a client is failing to respond and remain flexible if a reevaluation is needed. Also, it is unethical to continue providing a failing treatment if the client is not responding, as their symptoms are remaining untreated.
EXAMPLE: A therapist has been using CBT to treat a client diagnosed with depression. However, after 3 months of treatment the client’s score on the BDI is unchanged. This indicates the client is failing to respond to treatment.
informed consent for treatment
WHAT: A client’s agreement to participate in treatment on the basis of their understand of the potential risks and benefits, diagnosis and treatment plan, policies, and terms of confidentiality.
- verbal and written consent needed
What: It is a person’s voluntary agreement to participate in treatment on the basis of their understanding of its nature, its potential benefits and possible risks, and available alternatives. Verbal and written consent is required. It must occur before the treatment begins. The therapist will review the key information regarding the proposed treatment, summarize her hypothesis about diagnosis and formulation, describe other options available to the client, not just her recommended plan and obtain the client’s permission.
Informed Consent for Treatment- part of CBT case level formulation discussed in EBP. Before beginning treatment, the therapist reviews the key information in a formal process to obtain the patient’s informed consent to proceed with the proposed treatment plan. Informed consent is part of the pre-treatment phase-case formulation aids in the consent process because most patients want to have confidence their therapist truly understands their difficulties and will provide treatment that addresses the problems. Informed consent is the patient’s permission to move forward with the treatment plan.
Why: Informed consent is a crucial aspect of ethical counseling practice that enhances client engagement, fosters a positive therapeutic relationship, and protects both the client and counselor. By ensuring clients understand their treatment options and the implications of those options, counselors can support informed decision-making and facilitate a more effective therapeutic process.
Example: A counselor starts seeing a new patient for depression. Before the therapy begins the counselor sends the patient an informed consent document and goes over what will be entailed in therapy. The therapist does this to protect the client and their own rights as well.
practice guidelines
Who: Guidelines serve as an educational resource for counselors, providing information on current best practices and encouraging ongoing professional development. They help practitioners stay updated with advancements in the field.
What: Systematically developed recommendations that provide guidance to mental health professionals on how to deliver effective therapeutic interventions. These guidelines are based on a synthesis of current research, clinical expertise, and practitioner consensus, and they aim to improve the quality of care for clients while enhancing the effectiveness of therapeutic practices.
Why: Practice guidelines in counseling are essential tools that help ensure the delivery of effective, evidence-based, and client-centered care. By promoting standardization, improving treatment outcomes, and supporting professional accountability, these guidelines play a crucial role in enhancing the quality of mental health services provided to clients.
Example: A new therapist is anxious about conducting therapy on their own. In order to get a better understanding of the clinical framework, the therapist reads the APA Practice Guidelines for the Treatment of Depression to get some clarity.
precipitants of the problem
Who: These events typically affect the client in a negative way and is a main factor as to what brought them to therapy.
What: Refer to specific events, situations, or stressors that trigger or exacerbate a client’s mental health issues or problematic behaviors. These precipitants are often immediate factors that can lead to a crisis or intensify existing difficulties, prompting the client to seek counseling
Why: Precipitants of the problem are crucial to understanding the dynamics of a client’s mental health issues. By identifying these triggers, counselors can provide more targeted interventions and support, ultimately enhancing the effectiveness of the therapeutic process.
Example: A patient comes to therapy for depression. Upon the intake evaluation the therapist discovers that the patient has lost their job, dealt with a death in the family, and recently went through a breakup. These negative events have enhanced their depression symptoms making them precipitants of the problem.
problem list
Who: This is used by the counselor to organize and conceptualize what problems have brought the patient to therapy.
What: A problem list is a foundational part of case conceptualization. It’s essentially a structured list that outlines the client’s primary concerns, symptoms, or challenges that need to be addressed in therapy. The purpose is to clearly identify and prioritize these issues so that both the therapist and client can have a clear focus for treatment.
Why: Problem lists are crucial in case conceptualization because they provide a structured foundation for understanding the client’s difficulties, guiding the treatment process, and measuring progress. It aligns the therapeutic efforts with the client’s unique needs, fostering a personalized and organized path to improvement.
Example: A patient comes to therapy for the treatment of their depression. During the case conceptualization stage the therapist asks the patient many questions about what brought them in and what they are struggling with. The therapist will then create a problem list based off what the patient has said to better understand what brought them to treatment and how to tailor treatment to the patient.
mechanisms of action
Who: Mechanisms of action help therapists go beyond surface-level symptoms to address the underlying processes that sustain a client’s problems, enabling more meaningful and lasting therapeutic change.
What: Mechanisms of action refer to the underlying processes or factors that drive the client’s problems and maintain their symptoms. They are the “how” and “why” behind the client’s difficulties and inform how change will happen in therapy.
Why: Understanding these mechanisms is important because it allows the therapist to develop interventions that target the root causes of problems, rather than just addressing symptoms.
Example: A patient comes to therapy due to GAD. The therapist looks at what mechanisms of action are persisting the patients anxiety. After a discussion the therapist notices that the client is continually negatively reinforced by avoiding social stressors. This gives the therapist an idea of the root issue that keeps the patient anxious.
nonadherence
Who: Nonadherence is a common and complex issue in counseling, and it can significantly impact the effectiveness of treatment for the patient.
What: Nonadherence (or noncompliance) refers to a client’s lack of follow-through with aspects of the treatment plan. This can mean not attending sessions consistently, not engaging in agreed-upon therapeutic exercises, or not implementing coping strategies or lifestyle changes discussed in therapy.
Why: Addressing nonadherence is essential in therapy, as it not only supports treatment progress but also builds the client’s confidence and sense of agency in managing their mental health.
Example: Sarah has been forced to attend therapy after a recent court order from a judge. She feels as though she doesn’t need therapy. She attends the sessions but doesn’t complete any homework, refuses to take her medication, and doesn’t open up much during her sessions. She is showing nonadherence to therapy because she is being forced to go.
