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 voluntary agreement to participate in treatment on the basis of their understanding of…
- potential risks and benefits
- tx plan + goals
- diagnosis/case concep
- payment/fees
- limits of confidentiality
*verbal + written consent needed
WHY: It is legally and ethically required for a client to give informed consent to treatment. It emphasizes the collaborative approach to therapy, and ensures the client trusts the therapist to administer the therapeutic process.
EXAMPLE: A therapist is going over the informed consent with a new client with anxiety. The therapist discusses the terms, process, goals of therapy. The therapist has recommend ERP as tx, and explains that while it may be distressing initially, it could provide long-term benefits.
practice guidelines
WHAT: Guidelines that direct mental health professionals on how to diagnosis and ethically treat disorders.
- based on the latest, best available research OR the judgement of an expert committee
WHY: Practice guidelines are tools set in place to help with clinical decision making, and improve the quality of and effectiveness of treatment. They reinforce professional accountability and ethical practice.
EXAMPLE: A new therapist has just begun seeing clients with eating disorders. They are nervous about the new job, and reference the APA Practice Guidelines on the treatment options for eating disorders.
precipitants of the problem
WHAT: The event/trigger/stressor that worsen a client’s mental health and prompted them to seek therapy. diathesis in diathesis-stress model
“Why is this client coming in treatment now?”
WHY: Important to consider the precipitant of a client seeking treatment while conceptualizing their case. Understanding these factors allow therapists to create a targeted intervention and help the client manage the trigger in the future.
EXAMPLE: A client has come into treatment exhibiting symptoms of depression. The therapist learns the precipitant of the client seeking treatment was the loss of their job. The therapist may explore the event of the job loss further, and also generate ways to cope with a future job loss.
problem list
WHAT: A list of all the client’s problems/concerns from all aspects of their life.
- first step of formulating a case
should be from the perspective of the client’s experience
WHY: Important as it helps to identify what the client views as their most pressing problem. It guides what should be focused on in therapy, and allows for treatment progress.
EXAMPLE: A therapist is creating a case conceptualization for a new client and is gathering information as to what brought them into treatment, what they’re currently struggling with, etc. The therapist will create a problem list and use it as guidance while developing the treatment plan.
mechanisms of action
WHAT: The mechanisms that cause and maintain a client’s problems/symptoms.
- treatment plan should be created to target the mechanisms
- include cognitive, behavioral, and biological aspects
often faulty schemas and/or core beliefs
WHY: Important to be able to recognize mechanisms of action and how they will be targeted with intervention, as they are the processes by which therapeutic change occurs.
EXAMPLE: A client comes to therapy with a social anxiety disorder. After somme conversation, the therapist identifies one mechanism to be the client being negatively reinforced for avoiding social situations. This provides the therapist with a focus of treatment.
nonadherence
WHAT: A client’s OR therapist’s noncompliance with treatment plan. Client nonadherence should be addressed in treatment treated the same as another behavioral symptom
Client includes…
- not attending sessions
- not engaging in session
- not implementing out of session changes (lifestyle changes, new coping strategies, homework, etc.)
Therapist includes…
- not monitoring progress
- not getting informed consent
- not reviewing hw assignments
WHY: Client and therapist nonadhearence can damage the therapeutic alliance and slow or stop therapeutic progress.
EXAMPLE: A young woman was court-mandated to attend therapy. She attends sessions, but frequently expresses her distain, does not complete homework, and does not open up much during session. She is showing nonadherence and as a result, there is likely no therapeutic alliance, nor will there be any positive change.
