528 - 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
Who: Counselors consider adjunct treatments based on individual needs, therapeutic goals, and evidence supporting the efficacy of the treatment for the client’s specific challenges. They also work collaboratively with other providers when necessary (e.g., psychiatrists for medication management or physical trainers for exercise programs) to ensure a cohesive treatment plan that aligns with the client’s goals.
What: Refers to an additional or supportive therapy that complements the primary therapeutic approach. Adjunct treatments are used alongside the main counseling or psychotherapy method to enhance the overall effectiveness of treatment and address various aspects of a client’s mental health or well-being. They are not meant to replace the primary treatment but rather to support it by providing complementary benefits or addressing other symptoms or challenges that the main therapy might not fully cover.
Why: Adjunct treatments are important because they enhance the main therapeutic approaches by addressing additional needs that may limit the effectiveness of therapy. They are also apart of a holistic approach that help enhance symptom management for the client.
Example: Sarah, is attending counseling for generalized anxiety disorder. Her primary treatment is cognitive-behavioral therapy, where she works with her therapist on identifying and challenging anxious thoughts and developing healthier coping mechanisms. However, Sarah often feels overwhelmed by her anxiety between sessions, struggling to regulate her emotions in the moment. To help her manage this, her therapist recommends mindfulness-based stress reduction as an adjunct treatment.
case conceptualization/formulation
Who: Used by the counselor in order to fully understand the context and mechanisms behind a patients presenting symptoms.
What: Process of gathering, organizing, and synthesizing information about a client to understand their concerns, underlying issues, and the factors that contribute to their current mental health state.
Why: Case conceptualization is important because it serves as a framework for making sense of a client’s problems, identifying patterns, and developing an effective treatment plan tailored to their needs. This process helps counselors move beyond simply addressing symptoms by offering a deeper understanding of the client’s experiences, strengths, and challenges.
Example: Julie comes to therapy presenting symptoms of depression. Her therapist uses a case conceptualization to fully understand the context, precipitating events, and mechanisms that persists Julies depression.
client factors
Who: Understanding these factors allows therapists to tailor their approach to better align with the client’s unique strengths, needs, and circumstances.
What: The characteristics, circumstances, and personal qualities that clients bring into the therapeutic process, which can significantly influence the effectiveness and outcomes of therapy. Research shows that client factors often play a larger role in therapeutic success than specific therapeutic techniques.
Why: Client factors are important because they encompass the personal qualities, beliefs, strengths, and life circumstances clients bring to therapy, shaping the therapeutic relationship and influencing outcomes. By recognizing and working with these factors, therapists can create a more client-centered approach, increasing the likelihood of meaningful and lasting change
Example: A patient comes into therapy for suicidal thoughts and tendencies. They are honest and open with the therapist and shows an effort to receive help. These are client factors that work as assets in completing therapy.
common factors
Who: Understanding and emphasizing these factors can enhance therapeutic outcomes and foster a supportive therapeutic relationship between the patient and the clinician.
What: Refers to the essential elements shared across different therapeutic approaches that contribute to positive treatment outcomes, regardless of the specific techniques or theoretical orientation. Research in psychotherapy has consistently shown that these common factors play a significant role in the effectiveness of therapy.
Why: Common factors in therapy are important because they universally apply to many people, enhance client outcomes, help build resilience, and promote flexibility.
Example: Consider a client, Maria, who seeks therapy for anxiety. Maria is initially hesitant but finds comfort in her therapist’s warm, empathic approach. Over time, they establish a strong alliance, and Maria feels safe exploring her fears. The therapist collaborates with her to set realistic goals, which Maria finds motivating. As they work through her anxiety, Maria gains insights into her thought patterns and starts to feel hopeful about her ability to manage her anxiety.
In this example, common factors like empathy, the therapeutic alliance, hope, and collaboration are integral to Maria’s progress, regardless of the specific techniques the therapist uses.
efficacy vs effectiveness research
Who: Used by researchers and clinicians to evaluate treatments based on the setting and their clinical implications.
What: Efficacy research examines whether a treatment works under ideal, controlled conditions. It seeks to determine if a therapy or intervention has a positive effect in a highly controlled, often experimental setting.
Effectiveness research assesses whether a treatment works in real-world conditions, where variables are less controlled. It looks at the impact of a treatment when applied in routine clinical settings.
Why: Both types of research are necessary in evidence-based practice: efficacy research demonstrates the fundamental value of a treatment, while effectiveness research helps bridge the gap between research and real-world application.
Example: In an efficacy study, researchers might investigate the effects of CBT on depression in a highly controlled, ideal setting. For instance, they could recruit a group of adults diagnosed solely with major depressive disorder, excluding those with other mental health conditions to isolate the impact of CBT on depression.
An effectiveness study would then explore how well CBT for depression works in a real-world counseling context. Researchers could conduct the study in various community mental health clinics with clients who represent the diversity of the population seeking mental health services.
empirically supported treatments
Who: Typically used by the therapist to treat mental illness due to their high efficacy found through research.
What: Therapies and interventions that have been scientifically tested and proven effective through rigorous research. These treatments have demonstrated success in reducing symptoms or improving functioning in individuals with specific mental health conditions, typically through randomized controlled trials (RCTs), longitudinal studies, or meta-analyses. ESTs are designed to provide mental health practitioners with evidence-based approaches that increase the likelihood of positive outcomes for clients.
Why: ESTs guide therapists to use evidence-based approaches while remaining flexible and adapting techniques to fit the client’s unique context. They help provide a reliable foundation for mental health treatment, allowing therapists to deliver scientifically validated care while considering each client’s unique circumstances and cultural background.
Example: A patient comes to therapy to receive treatment for her borderline personality disorder. The therapist decides to use DBT as a form of treatment due to it being empirically studied as an efficacious treatment for BPD.
evidence based practice
Who: EBP allows the counselor to deliver treatment that is research-backed, responsive to the client’s needs, and aligned with professional best practices.
What: Evidence-Based Practice (EBP) in counseling is a decision-making approach that integrates three essential components to ensure effective, ethical, and personalized treatment which include: best available research evidence, clinical expertise, and client characteristics, values, and preferences.
Why: Evidence-based practice is important in counseling because it fosters ethical, effective, and accountable care while improving client outcomes. It also strengthens the counseling profession by demonstrating a commitment to scientifically informed, client-centered approaches, ultimately enhancing both the effectiveness and credibility of counseling services.
Example: A patient comes to therapy because they are struggling with their generalized anxiety disorder. The therapist chooses to use CBT as a treatment due to its empirically supported nature in treating GAD and other anxiety disorders. This is using EBP because the therapist is utilizing scientifically backed interventions to help benefit the patient.
failure to respond
Who: This typically happens on the clients end when therapy does not seem to be benefiting them.
What: Refers to a situation where a client does not show meaningful improvement or progress despite consistent engagement in therapy. This can occur for various reasons and might reflect a mismatch between the treatment approach and the client’s needs, barriers in the client’s personal or environmental context, or other complex factors affecting the counseling process.
Why: Recognizing when a client is not responding to treatment is important as it allows counselors to make informed adjustments, ensuring that the therapy process remains flexible, client-centered, and ultimately more effective in supporting the client’s mental health journey.
Example: A patient with BPD is currently undergoing DBT. The therapist notices that the client is not improving and still has suicidal thoughts while undergoing therapy. The client is failing to respond to treatment and this may be due to another factor such as biology and a lack of neurotransmitters.
informed consent for treatment
Who: Counselors should revisit consent as treatment progresses, particularly if new treatment methods are introduced or if the client’s circumstances change. This ensures that clients remain informed and engaged throughout their therapeutic journey.
What: A fundamental ethical and legal process that ensures clients are fully aware of and agree to the terms, risks, and benefits of the therapeutic services being offered. It empowers clients by providing them with essential information, allowing them to make knowledgeable decisions regarding their mental health treatment.
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.
