Beutler Model of Treatment Planning Flashcards
What are the elements of the Beutler Model Coping Style?
A continuum
Externalising ————————– Internalising
“Externalisers” are people who generally:
- Blame others, events, bad luck, fate
- Actively try to avoid their problems
- More impulsive, manipulative, aggression risk
“Internalisers” are people who generally:
- Blame themselves – perceive poor skills/abilities
- Seek understanding and answers (risk of intellectualising)
- Constrict, repress, minimise, control
What is the Beutler Model of Treatment Selection?
- Based on identification of relevant client characteristics
- Links approach to characteristics with evidence-based research.
- 6 client dimensions
- Functional Impairment; Social Support; Problem complexity/chronicity; Coping style; Resistance; Subjective distress
- Additional Problem-solving phase (based on stages of change)
What are the 6 Client Dimensions of the Beutler Treatment Model?
- Functional Impariment
- Social Support
- Problem complexity/chronicity
- Coping style
- Resistance
- Subjective distress
How does the current DSM-V rate current functioning?
Using the WHODAS
What is the WHODAS and what does it stand for?
DSM-V rating of functional impairment
WHO Disability Assessment Schedule (WHODAS)
WHO (World Health Organisation)
What is important to assess in Functional Impairment?
Does the concern interfere with the client’s ability to manage everyday social, occupational, interpersonal, other tasks?
What is the Severity of the impairment?
Higher severity likely to relate to:
- less ability to cope
- Poorer insight
- Chronicity of symptoms
What other things are there to consider when assessing functional impairment?
Don’t rely solely on clients self-report of their distress by their level of functioning
A more objective assessment required, consider:
- Ability to function and interact with the interview
- Poor concentration and distractibility
- Number of area’s where functioning is impaired
- Higher scores on measures (e.g., BDI-II) suggest a higher degree of incapacity
- DSM-V – rate current functioning using WHODAS
Wha are the High Level and Low Level criteria for Functional Impariment?
High level of functional impairment – may require hospitalisation to achieve stabilisation
- Intense in frequency and duration
- Benefits of medication
- Focus on the symptomatic areas of concern (e.g., neurovegative symptoms) – greater urgency to achieve
Mild-Moderate – suitable for outpatient treatment
- Moderate frequency and duration
- Focus can be directed towards long-term outcomes, which may change (i.e., less urgency)
- But do need to ensure other specific symptoms are addressed
•Both – ensure social supports to aid functioning
What doesthe Beutler Model for Social Supports take into consideration?
What is the level of support from:
- family members
- Friends
- Employment
More than assessing the number – need to assess the quality
- Trusted & respected by others
- Sense of belonging to a family network
- Relatedness (i.e., sharing common interests)
- Availability – does not feel lonely or abandoned.
What treatment approach would you use for High and Low Social Supports?
High social support
- Shorter treatment
- Focus on enhancing the quality of relationships
Low social support
- Longer treatment
- Benefit of group interventions
- Teaching of strategies to manage symptoms (e.g., CBT)
Beutler Model Comlexity/Chronicity - what do you consider?
Underlying patterns in a person’s life that may/may not result in a degree of impairment
Related to internal unseen events – theoretically bound.
3 features:
- Several problem domains/diagnoses (comorbidity)
- Pervasive/recurrent patterns & themes of problem behaviours
- Presence of a personality disorder (or personality style that resembles a PD
What would you consider are complex problems in the Beutler Model?
Complex Problem
- Repeated behavioural patterns across unrelated situations – leads to suffering
- Behaviours are attempting to resolve interpersonal or dynamic conflicts
- Interactions seem related to past relationship (rather than present)
What would you consider are non - complex problems in the Beutler Model?
Non-complex problems
- Situation-specific & related to precipitating events
- Transient
- Related to inadequate knowledge of skills & use of prior learnt unbeneficial behavioural patterns to cope/manage
What is the treatment approach in the Beutler model to High Levels and Low Levels of Complexity?
High problem complexity
- Longer-term treatment
- Resolve underlying conflicts through exploring patters of behaviour & relationships, interpreting transference
- Role-play work of beneficial responses to situations
Low problem complexity
- Targeting specific symptoms
- Targeting precipitants and perpetuating factors
What is the Beutler Model treatment approach to Coping Styles?
High Externalisers
- Symptoms-orientated interventions (e.g., relaxation, cognitive restructuring)
- Specific techniques for building skills (e.g., social skills, anger management)
High Internalisers
- Develop insight (e.g., interpreting resistance and transference)
- Develop emotional awareness (e.g., mindfulness)