ch 9 Flashcards
multicultural evidence-based practice
empirically-supported therapies (ESTs)
increasingly promoted
evidence based theories
involve a very specific treatment protocol for each disorder
successful psychotherapy is dependent upon three interacting components
the therapy selected
therapist qualities and skills
client characteristics
evidence-based practice (EBP)
an integrated model that combines research, therapist judgement and qualities, and client culture and characteristics
the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences
shortcomings of ESTs
owing to the focus on choosing treatment based on the specific disorder, socioeconomic contexts not considered
the validity of it for minority groups often questionable
the importance of the therapist-client relationship is not adequately acknowledged
too much emphasis is placed on randomized controlled trials versus other forms of research, such as qualitative research designs
modifications to empirically supported cognitive behavioral strategies to support minorities
engagement strategies: recognizing importance of personal relationships
activity schedules: adjusted to needs/culture of client
assertiveness training:
cognitive restructuring
cultural adaptations can include factors such as…
matching the language and racial or ethnic backgrounds of the client
incorporating cultural values in the specific treatment strategies
utilizing cultural sayings or metaphors in treatment
considering the impact of environmental variables, such as acculturation conflicts, discrimination, and income status
therapeutic alliance
consistently related to treatment outcomes and their success
difficulties in it may be factor in underutilization of mental health services and early termination
therapist-client relationship variables as they relate to treatment outcome…
the therapeutic relationship makes substantial and consistent contributions to psychotherapy outcome, independent of the specific type of treatment
the therapy relationship acts in concert with discrete interventions, client characteristics and clinician qualities in determining treatment effectiveness
adapting or tailoring the therapy relationship to specific client needs and characteristics enhances the effectiveness of treatment
practice and treatment guidelines should explicitly address therapist behaviors and qualities that promote a facilitative therapy relationship
empirically supported relationship (ESR) variables include…(critical for effective multicultural counseling)
the development of a strong therapeutic alliance, solid interpersonal bond, and effective management of countertransference
core conditions of effective treatment
empathy, respect, genuineness, and warmth
connectedness
having feelings of closeness with the therapist, working together in an enabling atmosphere, receiving support for change, and being provided an equality of status within the working relationship
cultural humility (important aspect to working with diverse groups)
defined by flexibility; self-reflection, mutual empowerment, awareness of bias; a lifelong, learning-oriented approach to working with diversity; and a recognition of the role of power on the part of the therapist
three elements of therapeutic alliance
an emotional or interpersonal bond between the therapist and client
mutual agreement on appropriate goals, with an emphasis on changes valued by the client
intervention strategies or tasks that are viewed as important and relevant by both the client and the therapist
collaboration
a shared process in which a clients views are resoected and his or her participation is encouraged in all phases of therapy
empathy
know to significantly enhance the therapeutic bond
the ability to place oneself in the clients world, to feel or think from the clients perspective, or to be attuned to the client
allows the forming of an emotional bond
look for verbal and nonverbal cues
emotional empathy
having an emotional understanding or emotional connection with the client
cognitive empathy
understanding the clients predicament cognitively, whether on an individual, family, or societal level
Involves. therapists ability to understand the issues facing the client
positive regard, respect, warmth, and genuineness
involves identifying and focusing on the strengths and assets of the client including an appreciation for his or her values
creation of an emotional bond
empathy
positive regard, respect, warmth, and genuineness,
self-disclosure
management of countertransference
goal consensus
countertransference
involves the therapists emotional reaction to the client based on the therapists own set of attitudes, beliefs, values, or experiences
empirically based practice
includes both ESTs and relationship values but is broader and more comprehensive
assumption underlying it is that the search for the best research evidence begins with a comprehensive understanding of the clients background and problem and goes on to consider which therapeutic approach is most likely to provide the best outcome
accepts research evidence from qualitative studies, clinical observations, systematic case studies, and interventions delivered in naturalistic settings
clinical expertise focuses not only on the quality of the therapeutic relationship and alliance, but also on the skills essential for comprehensive assessment of the clients problem and strengths
based on the ongoing emphasis on client characteristics, culture, and preferences and the importance of working collaboratively with the client to develop goals and treatment strategies that are mutually agreeable
identification of client variables includes
age and life stage
sociocultural factors
environmental stressors
personal treatment preferences
