Chapter 14 - Key Elements for Change Flashcards
What is process research?
research that examines patterns, using therapist and or client data, that are evident within and across therapy sessions
(examines what happens in therapy)
what is process outcome research?
examines the relation between variables related to the process of providing psychotherapy and the outcome of psychotherapy
- How what happens in therapy is related to client change and tells us about HOW therapy works.
What are common factors?
therapeutic elements that occur in all or most treatments and are believed to be critical for client outcomes.
critical for successful client outcomes
what is fidelity?
when clinicians follow the same protocol.
–> however, because every person is unique, each treatment will also be delivered in a unique way
brings into question how much of the success of treatment is due to the treatment and how much is due to fidelity
What are some client variables?
- gender, age, SES, belief in therapy, goals, previous treatment, psychological minded, marital status
we examine these because diagnosis isn’t the only factor that determines therapy outcomes.
Client factors:
What is higher SES associated with?
higher engagement / higher completion and improvement
Client factors:
what is having a similar ethnicity to the therapist associated with?
more engagement / completion and improvement
Client factors:
Which gender is more likely to seek out treatment?
Women… however, this makes no difference in completion and improvement across time.
Client Factors:
what is higher age associated with?
more engagement… but doesnt make a difference in completion
Client factors…
what is symptom severity associated with?
differing outcomes for engagement, but poorer outcomes with completion and improvement
What is positive engagement associated with?
more engagement and higher completion
What is psychological reactance?
the tendency to react against attempts to influence or limit one’s behaviours or options
how is psycholigcal reactance associated with treatment outcomes?
low reactance = greater therapeutic gains in more directive treatments
high reactance - greater therapeutic gains in less directive treatments
What is psychological mindedness?
the ability to understand people and problems in psychological terms.
–> related to more positive treatment outcomes
What are some therapist variables that influence treatment?
- Professional background (mental health training more positive outcomes than regular health training)
- experience (has a small positive effect)
- Wellbeing ( the therapists wellbeing is consistently positively associated with treatment outcomes)
- Self disclosure ( small positive effect)
NO real effect of age or gender.
Ethnicity has an effect if the therapist is multicultural
What are some benefits of Therapeutic Self disclosure?
- relaxing initial rigid boundaries
- foster a more egalitarian relationship
- humanizing dimensions of therapy
- help clients adopt active and collaborative roles in therapy
- model interpersonal behaviours
(overall just helps to build a warmer and more authentic therapy experience)
How can self disclosure be harmful?
- can shift focus away from the client
- can denormalize the therapeutic space
- if self disclosure paints therapist in negative light they can lose the perception of capability / professionalism
- role reversal (client can feel like they need to take care of the therapist)
- risks exploiting the client
therapist variables account for 3% of variability of outcome in efficacy trails and 7% in effectiveness trials
this is probably because in therapy (like exposure therapy in OCD), practice exposure and homework makes the biggest difference in the outcomes.
the difference in therapist effectiveness is the most noticeable wen treating patients with high levels of problem severity.
helpful therapists had patients who improved from 13 to 55%
harmful therapists had patients who deteriorated in functioning
Treatment Variables:
interpretation
- comes from a more psychoanalytic / psychodynamic perspective…
- includes the thoughts, emotions and behaviours in the unconscious process..
- We are interpreting what the client is telling us and making a hypothesis about what that might mean.
- no consistent evidence in support of this being helpful. BUT there is more positive outcomes for individuals with high interpersonal skills
(this is likely because if you make an interpretation that is incorrect they will tell you).
Treatment Variables:
Directives.
is it better to be direct and guiding… or a neutral reflective therapist?
- can be determined by the clients level of reactance..
- therapists will usually adjust and be flexible with their interaction style to emphasize either direct guidance or self exploration and self directedness.
CBT is more directive than other treatments
- you are assigning homework and suggesting the homework should be done in a specific way.
Treatment Variables:
Between Sessions Assignments
has a positive effect….
medium correlation between assigning homework and positive effects…
the more you practice and the more you work the better you will get so this makes sense
Treatment Variables:
Insight
insight is being aware of symptoms and feelings and how things impact them…
if someone has low insight they probably won’t be able to interpret the cause and effect of things..
Insight is helpful for individuals who are internalizing (depression and anxiety) – giving them an additional perspective to work with is helpful.
Treatment Variables:
Symptom alleviation
most effective for clients who externalize.. (e.g., ODD, CD)
symptom reduction can be a good substitute for dead persons goals..
more about tollerating and coping than never feeling a type of way again
3 factor model
What are SUPPORT FACTORS *
having emotional / social support helps to reduce isolation
a therapeutic alliance is one of the most important parts of therapy - if you dont have a strong relationship you are more likely to drop out
working with someone who has experience with what youre going through can be super helpful
AND having accurate empathy for the client..
3 factor model:
what are LEARNING FACTORS? **
- psychoeducation (presenting information in a way where they can take what they need and leave the rest)
- Emotional experiencing (having a safe base to have emotional experiences where someone can feel anger and won’t feel retaliated against)
- Insight - Why are people experiencing certain things?
- Feedback - can mirror what you are sensing from the client and it can help them see how that pattern might be affecting their lives.
- Behavioural Regulation - Develop skills that allow them to develop regulation of their behaviours
3 factor model:
What are ACTION FACTORS
- Modeling what you want people to learn and doing it with them
= e.g., everything and nothing model - showing people we can face our fears and do it together
- catharsis or release of emotions
what are integrative treatment models?
theoretical models that explicitly incorporate aspects of multiple theoretical approaches and frequently common factors
What are some things that the therapeutic alliance predicts?
- success in therapy
- staying in therapy
- coming back to therapy
What are the 3 integral pieces of the Therapeutic Alliance?
1) Affective bonds
- respect for eachother, expertise and lived experience
- trust and liking eachother
- feeling comfortable with that person and having some kind of admiration for eachother
2) Consensus about goals
- What types of goals should we set in therapy
- Have to collaborate on goals
3) sense of partnership
- working together to tackle problems,
- knowing someone will be there by your side to work towards goals.
What are two reasons there seems to be not as much difference between different modes of therapies and schools of thoughts (psychotherapy equivalence)
1) alot of therapies are just extensions of eachother like DBT and CBT
2) self selection bias.. some people will pick the therapy thats most effective for them.
- basically just saying that is less due to theoretical factors and more due to common factors.
what are some things that do NOT work
- confrontation
- assumptions (gender /sexuality/ stereotypes)
- rigidity (have to tailer therapy to the client)
- Flexibility without fidelity
( being to flexible that you aren’t delivering the therapy in a helpful way)
What are some variables that ARE predicted to promote chagne.
Relationship
- alliances
Therapeutic behaviours
- collaboration
- sensitivity to ruptures
- empahty
- authenticity and genuineness
What are some client variables that are assumed to reduce chance of change?
- Greater impairment
- personality disorder
- Financial difficulties
- Significant interpersonal problems in childhood
- Unfavorable attitudes to treatment
