Evidence Based Practice Flashcards
ADDRESSING Model
WHAT- Model used to fully understand a client and see if they are part of a marginalized group
A - age
D - disability at birth
D - disability acquired
R - race
E - ethnicity
S - SES
S - sexual orientation
I - indigenous group
N - nation of origin
G - gender
WHY- This model is important as it allows for the therapist to consider a range of cultural factors that influence a clients identity and their experiences which aids in creating relevant and effective treatment goals
EX- Dahlia is an 18 year old with no disabilities, she is buddhist, Indian, lesbian, upper class, no indigenous heritage, from the US, and identifies as female. The therapist uses these factors after implementing the addressing model to see if they are influencing her presenting problems
Adjunct treatment
WHAT- Additional interventions (1+) used in combination with the primary intervention to enhance effectiveness and address other aspects of the client’s mental health. Adjunct treatment is usually done with a different practitioner than the primary one. Examples of common adjunct treatment include medication, group therapy, couples/family therapy, with medication being the most common
WHY- Important to know that adjunct treatments are common and usually a good option to treat a client as sometimes a single intervention does not properly address all the clients symptoms. It is a more holistic approach, considering the client as a whole
EX- A therapist is using CBT to treat a clients anxiety. She is making progress, but reports her anxiety is overwhelming between sessions. The therapist recommends the client consider adding medication as an adjunct treatment. The therapist explains this will address the neurological aspects of her anxiety which can bring her down to baseline and more responsive to the CBT
Case conceptualization/formulation
WHAT- Idiographic approach for obtaining and organizing information about a client. Usually formulated after the first few sessions with a client and can be adjusted throughout treatment. Therapists collect data through interviews, self-reports, and observations. Composes of:
1. Diagnosis/symptoms/problem list
2. Information about the clients history
3. Hypothesis about origins, precipitants, and mechanisms maintaining the disorder
4. Highlighting client assets
5. Treatment planning
WHY- Case conceptualization is important because it helps therapists by providing insight into the client’s symptoms, triggers, and underlying mechanisms. It aids the therapist in choose the most effective evidence-based interventions and enables the therapist and client to work together toward shared goals.
EX- Client: 35-year-old woman experiencing persistent sadness, isolation, and low motivation after losing her job.
Case Conceptualization Using a CBT Model
Precipitating Factor (Trigger): Job loss. Cognitive Factors: “I’m a failure; I’ll never find another job.” Emotional Response: Sadness, hopelessness. Behavioral Response: Social withdrawal, avoiding job applications. Maintaining Factors: Lack of positive reinforcement, self-critical thinking.
Client factors
WHAT- Characteristics, circumstances, or resources that influence a clients engagement with overall therapy and the effectiveness of treatment. These factors can include: previous experiences with therapy, personality traits, the ADDRESSING model, values, medical/psych history, etc. These factors significantly impact the outcome of therapy as they influence presentation and maintenance of problems
WHY- Understanding client factors allows clinicians to customize interventions to the unique individual, build rapport, and address any barriers to treatment.
EX- A client with a strong family network might have better resources to implement treatment strategies compared to a client who does not have close social ties, the therapist would consider this when deciding on specifics for interventions.
Common factors
WHAT- Common factors are the necessary characteristics that are hypothesized to be the reason for much of the effectiveness of therapy and eliciting change. The 4 categories are extra-therapeutic (outside of session), therapeutic relationship, expectations, and specific techniques. These factors are persistent regardless of theoretical orientation
WHY- Important for a clinician to identify and strengthen these factors with a client in order to provide the best possible treatment experience that leads to positive outcomes.
EX- A therapist actively listens to a client’s concerns, validates their feelings, and shows genuine interest in their experiences, demonstrating empathy and understanding. The therapist is building the therapeutic alliance which is one of the common factors
Efficacy vs effectiveness research
WHAT- Terms used to describe the ability of an intervention or treatment to produce desired results. Efficacy refers to the internal validity of the research, that it is able to produce the desired results under controlled conditions. Seeing that the DV is impacted by manipulation of the IV. Effectiveness refers to the external validity of the research, that the findings are generalizable and can be produced in real world settings.
WHY- Important to know the difference and implications of each when consuming research to help make the best informed decision on a treatment for a client
EX- Researchers are conducting an outcome study on ERP for substance use. After a controlled trial, they find that symptoms are reduced following treatment, indicating good efficacy. The researchers will now test the effectiveness to see if the study is applicable in real world settings.
Empirically supported treatments
WHAT- Treatments that have been scientifically proven effective through strict, rigorous research. Key characteristics of ESTs are scientific validation, specificity, replication. Therapist can tailor ESTs to individual needs, blending research backed approaches with personalized care. They are used in clinical settings, hospitals, schools, and community mental health programs
WHY- ESTs are designed to provide mental health professionals with evidence based interventions which is essential to ensure that clients are getting safe and reliable care. Training and certification programs ensure therapists are properly equipped to deliver these treatments
EX- A therapist is using CBT to treat GAD because CBT has a lot of empirical support in treating this disorder. The therapist also keeps up to date on new research or findings in order to best serve clients
Evidence based practice
WHAT- Refers to the integration of best available research, clinical expertise, and client preferences to provide high quality and effective care. EBP ensures that interventions and treatments are supported by scientific evidence and tailored to meet the individual needs or clients
WHY- EBP ensures that one is serving clients ethically, effectively, and relevantly. By bridging the gap between research and practice, EBP supports informed decision making and enhances credibility.
EX- A therapist treating a client with depression using EBP decides to use CBT because of its strong evidence of effectiveness, the client is from a non-western culture so the therapist uses a multicultural approach to tailor treatment, and the therapist accommodates the clients preference to active problem solving over mindfulness exercises.
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 the client and the therapist or a mismatch between the client and intervention. If client is showing a lack of process, it is in best practice to initiate a treatment or diagnosis reevaluation.
WHY- Important for clinicians to be aware of signs that a client is failing to respond t take action to do a reevaluation. Because, it is unethical to continue to provide failing treatment as their symptoms are remaining and not improving.
EX- 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 has remained unchanged, indicating they are failing to respond to treatment
Informed consent to treatment
WHAT - It is a person’s voluntary agreement to participate in treatment on the basis they understand the nature of treatment, the potential benefits and risks, and available alternatives. The legal aspects of informed consent are comprehension, capacity, and voluntary. Verbal and written consent is required and must occur before treatment begins
WHY- Informed consent is a crucial aspect of ethical counseling practice that enhances a clients engagement, fosters a strong therapeutic alliance, and protects both the client and counselor
EX- A counselor starts seeing a new patient for depression. Before treatment begins, the therapist send the client the informed consent and goes over all that will be entailed.
Practice guidelines
WHAT- Systematically developed recommendations that provide guidance to mental health professionals on how to deliver effective therapeutic interventions. These guidelines are established by professional organizations such as the American Psychological Association (APA) and the National Institute for Health and Care Excellence (NICE) to ensure that therapy aligns with the latest scientific research and ethical standards. These guidelines are based on a synthesis of current research, clinical expertise, and practitioner consensus.
WHY- Therapists refer to guidelines to determine which therapy (e.g., Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT)) is best suited for a client’s condition. Practice guidelines in counseling are essential tools to help ensure the delivery of effective, evidence-based, and ethical treatment to improve the quality of care for clients.
EX- A new therapist is anxious about conducting therapy of her own. In order to get a better understanding of how to treat her client with depression, she reads the APA practice guidelines for the treatment of depression to get some clarify.
Precipitants to the problem
WHAT- Refers to immediate triggers, events, or stressors that result in onset, worsening, or reoccurance of an individuals mental health problems or problematic behaviors. These can include situational stressors, environmental changes, interpersonal conflicts, or physiological factors. Precipitants can lead to a crisis or intensity of existing difficulties, prompting the client to seek counseling
WHY- Precipitants are an important part of case conceptualization and can help the therapist understand the causes and connections to mechanisms of the problem. By identifying these triggers, clinicians can provide more targeted interventions and support
EX- A patient comes into therapy due to their depression. During the initial intake, the therapist finds out that the client recently went through a bad breakup with a long term boyfriend. This negative event has enhanced their depressive symptoms making it a precipitant to the problem.
Problem list
WHAT- A structured list that outlines the client’s current concerns, symptoms, or challenges that they want to address in therapy.
These are overt difficulties the client is having in any of the following domains: psychological symptoms; interpersonal, occupational, school, medical, financial, etc. The purpose of the problem list is to clearly identify and prioritize the issues and allows the client and therapist to have a clear focus for treatment
WHY- Problem lists are crucial to case conceptualization because they create the foundation for understanding the clients problem, guide treatment, and serve to measure process.
EX- A patient comes into therapy for depression. The therapist asks the client many questions about what brought them in and what they are struggling with. Based on what the client says, the therapist can then create a problem list.
Mechanisms of action
WHAT- Mechanisms of action refer to the underlying processes or factors that are driving and maintaining a clients symptoms or problems. They are the “how” and why” behind the clients difficulties and inform how change will happen in therapy. Mechanisms can be cognitive, emotional, behavior, and interpersonal and can be ingrained in someone as a core belief or unrecognized behavioral pattern
WHY- Understanding mechanisms is an important part of case conceptualization because it allows a therapist to develop interventions that target the root causes rather than the symptoms
EX- A client comes to therapy because of their GAD. After discussion, the therapist notices that the client is negatively reinforced by avoiding social stressors. This provides insight that the therapist can use to tailor interventions to the client.
Non-adherence
WHAT- Non-adherence (or noncompliance) refers to when a client does not abide by the proposed therapeutic regimen relating to the treatment plan. This can mean not attending sessions, not engaging in agreed upon exercises or not implementing coping strategies or lifestyle changes discussed in therapy. Non-adherence can occur due to client resistance, physical or cognitive limitations, or inadequate communication between the client and therapist
WHY- Non-adherence is a common and complex issue in counseling and it can significantly impact the effectiveness of treatment for a patient
EX- Sarah has been forced to go to therapy after a recent court order form a judge. She feels like 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 during session. Sarah is displaying non-adherence
Outcome measures
WHAT- Outcome measures in therapy refer to standardized tools, assessments, or client-reported data used to evaluate the effectiveness of treatment over time. These measures can assess changes in symptoms, behaviors, emotions, or overall well-being before, during, and after therapy. These measures help therapists track progress, adjust interventions, and ensure that therapy is meeting the client’s goals. Outcome measures allow therapist to evaluate the effectiveness of different therapeutic approaches for broader use in psychology to support evidence-based practice and improve care
WHY- Outcome measures are useful in that they can guide treatment decisions and help clients recognize their own improvement
EX- A therapist wants to assess the effectiveness of their current treatment plan with their client who is experiencing social anxiety. The therapist uses outcome measures like a self-report scale to help measure social engagement and to track changes in the clients social activity
Origins of mechanisms
WHAT- Origins are the seeds that shaped us into who we are and can be the root cause/beginning of what started a client’s problem. Can be external environment events, cultural factors, or biological factors; generally factors that are impactful before the age of 18.
WHY- Understanding the origins of mechanisms in case conceptualization is crucial for therapists as it provides a framework for selecting effective interventions tailored to the unique needs of each client
EX- A patient comes into therapy for depression. During the case conceptualization and intake process the therapist discovers the patient experienced childhood abuse. This abuse could have been an origin of the mechanisms of escape/avoidance, in order to protect themselves
Therapy interfering behavior
WHAT- Therapy interfering behavior (TIB) refers to actions, attitudes, or patterns exhibited by clients during therapy that hinder or obstruct the therapeutic process. These behaviors can disrupt the client’s progress, affect the therapeutic relationship, and limit the effectiveness of the interventions being employed. Through open communication, self-awareness, and collaborative problem-solving, both therapists and clients can navigate these challenges
WHY- Recognizing and addressing therapy interfering behaviors is crucial for therapists to maintain a productive and effective therapeutic environment.
EX- A patient comes to therapy but has a hard time opening up due to stigma around therapy being for weak people. This is a therapy interfering behavior and the therapist uses WEG skills and psycho education to gently lead the client away from this thinking
Treatment goals
WHAT- Treatment goals are broad, overarching aims that define what the client and therapist hope to accomplish during therapy. Treatment goals are typically based on the client’s presenting problems and needs, which are identified during the case conceptualization process. Goals should be specific, measurable, and attainable, relevant, and time-bound
WHY- They are central to both treatment planning and case conceptualization because they provide a sense of purpose and direction for the therapeutic process
EX- Patient comes into therapy struggling with PTSD. He states that he has trouble sleeping and drinks heavily a couple days a week to help. A treatment goal she sets with his therapist is to improve his sleep which is evidenced by needing to drink less before bed
Treatment monitoring
WHAT- Treatment monitoring in counseling refers to the ongoing process of assessing a client’s progress toward the goals and objectives outlined in the treatment plan. It allows therapists and clients to stay on track, make informed adjustments, and celebrate milestones along the way
WHY- It’s a key component of case conceptualization, as it ensures that the interventions are effective and aligned with the client’s needs
EX- A therapist is treating a patient for BPD using DBT. In order to track the patient’s progress the therapist does weekly check-ins, reviews any skills training homework, and helps guide the patient through any progress or struggles they are facing as a form of treatment monitoring.
Treatment plan
WHAT- A treatment plan is a structured, individualized document that outlines the therapeutic goals, strategies, and interventions that will be used to address a client’s specific needs. It is developed collaboratively between the therapist and client to guide the therapeutic process in an organized and goal-oriented way. Treatment plan usually includes: presenting problems, goals and objectives, interventions, timeline for treatment, and evaluation. It’s an essential part of case conceptualization, connecting the identified problems and underlying mechanisms of action to targeted steps for change
WHY- A well-developed treatment plan is important because it makes therapy more focused and effective by establishing a roadmap that addresses the client’s issues, empowers the client, and allows for consistent monitoring and adaptation as progress is made
EX- A client comes to therapy struggling with depression and low self esteem. Based on the client’s symptoms the therapist creates an organized treatment plan in which they make clear goals and objectives. Goal 1 would be to reduce depression symptoms, goal 2 would be to improve self esteem/self compassion, and foster positive social connections.
