Intervention Flashcards
Interpersonal therapy general
Short term
Improve relationships and create social support
Grounded in ATTACHMENT theory, seek for understanding NOT changing
Either modify relationships or change expectations
Effective for depression and eating disorders
Given thus attachment style, personality, ego, defence mechanism, life experiences, how can they be helped to improve here and now relationships and build more effective network
Emphasise social relationship over therapeutic relationship - different from dynamics therapy
Transference experience helps w informing potential problems and predict therapy outcomes
IPT essential characteristics (4)
(1) focused on relationships
- improve communication or change expectations, OR
- build or better use of support network
(2) use relationship to conceptualise distress
- interaction between attachment and stressors is critical (if the person securely attached, they can deal with crisis well)
- when crisis occurs, those who cannot ask for care, and get care, will become more prone to develop symptoms
(3) time limited - 8-20 sessions
Assessment 1-3
Middle 4-12
Concluding 1-2
Maintenance phase - mutual agree between therapist and patient
Clinician has active role and maintain focus of therapy
(4) do NOT address transference relationships
IPT problem areas (3)
1) Grief loss
Understand the experience, NOT pathologise
Facilitate mourning process
Reconnect w others
Develop 3d picture of the loss person, identify good and bad characteristics
2) Interpersonal disputes
Understand communication patterns
The way they conceptualise conflict
Do NOT require relationships being repaired
Patient to make active and informed decision
Learn to communicate their needs
Role play to reinforce new communication
3) Role transitions
Life cycle changes
Loss of important social supports, demands for new skills
Help transition from old role, including experience grief over loss
Develop realistic and balanced view
Develop new social supports and skills
Interpersonal conceptualisation - model of self
Self competent (1)
Not self competent (2)
Will provide care (A)
Won’t provide care (B)
1A secure
Both give and receive
Self competent and believe care availability - help reduce stress
2A Preoccupied
Seek care constantly, when needs are not met, want more care. Lack of ability to care for others —> poor social network; hard to ask for help, more vulnerable
1B Dismissive
Dominant and controlling
Quick to reject others
Self confidence but marked deep insecurity
Drives to engage in relationships despite unsatisfactory nature
2B fearful
Believe other will not provide care
Avoid becoming close
Poor social connection
Avoiding asking for help
Most vulnerable
Transference vs countertranference
Transference: redirection of feelings about a person onto someone else (client projecting their feelings about someone onto the therapist)
Countertransference: redirection of the therapist’s feelings toward the client
IPT initial sessions
Initial:
- assessment (determine whether IPT is a good option)
- guided by evidence, attachment style, motivation, insight
- diagnosis should be made - well suited for mood and anxiety disorders
- suitable for those w work conflicts and marital issues
- make hypothesis for client’s model of relationships
- preoccupied and dependent may find it hard to form relationships and end relationships
- dismissive and fearful may find it hard to trust and relate (may need more initial)
- plan for problems that may arise later
4 specific tasks:
- conduct an interpersonal inventory
- collaboratively develop an IPT summary
- work collaboratively w the patient to determine area of focus
- develop treatment agreement
Interpersonal inventory
- interpersonal circle (place 6-8 people for closeness)
- ask how things have changed, how they would like it to look
Interpersonal formulation based on biopsychosocial/ cultural/ spiritual model - not showing to client
Interpersonal summary: collab project - in client’s own words, why they have problems, listing their own strengths, writing their goals <— this the road map for therapy
Treatment agreement
- Explain rationale
- Flexible time frame to be negotiated
- Number, frequency, duration, focus of therapy, role of therapist, client’s responsibility
- Contingency planning eg lateness, illness
IPT middle sessions
Work together to address problems
- identification of specific problems
- exploration oft perception
- brainstorming for possible solutions
- implementing proposed solution
- review progress and encouragement
Technique: interpersonal incidents and communication analysis
- analyse patterns of communication - help communicate more effectively
- client describe a specific interaction to understand the client’s communication and what triggers the problems
Use of affect
- connect w emotions - more likely to change behaviour
- incongruence between shown emotions and reported emotion - examine this
- process affect (during therapy, when they describe the events) vs content affect (in the past, at the time of events)
Problem solving 4 components:
- detailed examination of problem
- generate potential solutions
- select a course of action
- monitor and refine solution
Solution to be based on client’s own ideas
IPT maintenance
End of therapy is NOT the end
Agree to have sessions in the future
Always discuss maintenance treatment
Alternatives exist for maintenance treatment: scheduling maintenance sessions monthly or longer, ask to contact therapist if problems occur, plan to contact others in the future if you’re not available, specific agreement to be created
Two-phase treatment to help prevent relapse
IPT key mechanisms (4)
Enhance social support
Decrease interpersonal stress
Process emotions
Improve interpersonal skills
Motivational interviewing general
Effective for substance use
Develop motivation to change will
- increase engagement in therapy
- increase symptoms improvement
Collaboration
Acceptance
Compassion
MI THEORY
2 components
1. Technical (the intervention)
2. Relational (therapeutic relationships)
OARS
- open questions
- affirmations
- reflections
- summary statement
—> change talk, reduce sustain talk, resolve ambivalence to change
Therapist:
- non judgemental
- collaborative
- acceptance space
- compassion
4 pillars:
- Compassion
- Collaboration
- Acceptance
- Evocation
MI Application
Use core interview to elicit intrinsic motivation for behaviour change
Using the client’s strengths and resources to facilitate behaviour change.
4 major processes:
- engaging: establish alliance, determine how motivated by degree of change and sustain talk
- focusing: narrow discussion to make collaborative decision
- evoking: eliciting patient own motivation and commitments
- planning: formulate specific plan m, articulate steps to achieve change
MI engaging
Establish strong alliance
Avoid promote disengagement:
- assessment - passive stance for patient
- expert: client defensiveness
- premature focus: not ready for change, struggle
- labelling: judgemental
- chat: insufficient direction
Use open-ended questions
Reflective listening
Affirmation: recognise efforts, foster beliefs
Summary statement
MI focusing
Prioritise
Agenda mapping with client - ask them where they want to start
Assist if they cannot
Building their confidence
MI Evoking
Elicit reasons to change:
- recognising change talk
- using evocative questions and reflection
- employ important confidence ruler
- use decisional balance
- exchange information
- explore goals and values
- looking back and looking forward
- querying extremes
MI recognising change talk
DARN-CAT
DARN
- desire
- ability
- reasons
- need
CAT
- commitment - i will stop drinking
- activation - i am ready to …
- taking steps - i am no longer…
MI Evocative questions and reflections
Potential wish to make change (how would you like your life to look)
Their ability (what do you do well)
Reasons - why (what would be the benefit)
Necessity of making change (how important)
Ask open-ended questions more focused on CAT
Commitment questions (what do you think needs to happen next)
Use reflections as strategies for change talk
MI Importance and confidence rulers
Assess level of motivation
On a scale of 0-10 how confidence
Follow up questions:
- why 5 not 7
- why 5 not 0
- what it takes to go from 5 to 7
MI Decisional balance
Explore ambivalence to examine pros and cons of behaviours
Ask about their reasons to stay the same or change
MI Exchanging information
Respect their knowledg
Support autonomy
Ask permission to share or provide information
Make sure the patient understands by asking for their own interpretation or reaction to that info
MI exploring goals and values
Reveal discrepancies between goals and current behaviours
Often make them feel uncomfortable and prompt the need to change
MI looking back and forward
When problem began
Comparing to present
Focus on not engaging in the problematic behaviour
Hope for things to improve
MI Querying extremes
Worst things that could happen
Best things that could happen
MI Signs of readiness
- Decreased discord and sustain talk
- Decreased discuss about the problems
- Resolve: understand change is necessary
- Increased change talk: offer DARN-CAT statement
- Questions about change: ask about that it would look like
- Envisioning and experimenting: imagine pros and cons of making changes
MI Planning
- Targeted behaviour change
- Why making change
- Steps need to take place
- Who can support
- How to know if plan is working
- What can get in the way and how to address it
- What to do if plan does not work out
MI summary
Client centred
Directive method to enhance intrinsic motivation
Effective for alcohol and substance use
Components: Collaboration, compassion, evocation, acceptance
Processes: Engaging, focusing, evoking, planning
OARS: open-ended questions, affirmations, reflection, summaries
DARN-CAT: desire, ability, reasons, need - commitment, activation, taking steps
Key interventions: evocative questions and reflection, important and confidence rulers, decisional balance, exchanging info, exploring goals and values, looking back and forward, querying extremes
Self efficacy enhancement: build confidence to make and maintain behaviour change
Solution focused therapy - general
Focus on problems, origin and amelioration
Look for change already occurring and seek to build on these
Grounding: positive psych
Explore strengths and build on
Achievement of positive aims, not treating deficits
Goal attainment rather than problem solving
Client goal - better way to achieve it
Can be just do more of what already works
Building NOT teaching
NOT seeking change but deeper and more consistent grounding in who the person is
SFT - elements
- Inquiry into precession change to initiate conversation
- Use MIRACLE QUESTION to frame goal
- Search for exceptions to patterns and explore possible solutions
- Use scaling questions for status and anchor progress
- Positive feedback and homework
SFT - Inquiry into presession change
Changes occur when making and attending first appointment
Co-construct positive goal
When not identifying presession change —> narrow focus, inquire about goals for current session (what would happen to make the session useful)
Patients are often actively coping and finding solutions to keep them functioning - focus on these adaptive efforts leading to discussion of strengths and solution
SFT - miracle questions
Goals to achieve solution rather than lessening or eradicating problems
Shift the focus to future and all is going well, positive changes
Allow patient step out of current constraints
SFT - search for exceptions to problem patterns
Eg. Problem patterns at work may not show up on friendships
Explore variations in problem patterns, pointing the way to persons strengths
Helpful for those who strongly identify with their problems
Patient is the patient expert in therapy
SFT - use of scaling questions
Gauge progress and anchor solution focus
Exploring what they are doing and when they are making progress
In beginning of second session and subsequent
Positive movement: exploring what make the movement posible
Negative movement: what to do to avoid failing to the bottom end of the scale
SFT - positive feedback and homework
Reflecting strengths client can build to reach goals
Client to perceive, internalise, extend strengths
Homework: bridging time gap between sessions - NOT skills teaching as in CBT. Failure to do homework: NOT right one at the time, clear way for exploration for alternative exercises
SFT summary
NOT require diagnosis, only a clear goal
Can be for children, adolescents and families
Look for exceptions and strengths to build upon these
CBT general
Time limited 12-16 sessions
Thoughts, emotions, behaviours
Core beliefs or schemas
For depression, GAD, panic, social phobia, OCD, PTSD, schiz
First line treatment for most
Focus: teaching skills so client becomes their own therapist
Goal setting, open to feedback, completing homework
CBT Case conceptualisation
Relevant data - core belief - conditional assumptions - compensatory strategies - situations - automatic thoughts - meaning of automatic thoughts - emotions - behaviour
CBT - cognitive intervention
Identifying and evaluating thoughts causing distress
Identify - examine - evaluate - modify thoughts, assumptions, schemas
Catastrophe, back and white, tunnel vision, personalising, mind reading
Identify core belief: helpless, unlovable, worthlessness
Thought diary, worksheets, socratic questions
Start cognitive w anxiety
W depression start with behaviour first
CBT - cognitive and behaviour application
Chain analysis - vulnerability, activating events, thoughts, feelings, behaviours
Freeze a frame - describing the timelines of a specific events - helpful for suicide prevention
Understand function of behaviours
CBT - behaviour experiments
Experiment to test validity of belief or reinforce new belief
Not always possible
Goal: cognitive flexibility
For those who get something but dont yet connect w emotion
Reinforce collaboration
CBT - Psychoeducation
Education about
- the illeness
- mastering techniques to manage symptoms
Become independent in managing their own condition
Eg early symptom detection, emotional regulation, activity scheduling
Improve treatment outcomes for bipolar and schiz
CBT - Exposure therapy
Imaginal: trauma, when vino not possible
In vino: real life
Interoceptive: bodily sensation, used for panic and agoraphobia
Improve self efficacy and reduces anxiety
4 steps:
- preparation
- creation of hierarchy
- initial exposure
- repeated exposure
SUDS: subject unit distress score 1-100
Repeated daily is ideal
CBT Behavioural activation
Activity schedule
For depression
Start with this for depression before cognitive therapy
Increase sense of pleasure and mastery
Determine level of activity
Things contribute to distress
Identify plan for activities to increase PLEASURE AND MASTERY
feel motivated once starting doing activities
CBT Relaxation
Discussion of benefits and drawbacks
Purpose: provide w rapid, reliable; easy to apply means to cope and moderate anxiety
- Progressive muscle relaxation - notice tension, tense and relax different muscle groups
- Breathing restraining - hyperventilate when anxious eg panic, re-breath the air they exhaled by cupping hands over mouth, or lunch bag - taught in session, practice for homework-
Slow and calm breathing: diaphragmatic breathing, rhythmic breathing
^^^ the above 2 NOT CBT specific
CBT Sessions
- mood checking and agenda setting
- review homework
- discuss agenda topics and teaching skills
- setting homework
- summary
- feedback
Treatment outline:
Depression: assessment, psycho ed, behavioural activation, cog restructuring, core belief work, symptom improvement, termination
Anxiety: assessment, psycho ed, emotional regulation, cognitive strategies, exposure work, core belief, symptoms improvement, termination
