PSYC 528 Flashcards
ADDRESSING Model
What: This model contributes to a full understanding of a client including their beliefs, morals, and values. This can help therapists learn these areas of bias and inexperience. The ADDRESSING model is helpful to see where the client might be a minority and what they could be struggling with when presenting to therapy.
A: Age
D: Disability at Birth
D: Disability Acquired
R: Religion
E: Ethnicity
S: Sexual Orientation
S: Socioeconomic Status
I: Indigenous Heritage
N: Nation of Origin
G: Gender (pronouns)
Why: This model is helpful in getting to know and understand who the client is and formulating treatment goals in collaboration with the client. Helps the therapist meet the client where they’re at.
EX: Sam is a new client who identifies as a cis gender, Jewish female. She is 68 years old. As her therapist does the initial interview, the therapist will want to gather information about how her Jewish heritage/faith and age are influencing her presenting problems, if at all.
Adjunct Treatment
What: One or more secondary interventions used concurrently with a primary intervention to enhance treatment effectiveness.Each adjunct intervention brings its own characteristic perspectives and methods to bear on the client’s mental awareness and healing. Adjunctive therapy is typically conducted by a different practitioner than is the primary intervention. Medication is commonly used as an adjunct treatment to CBT, along with group therapy.
Why: This is important because in a lot of cases during treatment, one type of therapy isn’t enough for the client to reach their treatment goals.
EX: Susan comes into treatment with symptoms of Major Depressive Disorder, and along with CBT, she will start seeing a psychiatrist in regards to taking an SSRI as and adjunct treatment.
Case Conceptualization/Formulation
What: A method and clinical strategy for obtaining and organizing information about a client, understanding and explaining the client’s situation and maladaptive patterns, guiding, and focusing treatment, anticipating challenges and roadblocks, and preparing for successful termination. It includes creating a problem list, precipitants to these problems, origins of the problems, mechanisms that maintain these problems, a diagnosis, client strengths, and primary/ adjunct treatment. It is generally formulated after the first few intake sessions and it is used throughout the process of therapy, and can change as needed depending on what is best for the client’s therapeutic process.
Why: Careful case conceptualization can guide treatment, enhance the therapeutic alliance, and help both clients and clinicians measure if counseling is progressing towards therapeutic goals. It is extremely important as every client has different problems for different reasons. It allows an idiographic outlook that can be amended as needed.
EX: During the intake session, the therapist began to conceptualize her client’s problem by obtaining a problem list, precipitants, mechanisms and origins. She was able to see that the job loss that Frank went through caused depression because he had a core belief of him always failing
Client Factors
What: Client factors are aspects related to the client that impact their presenting problem(s) and its presentation. Client factors include multicultural factors, previous experience with therapy, expectations about therapy and therapeutic outcomes, readiness to change, etc.
Why: The values, worldviews, and beliefs of a client are also quite important, environmental context, and treatment preferences. Each client will have different factors and assessing these is vital in the case formulation process. They can influence all aspects of the therapy process including therapeutic alliance, treatment planning, case conceptualization so it’s important to understand client factors.
EX: Caroline has very high self-efficacy, resilience, but low insight. These are all client factors that contribute to outcomes of treatment.
Common Factors
What: Theory proposes that different approaches in psychotherapy and counseling share common factors that account for much of the effectiveness of a tx and elicit change. There are four categories of common factors, extratherapeutic, therapy relationship, expectation, and specific techniques. These include, a culturally appropriate explanation for client distress, a healing setting, a bond between client and therapist, emotional expression, exposure to feared stimuli, feedback from therapist, insight into one’s problems, positive expectations, working alliance, therapist credibility or expertise and trust in the therapist. Extratherapeutic factors include client factors such as severity of disturbance, motivation, capacity to relate to others, ego strength, psychological-mindedness, the ability to identify a single problem to work on in counseling and sources of help and support within the environment. The therapeutic alliance is a necessary but not sufficient part of therapeutic outcomes.
Why: These are important because they can determine therapeutic outcomes and should be identified early on in therapy.
EX: You’re treating a client with PTSD and you’re trying to decide between two treatments so you turn to the research. You find that both txs you are considering produce similar results. You conclude that this may be due to common factors in psychotherapy and you decide to think more about the client as a person and what therapy she might prefer
Efficacy vs Effectiveness Research
What: Efficacy research determines whether an intervention produces the expected result under ideal circumstances. Effectiveness trials (pragmatic trials) measure the degree of beneficial effect under “real world” clinical settings. Efficacy assesses the internal validity while effectiveness assess the external validity of interventions. Both are important aspects of research as treatments need to be efficacious in order to be rooted in science and accepted among the community.
Why: The effectiveness of a study is crucial to make sure that an intervention will work under a variety of conditions, not just the ideal conditions. These types of research complement each other and help provide more information that would not otherwise be available.
EX: A researcher is doing an efficacy trial on the use of CBT for depression. The placebo group will receive classic talk therapy without any specific CBT interventions
Empirically Supported Treatments
What: They are specific psychological treatments that have been proven to be effective in controlled research for specific conditions. They typically target single disorders, follow a strict protocol that is based on nomothetic formulation that describes classes of target behavior. The development of these is an important positive development in the field but does not account for client factors, nonadherence, challenging situations, clients with multiple disorders, clinician expertise, and a variety of other factors.
Why: These treatments are proven to work but are very strict so the outcome measures are not great.
EX: Jane uses CBT in her practice to treat generalized anxiety disorder because it is an empirically supported tx. She stays up to date on new research and findings in order to assure she is providing the best treatment to her clients
Evidence Based Practice
What: The integration of the best available scientific research from laboratory and field settings with clinical expertise so as to provide effective psychological services that are responsive to a client’s culture, preferences, and characteristics. The three important ideas are client characteristics, clinician expertise, and best available research. EBP ensures that the research on psychological assessment, case formulation, intervention strategies, therapeutic relationships and outcomes, and specific problems and patient populations is both clinically relevant and internally valid.
Why: The goal of EBP is to promote empirically supported principles that can be used to enhance public health. It combines EST with client factors to provide the best possible treatment for a client.
EX: ACT is an EBP that uses stricter interventions but allows them to be mended and provide flexibility to be able to treat the client correctly.
Failure to Respond
What: This occurs when a client’s symptoms are not improving from treatment and they prematurely end therapy, or the goals for therapy are not met. Progress monitoring can help identify failure so that the therapist can discuss with the client and course-correct treatment which may include changing or discontinuing treatment, or referring to another treatment setting. This is a common occurrence in therapy even when the therapist is practicing with WEG skills and using an EBP.
Why: It is not ethical to continue to provide a failing treatment indefinitely if after repeated efforts to turn therapy around, the patient is not responding.
EX: Caroline takes the BDI every week so the therapist can see if her depression symptoms are improving, her scores have not changed and she is failing to respond to treatment.
Informed Consent for Treatment
What: It is a person’s voluntary agreement to participate in treatment on the basis of their understanding of its nature, its potential benefits and possible risks, and available alternatives. Verbal and written consent is required. It must occur before the treatment begins. The therapist will review the key information regarding the proposed treatment, summarize her hypothesis about diagnosis and formulation, describe other options available to the client, not just her recommended plan and obtain the client’s permission.
Why: The therapeutic alliance is key in this part as the client needs to have confidence that the therapist truly understands their difficulties and will provide treatment that addresses them. This formal process helps to avoid nonadherence. This is important for both legal and ethical reasons as well as it is correlated with better therapeutic outcomes.
EX: The therapist discusses Caroline’s treatment options for anxiety including mindfulness and exposure therapy, she explains that exposure is risky but a very good way to face her anxiety and mindfulness can be used as an adjunct.
Practice Guidelines
What: These are criteria and strategies designed to assist mental health care providers in the recognition and treatment of specific disorders, as well as to outline ethical practice. These are based on the latest and best available research or the considered judgment of expert committees
Why: These guidelines assist in clinical decision making and make sure the counselor is practicing ethically.
EX: When assessing a patient with schizophrenia, the APA suggests that the initial assessment should include, previous history of trauma and symptoms, substance use, as well as suicide risk assessment.
Precipitants of the Problem
What: In a diathesis-stress model of psychopathology, a precipitant is the stressor that activates the diathesis (underlying mechanism that made the client susceptible to psychopathology). Precipitants generally answer the question of “why is the client coming into treatment now?” Sometimes the precipitants are obvious but in most cases they are not immediately evident.
Why: Identifying precipitants of the client’s problems is a key part of cognitive-behavioral case conceptualization. Allows therapists to test hypotheses regarding underlying mechanisms of problems
EX: A client is experiencing depression, a precipitant could be a job loss.
Problem List
What: This a comprehensive list of all the client’s problems that a therapist complies from all domains of their life. This is the first step in developing a case formulation and assesses psychiatric symptoms, interpersonal, occupational, school, medical, financial, housing, legal, leisure, and difficulties with mental health or medical treatment. It also helps to identify the most pressing problems in the client’s life and list these in order of priority to target in treatment. The problem list is derived from multiple sources of information, including the clinical interview, assessment measure, structured interview protocols, and other treatment providers.
Why: Some things to keep in mind when developing the problem list include, any problems that will interfere solving other problems, life threatening situations, problems that interrupt the therapy itself, the problem the client most wants to solve, any problem that might destabilize the client, ones that can help solve other problems, as well as problems that have an easy fix.
EX: A client is experiencing depression, problems can include SI, tension with family members, lack of interest in activities.
Mechanisms of Action
What: These are the deeper processes by which psychotherapeutic change occurs. The mechanisms that cause and maintain the client’s problems must be identified to create mechanisms of action. These are generally the schemas and core beliefs a client has held for most if not all of their life.
Why: Therapy targets these mechanisms to create change at the deeper level. By targeting these mechanisms, it allows change to occur. From a behavioral perspective, avoidance also tends to be a driving mechanism. Why does a therapy work, and why it maintains the symptom.
EX: A client has anxiety, the mechanism of action for exposure targets negative reinforcement to decrease it which in turn will decrease the anxiety
Nonadherence
What: It is the failure to carry out a behavior that has been agreed to or is expected, such as an intervention or homework assignment. Most likely due to inadequate information between the practitioner and individual, cognitive limitations that prevent the client from following therapeutic recommendations, adverse effects that aren’t being addressed. Can be done by both client and therapist. Therapist nonadherence includes not monitoring progress, failing to obtain informed consent, and not reviewing homework assignments. Client nonadherence includes not doing homework, not attending regular sessions, not proposing agenda items for the session, and not using time productively
Why: Nonadherence can slow down the therapeutic process or cause it to fail. If it does occur, the therapist should address all concerns.
EX: Caroline has not been doing her homework although it was agreed upon in the treatment plan, this is nonadherence to therapy.
