Week 11: Treatment Planning Flashcards
What are splitters?
Clinicians which tend to focus on “specific” techniques in terms of treatment planning
What are lumpers?
Clinicians who tend to focus on common, non-specific factors that facilitate change in terms of treatment planning
e.g. Rogers - genuineness, empathy, unconditional positive regard.
What is the 1st general approach to treatment planning?
Focus on the therapy
Treatment planning approaches were once related to particular therapeutic approaches.
This relates to the client-centred approach which Carl Rogers referred to as including:
Genuineness
Unconditional positive regard
Accurate empathy
Involves nonspecific qualities, basic case management and enhancing client relationship
What is the 2nd general approach to treatment planning?
Concentrate on the presenting issue, specific diagnosis or symptoms of the client.
Relies on accurate diagnosis, is very similar to medical procedures.
Also referred as ‘differential therapeutics’
Where has ‘differential therapeutics’ been successful?
In anxiety related conditions
Less suitable for treating types of depression.
What is the 3rd general approach to treatment planning?
Focus on client characteristics, so look for traits which are likely to influence engagement and success in treatment and change process.
How many characteristics have been investigated in terms of client characteristics and treatment planning?
Over 200 have been suggested, and 100 have been researched.
Through addressing these traits, treatment effectiveness has improved.
What are the 6 different categories of potential recommendations?
Treatment
Placement
Further evaluation
Changes to the client’s environment
Education and self-help
Other recommendations
What are the two considerations to focus on when making recommendations following assessments?
What is the most appropriate, evidence based approach for the client’s presenting issue.
How to communicate the recommendations so the client can understand them and take action.
What are the 4 overarching factors which drive decision-making around interventions for a client?
Case formulation
Understanding the problem
The context of the problem
Specific client characteristics which may affect treament
What are the social determinants of health?
The non-medical factors which influence health outcomes.
Can impact health equity in positive and negative ways.
Place of birth, home environment, work environment, external forces and systems that the person interacts with.
Social determinants of health account for ____% of health outcomes.
30-55%
Low educated subgroups report _____% more often “poor health” than tertiary educated
100%
Effective case management requires what?
Practitioners to survey general case issues, focus on salient features and make recommendations based on this.
What should recommendations include?
How restrictive the treatment should be, severity of the problems and whether patient is a danger to self or others.
What are options of possible local resources within a client’s community?
Inpatients, outpatient clinic, medical facility, suicide prevention centre, AA
What resources could be included in order to enhance treatment?
Self help resources (books, links)
What other decisions are required regarding treatment options?
The frequency and duration of treatments
In terms of a client’s environment, what should a practitioner be recommending?
Ways to optimize the client’s environment.
e.g. encourage the client to use available social support or find adequate support structures
Or remove them from certain environments in order to avoid possible relapse
How should recommendations be tailored for clients?
Deliberately based on the client’s characteristics and circumstances.
Many therapists often provide the same or similar interventions for all of their clients.
Why do therapists provide similar interventions for all of their clients?
Typically because it aligns with the school of therapy they therapist is most familiar with.
Why are there issues around providing the same intervention for all clients?
Because different clients will respond in varied ways to interventions
What did a study show about clients that were suspicious and poorly motivated?
They did poorly with therapists who were empathetic, and accepting.
Indicates that not all treatments and therapeutic style are best for all clients.
When is relationship quality likely to deteriorate in terms of a therapeutic relationship?
When the therapist uses highly directive techniques with a defensive client.
What is the do-do bird verdict?
There are minimal differences between various therapies
Everyone wins and all deserve a prize
What is the most impactful in terms of therapeutic outcomes.
Similarity between client/therapist
Acknowledging client preferences in terms of therapist
Acknowledging the clients preference.
When does dissimilarity between client and therapist appear to support therapeutic outcomes?
When there the therapist and client have different attachment and dependency needs
What factors should one consider when deciding if a client should receive inpatient care?
Psychological, physical and social problems of the client
Actual and potential of the problem behaviour
Impact on the community of problem behaviour
When is recommending further evaluation appropriate?
When the assessor believes there is more information to be gathered about client and their problem that fall outside area of expertise.
e.g. medical testing
If well implemented, what effect can self help techniques have?
Extremely good effect, almost the same effect size as professional counselling
what are examples of miscellaneous recommendations?
Recommending the client sign a release of information so the evaluator can give feedback to others
Recommending a client surrender their driving licence (perhaps due to memory issues or addiction)
Is recommending no treatment a potentially valid decision for an evaluator?
Yes.
If the assessment reveals no need for it.
What should an evaluator link recommendations back to when writing a report?
Recommendations should be linked to specific problem or goal that came out of the assessment
What are the 4 components involved in case formulation?
- describe the symptoms
- predisposing factors
- environmental factors
- causal mechanisms
What is the diathesis-stress model
categorises assessment findings into 3 groups:
- diatheses - personal quality that contribute to the problem
- stressors - external factors which contribute (past and present)
- outcomes - resulting problems and issues
What is the Development Model?
There is a mismatch between the client’s ability to function and the demands of their life.
What is the Common Function Model?
That there is a common underlying function of a person’s problems.
They are all serving a purpose.
What is the Complex Model?
Type of case formulation that recognises clients are more complex that most models will allow for.
Aims to illustrate how the impact of problems in one context play out in other contexts of a clients life.
What is a key benefit of case formulation?
Case formulation allows treatments to not only focus on the symptoms of a problem but also the underlying mechanisms that maintain them.
What factors should be taken into consideration when considering how a diagnosis may influence treatment recommendations
Developmental (esp. for children) and cultural factors
What is a useful way of measuring functional impairment during an assessment?
Mental status exam
What is the MMPI-2 (Minnesota Multiphasic Personality Inventory) useful for in terms of functional impairment during an assessment?
Elevated scales can indicate functional impairment and possible suicide risk
Which conditions may benefit from having no treatment (or may have a negative or no response to treatment)?
Borderline Personality Disorder
Antisocial Personality Disorder
Normal grief will improve on its own
What does problem complexity mean?
Underlying patterns of the client’s life which may or may not lead to functional impairment.
Why is problem complexity more difficult to measure in terms of understanding a client’s problem?
It is more theoretically bound
What are 3 main features of problem complexity?
- Comorbidity
- Chronic, pervasive
- Personality disorder
What projective tests may be useful when understanding the complexity of a problem?
TAT
Rorschach
Low complexity problems are best treated by doing what?
Treating specific symptoms, stressors and factors that maintain the problem
High complexity problems are best treated by doing what?
Using broad treatments which will resolve underlying issues and patterns in terms of interpersonal relationships.
What is subjective distress?
The degree that a client experiences their problems
Is there an optimal window in terms of subjective distress for a client?
Yes, a moderate level of subjective distress will act as a precipitator for change.
Too high will impair functioning, too low and the client won’t have the motivation to change.
What types of techniques can help to increase subjective distress to an optimal level for a client?
Two-chair work
Confrontation
Discussing painful memories
What types of techniques can help to decrease subject distress to an optimal level for a client?
Body-based:
Progressive muscle relaxation Biofeedback
Guided imagery
Cognitively based:
Meditation
Reassurance
Time management
Why is is helpful to teach a client new coping skills along with medication (if required)?
Because the coping skills will help to decrease likelihood of relapse after medication has been stopped.
What are externalisers more likely to do in terms of coping style?
Blame others for their problems
Not respond to insight with behavioural change
Manipulation and aggression
Extroversion
What are internalisers more liekly to do in terms of coping style?
Feel more subjective distress Intellectualise
Minimise issues
Withdraw socially
Have physical symptoms linked to nervous system
What instrument can help to highlight whether a person in internalising or externalising?
MMPI-2
What will have better treatment outcomes for externalisers?
Focused on behavioural, symptom orientated therapy.
Social skills enhancement
Reinforcement
Relaxation
What will have better treatment outcomes for internalisers?
Treatments which develop insight and emotional awareness
Meditation
Two-chair work
What sorts of therapies are more effective for clients with low social support?
Longer forms of CBT along with a supportive group intervention to help build support
What is reactance?
A state in which a person feels their freedoms are being threatened.
The state version of the resistance trait
What are reactant clients likely to have in terms of therapeutic outcomes
Poor therapeutic outcomes.
What instrument can measure reactance?
MMPI-2
PAI RXR
Therapeutic Resistance Scale
What approach is useful for clients who are responsive and compliant in terms of therapy?
A structured and directive approach
Cognitive restructuring
Advice
What approach is useful for clients who are highly resistant in terms of therapy?
Non-directive, self-directed and supportive interventions.
As well as paradoxical techniques.
Self-monitoring and reassurance
What are the five stages of the change process that clients may be in during evaluation?
- Precontemplation
- Contemplation
- Preparation
- Action
- Maintenance
What sorts of clients are likely to be in the pre-contemplation stage?
They are unaware that change needs to take place. Others around them will see the need for change.
Likely to be more resistant.
May have been referred through the legal system, or due to threats from family, work, etc.,
What tools can help assess what stage of change a client is in?
URICA - general issues
SOCRATES (drugs and alcohol use)
What is particularly important during the Contemplation and Preparation stages of change?
The therapeutic relationship
What is a major client characteristic to pay attention to?
The client’s cultural background
Which types of clients appear to benefit most from culturally adapted treatments?
Asian American clients
Particularly adult and older adult clients.
What 3 areas are relevant when considering client preferences in terms of treatment?
- Role of client and therapist
- Preferences in terms of therapist
- Treatment preferences
What is the Systematic Treatment Selection model?
Focuses on making decisions around treatments based on the characteristics of the clients and scientifically supported treatments.
What are the key variables that are relevant to Systematic Treatment selection?
- Functional impairment
- Social support
- Problem complexity/chronicity
- Coping style
- Resistance
- Subjective distress
- Stage of change
