Week 8 - Clinical Psychology 1 Flashcards
Who can make assessment orders?
Only medical practitioners (others can apply to the practitioner to do the assessment)
What is an assessment order?
Allows for capacity to be assessed without consent of the person, in order to confirm whether the person meets the assessment criteria, and to determine if the person meets the treatment criteria
Who is a part of the tribunal that makes a treatment order?
A chair person (who is a lawyer)
A psychiatrist
A person with experience in mental health
How can you prove that a therapy is effective, even if it is not?
Have a strong allegiance to the therapy
Increase patient’s expectations
Use weak spots of randomised trials
Design trial in the right way: small samples, waiting list control groups but no comparative trials
Use the right publication strategy
How can randomised control trials be manipulated to produce better results?
“Weak spots” of randomised trials - risk of bias
Small samples
Waiting list control group
No comparative trials
What are the “weak spots” of randomised trials?
aka “Risk of bias”
Can randomise participants by using date of admission, date of birth or clinic reord number instead of randomly generating them
Allocation concealment - Can assign participants you expect will respond well to the treatment
non-blinded raters of clinical assessments of outcome
ignoring drop outs
How do small sample sizes increase the likelihood that a treatment will be proven effective?
Make it possible that there are systematic differences between groups as..
numbers are not large enough to be able to accurately reproduce a chance distribution of these differences
The influence of outliers is inflated
How do waitlist control groups increase the likelihood that a treatment will be proven effective?
Waitlist control groups result in much larger effects for the therapy than other control groups
How are treatment orders made?
By the Mental health tribunal (min 3 members to hear a request), following application from an approved medical practitioner. Another approved practitioner must also have assessed when there isn’t an existing assessment order.
What might a treatment order require of someone?
Be given specified treatment
Treated at a particular place, such as a hospital or community mental health premises
Require a person who is being treated to be admitted to and detained in an approved facility so that the person can be treated
Provide for other incidental matters that the mental health tribunal thinks are necessary or desirable in the circumstances
What are advanced care statements/directives?
Plan put in place in advance of incapacity
In Tas, people with decision-making capacity or a person legally appointed as the enduring guardian can complete an advance care directive.
it may contain instructional directives or values directive
In Tasmania, a person who has decision-making capacity is able to do what?
Appoint an enduring guardian
Complete an instructional and/or values advance care directive
What does an advance care directive come into effect?
When the person loses decision-making capacity
What is an instructional directive?
a person can provide specific directions about treatment that they would consent to, refuse and/or withdraw
What is a values directive?
A person can describe their more general views regarding their values and preferences for care
What should we base therapeutic practices on?
The scientist-practitioner model
What is the scientist-practitioner model?
Scientist-practitioner psychologists embody a research orientation in their practice and a practice relevance in their research
What are the criticisms of the scientist-practitioner model?
The changing face of science - behaviourist and beyond
Clinicians can derive knowledge from practice
Science/evidence doesn’t always inform practice
How many practitioners conduct research?
What are common therapy factors?
Attributes which are intrinsic to many (if not all) psychotherapeutic approaches
Therapeutic alliance
Expectancies (of client and clinician)
Instilling hope
Providing an explanation of behaviour and rationale for treatment
What are specific factors of therapy?
The techniques associated with specific therapies (for example, exposure techniques in CBT). Specific factors must be ‘manualisable’- instructions for the activity must be able to be developed and clinicians must be able to be taught how to apply the factors
What therapy factors can be tested for efficacy?
Specific factors
How can you test the efficacy of specific factors?
Random control trials and then if sufficient evidence of efficacy, these therapies can be considered to be empirically supported therapies
What did Ahn and Wampold (2001) find about the empirically supported therapies?
No difference between therapies which had the required specific factors, and those with no or few specific factors and suggested that it is common factors which are important for treatment to work
What is the scientific-practitioner gap?
Some practitioners argue that we should be focused on the common factors - therapeutic alliance, increasing self-efficacy, enhancing expectancy
Others argue that as a scientific discipline we need to focus on measurable, manualisable specific factors
Others argue this is a false dichotomy - increasingly we are measuring common factors (especially therapeutic alliance) and integrating them into empirically supported therapies (EST) is generally recognised as being important
What are some unwanted outcomes of clinical treatment?
Deterioration of existing symptoms
Emergence of new symptoms
Dependency on therapist
Non compliance of client
Negative wellbeing/distress
Stress/changes in family relations
In Lilienfield, 2014 what are the four underlying cognitive impediments to accurately evaluating improvement in psychotherapy?
Naive realism
Confirmation bias
Illusory Causation
Illusion of control
What are the 3 overarching categories that describe the 26 causes of spurious therapeutic effectiveness?
a) perception of client change in its actual absence
b) misinterpretations of actual client change stemming from extra therapeutic factors
c) misinterpretations of actual client change stemming from nonspecific treatment factors
What is the threefold framework for evidence based practice?
a) research findings regarding the efficacy and effectiveness of psychotherapies
v) clinical expertise
c) client values and preferences
How are empirically supported therapies (ESTs) different from evidence-based practice?
ESTs are interventions that have been demonstrated to work better than no treatment (or an alternative treatment) for specific disorders in independently replicated
a) controlled between-subject designs
b) single-subject designs, namely thought in which participants serve as their own controls
Why is evidence-based practice more reliable than empirically supported therapies?
Incorporates control groups
within-subject designs
blinding
randomisation
other methodological bulwarks against inferential mistakes
What are the implications of naive realism on the evaluation of a psychotherapy outcome?
Can lead clinicians, researchers and others to assume that they can rely on their intuitive judgements
As a consequence, these individuals may
a) misperceive change when it does not occur
b) misinterpret it when it does
c) or both
