Week 9 Effective Therapy Flashcards
What are the benefits of client empowerment?
- Instills hope in them
- Teach client in a way that appears like client discovers it for himself. So they become like a self-therapist. Goal is to make client not need you anymore :D
Why is it important to be observant?
Many nuances in conversation, visual appearances and body language. Must go by FEEL.
What is the differences between APA and NICE guidelines in general?
APA: Provide you with information on efficacy of therapies, but no definite answers about its efficacy.
NICE: More prescriptive and specific because they even go into the type of treatment, frequency, duration.
In the case of DID, when eliciting alters, if clients leave, it is most likely because the client don’t like the therapist. T/F?
False.
Can be don’t like but can also be that the client is in a shitty phase of life rn e.g abuse. So it’s hard to expect therapy to be effective.
so, whenever there are suboptimal outcomes, must ask why first and don’t assume that there must be progress if person goes through therapy.
According to the NICE guidelines, for people with persistent sub-threshold depressive symptoms or mild to moderate depression who have not benefited from a low-intensity psychosocial intervention, discuss the relative merits of different interventions with the person and provide?
List of treatments basically
- Antidepressant (SSRI)
2. High-intensity psychological intervention, either CBT, IPT, behavioural activation, behavioural couples therapy
What are some side effects of SSRI, or rather what considerations should be taken when administering SSRI?
Increased risk of bleeding, especially in older people.
In people taking other drugs that have the potential to damage the gastrointestinal mucosa or interfere with clotting.
Older people: Consider prescribing a gastroprotective drug who are taking non-steroidal anti-inflammatory drugs or aspirin.
Fluoxetine, fluvoxamine and paroxetine are associated with a higher propensity for drug interactions than other SSRIs.
Paroxetine is associated with higher incidence of discontinuation symptoms.
How should CBT sessions for individuals with depression be timed?
duration should be 16-20 sessions for 3-4 months.
for those with moderate or severe depression, consider 2 sessions per week first.
follow-up: 3-4 sessions over 3-6 months for all ppl with depression.
How should IPT be administered for those with depression?
16-20 sessions over 3-4 months.
More severe one then twice a week for the first 2-3 weeks.
Behavioral activation how long how many sessions
16-20 sessions
3-4 months
The choice of treatments depends on ________ and _____________.
clinical intuition
personal experience
Why are people now less inclined to seek help for mental health issues?
Pharmaceutical companies now have solutions also. People might see mental health as hardware problem so use hard medicine to treat hardware.
How did the Dodo bird effect come about?
All therapies are said to be not effective, might as well don’t do anything.
But then again is it even fair to compare therapies with each other?
Then on the flip side all therapies work and must have their due credit ah
Whether therapy works for a client or not is most dependent on the type of therapy the psychologist administers.
True or false?
False.
40% of extra therapeutic factors that therapist cannot control.
30% of the relationship between client and therapist
only 15% of the therapy modality used.
Also got within treatment effects (what can be controlled) - there can be many overlapping factors also.
What perspective should one use to look at therapy? What perspective should not be used?
Common factors
Medical model
Describe the medical model in looking at mental issues.
Means you are looking at mental issues as a disease, so the type of therapy matters.
Posits that different therapies are differentially effective and for different disorders. Must see what the disorder is to decide the intervention being used.
What does the common factor perspective propose about mental issue?
Alliance and therapist most important. Model or technique account for very little
Transtheoretical - regardless of orientation you have, the alliance still trumps everything
Are
a) gender
b) age
c) experience
significant predictors of effectiveness of therapy/outcome?
no for all.
What is a significant predictor of effectiveness of therapy then?
the amount of time spent on deliberate practice.
constantly reviewing what is needed from therapy, taking away from previous sessions in an engaged manner.
What is deliberate practice?
Individualised training activities especially designed to improve specific aspects of an individual’s performance through repetition and successful refinement
Must be focused on achieving specific targets and outcomes should also be carefully monitored over an extended time period
E.g Ms chai writes notes for you on what to do for a particular piece, then you work on the tempo from bars 12-13 for long to get that transition right.
How is deliberate practice done in the context of therapy?
Record your therapy session. Be consistent in asking client about feedback and make it forma.
Bring this to your supervisor.
e.g. if therapist has difficulty facing confrontational clients and has the tendency to get defensive when confronted, supervisor should keep trying to get the therapist to rephrase their responses and give their feedback along the way for improvement [practice SMART]. This through role-play and feedback, deliberate practice happens. It is not as effective as just doing the therapy over again.
How do you obtain objective client feedback?
- Ask client’s family
2. Questionnaires then u compare past and present.
An effective therapist has a _________ orientation, as opposed to a ____________ one.
psychological
biological
What must be present in order for a strong therapeutic alliance to be formed?
- common goals
- agreed tasks to meet goals - what mechanism for change?
- level of bond (how close do i feel to you?)
An effective therapist should be able to handle ____________________ well.
challenging interpersonal encounters
An effective therapist should have an _____ attitude to admit one’s limitations and failings.
open
What domains do the outcome rating scale cover?
- individual
- interpersonal
- social
- overall
What does the session rating scale cover?
relationship, goals and topics, approach/method, overall
E.g as a client, did you feel respected, heard and understood?
What can the therapist do with these ratings?
- Measure every session, then plot a graph for the client and have a discussion with them.
- Always discuss about the ratings qualitatively, not just quantitatively because it is about conversations, talking and exploring.
- If there are discrepancies (e.g certain domains are marked high but client doesn’t seem to be improving), ask client for honest feedback and build an open environment.
- If outcome is going on a downward trend, do not just keep going and please change something. Be open to criticism and gather feedback.
- Look at session notes and make suggestions. See if it makes sense to clients.
- Gather qualitative feedback so that you can understand why client gives you certain ratings.
List 4 areas in which deliberate practice can be used to improve therapy.
- Improving outcomes of at-risk cases
- Creating social experiments in naturalistic settings to test, recalibrate and improve empathic accuracy
- Enhancing environments for targeted learning of fundamental therapeutic skills, such as rehearsing difficult conversations
- Provides a necessary scaffolding for the development of therapeutic skills beyond their current ability
What can be done concurrently with deliberate practice to maximize outcomes?
classroom training, work-life balance, time off for personal activities to enhance learning, skills acquisition and maintenance of expert performance that is related to desired outcomes.
What are the components needed for superior performance?
- determining a baseline level of effectiveness
- obtaining systematic, ongoing, formal feedback
- engaging in deliberate practice.
