Chapter 11 – Intervention: Overview Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Focus on ‘evidence-based approaches’ to therapy Focus on ‘evidence-based approaches’ to therapy Growing use of technology and treatment Growing use of technology and treatment Informed consent: Client must agree to services that are being given Informed consent: Client must agree to services that are being given –Client should know what works best for a given disorder as well –Adult gives consent for child, but child must assent (verbally agree) to be treated Ethics of Intervention Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Inform client of: Inform client of: –Confidentiality and limits of confidentiality –Financial arrangements –What to expect in therapy –Alternative treatments Therapist must monitor whether the treatment is working Therapist must monitor whether the treatment is working Treatment should be based on best- available evidence Treatment should be based on best- available evidence Ethics of Intervention Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Norcross (1990) defined psychotherapy as: Norcross (1990) defined psychotherapy as: – –“…the informed and intentional application of clinical methods and interpersonal stances derived from established psychological principles for the purpose of assisting people to modify their behaviors, cognitions, emotions, and/or other personal characteristics in directions that the participants deem desirable.” Psychotherapy Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

APA (2013) passed resolution recognizing psychotherapy as effective APA (2013) passed resolution recognizing psychotherapy as effective Intended to promote psychotherapy in health care systems as evidence-based care Intended to promote psychotherapy in health care systems as evidence-based care Psychotherapy practiced by professionals from many disciplines (psychology, psychiatry, social work, nursing) Psychotherapy practiced by professionals from many disciplines (psychology, psychiatry, social work, nursing) Psychotherapy Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Based on psychoanalytic theories of Freud and recent theorists. Central concepts: Based on psychoanalytic theories of Freud and recent theorists. Central concepts: –Unconscious: Most of what motivates an individual is outside of awareness –Conflicts between Id (impulsiveness) and Ego (planning, higher cognitive functioning) –Transference: Problematic interpersonal relationship re-enacted with therapist –Counter-transference: Therapist’s problematic interpersonal relations OR how the client makes the therapist feel Short-term Psychodynamic Therapy Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Some versions of this approach: Some versions of this approach: –Luborsky’s Supportive-Expressive Therapy –Strupp’s Time-limited Dynamic Therapy Most all focus on process of: Most all focus on process of: –1) Bringing to awareness unconscious –2) Re-enacting problematic relationship with the therapist –3) Working through this pattern and development of new interpersonal patterns Short-term Psychodynamic Therapy Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Additional foci of this approach: Additional foci of this approach: –Identification of themes and central conflicts –Defensive patterns in the person’s life –Evoking emotions –Goal-setting –Termination of therapy Strong evidence of effectiveness in depression, panic disorder, substance abuse, borderline PD, etc. Strong evidence of effectiveness in depression, panic disorder, substance abuse, borderline PD, etc. Short-term Psychodynamic Therapy Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Much more emphasis on problems with communication and on dysfunctional relationships than dynamic therapy (although some overlap) Much more emphasis on problems with communication and on dysfunctional relationships than dynamic therapy (although some overlap) Clear understanding of current and past relationships is central to this approach Clear understanding of current and past relationships is central to this approach Brief – usually 3-4 months Brief – usually 3-4 months Work on actively changing interpersonal patterns Work on actively changing interpersonal patterns Interpersonal Therapy (IPT) Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Focus is often on role transitions (becoming a parent, student to professional, etc.) Focus is often on role transitions (becoming a parent, student to professional, etc.) Originally developed for depression, but has been applied to several populations including late life, different cultures, and several disorders (including eating disorders, anxiety and substance abuse) Originally developed for depression, but has been applied to several populations including late life, different cultures, and several disorders (including eating disorders, anxiety and substance abuse) Interpersonal Therapy (IPT) Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

History in existential, humanistic and client-centered approaches (though little data on these approaches as helpful) History in existential, humanistic and client-centered approaches (though little data on these approaches as helpful) Focus is on Focus is on –Increasing awareness, reflection and expression of emotion –Enhancing emotion regulation –Transforming maladaptive emotions into adaptive emotions Process-Experiential Therapies Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Focus is also on in-session experiencing of affect along with processing the emotion experience Focus is also on in-session experiencing of affect along with processing the emotion experience Strong evidence for effectiveness with depression, couple distress and adult survivors of child abuse Strong evidence for effectiveness with depression, couple distress and adult survivors of child abuse Process-Experiential Therapies Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Behavior Therapy is the oldest form of CBT – with a focus on operant and classical conditioning as etiology of symptoms and problems Behavior Therapy is the oldest form of CBT – with a focus on operant and classical conditioning as etiology of symptoms and problems –Symptom and present focused Bandura – learning can take place by observation and imitation Bandura – learning can take place by observation and imitation Self-efficacy: person’s sense of competence to learn and perform new tasks (best predictor of tx success) Self-efficacy: person’s sense of competence to learn and perform new tasks (best predictor of tx success) Cognitive Behavioral Therapies (CBT) Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Ellis’s Rational-Emotive Therapy and Beck’s Cognitive Therapy are based on idea that thoughts about environment are the key to etiology and maintenance of a disorder Ellis’s Rational-Emotive Therapy and Beck’s Cognitive Therapy are based on idea that thoughts about environment are the key to etiology and maintenance of a disorder CBT is a mixture of cognitive and behavioral approaches CBT is a mixture of cognitive and behavioral approaches CBT validated in numerous DSM disorders CBT validated in numerous DSM disorders Cognitive Behavioral Therapies (CBT) Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Focus of treatment is on Focus of treatment is on –Identification of thoughts and behaviors that might be causing problems –Very active role of therapist with client –Use of current research in psychopathology –Didactic methods and Socratic questioning (i.e., encouraging the client to reflect) –Homework set –Tailoring approach to given individual Cognitive Behavioral Therapies (CBT) Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Anyone can refer to themselves as a ‘psychotherapist’ Anyone can refer to themselves as a ‘psychotherapist’ A license ensures the practitioner has met educational and experience guidelines A license ensures the practitioner has met educational and experience guidelines Duration varies, but median number of visits is 5-13 sessions Duration varies, but median number of visits is 5-13 sessions Evidence based treatments usually are between 10-30, so some may not be receiving the full ‘dose’ Evidence based treatments usually are between 10-30, so some may not be receiving the full ‘dose’ General Points on Seeking Psychological Services Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Couple therapy common for all types of couples going through various problems Couple therapy common for all types of couples going through various problems Many forms of family therapy where individual problem is thought to come from family communication dysfunction Many forms of family therapy where individual problem is thought to come from family communication dysfunction Group therapy (variety of orientations) Group therapy (variety of orientations) –Process groups – use group to explore interpersonal dynamics –Structured groups – focus on a specific problem Additional Forms of Psychological Services Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Self-administered: self-help books based on evidence based care Self-administered: self-help books based on evidence based care –Continuum of client working on their own to some work with a therapist –Some evidence that this is effective Computer-based treatment: Continuum of computerized aspects of evidence-based care to virtual reality Computer-based treatment: Continuum of computerized aspects of evidence-based care to virtual reality Telehealth: Range of treatments not in person (phone, , videoconferencing) Telehealth: Range of treatments not in person (phone, , videoconferencing) Additional Forms of Psychological Services Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.