Chapter 11 Intervention: Overview INTRODUCTION TO CLINICAL PSYCHOLOGY 2E HUNSLEY & LEE PREPARED BY DR. CATHY CHOVAZ, KING’S COLLEGE, UWO

 Ethics of intervention  Theoretical approaches:  Short-term psychodynamic psychotherapies  Interpersonal therapy (IPT)  Process-experiential therapies  Cognitive-behavioural therapies  Seeking psychological services  Alternative forms of psychological services Topics

 Focus in the text on ‘evidence-based approaches’ to therapy  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

 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  Treatment should be based on best-available evidence Ethics of Intervention

 Based on psychoanalytic theories of Freud and recent theorists. Central concepts:  Unconscious: Most of what motivates an individual is outside of awareness  Assumes that individuals are prone to 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 Theoretical Approaches: Short-term Psychodynamic Psychotherapies

Some versions of this approach:  Luborsky’s Supportive-Expressive Therapy  Strupp’s Time-limited Dynamic Therapy Most 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

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, BPD, etc. Short-term Psychodynamic Therapy

 Much more emphasis on problems with communication and on dysfunctional relationships than dynamic therapy (although some overlap)  Clear understanding of current and past relationships central to this approach  Brief–usually 3-4 months  Work on actively changing interpersonal patterns Interpersonal Therapy (IPT)

 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) Interpersonal Therapy (IPT)

 History in existential, humanistic and client-centered approaches (though little data on these approaches as helpful)  Focus is on  Increasing awareness, reflection and expression of emotion  Enhancing emotion regulation  Transforming maladaptive emotions into adaptive emotions Process-Experiential Therapies

 Focus is 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 Process-Experiential Therapies

 Behaviour 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 (self-efficacy)  Self-efficacy: person’s sense of competence to learn and perform new tasks (best predictor of Tx. success) Cognitive Behavioural Therapies (CBT)

 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 behavioural approaches  CBT validated in numerous DSM disorders Cognitive Behavioural Therapies (CBT)

Focus of treatment is on  Identifying thoughts and behaviours 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 Behavioural Therapies (CBT)

 Barlow (2004) suggested distinction be made between psychotherapy and psychological treatments  Former is general and the latter is targeted to Axis I and Axis II clinically significant disorders  Anyone can refer to themselves as a ‘psychotherapist’  A license ensures the practitioner has met educational and experience guidelines Seeking Psychological Services

As regulated health providers, psychologist and psychological associates are required by law to deliver competent, ethical, and professional services and are accountable to the public, through the College, for their behaviour and activities… College of Psychologists of Ontario (2004 )

 Evidence suggests that the overall use of mental health services has been increasing in recent decades  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’ General Points on Psychological Services

 Women/girls are twice as likely as men/boys to consult a psychologist  Most individuals consulting a psychologist are between ages of 30 and 50 yrs  Those in rural areas are one-third as likely to obtain services  22% of those consulting a psychologist have university education (compared to 13% of Canadian population)  Single-parent families make up 8% of Canadian population and are 20% of those who see a psychologist  People experiencing significant pain that interferes with ADL are twice as likely as other Canadians to consult a psychologist  People who receive psychological services also tend to be frequent users of other health care services  Adolescents and adults who feel so unhappy that they believe life is not worthwhile are five times as likely as other Canadians to seek psychological services Characteristics of Canadians Receiving Psychological Services

 Couple therapy  Common for all types of couples going through various problems  Family therapy  address Axis 1 disorders in one member  family communication dysfunction  Group therapy (variety of orientations)  Process groups: use group to explore interpersonal dynamics  Structured groups: focus on a specific problem Alternative Forms of Psychological Services

 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  Telehealth: Range of treatments not in person (phone, , chat, etc.) Alternative Forms of Psychological Services

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