Chapter 11 Intervention Overview Copyright 2014 John Wiley

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

Copyright © 2014 John Wiley & Sons, Inc. All rights reserved. Ethics of Intervention Focus on ‘evidence-based approaches’ to therapy n Growing use of technology and treatment n Informed consent: Client must agree to services that are being given n – 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 n 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 n Treatment should be based on bestn available evidence Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Psychotherapy n 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. ” Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

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

Short-term Psychodynamic Therapy n 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 therapist feel Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

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

Short-term Psychodynamic Therapy n 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 n Strong evidence of effectiveness in depression, panic disorder, substance abuse, borderline PD, etc. Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

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

Interpersonal Therapy (IPT) Focus is often on role transitions (becoming a parent, student to professional, etc. ) n 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) n Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

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

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

Cognitive Behavioral Therapies (CBT) n 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 n Self-efficacy: person’s sense of competence to learn and perform new tasks (best predictor of tx success) n Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Cognitive Behavioral 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 n CBT is a mixture of cognitive and behavioral approaches n CBT validated in numerous DSM disorders n Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

Cognitive Behavioral Therapies (CBT) n 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 Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.

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

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

Additional Forms of Psychological Services n 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 n Telehealth: Range of treatments not in person (phone, email, videoconferencing) n Copyright © 2014 John Wiley & Sons, Inc. All rights reserved.