Chapter 11 psychological intervention Defined Psychological intervention is a method of inducing changes in a person s behavior thoughts or feelings Involves intervention in the context of a professional relationship Does it help EBT and EBP Usually about 75 80 efficacy doesn t work for everyone For minor issues not things like schiz EBT evidence based treatment interventions or techniques that have produced significant change in clients and patients in controlled trials EBP evidence based practice includes treatments informed by a number of sources including scientific evidence about the intervention clinical expertise and patient needs and preferences Nature of specific therapeutic variables Patient client Degree of distress curvilinear those with either little or extreme disturbances will not do as well as those with moderate distress Intelligence some approaches require lots of introspection articulation and insight Motivation those who are forced to go will rarely benefit Openness Gender Race ethnicity social class many techniques are designed for white middle upper class not many take cultural background and expectations into account Therapist Age sex and ethnicity if you think it could interfere talk to the client about it can affect ability to relate Personality Personal style matters personality sensitivity and warmth are very important ideal therapist isn t helpful we don t have it all together Emotional well being need to recognize areas in their own life that are sensitive need objectivity put emotions in check if you can t then refer them Course of clinical intervention Initial contact role induction Clients often don t know what to expect generally explain what the clinic is all about and what kind of help is available discuss referral question why are they there Assessment observation consultation Appointments for assessment intake administer psychological tests interview others self Preliminary integration should be on going don t just make observations once and stop comprehensive construction of client s problems in light of all the psychological environmental and medical data available Goals of treatment Nice if goal is measurable must be handled with discretion sensitivity and skill Implementing treatment Termination evaluation follow up Psychotherapy research Eysenck said psychotherapy with neurotics was no more effective than none at all Looked at people with and without therapy 6 months after a breakup they were all the same Very controversial only done at 6 months everyone would generally be fine people w therapy probably got to that point faster though Process research when you look at one small variable in therapy Addresses the specific events that occur ex color of carpet having picture how much space between and how it could affect the therapy Relationship between outcomes and processes that occur during therapy Therapist competence and adherence to protocol is associated with a positive outcome Degree that clients reflect on think about and emotionally process is positively associated with outcome Therapist s use of guidance is generally not associated with outcome use of support and encouragement is inconsistently related Dr Phil approach Client s degree of cooperativeness is positively related to outcome as is degree to which clients express positive affect Chapter 12 Psychotherapy Psychodynamic perspective Psychodynamic uses unconscious motives and conflicts for the roots of behavior FREUD depends heavily on analysis on past experience primarily childhood personality is develop by age 6 or 12 Beginnings Anna O using hypnosis talked about first appearance of symptom and then it was gone problems with hypnosis not everyone can be hypnotized once trance is over symptoms come back Hysteria physical problem with no organic cause it s in your head free association talk therapy Brief view states that everything we do has meaning and purpose nothing is an accident Freudian slip our consciousness is a very small part of us goal of therapy is to make the unconscious conscious therapy is painful no pain no gain Anxiety real anxiety is based on real danger from outside world neurotic anxiety stems from a fear that one s id impulses will be expressed if unchecked anxious about losing control can t control impulses leads to obsessive compulsive habits moral anxiety rises from the feeling that one will not be able to conform to the standards of the conscience Defense mechanisms not necessarily bad okay in moderation Repression push things that you want to forget out of the conscious awareness usually threatening material Fixation frustration and anxiety of next psychosexual stage and remain at their present level don t want to be pushed out of their comfort zone Regression returning to a previous stage that before provided satisfaction Reaction formation occurs when an unconscious impulse is expressed by the opposite says one thing and behaves the opposite ex priest in a gay relationship saying all gays will go to hell behaviors Techniques females Free association Projection people s feelings are attributed to others Free association client says everything and anything that comes to mind talking cure don t think before you speak that censors the unconscious Transference client may transfer feelings toward therapist Catharsis releasing anger through other means doesn t really work Resistance general reluctance to discuss remember or think about events that are troubling Insight interpretation Total understanding of the unconscious determinants of one s irrational feelings thoughts or Working through process you do it slowly careful and repeated examination of how the individual s conflicts have operated in different areas of life Believes in symptom substitution ex problem with girlfriend is actually just a problem with Analysis of dreams seen as symbolic wish fulfillments that provide clues to childhood wishes and feeling manifest content what actually happens in the dream latent content dream s symbolic meaning Client may try to ward off efforts to dissolve neurotic methods of resolving problems they Resistance may oh by the way you as they re walking out the door if it s getting painful they may get defensive and will do anything to avoid the topic at hand Forms of resistance May talk less or say mind is blank may talk around a point or repeat the same material will change the subject may intellectualize playing logic game when it s about feelings feelings
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