Psychological Interventions Chapter 11 1 What is a psychological intervention What kind of evidence do we have that psychotherapy works What is the difference between efficacy studies and effectiveness studies Which kind do we particularly need more of a Psychological intervention Pg 312 persons thoughts behaviors or feelings method of inducing changes in a i ii In some cases its meant to solve a specific problem or improve an individuals capacity to deal with existing behaviors thoughts or feelings that are impairing their daily functioning In other cases the focus may be more on the prevention of problems rather than remedying an existing one iii Or even in yet other cases it may be less on solving problems or preventing problems but on increasing the persons ability to take pleasure in life or to achieve some latent potential 1 Goal is to effect changes in the individual reduce b Efficacy and effectiveness of a treatment has to be addressed symptoms i Efficacy studies Pg 313 internal validity by controlling the type of clients in the study by standardizing treatments and randomly assigning patients to treatment or non treatment groups studies that place a premium on 1 A study is considered efficacious to the extent that the average person receiving treatment in clinical trials is demonstrated to be significantly less dysfunctional than the average person waiting to receive treatment 2 Often in labs of university clinics ii Effectiveness studies Pg 313 emphasize external validity and the representivness of the treatment that s being administered considered to be effective to the extent that clients report clinically significant benefits from treatment 1 Considered more real world compared to efficacy studies may or may not include control groups or random assignment because the focus is on if a typical client receiving treatment reports clinically significant relief or benefit c Empirical evidence seems to support the efficacy of psychotherapy on average individuals who received it achieved some degree of relief i A meta analytic review of 475 psychotherapy outcomes reported that the average person receiving treatment functioned 80 better than those who did not receive treatment d There are fewer studies on effectiveness an issue of consumer report summarized the results of a survey of 4000 who sought treatment for a psychological problem i Most respondents were well educated the median age was 46 and about half of them were women 43 described their state before treatment as very poor ii The types of problems presented were a huge variety depression phobias panic disorders marital sexual problems substance abuse problems problems with children among others iii The results showed some level of improvement for the majority those who felt worse prior to treatment reported the most benefit 1 Psychiatrists psychologists and social workers were all equally effective including the severity and type of problem presented 2 Those who received therapy alone improved just as much as though who received it with medication the longer the treatments were the more benefits they produced e Evidence based treatments Pg 315 techniques that have produced significant changes in clients and patients in controlled trials those interventions or i Been shown to be efficacious by comparing those that receive the treatment to a control group a treatment is determined to be an EBT based on efficacy studies supporting its positive effects on patients f Evidence based practice Pg 315 of sources including scientific evidence about the intervention clinical expertise and patients needs and preferences treatments informed by a number i Particularly relevant to this in psychology is whether or not the treatments being performed were better or worse than those provided in psychiatry social work or other mental health disciplines 2 What are the common factors discussed in the book that cut across different types of psychotherapies a Supportive factors trust groundwork for changing clients beliefs and attitudes i Relationship Therapeutic alliance Pg 317 between therapist and patient forging of a strong therapeutic alliance is believed to be of primary importance for therapeutic change relationship 1 The effective therapist is someone who is accepting nonjudgmental objective insightful and professional all at one time ii Therapeutic expertise expert role Pg 320 demonstration of competence therapists 1 In therapy patients have the right to assume that they re seeing a warm competent person competence comes from training iii Active participation from both parties 1 Therapist have to make inferences decisions etc based on the feedback from the patient if the patient doesn t participate there s nothing for the therapist to work off of b Learning factors insight leads to behavioral change i Psychoeducation some forms of therapy may take on teaching overtones 1 Client may tutored on more effective ways to find a job or sexual information to help alleviate past difficulties and promote better sexual adjustment in the future ii Building competency mastery skills Pg 321 acquisition of a high level of knowledge or skill 1 The therapist that gives off the sense of mastery is more likely to function in an effective manner iii Hypothesis testing 1 Therapists give suggestions on new ways of thinking and behaving the client examines these tries them and the therapist and client revaluate 3 What are the steps or stages that tend to characterize a clinical intervention a Initial contact intake interview generally to explain what the clinic is about and what kind of help can be given i Can have a significant impact on the clients attitude and willingness to cooperate ii Once the clients reason for coming is discussed for the next step it may be useful to discuss several specific issues who are the staff and what are their qualifications fees confidentiality etc b Other assessments i A variety of assessment procedures can be made depending on the clients problems orientation of the professional staff and other factors ii For some clients consultations with other professionals may be desirable 1 Neurology work up medical examinations to rule out any physical problems for clients whose problems are related to economical or unemployment issues consultation with a social worker may be appropriate iii After the information has been collected and analyzed a preliminary integration is attempted what s desired here is not a simple
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