Contents Chapter 11 Psychological Interventions 3 Chapter 12 Psychotherapy The Psychodynamic Perspective 12 Chapter 13 Psychotherapy Phenomenological and Humanistic Existential Perspectives 22 Chapter 14 Psychotherapy Behavioral and Cognitive Behavioral Perspectives 35 Chapter 15 Group Therapy Family Therapy and Couples Therapy 49 Note highlighted portions are important concepts indicated by the professor to be distinguished as particularly relevant to the exam 49 Part 3 Clinical Interventions Chapter 11 Psychological Interventions Introduction Intervention Defined o Psychological intervention is a method of inducing changes in a person s behavior thoughts or feelings Behaviorists disagree on this point o Therapy involves retention in the context of a professional relationship o Psychotherapy is a form of intervention that occurs in a professional context whose aim is to solve psychological problems improve coping and functioning prevent future problems or increase life satisfaction Does Psychotherapy Help o A treatment is considered efficacious to the extent that the average person receiving the treatment in clinical trials is demonstrated to be significantly less dysfunctional than the average person not receiving any treatment o Effectiveness studies emphasize external validity and the representativeness of the treatment that is administered o Empirical evidence supports the efficacy of psychotherapy however this does not mean that everyone will benefit o November 1995 article in Consumer Report more counseling than clinical 75 80 reported successful some improvement the magic number 49 Psychiatrists psychologists and social workers all received high marks Those who received psychotherapy alone improved as much as those who received psychotherapy and medication Longer treatment more sessions was related to more improvement to a point o To consider How do we measure if therapy is successful Evidence Based Treatment and Evidence Based Practice o EBT originally called empirically supported or empirically validated treatment refers to those interventions or techniques that have produced significant change in clients and patients in controlled trials o EBP is a broader category in that it includes treatments informed by a number of sources including scientific evidence about the intervention clinical expertise and patient needs and preferences Features Common to Many Therapies Supportive factors such as trust lay the groundwork for changes in clients beliefs and attitudes learning factors such as insight which then lead to client action or behavioral change taking risks o support changes in client s beliefs attitudes client changes behaviors Relationship Therapeutic Alliance o The general ability of therapists to rise above their personal needs and to respond with professional skill in a nonjudgmental atmosphere 49 of confidentiality understanding and warmth is probably a major reason for the success and persistence of psychotherapy Building Competency Mastery o Self efficacy Bandura o In the case of dealing with a client s laundry list of issues brought to the table start with 2 points Anything life threatening The problems that when dealt with will have the greatest positive impact on client s well being the greatest initial effect Depth of a problem The changeability of a condition or behavior The deeper the condition the less changeable it is perceived to be Patient functioning How well a patient is getting along across a number of domains e g psychological social interpersonal occupational Nonspecific Factors o Successful therapy tends to be associated with faith hope expectations for increased competence Nature of Specific Therapeutic Variables The patient or client what they immediately bring to the table o The degree of the client s distress Curvilinear patients with little disturbance or extreme disturbance show poorer outcomes than do moderately disturbed patients o Intelligence Some therapeutic approaches require a great deal of talking articulation of past experiences insight and introspection behavioral therapy behavioral modification programs 49 o Age o Motivation o Openness o Gender Best to consider not age alone but rather the specific characteristics of the prospective client When people are forced either openly or subtly to become clients they rarely benefit from the experience Research is mixed possibly due to difficulties in measuring A kind of openness to the therapeutic process appears to make the client a better candidate for therapy Research does not support the view that the biological sex of the client is significantly related to the outcome in therapy May be important in some specific cases o Race Ethnicity and Social Class It does appear that many therapeutic techniques have been designed and developed for white middle and upper class clients Too few procedures seem to take into account the particular cultural background and expectations of the clients YAVIS syndrome young attractive verbal intelligent successful numerous reviews of existing research have concluded that there appears to be virtually no relationship between social class and outcome Few would disagree that cultural sensitivity on the part of the therapist is very important Important that clinical psychology develop culturally sensitive therapists who can work effectively with culturally diverse populations o Therapists reactions to patients 49 Some evidence that clients who receive higher global ratings of attractiveness or to whom the therapist can better relate are associated with better outcomes in therapy The Therapist o Having a specific theoretical or therapeutic orientation does not override the role of personality warmth or sensitivity o Age sex and ethnicity Solution seems to be for therapists to become more sensitized to age gender and racial identity issues as they relate to themselves as well as the client o Personality Even though the therapists personality is a potent force other factors in combination largely determine therapy outcomes Doubtful that the concept of the ideal therapist is very useful o Empathy warmth and genuineness Rogers described as necessary and sufficient now most say necessary but not sufficient conditions for good therapy outcomes o Emotional well being Important that therapists recognize areas in their own lives that are tender Therapists need to be able to look at their clients with objectivity and not become entangled in their own personal
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