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Chapter 14Intervention: Identifying Key Elements of Change
INTRODUCTION TO CLINICAL PSYCHOLOGY 2EHUNSLEY & LEE
PREPARED BY DR. CATHY CHOVAZ, KING’S COLLEGE, UNIVERSITY OF WESTERN ONTARIO
Topics
2
What Works for Whom, and When?Process and Process-Outcome Research
Common Factors in PsychotherapyThe Therapeutic AlliancePsychotherapy EquivalenceEmpirically Supported Therapy Relationships
Process research and process-outcome research:
Understanding what specifically causes effective outcomes within psychotherapy
Note that not all therapy is effective for all people
Effective therapy does not always indicate how it was effective
Research can look at any time frame: seconds, minutes, days, weeks, etc.
What Works for Whom, and When?
Example – Viewpoint Box 14.1 Looking closely at client outcome, Tang &
DeRubeis (1999) noted that many patients make sudden gains around sessions 4-6
Important to consider: Client factors (aspects about each specific client) Therapist factors (aspects about the specific
therapist) Treatment factors (aspects about the treatment
given)
Process and Process-Outcome Research
Client Factors that Influence Treatment: Sociodemographic Characteristics
Client Factors:Psychological Functioning
Client Factors:Personality Characteristics
Therapist Factors – Findings Limited findings on effect of ethnicity of therapist
on outcome Age, gender unrelated to outcome Therapists trained in mental health have better
outcomes than general health practitioners Inconclusive differences on sub-mental health
fields (clinical psych, social work, marriage and family counsellors, etc.)
Process and Process-Outcome Research
Therapist Factors that Influence Treatment:Sociodemographic Characteristics
Therapist Factors that Influence Treatment: Professional Background
Therapist Factors that Influence Treatment: Personality Characteristics
Examining Treatment Factors
Treatment Factors – Findings Note that when all patients are grouped together
there are not differences in directiveness, insight, or symptom reduction
Between-session assignments do not increase the effectiveness of therapy, but for treatments that require them (e.g., CBT) whether a client does the homework is predictive of success
Treatment Factors
Several ways to define common factors
Jerome Frank’s (1973) model of role of a healer in society
Weinberger (1995) factors noted: Therapeutic relationship Client expectations Confronting problems in therapy Client’s sense of mastery Client’s attribution for outcome
Common Factors in Psychotherapy
Lambert and Ogles’ three factors (support, learning and action)
Support Factors Reducing isolation Providing reassurance Therapeutic alliance Therapist expertise Therapist respect, empathy Acceptance, warmth Catharsis
Common Factors in Psychotherapy
Lambert and Ogles’ three factors (support, learning, and action)
Learning Factors Advice Cognitive learning Emotional experiencing Insight Feedback Exploration of assumptions Beliefs, expectations
Common Factors in Psychotherapy
Lambert and Ogles’ three factors (support, learning, and action)
Action Factors Practice Modeling Reality testing Facing fears Working through issues Development of mastery Behavioral regulation
Common Factors in Psychotherapy
Integrative treatment models have developed from this research
One factor has been most consistently linked to positive outcome: therapeutic alliance – the quality and strength of the therapist-client relationship
Common Factors in Psychotherapy
Positively related to treatment outcome for adults and adolescents
Can be assessed by client, therapist or an independent rater
Importance of understanding correlation does not equal causation
The Therapeutic Alliance
Dodo Bird Effect: term used when psychotherapy orientations are systematically compared there are no clear differences
Some differences exist in some studies (particularly meta-analyses when certain studies are grouped), or when looking at client or therapist differences
Psychotherapy Equivalence
Important concepts: Alliance and cohesion: importance of a good
working relationship Empathy: the ability to understand another
person’s experience Goal consensus and collaboration: importance
of patient and therapist agreeing upon treatment goals
Reactance/resistance and impairment: changing the directiveness and frequency based on the client
Empirically Supported Therapy Relationships
Some important concepts Client variables that might decrease benefits:
impairment, Axis II, unfavourable expectations
Helpful relational conditions: the formation of a therapeutic alliance
Helpful therapist behaviours: empathy, collaboration, authenticity, skillful
Intervention targets: interpersonal issues, problematic cognitions, maladaptive emotions & behaviours
Empirically Based Principles of Change
Copyright © 2010 John Wiley & Sons Canada, Ltd. All rights reserved. Reproduction or translation of this work beyond that permitted by Access Copyright (The Canadian Copyright Licensing Agency) is unlawful. Requests for further information should be addressed to the Permissions Department, John Wiley & Sons Canada, Ltd. The purchaser may make back-up copies for his or her own use only and not for distribution or resale. The author and the publisher assume no responsibility for errors, omissions, or damages caused by the use of these programs or from the use of the information contained herein.
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