chapter 11 – intervention: overview copyright © 2014 john wiley & sons, inc. all rights...

Chapter 11 – Chapter 11 – Intervention: Intervention: Overview Overview

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

Focus on ‘evidence-based Focus on ‘evidence-based approaches’ to therapyapproaches’ to therapy

Growing use of technology and Growing use of technology and treatment treatment

Informed consentInformed consent: Client must : Client must agree to services that are being givenagree to services that are being given– Client should know what works best for a Client should know what works best for a

given disorder as wellgiven disorder as well– Adult gives consent for child, but child Adult gives consent for child, but child

must assent (verbally agree) to be must assent (verbally agree) to be treatedtreated

Ethics of InterventionEthics of Intervention

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

Inform client of:Inform client of:– Confidentiality and limits of Confidentiality and limits of

confidentialityconfidentiality– Financial arrangementsFinancial arrangements– What to expect in therapyWhat to expect in therapy– Alternative treatmentsAlternative treatments

Therapist must monitor whether the Therapist must monitor whether the treatment is workingtreatment is working

Treatment should be based on Treatment should be based on best-best-available evidenceavailable evidence

Ethics of InterventionEthics of Intervention


Norcross (1990) defined Norcross (1990) defined psychotherapy as: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.”

PsychotherapyPsychotherapy


APA (2013) passed resolution APA (2013) passed resolution recognizing psychotherapy as recognizing psychotherapy as effectiveeffective

Intended to promote psychotherapy Intended to promote psychotherapy in health care systems as evidence-in health care systems as evidence-based carebased care

Psychotherapy practiced by Psychotherapy practiced by professionals from many disciplines professionals from many disciplines (psychology, psychiatry, social (psychology, psychiatry, social work, nursing)work, nursing)

PsychotherapyPsychotherapy


Based on psychoanalytic theories of Based on psychoanalytic theories of Freud and recent theorists. Central Freud and recent theorists. Central concepts:concepts:– UnconsciousUnconscious: : Most of what motivates an Most of what motivates an

individual is outside of awarenessindividual is outside of awareness– Conflicts between Conflicts between IdId (impulsiveness) and (impulsiveness) and

EgoEgo (planning, higher cognitive (planning, higher cognitive functioning) functioning)

– TransferenceTransference: Problematic interpersonal : Problematic interpersonal relationship re-enacted with therapistrelationship re-enacted with therapist

– Counter-transferenceCounter-transference: Therapist’s : Therapist’s problematic interpersonal relations OR problematic interpersonal relations OR how the client makes the therapist feelhow the client makes the therapist feel

Short-term Psychodynamic Short-term Psychodynamic Therapy Therapy


Some versions of this approach:Some versions of this approach:– Luborsky’s Luborsky’s Supportive-Expressive TherapySupportive-Expressive Therapy– Strupp’s Strupp’s Time-limited Dynamic TherapyTime-limited Dynamic Therapy

Most all focus on process of:Most all focus on process of:– 1) Bringing to awareness unconscious 1) Bringing to awareness unconscious – 2) Re-enacting problematic relationship 2) Re-enacting problematic relationship

with the therapistwith the therapist– 3) Working through this pattern and 3) Working through this pattern and

development of new interpersonal patternsdevelopment of new interpersonal patterns



Additional foci of this approach:Additional foci of this approach:– Identification of themes and central Identification of themes and central

conflictsconflicts– Defensive patterns in the person’s lifeDefensive patterns in the person’s life– Evoking emotionsEvoking emotions– Goal-settingGoal-setting– Termination of therapyTermination of therapy

Strong evidence of effectiveness in Strong evidence of effectiveness in depression, panic disorder, depression, panic disorder, substance abuse, borderline PD, etc.substance abuse, borderline PD, etc.


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

Much more emphasis on problems with Much more emphasis on problems with communication and on dysfunctional communication and on dysfunctional relationships than dynamic therapy relationships than dynamic therapy (although some overlap)(although some overlap)

Clear understanding of current and Clear understanding of current and past relationships is central to this past relationships is central to this approachapproach

Brief – usually 3-4 monthsBrief – usually 3-4 months Work on actively changing Work on actively changing

interpersonal patternsinterpersonal patterns

Interpersonal Therapy (IPT) Interpersonal Therapy (IPT)


Focus is often on role transitions Focus is often on role transitions (becoming a parent, student to (becoming a parent, student to professional, etc.)professional, etc.)

Originally developed for depression, Originally developed for depression, but has been applied to several but has been applied to several populations including late life, populations including late life, different cultures, and several different cultures, and several disorders (including eating disorders (including eating disorders, anxiety and substance disorders, anxiety and substance abuse)abuse)

Interpersonal Therapy (IPT) Interpersonal Therapy (IPT)


History in existential, humanistic History in existential, humanistic and client-centered approaches and client-centered approaches (though little data on these (though little data on these approaches as helpful)approaches as helpful)

Focus is onFocus is on– Increasing awareness, reflection and Increasing awareness, reflection and

expression of emotionexpression of emotion– Enhancing emotion regulationEnhancing emotion regulation– Transforming maladaptive emotions Transforming maladaptive emotions

into adaptive emotionsinto adaptive emotions

Process-Experiential TherapiesProcess-Experiential Therapies


Focus is also on in-session Focus is also on in-session experiencing of affect along with experiencing of affect along with processing the emotion experience processing the emotion experience

Strong evidence for effectiveness Strong evidence for effectiveness with depression, couple distress and with depression, couple distress and adult survivors of child abuseadult survivors of child abuse

Process-Experiential TherapiesProcess-Experiential Therapies


Behavior TherapyBehavior Therapy is the oldest form is the oldest form of CBT – with a focus on operant and of CBT – with a focus on operant and classical conditioning as etiology of classical conditioning as etiology of symptoms and problemssymptoms and problems– Symptom and present focused Symptom and present focused

Bandura – learning can take place by Bandura – learning can take place by observation and imitationobservation and imitation

Self-efficacySelf-efficacy:: person’s sense of person’s sense of competence to learn and perform competence to learn and perform new tasks (best predictor of tx new tasks (best predictor of tx success)success)

Cognitive Behavioral Therapies Cognitive Behavioral Therapies (CBT)(CBT)


Ellis’s Ellis’s Rational-Emotive TherapyRational-Emotive Therapy and and Beck’s Beck’s Cognitive TherapyCognitive Therapy are based are based on idea that thoughts about on idea that thoughts about environment are the key to etiology environment are the key to etiology and maintenance of a disorderand maintenance of a disorder

CBT is a mixture of cognitive and CBT is a mixture of cognitive and behavioral approachesbehavioral approaches

CBT validated in numerous DSM CBT validated in numerous DSM disorders disorders

Cognitive Behavioral Cognitive Behavioral Therapies (CBT)Therapies (CBT)


Focus of treatment is onFocus of treatment is on– Identification of thoughts and behaviors Identification of thoughts and behaviors

that might be causing problemsthat might be causing problems– Very active role of therapist with clientVery active role of therapist with client– Use of current research in Use of current research in

psychopathologypsychopathology– Didactic methods and Socratic Didactic methods and Socratic

questioning (i.e., encouraging the client to questioning (i.e., encouraging the client to reflect)reflect)

– Homework set Homework set – Tailoring approach to given individual Tailoring approach to given individual

Cognitive Behavioral Therapies Cognitive Behavioral Therapies (CBT)(CBT)


Anyone can refer to themselves as a Anyone can refer to themselves as a ‘psychotherapist’‘psychotherapist’

A license ensures the practitioner A license ensures the practitioner has met educational and experience has met educational and experience guidelinesguidelines

Duration varies, but median number Duration varies, but median number of visits is 5-13 sessionsof visits is 5-13 sessions

Evidence based treatments usually Evidence based treatments usually are between 10-30, so some may are between 10-30, so some may not be receiving the full ‘dose’not be receiving the full ‘dose’

General Points on Seeking General Points on Seeking Psychological ServicesPsychological Services


Couple therapyCouple therapy common for all types of common for all types of couples going through various problemscouples going through various problems

Many forms of Many forms of family therapyfamily therapy where where individual problem is thought to come individual problem is thought to come from family communication dysfunctionfrom family communication dysfunction

Group therapyGroup therapy (variety of orientations) (variety of orientations) – Process groups – use group to explore Process groups – use group to explore

interpersonal dynamicsinterpersonal dynamics– Structured groups – focus on a specific Structured groups – focus on a specific

problemproblem

Additional Forms of Additional Forms of Psychological ServicesPsychological Services


Self-administeredSelf-administered: self-help books : self-help books based on evidence based carebased on evidence based care– Continuum of client working on their own Continuum of client working on their own

to some work with a therapist to some work with a therapist – Some evidence that this is effectiveSome evidence that this is effective

Computer-based treatmentComputer-based treatment: : Continuum of computerized aspects of Continuum of computerized aspects of evidence-based care to virtual realityevidence-based care to virtual reality

TelehealthTelehealth: Range of treatments not : Range of treatments not in person (phone, email, in person (phone, email, videoconferencing)videoconferencing)

Additional Forms of Additional Forms of Psychological ServicesPsychological Services


chapter 11 – intervention: overview copyright © 2014 john wiley & sons, inc. all rights...

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