Chapter 10  Treatment utilization rates--relatively low.

Basic Features of Clinical Intervention  also common--persons with psychological problems--delay

seeking treatment for many years
What is psychotherapy
 method of inducing changes--person’s behavior, thoughts, or How important is the client’s diagnosis in a therapist’s selection of a
feelings. specific treatment methods and in the outcome of those treatments?
 form of treatment for problems of an emotional nature--which a  Sex
trained person deliberately establishes--professional relationship  Age
with a patient with the object of removing, modifying or retarding  Socioeconomic Status
existing symptoms, of mediating disturbed patterns of behavior,  Intelligence
and of promoting positive personality growth and development  Ethnicity
 planned, emotionally charged, confiding interaction between--  Other personality variables
trained, socially sanctioned healer and a sufferer
Sex
Does psychotherapy help?  no evidence--sex of the client--related to psychotherapy outcome
Efficacy (Garfield, 1994)
 performance--intervention under ideal and controlled
circumstances What about clients’ personality and attitudes?
Effectiveness  Orlinsky, Grawe, and Parks (1994) report--two client variables
 performance--intervention under real-world conditions consistently show up--important in psychotherapy outcome
research: cooperation vs resistance and openness vs defensiveness
Participants in psychotherapy  Motivation can also be influenced by clients’ beliefs and
A. CLIENT expectations, so it is not surprising--who have more hope of
 Unhappy marriage improvement and less fear of change--more likely to benefit from
 Lack of confidence treatment .
 Identity crisis  Clients’ level of distress and coping style (e.g., externalizing or
 Sexual problems internalizing)--also important.
 Depression  frequently more important to know-- kind of patient has the
 Anxiety or Fear disorder than what kind of disorder--patient has” (Messer, 2006, p.
39).
 some persons, disturbance--so great--day-to-day functioning--
impaired, there is a risk of suicide or harm to others, and B. THERAPIST
hospitalization may be necessary.  According to Inskipp (2000), psychotherapy --interpersonal
 common essential feature--person’s usual coping strategies are no activity, psychotherapists must possess strong interpersonal skills,
longer sufficient to deal with the problems. including those related--communication, relationship building, and
self-monitoring
4 most common mental illness among Filipinos  can recognize differences and intensities in clients’ emotional
experiences, and who also have a verbal repertoire capable--
putting these shadings--words, are more likely to effectively
communicate their understanding--clients.
 need--communicate sincerity and to warmly support troubled
clients without judging them, and at the same time, must have--
skill to remind clients of their capacity and responsibility--making
beneficial changes--lives − genuineness, empathy, and
unconditional positive regard
 need skills--self-awareness or self-management

 Machado, Beulter, and Greenberg (1999) found--trained therapists

could recognize others’ emotions better than untrained novices
could.
 with more training and experience also tend--have lower client
drop-out rates.
 not clear exactly what kind of training and what level of
experience--best.
Schröder and Davis (2004) found--therapists’ complaints clustered  Psychotherapists must therefore coordinate psychotherapy with
into three groups: other treatments, such as medication, physical therapy, or
 Competency-related difficulties psychosocial rehabilitation.
 Personality-based difficulties
 Situational difficulties Goals of Clinical Interventions
 Reducing Emotional Discomfort
How do therapists prepare for and cope with these challenges?  Fostering Insight
 “through undergoing personal therapy”  Providing New Information
 Encouraging Catharsis
Therapeutic Relationship  Assigning Extratherapy Tasks (Homework)
DIMENSIONS  Developing Faith, Hope, and Expectations--Change
a. emotional bonds--develop between--therapist and client (liking,
trust, etc.), Ethical Guidelines for Clinical Interventions
b. shared understanding of what--to be done (tasks) and what--to be General Principles
achieved (goals). A. Respect--Dignity of Persons and Peoples
therapeutic alliance B. Competent Caring--Well-Being of Persons and Peoples
C. Integrity
Carl Rogers D. Professional and Scientific Responsibilities--Society
 “the words—of either client or [therapist]--seen as having minimal
importance compared with the present emotional relationship-- A. Respect for the Dignity of Persons and Peoples
exists between the two”  Respect--dignity recognizes--inherent worth of all human beings,
regardless of perceived or real differences--social status, ethnic
Sigmund Freud origin, gender, capacities, or other such characteristics.
 Psychoanalysts and psychodynamically oriented clinicians also  inherent worth means--all human beings--worthy of equal moral
regard--alliance--critical but are less inclined--believe-- consideration.
relationship itself is the main ingredient--therapy.
B. Competent Caring--Well-Being of Persons and Peoples
Aaron T. Beck  involves working--benefit and, above all, doing no harm.
 Most behavioral and cognitive-behavioral therapists tend--view--  includes maximizing benefits, minimizing potential harm, and
therapy relationship--important but not sufficient condition of offsetting or correcting harm.
therapy  Competent caring requires--application of knowledge and skills--
appropriate--nature of a situation as well as the social and cultural
Promoting--Therapeutic Alliance context.
 Orlinsky and Howard (1986) found--alliance is likely--flourish  Another requirement--adequate self-knowledge of how one's
when both parties--capable of bringing three elements to the values, experiences, culture, and social context might influence
situation: one's actions and interpretations.
1. role investment (personal effort both parties devote--
therapy) C. Integrity
2. empathic resonance (degree to which both parties--“on the  based on honesty, and on truthful, open and accurate
same wavelength”) communications.
3. mutual affirmation (extent--which both parties care--each  Includes recognizing, monitoring, and managing potential biases,
other’s wellbeing). multiple relationships, and other conflicts of interest--could result-
-harm and exploitation--persons or peoples.
Settings for Psychotherapy
Outpatient Settings D. Professional and Scientific Responsibilities to Society
 first--privacy. Responsibilities include contributing--knowledge about human behavior
 emotional nature of therapy, clients have a right--expect-- and to persons’ understanding of themselves and others, and using such
communications remain between themselves and their therapists. knowledge--improve --condition of individuals, families, groups,
 soundproof, or nearly so communities, and society
 Arrangements should be made--hold calls and other interruptions
during therapy sessions. VIII.Therapy
 should not be too far removed from other people. A. Confidentiality
 Comfortable places to sit 1. regard confidentiality as an obligation--arises from our client’s
 Therapists’ should feel free--have their offices express their tastes trust. We therefore restrict disclosure of information--clients
and affections, but the personalization of decor should not be so except in instances when mandated or regulated--law.
exotic or so expressive--make clients feel--don’t quite belong 2. evaluation purposes, we discuss--results of clinical and counseling
there. relationships with our colleagues concerning materials--will not
 offices--group therapy sessions, therapists should try--structure-- constitute undue invasion of privacy.
environment in a way--maximizes therapeutic goals 3. release information--appropriate individuals or authorities only
after careful deliberation or when--imminent danger--individual
Inpatient Settings and the community. In court cases, data should be limited only--
 occurs in public, private, and VA hospitals, residential pertinent--legitimate request of the court.
rehabilitation and treatment centers, prisons, jails, and many other
settings. B. Informed Consent
 in hospitals, clinicians--likely-- treating clients with severe 1) seek--freely given and adequate informed consent--psychotherapy.
problems, such as schizophrenia or major depressive disorder inform clients--advance the nature ananticipated course of therapy,
 Clinicians working in hospitals-- often part of a treatment team-- potential risks or conflicts of interests, fees, third party
includes physicians, psychiatrists, social workers, and other involvement, client’s commitments, and limits of confidentiality.
personnel.
2) respect client’s rights--commit to or withdraw from therapy. I. Interruption
3) In instances where there--need to provide generally recognized  assume orderly and appropriate resolution of responsibility--client
techniques and procedures--not yet established, we discuss with in instances when our therapy services--terminated.
our clients--nature of the treatment, its developing nature,
potential risks, alternatives and obtain consent--voluntary J. Termination
participation. 1. terminate therapy--quite sure--our client no longer needs--therapy,
4) discuss with our clients both our rights and responsibilities-- is not likely--benefit from therapy, or would be harmed by
appropriate points--working relationship. continued therapy.
5) In instances where the therapist--still undergoing training, we 2. In cases--therapy--prematurely terminated, we provide
discuss--matter with--client and assure them--adequate pretermination counseling and make reasonable efforts--arrange--
supervision will be provided. orderly and appropriate referral.

C. Client’s Wellbeing Some Practical Aspects of Clinical Intervention

1. 1engage--systematic monitoring of our practice and outcomes Case Formulation and Treatment Planning
using--best available means in order--ensure--well being of our  Assessment--purposes of treatment leads--clinician’s case
clients. formulation, a conceptualization of the client’s problems.
2. We do not provide services--clients in instances when we are  Case formulations (also called case
physically, mentally, or emotionally unfit to do so.  study guides) may vary depending--clinician’s theoretical
3. responsible--learning and taking into account beliefs, practices and orientation, but the critical elements--formulation--facts and
customs--pertain to different working contexts and cultures impressions about the client--can be used--planning treatment.

D. Relationships Approaches to Treatment Planning (Makover, 2004)

1. do not enter into a client- clinician relationship other than-- 1. Therapist-based treatment planning or orientation-
professional purposes. based/theorybased planning − the therapist learns a basic
2. do not enter into multiple relationships--can have unforeseeable theoretical orientation to psychotherapy and uses it for every
beneficial or detrimental impact--clients. client.
3. maintain--professional relationship with our clients, avoiding 2. Diagnosis-based treatment planning − the client’s diagnosis, not--
emotional involvement--would be detrimental for the client’s well therapist’s orientation, determines--mode of treatment selected.
being. 3. Outcome-based treatment planning − base--treatment planning on
4. do not allow--professional therapeutic relationships with our factors--affect treatment outcome.
clients--prejudiced by any personal views we hold about lifestyle, 1. client (e.g., diagnosis, personality traits, expectations),
gender, age, disability, sexual orientation, beliefs and culture. 2. therapist (e.g., theoretical orientation, techniques and
5. do not engage--sexual intimacies with our current therapy clients, competencies, personality traits),
their relatives or their significant others. We do not terminate 3. situational or emergent qualities (e.g., treatment setting,
therapy--circumvent--standard. therapeutic alliance).
6. do not engage--sexual intimacies with our former clients, their
relatives, or their significant others--at least 2 years after cessation Therapist Objectivity and Self-Disclosure
of our therapy with them.  • Once therapy has begun, clients are expected to disclose a great
deal of personal information—indeed, therapy would be
E. Record Keeping impossible without it—but what about therapists?
 keep appropriate records with our clients and protect them from  Therapists must decide whether--share personal information such
unauthorized disclosure unless regulated--court. as their emotional reactions, incidents--own lives, and the like −
therapist self-disclosure
F. Competent Practice  There--potential benefits and risks--both disclosure and
1. keep up--date with the latest knowledge and scientific nondisclosure.
advancements--respond to changing circumstances. We carefully  Therapists who never self-disclose risk being perceived--aloof or
review our own need--continuing need--professional development impersonal, which might damage--therapeutic relationship.
and engage--appropriate educational activities.  Therapists who frequently self-disclose risk being perceived as
2. responsibly monitor and maintain our fitness--provide therapy-- impulsive, self-focused, or compromising the professional nature--
enables us to provide effective service. client–therapist relationship
3. When--need arises, we seek supervision or consultative support.

G. Working with Young People

 assess and ensure--balance between young people’s dependence
on adults and careers and their capacity--acting independently.
 carefully consider--issues of young people such as capacity to give
consent, confidentiality issues and receiving of service
independent--parents and legal guardian’s responsibility

H. Referrals
1. ensure--referrals with colleagues--discussed and consented by our
clients.
 provide--explanation to our clients regarding--disclosure of
information--accompany the referral.
2. ensure--recipient of the referral--competent in providing--service
and the client will likely benefit from--referral.
3. considering referrals, we carefully assess--appropriateness--
referral, benefits of the referral--client and the adequacy of client’s
consent for referral.