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Chapter 11

Clinical Psychology Chapter 11.docx

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John Stephens

Chapter 11- Psychological Interventions Intervention Defined • Role – Inducing change via professional relationship – Solve or prevent problems • Very rare to have a cure usually just minimizes problems • At times its about enrichment or augmentation – Achieve latent potential – In essence talking about a professional relationship (not casual) that can be very intimate (sharing a lot of information) – Expressed as socially sanctioned healing • Psychotherapy – Treatment for emotional problems – Affect changes in the individual (e.g., reduce symptoms) – Professionally established relationship that has protection built into it along with boundaries Does Psychotherapy Help? Efficacy vs. effectiveness on midterm • Efficacy – Person receiving treatment must show significant reduction in the levels of dysfunction – Focus on internal validity • Effectiveness – Treatment option must be representative – Emphasize external validity – It connects the real world with the therapeutic world • Effect size – Change relative to a comparison group that does not receive the treatment • Efficacy studies – Standardized – Selected, more homogeneous participants – High efficacy studies will be highly controlled with high standardization – They seek the principles of science to be on their side – Aren’t necessarily psychotherapists they will be trained confederates i.e. grad students etc. – High internal validity • Effectiveness studies – More “real world” testing – May or may not include a control group – Student on an array of psychotherapists for example • 1995 study done by Consumer Reports magazine • Summarized the survey responses of 4,000 readers who had sought treatment for a psychological problem • Most respondents well educated, median age = 46, half women • Wide variety of psychological problems reported Consumer Reports Study: Results • Majority reported some improvement • Those who felt the worst before treatment reported the most improvement • All types of mental health professionals appeared to be equally effective • Respondents who received psychotherapy alone improved as much as those who received psychotherapy plus medication • Longer treatment (more sessions) was related to more improvement Evidence Based Treatments and Evidence Based Practice • Evidence Based Treatments (EBTs) – Question of efficacy vs. other treatments – EBTs have produced significant change in trials – APA established criteria for EBTs in 1995 – Combine trials of EBTs through use of meta- analysis • Evidence Based Practice (EBP) – Broader, contains non controlled trials (i.e., no control or comparison group) – Question of whether one can scientifically measure effect without a comparison group – Rise in use with healthcare reforms Features Common to Many Therapies • Common factors – 3 Types: • Supportive • Warm blanket feeling • Learning • Assessment, understanding • Action • Recently seeing a lot more of this • In some bases literally in the real world teaching them – Involved in all effective psychotherapies • Key to the effectiveness? • Baseline for change? • Could be false because they could be presenting themselves at that time in a certain way • Relationship/Therapeutic alliance – Relation between client/ therapist – Unique in importance – Not necessarily curative – Must be (good list for midterm) • Non-judgmental • Objective • Insightful • Professional • Expert role – Expert knowledge about psychological problems – Competency/ training – Maintaining equal respect • Building competency – Therapist • Educator • Promote self-efficacy • Facilitate mastery experiences  Non specific factors o Influence of immeasurables: hope, belief o “Placebo effect” of therapist? Nature of Specific Therapeutic Variables • Patient/ client – Degree of distress – Intelligence – Age – Motivation • Voluntary – Openness – Gender
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