Approaches to Clinical Psychology: Module 6 - Basics of Clinical Intervention
main ethical concerns for psychotherapists
confidentiality, competency, informed consent, and conflict of interest
APA Ethical Principles of Psychologists and Code of Conduct
current edition includes five general principles and ten ethical standards whose subsections contain 151 rules
rupture
deterioration of a therapy relationship signaled by disagreement about goals, reduced collaboration, and a strained emotional bond between therapist and client
psychotherapy
treatment techniques administered by mental health professionals in a professional relationship to help clients overcome psychological problems
treatment settings
types and characteristics: - outpatient (most common). Offices, schools, and other community locations. Ideally, create a sense of privacy and comfort - inpatient. Hospitals, prisons, and other residential facilities. Clinicians usually working on a treatment team
cognitive, cognitive behavior, and acceptance based approach
emphasizes development of cognitive skills, especially for identifying unhelpful thinking, evaluating, and modifying beliefs, learning to observe even painful thoughts and experiences without criticizing our reactions to them, and thus changing problematic behaviors, regulating emotions, and relating to others in new ways
psychodynamic approach
emphasizes exploration of unconscious conflicts and other psychological forces that underlie behavior disorders
behavioral approach
emphasizes techniques derived from learning theory to identify and alter specific behaviors associated with psychological disorders
social systems approach
emphasizes the influence of social and cultural forces operating in clients' lives, including experiences of poverty or discrimination. Often conducted in group and family formats
humanistic approach
emphasizes use of the client-therapist relationship to create conditions in which clients recognize and act on genuine feelings and reach their full growth and potential
record keeping
ethical standards require therapists to keep records of clients' identifying information, dates and types of service, fees, assessment results, treatment plans, and consultation with others
challenges for therapists
examples: - concerns about one's competency - concerns about one's personality impairing effectiveness - concerns about one's working situation
therapists
important characteristics for therapy: - interpersonal skills: (communication, self-monitoring, and relationship-building [macroskills]) -intrapersonal skills (secure attachment, coping ability, self-management, self-awareness, positive attitude)
clients
important factors in therapy: - lack of access to treatment - nature of their problems -motivation for, or ambivalence about, treatment -autonomy (freedom to make choices)
fostering Insight
promote self-examination and self-knowledge
building a strong therapeutic relationship
provide a safe, collaborative, and supportive atmosphere in which clients can feel comfortable about engaging in treatment
APA specialty guidelines
relate to child custody, older adults, diverse populations, LGBTQ+ clients, health-care practice, forensic practice, and use of technology, among others
extratherapy assignments (homework)
remind clients of important points from therapy sessions that might be forgotten and encourage them to practice newly learned behaviors at home
therapist objectivity and self-disclosure
there are potential benefits and risks associated with therapist self-disclosure and nondisclosure. The decision to self-disclose should be informed by what is best for the client
sources of ethical guidance
- APA Ethical Principles of Psychologists and Code of Conduct - APA specialty guidelines
goals of clinical interventions
- building a strong therapeutic relationship - fostering insight - providing new information (education) - extratherapy assignments (homework) - developing expectations for change
providing new information (education)
- counter misconceptions, explain how problems can arise, be maintained, and alleviated - suggest helpful reading material (bibliotherapy) or other resources
case formulation (case study guide) and treatment planning
- def.: A clinician's conceptualization of the client's problems, strengths, and protective factors, along with their interconnections, origins, and the factors that maintain problems -case study guides and treatment selection can be based on the therapist's theoretical orientation, on results of empirical research about which treatments work best for particular disorders, on clients' values, goals, and preferences, or a combination of all these factors
developing expectations for change
- present a theory-based rationale for treatment - promote early success experiences
treatment duration and fees
- treatment duration can range from one day to several years - single-session fees can vary substantially, depending on location, type of therapist, insurance, and other factors
insight
clients' awareness and understanding of the nature, causes, and factors maintaining their problems
premature termination
clients' leaving psychotherapy before the treatment process has been completed
termination
termination of successful treatment is typically a positive experience for both client and therapist. Premature termination can be problematic, but often also preventable
placebo effect
the appearance of treatment benefits on clients' belief that the treatment will help
client-therapist relationship (therapeutic alliance)
the emotional bond between therapist and client and their shared understanding of treatment tasks and goals characteristics and influential factors: - quality is related to treatment outcomes - strength can rise, fall, and rupture over time - promoted by therapist's genuineness, empathy, unconditional positive regard, encouragement and sharing of the client's goals. Alliance can be a cause or an effect of symptom improvement; exact mechanisms of influence are still unclear
interpretations
therapist comments designed to prompt clients to examine their thoughts and actions and reach more informed conclusions about them
conflict of interest
therapists must ensure that their clients' interests are prioritized
competency
therapists practice only within their areas of expertise and training
confidentiality
therapists protect the client's privacy and, except in specific circumstances, do not reveal information shared in therapy
informed consent
therapists tell clients about the limits of confidentiality, about potential outcomes of treatment, and other factors that might affect their willingness to enter treatment