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