Counseling & Psychotherapy Slides

Theoretical Orientation

A consistent perspective on human behavior, psychopathology, and the mechanisms of therapeutic change

Case Conceptualization

A clinicians understanding of a client’s problems viewed through a particular theoretical orientation.

The Medical Model for treating illness

Illness or Disease

Biological Explanation

Mechanism of Change

Therapeutic Procedures

Specificity

A medical approach to psychical treatments (Psychoanalysis)

Hysteria

Repressed Traumatic Events

Insight into the unconscious

Free Association

Take Freud’s word for it…

2 emerging forces in the field of psychology

Humanism & behaviorism

Common themes

Medical models for psychological treatment

Research supporting specificity of mechanisms of change

Empirically based practice in psychology

Randomized clinical trials

Emergence of treatment manuals

Can therapy clients be categorized by disorders?

What is the role of sociocultural factors?

Theoretical integration

The fusion of two or more theories into a single theoretical orientation

Examples of Theoretical Integration

Cognitive-Behavioral Therapy

Cognitive-Interpersonal Therapy

Cyclical Psychodynamics

Transtheoretical Model

Technical Eclecticism

Focus is on techniques not theory

Four components common to all psychotherapies

Emotionally charged, confiding relationship

A “healing setting”

A rationale, conceptual scheme or myth that provides an explanation for the patient’s symptoms

A ritual or procedure consistent with the explanation

The Contextual Model

Benefits of psychotherapy accrue through social processes

Eusocial Species

Healing occurs as a function of social pathways

(as opposed to through some medical mechanical means)

3 pathways to client change

The “Real” Relationship (empathy)

Expectations (positive)

Specific Ingredients (Tasks & Goals, Therapeutic Actions, Healthy Actions)

Specific ingredients

Vary based on theoretical orientation

The Contextual Model reminders

Does NOT replace a theoretical orientation

Alternative to Medical Model in explaining efficacy

No need for treatment specificity

Determining Efficacy

Randomized Clinical Trials

Participants are randomly assigned to treatment or control

Double Blind (blind to condition, measurement is blind to condition)

Determining efficacy w/comparison with no treatment

Treatment from a specific theoretical approach

Control: Waitlist or assessment with no significant active treatment

Efficacious: Treatment has been found to be superior to no treatment or waitlist conditions in at least two independent studies

Determining efficacy comparisons w/ other treatments or placebo

Control: nonspecific processes or attention placebo

Efficacious and Specific: Treatment has been found to be superior to other treatments or placebo attention conditions in at least two independent studies

Determining efficacy (combination studies)

One specific component of a theoretical approach VS

Control: The theoretical approach as a whole

OR

A combination of approaches VS

Control: Individual parts of the combination alone

Efficacious and Specific based on the same standards

Single case studies

Establish a stable baseline

at least three assessment points

ABAB design (therapy, no therapy, etc)

Multiple baseline designs

Across behavior, settings, and participants

Efficacious

At least three participants in research by a single group

2 or more independent research studies

Outcome assessment

Must be done reliably

Diagnoses should be blind interviews

Other assessment tools must demonstrate psychometric reliability and validity

Multiple methods of assessment is preferred

Statistical Significance

Outcomes aren’t necessarily meaningful

Clinical significance

Functional change

Return to normalcy

Personally important goal

Treatment fidelity

Treatment manual as applied

Therapist training and monitoring

Experience in a particular approach vs overall experience