week 12: change: stages, mechanisms, patterns, and ethics in psychotherapy

What are the five stages of change in the Transtheoretical Model (Prochaska & Norcross, 2014)?

1. Precontemplation

2. Contemplation

3. Preparation

4. Action

5. Maintenance

Define the “precontemplation” stage.

The stage where an individual is not yet considering change and may be unaware that a problem exists.

What is the primary therapist task during the Precontemplation stage?

To raise doubt, increase the client’s perception of risks/problems with current behaviour, and build rapport.

Define the “contemplation” stage.

The stage where the individual is ambivalent; they acknowledge the problem and are considering the change but are not yet committed to it.

What is the primary therapist task during the contemplation stage?

To help the client determine the best course of action and develop a concrete plan.

Define the “preparation” stage.

The stage where the individual has decided to change and is beginning to make specific plans for action.

What is the primary therapist task during the preparation stage?

To help the client determine the best course of action and develop a concrete plan.

Define the “action” stage.

The stage where the individual actively implements their plan and begins treatment or behavioural modification.

What is the primary therapist task during the action stage?

To focus on the plan, help the client take active steps, and manage ongoing ambivalence.

Define the “maintenance” stage.

The stage where changes are integrated into the client’s lifestyle and the focus shifts to preventing return to old patterns.

What is the primary therapist task during the maintenance stage?

To identify potential obstacles and utilize prevention strategies.

What did Wampold (2015) identify regarding mechanisms of change?

He identified common mechanisms across therapies, including catharsis, exposure, corrective experiences, and emotion regulation.

Define catharsis.

Releasing blocked emotion and finding more effective ways of expressing emotion.

Define exposure.

Systematic and repeated confrontation with feared situations/emotions, leading to non-avoidance.

Define corrective experiences.

A disinformation of a client’s conscious/unconscious expectations; a process where the client experiences a new, healthier reaction from the therapist that contradicts previous negative life experiences.

Define development of emotion regulation.

Learning to understand, and influence the experience and expression of helpful emotion.

Define development of mentalization.

Learning to understand oneself and others; to make sense of and anticipate the behaviours and reactions of others.

Define new narratives of self.

Constructing a meaningful explanation and understanding of one’s life.

Define “sudden gains” in therapy.

Large, stable improvements in symptoms that occur between a single set of sessions (Tang & DeRubeis, 1999).

Define “rapid response” in therapy.

A substantial decrease in symptoms early in treatment that eventually levels off (Ilardi & Craighead, 1994).

Define a “symptom spike” in therapy.

A brief period where a client’s symptoms worsen or become more volatile just before a significant decrease occurs (Hayes et al., 2005).

What did Owen et al. (2015) find regarding “slow and steady” change?

It is a trajectory where the client shows a consistent, linear increase in functioning throughout treatment.

According to treatment matching research, which clients benefit most from nondirective therapy?

Clients with high levels of resistance.

Which clients benefit most from directive psychotherapy?

Clients with low levels of resistance.

How should therapy length be adjusted for baseline impairment?

Clients with higher baseline impairment benefit more from longer-term or more intensive psychotherapy.

What therapy focus is best for “externalizing” coping styles?

A focus on symptom reduction and behaviour change.

What therapy focus is best for “internalizing” coping styles?

A focus on fostering insight and self-awareness.

List the four principles of the Canadian Code of Ethics.

1. Respect for Dignity of Persons

2. Responsible Caring

3. Integrity in Relationships

4. Responsibility to Society

Define “respect for dignity of persons”.

The ethical principle that every person should be treated as an end in themselves, with innate worth regardless of characteristics.

Define “responsible caring”.

The obligation to ensure that therapeutic activities benefit the client and, at minimum, do not harm.

Define “integrity in relationships”.

The requirement for therapists to be. honest, open, and objective while avoiding conflicts of interest.

Define “responsibility to society”.

The expectation that psychologists conduct their affairs to promote the welfare of all human beings in society.

What is “informed consent”?

An ongoing process ensuring clients understand the therapist’s qualifications, fees, services, and the limits of privacy.

What are the typical limits to confidentiality?

Imminent danger to self or others, suspected abuse of a minor/vulnerable person, or a court subpoena.

Define “duty to warn”.

The ethical responsibility to notify a third party if a client poses an imminent, real threat of serious physical harm to them.

What are “dual relationships”?

Situations where a therapist is in a professional role with a client and another role simultaneously (e.g. social, financial, sexual).

Why are sexual relationships with clients strictly prohibited?

They are considered a major boundary violation that is exploitative and harmful to the client.

Define “therapist well-being” as an ethical obligation.

The requirement for therapists to maintain their own mental/physical health to ensure it doesn’t impair their clinical work.

What defines the “worse but better” trajectory?

A decrease in functioning at the start of therapy, followed by a rapid increase and eventual plateau (Owen et al., 2015).

What defines “early and late change” trajectories?

Initial gains followed by a plateau, with a second period of improvement occurring later in the process.

What is the “Regulated Act of Psychotherapy” in Ontario?

A controlled act involving the treatment of a client’s serious impairment of thought, mood, or perception through a therapeutic relationship.