PSYC2140 - Week 8

PSYC2140: Clinical Psychology Interventions Across Location and Lifespan

Clinical Psychology Interventions

What do clinical psychology interventions look like?

  • To visualize these interventions, participants are encouraged to utilize the iClicker platform at join.iClicker.com.

Approaches to Therapy

Common Theoretical Orientations

  • Dialectical Behaviour Therapy (DBT)

  • Acceptance and Commitment Therapy (ACT)

  • Metacognitive Therapy

  • Psychoanalytic Therapy (also called Psychodynamic Therapy)

  • Motivational Interviewing

  • Emotion-Focused Therapy

  • Positive Psychology Interventions

  • Cognitive Behaviour Therapy (CBT)

  • Psychodynamic Therapy

  • Humanistic Therapy

The Original Psychotherapy

  • The origins of psychotherapy can be traced back to Freud’s psychoanalysis in the ~1890s.

  • Psychoanalytic and Psychodynamic therapy terms are used interchangeably today.

  • Core principles of Psychodynamic Therapy (Shedler, 2010):
      - Unconscious mental life plays a significant role in behavior.
      - Memory, perception, judgment, affective, and motivational processes operate outside of conscious awareness.
      - There are aspects of our lives we avoid acknowledging.
      - The past has a persistent influence on present behavior; patterns learned in past situations may repeat in future circumstances.
      - These patterns can be adaptive or maladaptive.
      - The therapeutic relationship is key to this process.

What Does Psychodynamic Therapy Look Like?

Observational Aspects

  • What I Expect

  • What I Observed

  • Where do these observations take place?

  • Client/Patient behaviors: Includes what they say and do.

  • Therapist behaviors: Includes what they say and do.

  • Example Case: Dynamic Relational Therapy for Perfectionism & Anxiety, Dr. Paul Hewitt, video link provided.

Humanistic Therapy

  • The humanistic approach originated with Carl Rogers in the 1950s as a reaction to psychodynamic therapy.

  • Also known as person-centered therapy.

  • Core Principles (Pomerantz, 2023):
      - Inherent goodness is part of human nature and should be encouraged.
      - Self-actualization is a natural tendency in people to grow personally.
      - Positive regard involves acceptance, warmth, and love from others, including the therapist’s involvement.

What Does Humanistic Therapy Look Like?

Example

  • Case Study: Exploring Career and Personal transitions with an African American Male Client, Dr. David Elkins, video link provided.

  • Therapist's Actions and Modifications:
      - Emphasis on self-actualization and positive regard
      - Observations made during the therapy session will be documented.

Cognitive Behaviour Therapy (CBT)

  • CBT grew out of the work of Aaron Beck in the 1960s and serves as a reaction to earlier psychodynamic approaches.

  • It combines behavior therapy and cognitive therapy techniques.

  • Core Principles (Pomerantz, 2023):
      - Aims to improve functioning and decrease symptoms through:
        - Changing faulty or unhelpful thinking patterns.
        - Utilization of conditioning methodologies such as operant conditioning (involving reinforcement and punishment).
        - Classical conditioning through exposure and systematic desensitization methods.

What Does Cognitive Behaviour Therapy Look Like?

Specific Case

  • Example Case: Improving Mood by Questioning Maladaptive Thoughts, Dr. Martin Antony, video link provided.

  • Observational Details: Activities and interventions performed by the therapist aimed at changing unhelpful thinking patterns will be noted.

Preference in Therapy Approaches

Poll Question:

  • Which approach would you prefer?
      - a. Psychodynamic
      - b. Humanistic
      - c. Cognitive Behavioural
      - d. None of them
      - e. No preference/all equal

Types of Therapy Practiced

Survey Results

  • Adaptations made from Pomerantz (2023); Norcross et al. (2005); Norcross & Karpiak (2012).

  • Visualization of Preferences Over Time:
      - Data drawn from a survey of APA clinical psychologists regarding their theoretical orientation to therapy from various years (1960 to 2010).
      - Therapies reported include Eclectic/Integrative, Cognitive, Psychodynamic/Psychoanalytic, Behavioral, and Humanistic/Existential/Gestalt.

Common Factors in Psychotherapy

The Dodo Bird Verdict

  • The term denotes a phenomenon in psychotherapy where studies reveal that various therapeutic approaches yield similar results.

  • Quote: “At last the Dodo said, ‘Everybody has won and all must have prizes.’” – Lewis Carroll, Alice’s Adventures in Wonderland

Examples: Youth Depression

IMPACT Trial (Goodyer et al., 2017)

  • Study insights indicate no significant difference in depression outcomes across various interventions involving N = 465 adolescents experiencing depression.
      - Interventions Compared:
        - Brief Psychosocial Intervention (BPI) (Median = 6 sessions)
        - Cognitive Behavioural Therapy (CBT) (Median = 9 sessions)
        - Short-Term Psychoanalytic Psychotherapy (STPP) (Median = 11 sessions)
      - Depression Score Trends: Statistical data reflect the symptom scores over time in weeks are compared across treatments.

Examples: Borderline Personality Disorder

Randomized Controlled Trial (McMain et al., 2009)

  • No significant differences in outcomes were observed across treatments for adult individuals with borderline personality disorder (N = 180).
      - Types of Treatments:
        - Dialectical Behaviour Therapy (DBT) (included individual sessions + group sessions)
        - General Psychiatric Management (individual sessions only)

Common Factors of Psychotherapy

  • Key Elements:
      - Strong positive relationship with the therapist
      - Mutual respect
      - Trust formation
      - Structure provided in sessions
      - Support mechanisms employed
      - Opportunities for Learning
      - Action-oriented strategies utilized

  • Citations: Cuijpers et al., 2019.

Some Caveats

Considerations on Treatment Matching

  • Statement: A one-size-fits-all approach could bypass the opportunity to tailor treatments that match an individual’s specific needs (Ng & Weisz, 2016).

Potential Benefits of Personalization

Research Insights

  • Study: Bending Adolescent Depression Trajectories through Personalized Prevention (Young et al., 2020) involved 204 adolescents.

  • Methodology: Created risk profiles based on two dimensions:
      - Cognitive risk (thinking styles and attitudes)
      - Interpersonal risk (family and peer dynamics).

  • Adolescents were assigned to treatments matching their risk profile, demonstrated improved depression outcomes when there was a match versus when treatment was mismatched.

Developmental Considerations

Child Therapy vs. Adult Therapy

  • Therapy approaches for children and adolescents are largely adaptations of therapies developed for adults.

  • Common Adaptations Include:
      - Making materials and sessions more child-friendly
      - Utilization of games, drawing, and similar activities
      - More concrete rather than abstract techniques
      - Increased involvement of parents in the therapeutic process, including outside of sessions (Garber et al., 2016; Chorpita & Weisz, 2009).

Developmental Skills Essential for CBT

  • Skills Needed for Engagement:

  • Metacognition: Developing a basic awareness typically occurs around age 8 with advanced understanding by ages 9-13.

  • Scientific Reasoning: Making hypotheses develops around age 10 and continues into adulthood.

  • Perspective Taking: Understanding others' viewpoints starts as early as age 4-5, with protracted development.

  • Emotion Understanding: Basic recognition of emotions develops in childhood while more complex emotions mature around age 11 and into adolescence (Garber et al., 2016).

Comparing Adult vs. Child Cognitive Behavioural Therapy

Video Analysis

  • Adult Perspective: Dr. Michelle Craske, video link provided.

  • Child Perspective: Dr. Bonnie Zucker, video link provided.

  • Note-Taking Guide Provided for comparative analysis includes specifics to adult and child presentations.

Unique Considerations When Working With Adolescents

  • Key Factors:
      - Desire for autonomy from parents.
      - Transitions in school and education.
      - The importance of social status.
      - Perception of an “imaginary audience.”
      - Increased relational aggression.

SUMMARY

  • Psychotherapy approaches present unique methodologies but share some common factors that contribute to similar therapeutic outcomes.

  • There is potential for enhanced outcomes through a tailored approach that aligns with clients' specific challenges.

  • Practitioners must take into account the developmental stage of their clients, adapting their methods accordingly.