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Summary Clinical Psychology: A modern health profession by Linden, Hewitt Ch 10, 11, 12, 15
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1Summary Clinical Psychology: A
Modern Health Profession Part II
Chapter 10: The Process of Psychotherapy
Defining Psychotherapy
A definition can be: “the treatment of mental and emotional disorders through
the use of psychological techniques designed to encourage communication of
conflicts and insight into problems, with the goal being relief of symptoms,
changes in behavior leading to improved social and vocational functioning, and
personal growth”
The Therapy Environment
Usually therapy takes place in the office, for 50-60 minutes, once a week.
However, sessions can be longer and more frequent if necessary. There are three
things that differentiate psychotherapy from pleasant and beneficial generic
human interaction:
a) The degree of formal education the professional has obtained;
b) The fact that the psychologist was trained to diagnose and treat mental
disorders;
c) The role definitions that the therapist and client agree upon.
Homework Assignments
Homework assignments can accelerate the learning that can happen in therapy.
Homework is associated with additional improvements and ads to therapy
outcome.
Therapy Length
It varies greatly, average number is around 5 (but this depends on the insurance
companies! and the ones from the textbook are from Canada!). In 5 sessions,
only 20% of patients shows notable improvement. In 12-13 sessions,
approximately 58-67% of patients shows improvement.
Multiclient Therapy
Therapy can result in issues for family members (sometimes the person in
therapy wants to quit smoking, but other family members do not, which results in
conflict). Other times, multiclient therapy takes place in the form of marital
therapy. Or when the therapist wants to get another perspective on things from
someone else. Most of the time group therapy takes place because of
psychoeducation, which is most efficient in a group.
Elements in the Process of Therapy
1. Client variables
2. Qualities of the therapist
3. The most suitable choice of treatment technique or theoretical orientation
The Client
Who Goes into Therapy?
, 2
Young Attractive Verbal Intelligent and Successful (YAVIS) clients have a high
chance for improvement. The modal client is female, in her 20s or 30s and fairly
well educated. Stable individual differences (such as SES or gender) do not
account for therapy success or failure.
Client Readiness
For people to benefit from psychotherapy, it is important that they are able to
access, understand and verbalize their own emotional experience, also called
level of emotional awareness (EA). There are five different levels of EA (see
p. 209), that can be measured by means of an interview.
People with a high level of distress (does not count for people with personality
disorders or comorbid disorders) when initiating treatment have a greater chance
of improvement; however, this might also be because there is simply more room
for improvement there.
Characteristics of the Therapist and Outcome
There can be a big difference in years of actual practice training psychologists
have actually had (for example, people with a PhD have less clinical experience).
Studies have however failed to find differences in level of skill between the
different levels.
One study has concluded that there is no difference between paraprofessionals
and psychotherapists, but this study contained many methodological flaws.
Approximately half of the variance in therapy outcomes is explained by
nonspecific skills, which can be subdivided in micro- and macroskills. Microskills
refer to the moment-to-moment behaviors in therapy, needed for the creation of
a goof client-therapist relationship. Macroskills are more complex and
conceptual skills such as developing a therapy plan and tracking behavioral
progress.
Techniques
Typical Presenting Problems
1. Release of emotions
2. Understanding how childhood and other earlier experiences affect daily
living
3. Issues of control and emotional closeness in intimate relationships
4. Reduction of subjective distress
5. Raising self-esteem and perceived competence
Even though theoretical orientations of therapists may differ, it is argued that
there are at least four common elements in every therapy that the patient can
benefit from (nonspecific benefits):
1. Emotional support
2. Provision of hope
3. Offering a rationale for how the problem came about
4. Placement of the problem within a wider context and comparison with
other people, also referred to as normalization
Microskills are important in client-centred treatment and in the Rogerian
movement. Microskills include:
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