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Samenvatting alle te kennen artikels Evidence based kritisch handelen

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Dit bestand bevat een samenvatting van alle te kennen artikels voor het vak Evidence based kritisch handelen. Deels in het Nederlands, deels in het Engels

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  • 31 december 2021
  • 124
  • 2021/2022
  • Samenvatting
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Door: BousN • 2 jaar geleden

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Spijtig om te horen, er werd enorm veel tijd gestoken in deze samenvatting. Kan je misschien uitleggen wat je bedoelt?

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Psychotherapy, psychotherapy research, and translating science into practice



In the field of psychotherapy, what works for children, adolescents and adults?

Origins of psychotherapy

 Origin dates back thousands of years, but the way it is currently practiced is no more than a
hundred years old
 May be traced to Socrates and the classical Greek philosophers
 Sigmund Freud: central role in establishing modern psychotherapy as a discipline and
profession
 Psychotherapy lead to the development of the humanistic, cognitive behavioral and
systematic psychotherapy traditions



Psychotherapy traditions

 Over 400 schools of psychotherapy, more than a dozen approaches
 Psychodynamic psychotherapy:
o < Freud
o “Psychological disorders arise from unresolved unconscious conflicts and the
associated use of maladaptive defence mechanisms”
o Free association and interpretation to help understand the unconscious
o Goals: character change and symptom alleviation
 Humanistic psychotherapy:
o Rogers (client-centred), Fritz (gestalt therapy) and experiential therapies
o “Avoidance or denial of current feelings, emotions, desires + deliberate or
inadvertent failure to take responsibility for these aspects prevents personal growth
and give rise to psychological symptoms”
o Therapeutic relationship between client and therapist
o Helping clients to become more fully aware of/take responsibility for their
immediate feelings, emotions, wishes (which may be out of their normal awareness)
o Goal: personal growth
 Cognitive behavioural therapy:
o Within the traditions of learning theory and cognitive science
o John Watson (behaviour therapy) and Aaron Beck (cognitive therapy)
o “psychological problems are learned and maintained by cognitive and behavioural
social learning processes, which often operate outside awareness”
o Use of highly specific treatment procedures for specific problems
o Strong collaborative therapeutic relationship between clients and therapist
o Goal: resolving presenting problems
 Systematic therapy
o Working directly with couples, parents, families and social networks
o Bateson
o “psychological problems may arise for a variety of reasons, but may be inadvertently
maintained by the way clients interact with members of families and social systems,
and the belief systems that underpin these interaction patterns”

, o Conjoint involvement of the client and members of their family or social system in
understanding the problems
o Goal: resolving presenting problems and enhancing relationships within the family
and social system



Psychotherapy integration:

 Combining constructs from different theories into more complex frameworks
 Provide coherent rationales for employing a variety of clinical techniques
 Focus attention on critical factors common to many forms of psychotherapy



Psychotherapy modalities:

 Group therapy benefits: group support, feedback, problem solving



Definition of psychotherapy:

 Contractual process in which trained professionals interact with client to help them resolve
psychological problems and address mental health difficulties
 To children and adults, on an individual/couple/group basis
 Psychological interventions = specific psychotherapeutic practices



Psychotherapy contract:

 Therapist and clients agree to fulfil certain roles:
o Therapist’s role: offer client a service in a professional and skilled manner + adhere
to ethical standards to maintain the client’s best interests
o Client’s role: co-operate with treatment procedures + agreeing to address
ambivalence about problem resolution when this occurs
o Fees: agreed sessional fee paid by the client of health insurance company



Psychotherapy training:

 Coursework:
o Material on how to conceptualize psychological problems and mental health
difficulties; interpreting research findings; conducting psychotherapy
 Self-reflection:
o Participation in personal psychotherapy
 Supervised clinical practice:
o Working with clients under the guidance of a trained therapist
 Continuing professional development:
o Supervision of cases by more experienced therapists of peer supervision; reading
professional journals; attending professional conferenced and trainings

,Ethics:

 Professional psychotherapy association + adhere to code of ethics

Statutory registration:

 Therapists must be licensed to legally practise their profession



Psychotherapy and counselling:

 Both involve engaging clients with psychological problems in a therapeutic relationship, with
a view to problem resolution
 Psychotherapists: more training, broader training programs



Psychotherapy and mental health professions:

 Mental health professions (psychology, social work, psychiatry, psychiatric nurses): many
offer a psychotherapy service but the remits cover a variety of other elements besides
psychotherapy



Psychotherapy in multimodal treatment programmes:

 Clients mat be offered psychotherapy alongside of pharmacotherapy or other psychical
treatments



Psychotherapy research:

 = systematic inquiry into the process and outcome of interventions conducted to alleviate
psychological problems
 Research may be organized into a hierarchy



Evidence-based practice:

 Judicious and compassionate use of the best available scientific evidence to make decisions
about client care
 Taking account of available scientific evidence, and clients’ unique problems and needs



Hierarchy of evidence:

 Least to most persuasive:
o Uncontrolled case studies
o Single group outcome studies
o Controlled trials / controlled single case experiments
o Narrative reviews of controlled trials
o Meta-analysis of controlled trials

, Evidence-based practice and practice-based evidence

 Efficacy studies are one source of scientific information for evidence based practice 
indicate how well treatments work under ideal conditions
 Practice-based evidence: can scientifically inform practice / indicates how well treatments
work under routine conditions
 PBE: a standard assessment is completed before treatment and after treatment



Translating scientific evidence into clinical practice:

 No single correct process  a number of solutions have been proposed
 At one extreme: those who favour the identification of specific empirically supported
treatment protocols, using stringent criteria, which take into account highly specific types of
evidence
 At the other extreme: those who support the use of multiple sources of evidence to inform
the development of general practice guidelines with differing strength of implication for
practice



Empirically supported treatments:

 Chambless criteria: list of empirically supported treatments (ESTs)
 Used to evaluate psychological treatments based on the weight of empirical support from
efficacy studies
 Distinction between well established treatments and those which are probably efficacious



Are ESTs suitable for routine practice?

 ESTs have been criticized for being brief, manualized interventions; unsuited to the multiple
needs of routine clients with complex co-morbid problems and issues of diversity
 ESTs can be transported into routine clinical settings, with positive impacts; but less positive
than in randomized controlled efficacy trials
 Slightly more effective than treatments which do not meet the Chambless criteria for being
empirically supported



Why so few psychodynamic, systemic, and humanistic ESTs?

 Most ESTs fall within the cognitive behavioural therapy tradition
 Fewer placebo controlled or comparative treatment outcome research trials have been
conducted outside CBT
 Criteria for ESTs are restrictive and could disenfranchise therapies which fall outside the CBT

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