Future Directions & Integration

Question 1

Quotations

Answer 1

• “Many clinicians have realized one true path to formulating & treating human problems does not exist – no single orientation has all the answers.”
  
  • “It makes no more sense for behavioral & psychodynamic therapists to argue about which approach is better than for cardiologists & orthopedists to debate whether the heart or skeleton is more important to health.”
  • “Outcome studies are about groups, & clinical decision making is about individuals.”

Question 2

predicted future of psychotherapy

Answer 2

○ Theoretical Orientations
§ Predict more multicultural, mindfulness therapies, CBT, MI, LGBTQ2+ affirming, strengths-oriented & integrative therapies
§ Predict less classical psychoanalysis
○ Psychotherapists
§ Predict more Masters-level counselors, social workers, psychiatric nurses, personal coaches & self-help groups
§ Predict fewer psychiatrists
○ Therapy Platforms
§ Predict more videoconferencing, texting, smartphone apps, & multiple/flexible platforms
#1 group expected to expand & proliferate are masters’ levels counsellors

Question 3

factors leading to integration

Answer 3

• More than 1000 systems of therapy identified
  
  • Many empirically supported treatments for various conditions available
  • Increasing diversity of clients & clinical concerns
  • Inability of any one treatment to address all clients
  • Growing awareness of common factors & specific strategies
  • Pressure from consumers & gov agencies for accountability *needs to be more pressure from ppl to reduce barriers & promote that diversity in treatment &advocacy
  • Searching for most effective & briefest treatment Packages
    *90% therapists are integrating multiple approaches

Question 4

trends in psychotherapy

Answer 4

• Ideological Purity - learning & applying one therapy model; you learn one approach & become an expert w a lot of depth
  ○ Confirmatory bias - this is where you look for info that’s consistent w what you already believe -> if you believe cognitive therapy is the best approach, you’re more likely to remember when CBT is effective, but you conveniently disregard the times when it is not the best fit -» so reinforcing a belief that a therapy method could be one-size-fits-all
  
  • Theoretical Integration - combining two or more theoretical approaches (maxing therapeutic effectiveness) - e.g., combining approach of CBT & MBCT -> approach is to observe thoughts/ruminations as a cloud that we can observe & recognize rather than change
  • Common Factors - searching for overlapping or key ingredients across many diverse theoretical perspectives
  • Technical Eclecticism - selecting techniques based on empirical research, pragmatics of the situation, or clinical intuition -> based on the resources or situation, what are you gonna do, how are you gonna help? (relying on your instincts & experience, not on an underlying theoretical basis).
  • Assimilative Integration - commitment to one primary therapy model, but open to incorporating techniques from other therapy models

Question 5

Michael Lambert’s common factor’s in effective treatment:

Answer 5

• Support Factors
  ○ Positive, reassuring, & trusting therapeutic alliance
  ○ Clinician’s warmth, respect, empathy, & genuineness
  
  • Learning Factors
    ○ Gaining insight
    ○ Changing thinking patterns & perceptions
    ○ Increasing self-acceptance
    ○ Increasing expectations for personal effectiveness
  • Action Factors
    ○ Confronting fears & problems
    ○ Having success experiences which build on each other
    ○ Modeling, practicing, & processing

Question 6

Jerome Frank’s common factors for psychological healing:

Answer 6

• Emotionally charged, confiding relationship w a helping person
  
  • A healing setting that provides safety
  • A rationale, conceptual scheme, or a myth
    ○ Clients need a plausible explanation for their symptoms & for the recommended treatment approach -> basically saying you need an explanation or to believe in smtg before being able to do a “ritual” (a process for improving function), otherwise it would be more like placebo.
  • A ritual
    ○ Participating in a process that both clients & therapists believe will achieve improved function

Question 7

Research: common therapeutic factors

Answer 7

○ Extra-therapeutic change (40% of outcome variance)
§ Problem severity, motivation to change, capacity to relate to others, social support
○ Therapeutic relationship (30% of outcome variance)
§ Attachment or bond between therapist & client
§ Rather than saying “therapy works”, therapist & client work together
○ Expectancy (15% of outcome variance)
§ Positive expectation, hope, placebo factors
○ Specific Techniques (15% of outcome variance)
§ Specific techniques from a given theoretical model

Question 8

Clinical formulation

Answer 8

• Tentative explanation or hypothesis
  ○ How a client comes to present at a certain point in time
  ○ Examine factors that predispose, precipitate, perpetuate, & protect
  
  • Multiple Perspectives in Assessment
    ○ Individual Factors - biological, behavioral, cognitive, & psychodynamic
    § E.g., psychodynamic precipitating factor: relationship loss
    § E.g., cognitive PF: chronic negative beliefs
    § E.g., behavioral PF: availability of reinforcement
    ○ Systemic Factors - couple, family, occupational/school, & social/cultural
  • Pragmatic model: Easily recalled & applied
    ○ Can be tested & revised over time w new info
  • Clinically useful: Linked to treatment

Question 9

Canadian Psychological Association Advocacy

Answer 9

Encouraging the fed gov to:
1) Pass a “Mental Health & Substance Use Health Care for All Parity Act” – e.g., mental health & physical health programs, services & supports should be equally accessible in Canada
2) Provide tax credit to employers to help reduce costs of expanding employer health benefit coverage for mental health
3) Collaborate w provinces & territories to create more professional Schools of Psychology in publicly funded unis – larger class sizes & more diversity among grad students
4) Invest more in mental health research & innovation - boost funding for research grants for grad students & post-doctoral fellows (e.g., SSHRC, NSERC)

Question 10

Integrating research & clinical reasoning

Answer 10

• Outcome Research *exam question
  ○ Randomized controlled trials
  ○ Empirically supported treatments for various clinical groups
  ○ High internal validity, but may not be generalizable - does it have real world applicability (what if it’s not represented in the research?)
  
  • Clinical Reasoning
    ○ Flexible to ind clients, but prone to error - if you’re only relying on clinical reasoning you’re gonna be subject to things like confirmatory bias
    § Syncretism - selecting treatments in an arbitrary, subjective, & unreasoned manner - could really have that allegiance effect and start applying it in ways that maybe aren’t helpful for the client. -> *need to think about scientific principles as they apply to your specific client
  • Synthesis
    ○ Combine strengths of both approaches; treatment planning involves both art & science

Question 11

pres: MBCT

Answer 11

Mindfulness-based cognitive therapy (MBCT) involves 8 weeks of treatment (often in a group). It promotes nonjudgemental acceptance of one’s thoughts, feelings, & physical sensations in the present moment. MBCT reduces rumination & prevents relapses in those w major depression.

Question 12

pres: Internet therapies

Answer 12

Internet Therapy often has comparable efficacy to in-person therapy. It often adopts CBT. Many ethical problems are raised, however (e.g., confidentiality, training, & digital competence).