Interventions Exam I

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shelbymailho
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Interventions Exam I
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2012-10-27 15:48:26
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interventions
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  1. What is Psychotherapy?
    Informed and intentional application of clinical methods and interpersonal stances that are derived from established psychological principles to assist people in modifying behaviors, cognitions, affect, and other characteristics in the direction that the participants define as desirable.
  2. Importance of Theory:
    • 1. Guides Therapy
    • 2. Describes presenting symptoms, problems, behaviors
    • 3. "delimits" relevant information
    • 4. Serves to organize info
    • 5. Helps in conceptualization
    • 6. Guides treatment, interventions
  3. Domains that a comprehensive theory should address:
    • 1. Cognitive
    • 2. Behavioral
    • 3. Affective
    • 4. Development
    • 5. Systemic
    • 6. Contextual
    • 7. Spiritual
  4. Interconnectedness of Domains
    Other aspects of theory:
    • 1. provides understanding of case (conceptualization)
    • 2. provides guidance on how to proceed (interventions)
    • 3. provides way to evaluate its effectiveness (evaluation)
  5. Overall Plan of Treatment:
    • 1. Assess client's needs
    • 2. Developing conceptualization and treatment plan
    • 3. Selecting Interventions
    • 4. Implementing and evaluating interventions
  6. Initial Tasks of Therapy:
    • 1. engaging the client
    • 2. assessing problems and strengths
    • 3. establishing a working contract
    • Tasks are repeated through therapy process
  7. Middle Tasks of Therapy:
    • 1. monitoring relationship
    • 2. direct work, implementing techniques
    • 3. monitor progress, modifying treatment
  8. End Stages of Therapy:
    • 1. modifying relationship
    • 2. evaluating progress and accomplishments
    • 3. referrals, transferring learned skills
    • 4. addressing termination and loss
    • 5. tapering sessions
  9. Commonalities of Theories
    • 1. Interpretation
    • 2. Insight
    • 3. Good therapeutic relationship
    • 4. Therapist characteristics
    • 5. Behavioral change
    • 6. Support
  10. Two Most Shared Commonalities of Therapy:
    • 1. Client's positive expectations of therapy
    • 2. Therapeutic Relationship
  11. Positive Expectations
    Client's faith and confidence in therapy, the therapist, and the process of treatment
  12. Roger's 4 Necessary Conditions
    • 1. Congruent
    • 2. Genuineness
    • 3. Unconditional Positive Regard
    • 4. Empathy
  13. Process of Change
    covert and overt activities people engage in therapy to make changes to behavior, affect, cognitions, and realtionships related to problem of development
  14. Consciousness Raising
    • Raising client's level of awareness leads to change
    • Therapies emphasize conscious awareness-increase info available so clients can make best response
    • Feedback and Education
  15. Catharsis
    Release of emotions in therapy leading to change
  16. Conditional Stimuli
    • Modifying stimuli that control how we respond
    • Can change how we respond to specific stimuli or change the environment so the stimulus doesn't occur often
  17. Counterconditioning
    Changing our responses to stimuli
  18. Stimulus Control
    changing environment to minimize stimulus occurence
  19. Contingency Control
    Contingency Management
    Re-evaluation
    • Contingency Control: Behavior occurence based on the consequences following behavior. If contingencies are changed, likely to change behavior
    • Contingency Management: modifying contingincies in environment
    • Re-evaluation: modifying responses to consequences without changing contingencies
  20. 4 Common Factors of Change
    • 1. client factors
    • 2. therapeutic relationship
    • 3. hope and expectancy for change
    • 4. theoretical model/intervention
  21. 7 Stages of Change
    • 1. Precontemplation
    • 2. Contemplation
    • 3. Preparation
    • 4. Action
    • 5. Maintenance
    • 6. Relapse
    • 7. Treatment
  22. Precontemplation
    • Uninformed about the consequences of their behavior, demoralized
    • Denial of any problem
    • Resistant, not ready for treatment
  23. Precontemplation Techniques
    • 1. Validate lack of readiness
    • 2. Clarify: decision is theirs
    • 3. Encourage re-evaluation of current behavior
    • 4. Encourage self-exploration, not action
    • 5. Explain ad personalize the risk
  24. Contemplation
    • See that there is a problem but not ready to act.
    • Procrastination and ambivalence.
    • Waiting for the magic moment.
  25. Contemplation Techniques
    • 1. Validate lack of readiness
    • 2. Clarify: decision is theirs
    • 3. Encourage evaluation of pros and cons of problem and behavior change
    • 4. Identify and promote new, positive outcome expectations
  26. Preparation
    • Plan of action.
    • Has typically taken some action in the past
  27. Preparation Techniques
    • 1. Identify and assist in problem solving re: obstacles
    • 2. Help patient identify social support
    • 3. Verify that patient has underlying skills for behavior change
    • 4. Encourage small initial steps
  28. Action
    Specific, overt modification in lifestyle; sustained effort at making changes
  29. Action Techniques
    • 1. Focus on restructuring cues and social support
    • 2. Bolster self-efficacy for dealing with obstacles
    • 3. Combat feelings of loss and reiterate long-term benefits
  30. Maintenance
    • 6-12 months of no symptoms
    • maybe up to 5 years of effort
    • not a static change
  31. Maintenance Techniques
    • 1. Plan for follow-up support
    • 2. Reinforce internal rewards
    • 3. Discuss coping with relapse
  32. Stages of the Counseling Process
    • 1. Establishing the relationship and defining the problem
    • 2. Assessment and establishing counseling goals
    • 3. Designing and implementing interventions
    • 4. Termination, follow-up, and evaluation
  33. Therapeutic Relationship Quality is affected by:
    • 1. Therapist factors (empathy, congruence, interpersonal/communication skills)
    • 2. Working alliance between client and therapist
  34. What is the single most important predictor of change?
    Therapeutic Relationship
  35. Key Features of Empathy
    • 1. Collaborative
    • 2. Understanding
    • 3. Consistency
  36. Benefits of Empathy
    • 1. Client sense of safety
    • 2. perception of being understood
    • 3. satisfaction with therapy
    • 4. decreases premature termination
    • 5. allows client exploration
  37. Reasonant Empathy vs. Immersion Empathy
    • 1. Feel with the client without taking on the client's feeling
    • 2. Take on client's feelings and obsess about client after session
  38. Empathy vs. Sympathy
    • 1. Communicating understanding
    • 2. Feeling sorry/sad for the client
  39. Cultural Empathy
    considering the context and society of both the therapist and client
  40. Positive Regard
    • Valuing the client
    • Appreciating the client as a unique and worthwhile person
    • Noncritical attitude and speech
    • Expressing positive regard: affirming client's sense of worth
  41. Trust
    • Core trait in the helping relationship
    • Behaving in a moral and ethical manner
    • Being reliable and consistent
    • Respond in a caring and respectful manner
    • Interactional and reciprocal
  42. Congruence
    • Genuineness in therapeutic relationship
    • Honesty
    • Open expressions of feelings and attitudes
  43. Attending to Client
    Attention is communicated via:
    Barriers to attending:
    • Attention communicated: Facial expressions, eye contact, body positions and movement, verbal responses
    • Barriers: being judgmental, biased or piegeonholing; attending to facts, interrupting, personal and cultural preferences
  44. The Working Alliance
    • Therapist and client agreement on
    • therapy goals
    • actions steps for attaining goals
    • emotional bond in therapeutic realtionship
  45. Alliance Ruptures
    Two types
    • when client and therapist succumb to hostile expressions during the therapy session
    • 1. Confrontation
    • 2. Withdrawal
  46. Repairing an Alliance Rupture
    • 1. Discuss the relationship and what is occurring
    • 2. Take responsibility for your role in the rupture
    • 3. Allow yourself to apologize for misunderstandings
    • 4. Give client space to express fears about negative feelings and about the relationship
    • 5. Be aware of your countertransference
  47. Roadblocks for Beginning Therapists
    • 1. Focusing on the first issue in a session
    • 2. Overlooking physical or medical issues
    • 3. Desire to rescue clients from their unhappiness
    • 4. Perfectionistic tendencies
    • 5. Unrealistic expectations
    • 6. Getting carried away with the latest techniques
    • 7. Geting lost in the counseling process
    • 8. Using inappropriate phrases
    • 9. An excessive desire to help
    • 10. An excessive desire to be liked
    • 11. Getting too emotionally involved
    • 12. Taking things too personally
    • 13. Difficulty differentiating normal from abnormal
    • 14. Being uncertain about self-disclosure
    • 15. Being uncertain about confidentiality
  48. List some Qualities of an Effective Counselor
    • -Natural interest in people
    • -Ability to listen
    • -Comfortable with verbal communication
    • -Empathetic and understanding
    • -Ability to introspect
  49. 5 C's of Confidentiality
    • 1. Consent of client/guardian to release info
    • 2. Court order
    • 3. Continued treatment requiring communication with healthcare agencies (insurance)
    • 4. Comply with the law- mandatory reporting
    • 5. Communicate a threat, or warn individuals of clear and imminent danger (alternative = Crisis)
  50. Potential Liabilities Related to Confidentiality
    • 1. Failure to Protect
    • 2. Failure to Warn
    • 3. Failure to Prevent
  51. Liability
    whether counselor has caused harm to client
  52. Malpractice
    professional negligence, not following accepted standards
  53. Ways to Protect from Malpractice
    • -Follow ethical standards
    • -Follow accepted practices
    • -Carry liability insurance
    • -Consult
    • -Liability can be civil or criminal
  54. Self-Disclosure: Pros and Cons
    • Pros:
    • -can help strengthen relationship
    • -can normalize experiences for the client

    • Cons
    • -can put therapist in danger
    • -could be bad for the client if it removes safety of the therapy relationship
  55. Decisions Regarding When to Self-Disclose
    • -Will it benefit the patient?
    • -How much discomfort will it cause the therapist?
    • -Is it about therapist's outside life or within the session?
    • -What purpose does answering the question serve?
  56. Transference
    clients react to therapist based on elements from their past
  57. Ways to Address Transference
    1. Focus on the immediate relationship: "you seem angry at me and I wonder what that's about"

    2. Interpret the meaning of the transference: "perhaps your anger towards me is related to the frustration of having you dad be so unavailable to you"

    3. Use questions to promote insights: "can you recall an earlier time in your life when you felt angry like this"

    4. Teach, advise, and educate about the transference: "we all have times where we transfer emotional reactions from prior relationships onto other people who are significant to us. When it happens here, it is usually useful for us to process in the session. As I'm saying this, are  you aware of any particular reactions that you are having about me?"

    5. Self-disclosure: "there are also times in my life where I react to someone in my current life with unresolved issues from my past"
  58. Countertransference
    the therapist's feelings and attitudes about the client
  59. Managing Countertransference
    • 1. Gain Awareness: become aware of strong emotional reactions to client; practice self-insight
    • 2. Develop conceptual understanding: awareness of hunches about what is happening at the moment relating to the client
    • 3. Examine and take responsibility for contributions to relational issues with clients
    • 4. Empathetic attunement: manage own anxiety to manage defensiveness, be aware of self and client
    • 5. Boundaraies or self-integration: be able to separate self from other
    • 6. Seek group and individual consultation and supervision
  60. Affiliative vs. Distancing
    Affiliative: client desires to bring therapist close

    Distancing: behaviors intended to disrupt relationship
  61. Unintentional Sexually Inappropriate Behaviors
    • -lack of social skills or knowledge
    • -may not understand boundaries
    • -uncomfortable discussing intimate aspects of his life
  62. Intentional Sexually Inappropriate Behaviors
    • -may be attempt to express authority or power
    • -implicit authority and power the therapist may trigger in the client (especially when therapist is younger)
    • -May respond by attempting to make the therapist feel uncomfortable as well
  63. Affiliative Unintentional
    commenting on the therapist's attractiveness or politely asking clinician on a date
  64. Affiliative Intentional
    a long-standing client who knows the limits who asks the clinician out
  65. Unintentional Distancing
    a client who is anxious and makes an off-color joke
  66. Intentional Distancing
    a client who leers at the clinician and tells her if she wants more info she will have to accompany him to his house

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