PSY4029 Professional Issues and Practices in Psychology Lecture 4 (2024-25) PDF

PSY4029 Professional Issues and Practices in Psychology Lecture 4 Psychological Interventions Esther Y. Y. Lau, Ph.D. (Clinical Psychology) R. Psych (B.C., Canada); R.Clin....

PSY4029 Professional Issues and Practices in Psychology Lecture 4 Psychological Interventions Esther Y. Y. Lau, Ph.D. (Clinical Psychology) R. Psych (B.C., Canada); R.Clin.Psy (HKPS, HK) Clin.Psy. in Accredited Register (HKICP, HK) 1 Flow ⚫ Different kinds of psychological intervention ◦ Level ◦ Target ◦ Directedness ⚫ Psychotherapy ◦ 3 stage intervention model ⚫ Different approaches ◦ Psychoanalytic ◦ Behavioural ◦ Cognitive ◦ Humanistic ◦ Positive psychology ⚫ Psychological intervention at group and system levels 2 Psychological intervention ⚫ Intervention ◦ All the suggestions, activities, and planning that are directed to the targets, including individuals, groups, or systems, with the aim of bringing about changes in the targets ◦ Clinical psychologists: clinical populations ◦ Educational psychologists: students ◦ Industrial organizational psychologists: workers ◦ Academic researchers: participants ⚫ Interventions differ in terms of ◦ Level ◦ Target ◦ Directedness ◦ Approaches 3 Psychological intervention ⚫ Terminologies ◦ Therapy vs training ⚫ Levels of Prevention ◦ Primary prevention ◦ Secondary prevention ◦ Tertiary prevention Cowen, Trost, Lorion, Dorr, Izzo, and Isaacson, 1975 4 Psychological intervention ⚫ Primary prevention ◦ Steps taken to prevent the onset of problems or disorders ◦ Intervene before problems or disorders occur ◦ Target group: general population ◦ Examples: Building up general social skills among kindergarteners Pre-marital counselling Promoting resilience for parents-to-be Sleep and psycho-spiritual enhancement for young people https://fidw00.wixsite.com/ main 5 When you pass through the waters, I will be with you; and when you pass through the rivers, they will not sweep over you. When you walk through the fire, you will not be burned; the flames will not set you ablaze. 6 (Isaiah 43:2) Psychological intervention ⚫ Secondary prevention ◦ Early identification of problems or disorders during their earliest stages and prompt intervention before the problems or disorders become severe ◦ Targeting at-risk population ◦ Examples: Marriage support Love Marathon 恩愛馬拉松 Youtube: https://www.youtube.com/@use r-zh6tg3ql3k Stepped-care sleep management for teachers https://www.carlab.hku.hk/ 7  Psychological intervention ⚫ Tertiary prevention ◦ Focuses on individuals who are already experiencing profound problems or disorders ◦ Reduces the consequence of severe dysfunction Retrain Re-educate Rehabilitate ◦ Examples: Cognitive-behavioural therapy for individuals with depression Strength-based intervention program for students who have just attempted suicide Hotlines https://www.openup.hk/ 8 Target domains ⚫ Increasing knowledge and skills ◦ Read and Write project ◦ Social skills training ◦ Training on executive functioning ⚫ Reducing mental illnesses and improving psychological well-being ◦ Cognitive-behavioural therapy ◦ Family therapy ◦ Positive psychology interventions 9 Directedness ⚫ Direct ◦ Intervention delivered directly to the target E.g., individual therapy; group therapy; cognitive-behaviour based exercises; training and development program ⚫ Indirect ◦ Interventions implemented on the targets’ environment E.g., teaching parents of children with dyslexia how to teach reading; collaborating with teachers in terms of curriculum planning 10 Flow ⚫ Different kinds of psychological intervention ◦ Level ◦ Target ◦ Directedness ⚫ Psychotherapy ◦ 3 stage intervention model ⚫ Different approaches ◦ Psychoanalytic ◦ Behavioural ◦ Cognitive ◦ Humanistic ◦ Positive psychology ⚫ Psychological intervention at group and system levels 11 Defining Psychotherapy ⚫ Psychotherapy: informed and intentional application of clinical methods and interpersonal stances derived from established psychological principles for the purpose of assisting people to modify behaviors, cognitions, emotions, and personal characteristics ⚫ Includes interpersonal persuasion, health care, psychosocial education, professional coaching, behavioral technology, reparenting etc. 12 3 Stage Intervention Model Stage One Stage Two Stage Three Exploration New Action Understanding Planning Egan, 2014 13 3 Stage Intervention Model Stage One Stage Two Stage Three Exploration New Action Understanding Planning Create an atmosphere that encourages exploration Show commitment to your client, the therapy process and the therapy relationship Give it time; be patient; insufficient exploration leads to faulty understanding and inappropriate plans Help your client arrive at his or her own answers Resist the temptation to give advice at this stage 14 3 Stage Intervention Model Stage One Stage Two Stage Three Exploration New Action Understanding Planning Stage Two is the turning point in the process Be flexible and resourceful, ready to move forward empathetically and constructively Offer encouragement when your client begins to see things differently Be supportive and sensitive so that when you challenge, your client is receptive and able to learn 15 3 Stage Intervention Model Stage One Stage Two Stage Three Exploration New Action Understanding Planning Plans are followed through when the client owns the solution Give advice and direction sparingly Enhance commitment to change by clear agreements and target setting 16 Flow ⚫ Different kinds of psychological intervention ◦ Level ◦ Target ◦ Directedness ⚫ Psychotherapy ◦ 3 stage intervention model ⚫ Different approaches ◦ Psychoanalytic ◦ Behavioural ◦ Cognitive ◦ Humanistic ◦ Positive psychology ⚫ Psychological intervention at group and system levels 17 Different approaches of psychotherapy (for your self-study) ⚫ Psychoanalytic approach ⚫ Behavioural approach* ⚫ Cognitive approach* ⚫ Humanistic approach ⚫ Positive psychology approach* 18  Psychoanalytic approach ⚫ Sigmund Freud ◦ A Viennese physician ◦ Started a private clinic after graduating from MD ◦ Proposed to his colleagues the belief that “neurosis was sexual conflict”, which resulted in professional insults Conflict between the id’s instinctive desires and society’s punishment for expression of those desires ◦ Started self-analysis, as a study of unconsciousness ◦ Developed Vienna Psychoanalytic Society, founder of psychoanalysis But he was so insisting on his ideas, so some of the “best minds” left: Alfred Adler, Carl Jung ⚫ Theory of personality ◦ Id: Desires expressed in different forms in different demand instant gratification ages ◦ Superego: Oral stage Anal stage deny these earthly and immediate pleasures Phallic stage ◦ Ego: Latency period compromising the two above Genital stage ◦ The demand for immediate gratification leads to inevitable conflicts with social rules 🡪 Defence mechanism, suppressing desires Too much or too little gratification results in fixation E.g., depriving oral stimulation in oral stage results in pessimism, because one thinks that his needs will not be met 19  Psychoanalytic approach ⚫ Therapeutic process ⚫ Theory of psychopathology ◦ Making unconscious conscious ◦ Early fixation results in vulnerability By free association, confrontation, More vulnerable; more energy needed clarification, interpretation, and to defend against pregenital impulses working through but less for coping with stresses 🡪 patients are acutely conscious of ◦ Stressful events stimulate the impulse their many defensive manoeuvres, that individuals have been controlling including symptoms over their lives 🡪need not fear their impulses to the Cues that lead to unconscious level degree they once did as children, because in transference relationship reaction as repetition of childhood they expressed impulses in intense experience – parent rejection words and did not result in negative ◦ The infantile reactions lead to panic that consequences their impulses may get out of control 🡪 channel impulses through new Leading to punishment controls and gives up immature defences and symptoms – more mature ego 20 Psychoanalytic approach 21 Psychoanalytic approach Stages of Development Stage Age Libidinal zone Libidinal object Developmental challenges Oral 0-1 Mouth, thumb Mother’s breast, Optimism vs. own body pessimism Anal 2-3 Anus, bowels Own body Stinginess vs. overgenerosity Phallic 3-6 Genitals Mother for boy Vanity vs. self-hatred Father for girl Latency 6-11 None Largely repressed NA Genital >12 Genital primacy Sexual partner Expression of personality 22  Behavioural approach ⚫ Ivan Pavlov ◦ A Russian physiologist who investigated the digestive systems of dogs ⚫ John Watson ◦ “Give me a dozen healthy infants, well-formed, and my own specified world to bring them up in and I'll guarantee to take any one at random and train him to become any type of specialist I might select – doctor, lawyer, artist, merchant-chief and, yes, even beggar-man and thief, regardless of his talents, penchants, tendencies, abilities, vocations, and race of his ancestors.” ⚫ Classical conditioning & Operant Conditioning 23 Behavioural approach ⚫ Therapeutic process ◦ Counterconditioning! Find a response that is incompatible with anxiety that can be paired with the stimuli that evoke anxiety Weaken the bond between the anxiety-provoking stimuli and the anxiety More adaptive response substitute for maladaptive anxiety response E.g., relaxation, exercise, sexual arousal Should be done in small steps! Aim for a low hierarchy, the anxiety at each level will be deconditioned 24 Behavioural approach ⚫ The therapeutic process ◦ Systematic desensitization Muscle relaxation Construction of anxiety hierarchy (most to least) Client thinks about a scenario which may provoke a mild level of anxiety If the client experience anxiety 🡪 think about the relaxing scene If not 🡪 move up the anxiety hierarchy 25  Behavioural approach ⚫ The therapeutic process ◦ Assertiveness training Anxieties with interpersonal interactions Assertiveness and anxiety are incompatible as anxieties over rejection, embarrassment, and failure can be inhibited by expressing oneself ◦ Stimulus control Avoid stimuli that elicit the problem behaviour and insert stimuli that cue adaptive behaviour ◦ Behavioural activation Improving daily activity, increasing pleasurable events, enhancing feelings of mastery for depressed 26 Behavioural approach ⚫ Theory of psychopathology ◦ Antecedent 🡪 Behaviour 🡪 Consequences (stimulus) (maladaptive beh.) (reinforcement) ◦ Maladaptive behaviours are followed by reinforcement Head banging 🡪 special attention Increases Head banging 🡪 withdrawing special treat Decreases ◦ Examples Pathological gambling 27 Behavioural approach ⚫ Therapeutic process (Behvioural Modification) ◦ Contingency management (maladaptive beh.) 1. Operationalize target behaviour State the problem and where they occur 2. Identify behavioural objectives Specifying behaviours and whether it should increase, decrease, or reinforced in appropriate situations 3. Take baseline measures 4. Naturalistic observations 5. Modify existing contingencies Can either introduce or remove reinforcement Teach adaptive alternative behaviours 6. Monitor the results Compare with baseline 28 Cognitive approach ⚫ Albert Ellis and Aaron Beck ◦ Both were trained in psychoanalytic tradition but dissatisfied with the clinical results of psychoanalysis ◦ Both have a goal of helping clients to become conscious of maladaptive cognitions Actively challenged irrational believes rather than passive ◦ Use cognitive processes to create life, maximize pleasure, minimize pain ◦ Problem oriented, directive, and psychoeducational 29 Cognitive approach ⚫ Understanding human mind as a computer ◦ Codes (i.e., changes) information, ◦ Stores information ◦ Uses information ◦ Produces an output (retrieves info) 30 Cognitive approach ⚫ Theory of personality & Pathology ◦ Rational-emotive explanation of personality Beliefs that Activating individuals use to Consequences events process the activating events Rejection by lover Rational: “Rejection Emotional Failure to get into was unfortunate” Behavioral graduate program Irrational: “I will never be successful” 31 Cognitive approach ⚫ Theory of psychopathology ◦ Common irrational beliefs 32 Cognitive approach ⚫ Therapeutic process Beliefs that Activating individuals use to Consequences events process the activating events Disputing Effective new irrational philosophy beliefs 33 Cognitive approach ⚫ Try to identify the irrational beliefs/maladaptive cognition in the following cases ◦ I have got a B- in a course. I will definitely get a third class honor. Overgeneralizing ◦ It is me who made my parents divorce. Excessive responsibility ◦ I cannot get into the CP program. I am such a failure. Selective abstraction ◦ I have just lost a competition. My friends should be teasing me right now. Self-references 34 Cognitive-Behavioural Therapy (CBT) 35 Cognitive-Behavioural Therapy (CBT) 36  Humanistic approach ⚫ Carl R. Rogers. ◦ Born in a family in which parents impose conditions of worth on children ◦ Received Ph.D. in clinical psychology ◦ Spent 12 years as a psychologist at a child guidance clinic ◦ Realized the importance of being “human” in his practice ⚫ Theory of personality ⚫ Theory of psychopathology ◦ All humanity has but one basic motivational ◦ The core of psychological force: a tendency toward actualization maladjustment is the incongruity The inherent tendency of the organism to develop all its capacities between the person’s total experience in ways which serve to actualize, maintain, and enhance the and what is accurately symbolized as organism part of the self-concept (i.e. self is ◦ In relating to the world, we respond not to some threatened) “real” or “pure” reality, but rather to reality as we experience ◦ Where a person’s ideal self and actual experience are consistent or very We actively participate in the creation of our subjective world similar, a state of congruence exists Rarely does a total state of congruence ◦ We differentiate our experiences from those of exist others Awareness of self develops into our self-concept: I or me ◦ As self-consciousness emerges, we develop a need for positive regard: need to be prized, accepted, loved ◦ We want these positive regard, and we therefore guide our behaviours to get these regards But usually these regards depend on significant others’ view 37  Humanistic approach ⚫ Therapeutic process ◦ Major purpose To increase the congruence between self and experience through a process of integration ◦ Therapist reflects on clients’ feelings, so that they become conscious Through person-centered approach with clients direct the flow of therapy ⚫ Therapeutic relationship ◦ Three main “Necessary and sufficient conditions” for constructive personality change: Genuineness: truthful self-expression Unconditional positive regard: for the client Empathy: sense the client’s experience 38 *Motivational Interviewing* A person-centered counselling style to address the issue of ambivalence in the process of change. A collaborative, goal-oriented style of communication with particular attention to the language of change, designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person's own reasons for change within an atmosphere of acceptance and compassion 39 Positive psychology approach ⚫ Positive psychology is the scientific study of what makes life most worth living (Peterson, 2008) ⚫ A scientific approach to studying human thoughts, feelings, and behavior, with a focus on strengths instead of weaknesses, building the good in life instead of repairing the bad, and taking the lives of average people up to “great” instead of focusing solely on moving those who are struggling up to “normal” (Peterson, 2008) 40 What is positive psychology ⚫ Positive psychology focuses on the positive events and influences in life, including: ◦ Positive experiences (like happiness, joy, inspiration, and love) ◦ Positive states and traits (like gratitude, resilience, and compassion) ◦ Positive institutions (applying positivity within organizations and families) 41  What is positive psychology ⚫ Subjective level: ◦ Well-being, contentment, satisfaction (in the past) ◦ Flow and happiness (in the present) ◦ Hope and optimism (for the future) ⚫ Individual level: Intervention ◦ Capacity for love and vocation, courage, interpersonal skill, perseverance, forgiveness, originality, future mindedness, wisdom etc. ⚫ Group level: ◦ Civic virtues ◦ Responsibility ◦ Altruism ◦ Tolerance ◦ Work ethic etc. 42 Why positive psychology? Too much focusing on the Negative ⚫ Overly narrow focus on the negative: mental illness, abnormal psychology, trauma, suffering, and pain ⚫ Little attention dedicated to happiness, well-being, strengths, and flourishing ⚫ “The science of psychology has been far more successful on the negative than on the positive side; it has revealed to us much about man’s shortcomings, his illnesses, his sins, but little about his potentialities, his virtues, his achievable aspirations, or his psychological height. It is as if psychology had voluntarily restricted itself to only half its rightful jurisdiction, and that the darker, meaner half.” Abraham Maslow 43 Positive psychology interventions ⚫ To increase well-being through positive psychology interventions (PPIs)—treatment methods or intentional activities that aim to cultivate positive feelings, behaviors, or cognitions ⚫ Programs, interventions, or treatments aimed at fixing, remedying, or healing something that is pathological or deficient—as opposed to building strengths—do not fit the definition of a PPI Sin & Lyubomirsky, 2009 44 Happiness level Lyubomirsky, Sheldon, & Schkade, 2005 45  Seligman’s PERMA model Focusing on positive emotions is more than smiling: it is the ability to remain optimistic and view one’s past, P Positive Emotions present, and future from a constructive perspective Activities that meet our need for engagement flood the body with positive neurotransmitters and hormones that E Engagement elevate one’s sense of well-being. This engagement helps us remain present, as well as synthesize the activities where we find calm, focus, and joy Positive relationships with one’s parents, siblings, peers, R Relationships coworkers, and friends is a key ingredient to overall joy. Strong relationships also provide support in difficult times that require resilience Answering “why are we on this earth?” is a key M Meaning ingredient that can drive us towards fulfillment. Religion provide many people with meaning, as can working, raising children, and volunteering Having goals and ambition in life can help us to achieve A Accomplishments things that can give us a sense of accomplishment. Having accomplishments in life is important to push ourselves to thrive and flourish 46 47  Positive psychology interventions: Happiness is not merely the absence of illness anger, distress, joy, happiness, anxiety, depression satisfaction, well-being Traditional Psychology Model Positive Psychology Model Focus on weaknesses Focus on strengths Treat illnesses Promote well-being Overcome deficiencies Build competence Reduce unhappiness Increase happiness Eliminate pain Seek pleasure Return to “normal” state Thrive and grow 48 Positive psychotherapy ⚫ Positive psychotherapy: using positive psychology to relieve depression ◦ By directly building positive emotions, character strengths, and meaning ◦ Building positive resources to counteract negative symptoms ⚫ Five interventions were initially tested ◦ Gratitude visit ◦ Three good things in life ◦ You at your best ◦ Identifying signature strengths ◦ Using signature strengths ⚫ The results showed that some of the exercises increased happiness and decreased depressive symptoms for six months ⚫ There was a significant effect for adherence to the exercise on happiness scores at all time periods ◦ Participants who continued to perform the exercises were more likely to maintain the benefits for a longer time 49 50 Integration ⚫ The contribution of different approaches ◦ Psychoanalytic Consciousness Childhood experience ◦ Behavioural Environmental antecedents and consequences Scientific method ◦ Cognitive Beliefs ◦ Humanistic Personal qualities of the therapist ◦ Positive psychology Individual strengths and capacities 51 Integration ⚫ Which approach do you think is the most effective approach in dealing with psychological problems? And why? 52 Factors contributing to the success of an intervention ⚫ Lambert (1992) 53 Flow ⚫ Different kinds of psychological intervention ◦ Level ◦ Target ◦ Directedness ⚫ Psychotherapy ◦ 3 stage intervention model ⚫ Different approaches ◦ Psychoanalytic ◦ Behavioural ◦ Cognitive ◦ Humanistic ◦ Positive psychology ⚫ Psychological intervention at group and system levels 54 Intervention groups ⚫ Psychological interventions are not necessarily conducted in an individual basis ⚫ In fact, conducting psychological interventions in groups is not only cost-effective, but also serves other purposes that individual intervention cannot achieve ⚫ But of course, many more interactions are present in intervention groups compared with individual interventions, and these interactions may interfere with the progress ◦ E.g., attention seekers, competition, formation of subgroups 55 Intervention groups ⚫ Special properties of intervention groups ◦ Universality ◦ Information ◦ Altruism ◦ Social learning ◦ Vicarious experience ◦ Practice of social skills ◦ Cohesiveness 56 Intervention groups ⚫ Examples of intervention groups ◦ 快樂家庭廚房全城運動 ◦ 有教無「戾」 - 校園欺「零」計劃 57 Intervention groups ⚫ Examples of intervention groups ◦ Project CARE Prevention of bullying Cognitive-behavioural in nature 10 group session Group participants into different categories Proactive aggressor Reactive aggressor Aggressive victim Passive victim Offer relevant intervention for each group 58 Phonotopia A Convenient Package to Enhance the English Phonics Ability of Chinese Children with Reading Difficulties Study Skills Training for University Students Common underlying Trainings challenge Executive functioning Study/exams skills Scheduling Essay writing skills Study Skills Training for University Students Common underlying Trainings challenge Executive functioning Study/exams skills Scheduling Essay writing skills References ⚫ Egan, G. (2014). The skilled helper: a problem-management and opportunity-development approach to helping. Belmont, Calif.: Brooks/Cole, Cengage Learning. ⚫ Prochaska, J. O. (2010). Systems of psychotherapy: a transtheoretical analysis. Belmont, Calif.: Brooks/Cole, Cengage Learning. ⚫ Seligman, M. E. P., Rashid, T. & Parks, A. C. (2006). Positive psychotherapy. American Psychologist, 51, 1072-1079. ⚫ VanderWeele T. J. (2017). On the promotion of human flourishing. Proceedings of the National Academy of Sciences of the United States of America, 114(31), 8148–8156. https://doi.org/10.1073/pnas.1702996114 63