Clinical Psychology Lecture Notes PDF

Lecture 11: Basic theoretical models of human functioning used in clinical psychology part VI. Introduction to clinical psychology Anna Gabińska, Ph.D. Lecture overview  Towards an integration of clinical models 3 Comer, Abnormal Psychology, 7e Towards the integration of clinical models  F...

Lecture 11: Basic theoretical models of human functioning used in clinical psychology part VI. Introduction to clinical psychology Anna Gabińska, Ph.D. Lecture overview  Towards an integration of clinical models 3 Comer, Abnormal Psychology, 7e Towards the integration of clinical models  Few practicing clinicians use one model of psychopathology rigidly - most see value in an eclectic approach.  Many theorists, clinicians and practitioners adhere to a biopsychosocial model:  Abnormality results from the interaction of genetic, biological, developmental, emotional, behavioral, cognitive, social, and societal influences.  Each psychological perspective is valuable to understanding abnormal behavior. Integration of clinical models  „The integration movement in psychotherapy suggests that one way of improving our outcome is not to force a choice between different treatments (or to invent new ones), but to assimilate within existing therapies constructs and techniques associated with other orientations” (Messer, 2001)  How many therapeutic techniques there are? ◦ Ross & Fonegy (1996) – 400 ◦ Norcross (2011) – 600 How many therapeutic techniques there are?  https://www.talkspace.com/blog/2016/09/ different-types-therapy-psychotherapy- best/  https://www.div12.org/treatments/ Towards an integration of models 7  Integration of clinical models  All models are greatly influenced by the beliefs of authors’ culture.  Each model focuses on one aspect of human functioning and no single model can explain all aspects of abnormality.  Different perspectives are more appropriate under differing conditions.  An integrative approach: ◦ provides a general framework for thinking about abnormal behavior ◦ allows to specify the factors especially relevant to particular disorders. 8 Integration of clinical models  Integrative therapists are often called “eclectic” – taking the strengths from each model and using them in combination  Most therapist use a Prescriptive Eclectic Theory, a combination of ideas and therapeutic techniques: ◦ CBT therapists show empathy; Learning therapists inquire about clients’ thoughts. 9  Integrative or eclectic? (Palmer and Woolfe, 1999)  Integration: the elements are part of one combined approach to theory and practice [bringing together with the intention of making something whole and new].  Eclecticism: draws ad hoc from several approaches in the approach to a particular case [selecting sth. out, taking sth apart].  Psychotherapy's eclectic practitioners are not bound by the theories or methodology of any one particular school. They use what they believe is appropriate and will work best. Multiple pathways to achieve integration in therapy  Common factors: looking across different theoretical approaches in search for common healing elements – identifying core composed of non-specific variables common to all therapies  common factors are shared, fundamental elements of therapy (rather than specific techniques) which are “active ingredients”. ◦ therapeutic relationship/alliance, ◦ instillation of hope, ◦ attention, ◦ corrective experience, ◦ practicing new behaviors, ◦ opportunity for catharsis. Cathartic technique in psychological practice (Trzebińska & Gabińska, 2015)  Catharsis – releasing emotions, venting anger  The cultural maxim: keeping emotions "bottled up" is harmful.  recognized as a healing, cleansing, and transforming experience, used in cultural healing practices, literature, drama, religion, and also in psychology.  Debriefing, Psychodynamic psychotherapy, Primal therapy, Psychodrama, Emotion - Focused therapy  Many mental health professionals consider it as a core technique to achieve positive therapeutic change.  Research on cathartic techniques  Research on the effectiveness of the techniques started as early as in 1950s, and even though studies yielded ambiguous results from the very beginning, the fact did not substantially affect the scope of use of such techniques.  Growing evidence that intensified expression of negative emotions may be harmful because, paradoxically, it causes an intensification of these feelings (Lohr, Olatunji, Baumeister, & Bushman, 2007). Limitations of cathartic technique  People having personality dispositions to experience negative emotional states (Kennedy-Moore & Watson, 2001)  Expressing anger (Bushman, 2002)  Bereavement (Bonanno, Keltner, Holen, & Horowitz, 1995; Bonanno & Keltner, 1997)  Debriefing which takes place immediately after the traumatic event (Devilly, Gist, & Cotton, 2006; McNally, Bryant, & Ehlers, 2003):  for victims of sudden violence (Rose, Brewin, Andrews, & Kirk, 1999)  victims of burns and car crashes (Mayou, Ehlers, & Hobbs, 2000) Limitations of cathartic technique  Evoking emotions connected with a trauma is harmful when it is not accompanied by a reevaluation of the traumatic situation (Lyubomirsky, Sousa, & Dickerhoff, 2006).  Expressive writing: effectiveness depends on the moment of application and the type of a problem.  For patients diagnosed with cancer the denial of negative experiences is more beneficial for their psychological well- being than describing one's feelings during the first stage of adaptation to the disease (Kreitler, 1999).  No positive effect in the case of mourning (Stroebe, Stroebe, Schut, & Zech Ivan den Bout, 2002) and repeated experience of sexual violence (Batten, Follette, Rasmussen-Hall, & Palm, 2002).  Which model is best?  Counselling and psychotherapy more cost-effective way of relieving anxiety and depression than medication, but only one type of therapy – CBT – has proved its effectiveness in Randomised Controlled Trials.  Major British study carried out in the NHS compared the outcomes of CBT, person-centred therapy (PCT) and psychodynamic therapy (PDT). Researchers compared outcomes of six groups: three treated with CBT, PCT or PDT only, and three treated with one of these, plus one additional approach.  All six groups averaged marked improvement.  The results indicate these three treatment approaches, practised in NHS, were consistent with previous findings that different approaches have similar outcomes. Stiles,WB et al. (2006). Effectiveness of cognitive-behavioural, person-centred and psychodynamic therapies as practised in UK National Health Service settings. Psychological Medicine., 36, 555-566.  Which model is best?  https://www.div12.org/psychological-treatments/ the website provides information about effective treatments for psychological diagnoses. https://www.nice.org.uk/guidance/ng222 - depression (2022) https://onlinelibrary.wiley.com/doi/full/10.1002/wps.20235 - psychodynamic approach (2015) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4707273/ - integrative approach (2015) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5797481/ - CBT (2018) “everybody has won and all must have prizes” What works in therapy? In one of a number of major reviews, Wampold identifies the following factors that affect outcomes:  General effects - common factors that underlie all psychotherapies: 70 per cent  Specific effects – that is particular aspects linked to a specific model: 8 per cent.  Unexplained variability – most likely linked to client differences: 22 per cent.  In other words, the model practised counts for only 8% towards positive outcome in therapy. Wampold BE. (2001).The great psychotherapy debate. New Jersey: Lawrence Erlbaum So what works? “The relationship is the most significant in-therapy factor as related to positive outcomes.” Paul, S and Haugh S (2008) The Relationship not the Therapy? In S Haugh and S Paul, The Therapeutic Relationship: Perspectives and Themes Ross-on-Wye: PCCS Books.  A new science of mental disorders: Using personalized, transdiagnostic, dynamical systems to understand, model, diagnose and treat psychopathology – ScienceDirect (Roefs et al., 2022)  The success rates of interventions aimed at treating mental disorders are modest (in both adults and adolescents, across the full range of mental disorders)  Many patients do not, or only scarcely, benefit from treatment, and others soon relapse after an initial success. good short-term outcomes of treatment are no guarantee of good long-term outcomes.  the sad reality is that many patients with mental disorders do not receive treatment at all and, if they are treated, roughly 60% either do not respond to treatment or relapse within a year.  Rates and Determinants of Use of Pharmacotherapy and Psychotherapy by Patients With Major Depressive Disorder(Gaspar et. al, 2019) 1. Treatment guideline recommendations are not followed for a large proportion of patients with MDD. 2. In the 12 months following a diagnosis of MDD, most individuals received pharmacotherapy or psychotherapy (94.7%), and unimodal therapy was more common (58.5%) than bimodal therapy (36.2%). 3. Most patients (54.7%) did not continue to receive either antidepressant or psychotherapy treatment after month 5 following their diagnosis. 4. A shorter time from diagnosis to treatment and a lower percentage of treatment costs paid by the patient were associated with increased antidepressant adherence and intensive psychotherapy use. 5. When psychotherapy was initiated, the median number of visits in the year after a patient's diagnosis was seven.  Assessing motivation for change: Stages of Change Prochaska, Norcross, & DiClemente  Precontemplation (Denial) ◦ “What problem? I’m not thinking about it.”  Contemplation (Ambivalence) ◦ “I wonder if I might have a problem? I’m thinking about it but not ready to decide anything yet.”  Preparation / Determination (Admission) ◦ “I have a problem.”  Action (Taking steps / Making changes) ◦ “I have a problem and I’m ready to do something about it.”  Maintenance (Continuing what works) ◦ “I’m stabilized and doing well. How can I support my ongoing recovery?”  Relapse / Recycle (Trying again) ◦ “I’m stabilized but have relapsed. How can I get back into active recovery?” „It is now widely appreciated that about 70 % of mental disorders can be diagnosed prior to age 25 years and that they comprise the single largest component of disease burden during the second decade of the life span” Kutcher et al. (2016, p. 567)