ALTERNATIVE MODES OF CLINICAL INTERVENTION

ALTERNATIVE MODES OF CLINICAL INTERVENTION

OBJECTIVES To enumerate and distinguish the therapeutic procedures. To identify the alternative individual clinical treatments, therapies and programs. To determine the different treatment modalities and a variety of new technologies. To understand the best practices across orientation in order to maximize their effectiveness with their clients.

From Crisis to Wellness-But Was it the Therapy? It often happens this way. Problems seem to go from bad to worse – the trigger could be severe pressures at work, an acrimonious fight with your spouse, or a child’s unruly behavior spiraling out of control. At some point, you recognized that it might be prudent to seek professional assistance from a therapist, but where do you turn ? If you are like most people, you will probably hesitate before actively seeking professional help. People hesitate because therapy carries a stigma, because the task of finding a therapist is daunting, and because they hope that their psychological problems will clear up on their own- which does happen some regularity.

From Crisis to Wellness-But Was it the Therapy? When people finally decide to pursue mental health care, it is often because they feel like they have reached rock bottom in terms of their functioning and they have no choice. Motivated by their crisis, they enter into treatment, looking for ray of hope. Will therapy help them to feel better? It may surprise you to learn that the answer generally would be “yes”, even if professional treatment itself utterly worthless and totally ineffectual. People entering therapy are likely to get better, regardless of whether their treatment is effective, for two major reasons: placebo effects and regression toward the mean.

From Crisis to Wellness-But Was it the Therapy? Placebo effects occur when people’s expectations lead them to experience some change even though they receive a fake treatment. Clients generally enter therapy with expectations that it will have positive effects, and as we have emphasized throughout this text, people have a remarkable tendency to see what they expect to see. Because of this factor, studies of the efficacy of the medical drugs always include a placebo condition in which subjects are given fake medication. Placebo effects can be powerful and should be taken into consideration whenever efforts are made to evaluate the efficacy of some approach to treatment.

From Crisis to Wellness-But Was it the Therapy? Regression toward the mean occurs when people who score extremely high or low on some trait are measured a second time and their new scores fall closer to the mean (average). Regression effects work in both directions: on the second measurement high scorers tend to fall back toward the mean and low scorers tend to creep upward toward the mean. For example, let’s say we wanted to evaluate the effectiveness of a one- day coaching program intended to improve performance on the SAT test. We reason that coaching is most likely to help students who performed poorly on the test, so we recruit a sample of high students who have previously scored in the bottom 20% on the SAT.

From Crisis to Wellness-But Was it the Therapy? thanks to regression toward the mean, most of these students will score, higher if they take the SAT a second time. So our coaching program may look effective even if it has no value. By the way, if we set out to see whether our coaching program could increase the performance of high scorers, regression effects would be working against us. The process underlying regression toward the mean are complex matters of probability, they can be approximated by a simple principle: if you are near the bottom, you have almost nowhere to but up. If you are near to top, you have almost nowhere to go but down.

Current Trends and Issues in Treatment Many clinicians and their clients believe that managed care has restricted access to mental health care and undermined its quality. One response to the demands of managed care has been to increase research efforts to validate the efficacy of specific treatments for specific problems. Combinations of insight, behavioral and biomedical therapies are often used fruitfully. Many modern therapists are eclectic, using ideas and strategies gleaned from a number of theoretical approaches. The highly culture-bound origins of western therapies have raised doubts about their applicability to other cultures and even to ethnic groups in Western society. Because of cultural, language, and access barriers, therapeutic services are underutilized by ethnic minorities in America.

INTRODUCTION These modes of intervention reflect trends in psychology, that view individuals’ behaviour as a reflection of the relationship system they inhabit. These approaches assume that psychological problem exist within social context each emphasizes interventions include groups, couples and family therapy; community mental health programs; prevention efforts and self help. Also include the new treatment modalities such as complementary/alternative medicine, spiritually, mindfulness, and a variety of new technologies.

Socially Oriented Clinical Interventions GROUP THERAPY It was the first social oriented therapy. It emphasizes in understanding and alleviating disturbances in interpersonal relationships as revealed in a group setting. Joseph Pratt He was the first to practiced group therapy at the turn of 20th century in Boston.

Therapeutic Factors in Group Therapy Sharing new information The group leader may offer advice and advice may also comes from other members of a group who share their experiences. Instilling hope Not only one can confidence be instilled by the therapists, but group members can provide hope and can comment on positive changes that they see in other members. Universality It helps their members to learn that they are not alone in their fears, low moods, or other difficulties. Altruism Groups give the client a chance to discover that they can help other people.

Therapeutic Factors in Group Therapy Interpersonal learning It presents repeated opportunities to practice fundamental social skills with various types of people and with immediate feedback on performance. Group Cohesiveness Members of cohesive group accept one another, willing to listen to and to be influenced by the group. Cohesiveness Most important factor in underlying the beneficial effects of group therapy.

The Practice of Group Therapy It usually consists of 6 – 12 members and is either homogenous or heterogeneous group. Group meetings usually last about 1 – 2 hours. They are longer than sessions of individual therapy because it takes more time for all of the clients in a group sessions to share their experiences and to process the information that is present.

Cognitive-Behavioral Group Therapy (Pseudoeducational groups) It is one of the more common types of group therapy in use today. They focus in learning and on sharing information rather than on group process.

Couples and Family Therapy It focuses on disturbed relationship rather than on individuals who happen to be in a relationship. It emphasizes on communication patterns within close relationships, therapists who work with couples who work with families and vice versa.

COUPLES THERAPY It focuses on dyad rather than individual partner. Couples seek therapy because of problems in affection and communication. The therapy focuses mainly on relationship difficulties but it sometimes be combined with other methods designed to address other problems.

Conjoint therapy The therapist sees both members of the couple at the same time. This is especially in separation counseling.

The goals and techniques of couple therapy depend partly on the conflicts that are the most pressing for each couple and partly on the theoretical orientation of the therapist. In general, most couple therapists tend to emphasize problem solving. The touchstone of problem solving is teaching the couples how to communicate and negotiate more effectively with each other.

FAMILY THERAPY This therapy aims to change patterns of family interactions so as to correct disturbances in those interactions. This arose from recognition that the problems of individual clients occur in social contexts and have consequences. Family therapy often begins with a focus on a family member who is having particularly noticeable problems. Typically, this identified client is a male child whom the parents label as having an unmanageable behaviour problem or a girl who is withdrawn and sad. The common goal of family therapy is to improved communication and to eliminate distraction within the family.

There are techniques for conducting family therapy. These are the following: Ecological Family Intervention Therapy (EcoFit) used techniques wherein they try to teach family members alternative, non-coercive ways of communicating their needs. They also encourage each family member to communicate clearly with others, educate them in behaviour- exchange principles and discourage blaming of the identified client for all family problems. Family therapy also tends to focus more closely on behavioural targets and methods. For example behavioural parent training or also known as parent management training wherein they used effective treatment of externalizing behaviour problem in children such as aggression. The parent-child interaction therapy, this therapy allows therapists to work with both parents and children and directly coaches parents about how to interact with their child.

COMMUNITY PSYCHOLOGY One of the primary goals of community psychology is to help individuals adapt to and cope with their environment. Another is to understand the causes of disorders more broadly and when possible, to modify community level causes before they have an opportunity to negatively influence individuals and groups.

Psychological Principles Understanding individual and social problems. Preventing behavioral dysfunction Creating lasting social change

A Brief History of Community Psychology 1950’s and 1960’s – an array of influences came together to accelerate the development of community psychology. 1952 – shortages of mental health professionals to deliver individual treatment. 1959 – sociopolitical turmoil over civil rights, gender equality, poverty, and the Vietnam War and passage of the Community Mental Health Centers Act in 1962, which provided funds for the construction of comprehensive mental health center.

A Brief History of Community Psychology 1973 - benefits of traditional psychotherapy. 1977 - skepticism about the reliability and validity of psychological diagnosis of disorders.

American Psychological Association Journals American Journal of Community Psychology Community Mental Health Journal Journal of Community Psychology

Principles and Methods that Differentiate Community Psychology from Traditional Clinical Traditional Social – System Change interested in promoting social- system level changes than in promoting person- oriented changes. emphasize indirect services that have no particular target client but are expected to achieve benefits because the social- system changes they produce radiate to intended target groups.

Principles and Methods that Differentiate Community Psychology from Traditional Clinical Traditional Promoting a Psychological Sense of Community strengthen the ability of a community to plan and implement its own changes by promoting a psychological sense of community. Paraprofessionals encouraging paraprofessionals to provide behavior change functions is a cornerstone of community psychology. Indigenous paraprofessionals they are drawn from the very groups that will receive their services.

Principles and Methods that Differentiate Community Psychology from Traditional Clinical Traditional Use of Activism social activism is the use of power to accomplish social reform. Use of Research as a Form of Intervention exemplified by what is called dissemination research experimentation designed to evaluate alternative methods of implementing programs that initial studies have shown to be successful.

PREVENTION Prevention which is now known as prevention science, influenced by National Institute of Mental Health’s Prevention Intervention Research Centres (PIRC’s), focused on multidisciplinary research to help the prevent the development of psychopathology. This is the head of the appearance of mental disorders by counteracting the risk factors and strengthening the protective factors.

PREVENTION STRATEGIES Improving parenting skills This strategies aimed to reduced the incidence of family violence, such as physical or sexual abuse or family violence that caused them to become aggressive. Teaching Social Skills Approach which involves teaching children and adolescents the interpersonal skills crucial to late development and adjustments.

PREVENTION STRATEGIES Changing Environments Making environments more supportive of adaptive behavior. For example, Head start that expand preschool opportunities and increase the commitment of parents and children to academic success. Reducing Stress Approach that takes the form of reducing environment stressors.

PREVENTION STRATEGIES Promoting Empowerment Empowering the powerless, to help them cope with their problems and for them to have confidence to take control of their lives.

TECHNOLOGICAL INNOVATIONS INFLUENCING PSYCHOLOGICAL TREATMENT Problems caused by technology Nearly 1,500 adolescent and adult clients experienced a variety of Internet-related problems Excessive use of Internet to view pornography Internet activities that led, or threatened to lead, to marital infidelity

TECHNOLOGICAL INNOVATIONS INFLUENCING PSYCHOLOGICAL TREATMENT Technology as a treatment tool E-health – mental health professionals can assess, diagnose and sometimes treat clients through remote contact via computer. Internet can be especially effective in delivering certain treatments, particularly those involving behavioral packages that target specific, discrete problems A clinical psychologist is usually involved in Internet-based treatment programs, either through an initial face-to-face meeting or at least through regular phone calls or e-mails to assess the progress of treatment.

SELF-HELP Encourage people to perform therapeutic functions for themselves, either in groups organized around specific concern or individually through a course of study.

New Treatment Modalities Complementary/ Alternative Medicines (CAM) Also known as integrative technique includes herbology, chiropractic methods, massage therapy, nutrition, applied kinesiology and biofeedback. Omega- 3 essential fatty acids to ameliorate symptoms of depression and to lessen the like hood of suicide attempts in people who have made previous attempts. Meditation for problems such as insomnia and other symptoms of stress. Herbal therapies in conjunction traditional treatment to reduce the side effects of chemotherapy in the treatment of prostate cancer.

New Treatment Modalities Techniques such as meditation, herbal remedies, massage, acupuncture and prayer in dealing with pain and other physical symptoms associated with lung cancer. Multiple CAM techniques for dealing with stressors related to living with HIV or AIDS.

New Treatment Modalities Spirituality Used of prayer or other spiritual methods to deal with stressors. Traditionally, clinical psychologists and clinical researches have not included spirituality and religiosity in the course of work.

New Treatment Modalities Mindfulness This described as intentionally bringing one’s attention to the internal and external experiences occurring in the present moment. Often taught to client through meditation exercises designed to help them accept their own thoughts and feelings but also they can achieve certain amount of detachment from those thoughts and feelings.

PSCHOTHERAPY INTEGRATION Psychotherapy Integration It is the process of combining elements of various clinical psychology theories in a systematic manner. Technical Integration Clinicians might use relaxation training, interpretation of transference, biofeedback, and nondirective listening skills. And might be thought as a “cafeteria approach” in that clinicians select from a broad array techniques.

PSCHOTHERAPY INTEGRATION Theoretical Integration Proposes to resolve the real and apparent conflicts among the major psychological theories so that there is genuine theoretical integration in psychology. Common factors seeks to identify the variables that are common to all (or most) effective treatment. Assimilative Integration Occurs when clinicians hold one primary theoretical orientation but use techniques from other approaches.

EVALUATION Multiple Choice: Encircle the best answer.

EVALUATION It is the process of combining elements of various Clinical Psychology theories in systematic manner. Behavioral Therapy Psychotherapy Integration Client- Centered Therapy Technical integration

EVALUATION 2. __________ therapy often begins with a focus on a family member who is having particularly noticeable problems. Family Couples Group Friend

EVALUATION 3. He was the first practiced at the turn of the 20th century in Boston. Ivan Pavlov Erik Erikson BF Skinner Joseph Pratt

EVALUATION 4. It is a field that applies psychological principles to understanding individual and social problems creating beneficial social changes. Self help Group therapy Community Psychology Child Psychology

EVALUATION 5. The therapist sees both members of the couple at the same time. Conjoint therapy Separation counseling Marital therapy Family therapy

EVALUATION Enumerate the 5 (five) Prevention Programs consistent with PIRC research model.

Answers: 1.B 2.A 3.D 4.C 5.A

6. Teaching Social Skills 7. Changing Environments 8. Promoting Empowerment 9. Improving parenting skills 10. Reducing Stress

ALTERNATIVE MODES OF CLINICAL INTERVENTION