clinical psychology

1. COURSE OF CLINICALCOURSE OF CLINICAL
INTERVENTIONINTERVENTION
Lecture 27Lecture 27

2.  It may be useful to examine the overallIt may be useful to examine the overall
sequence of therapeutic progress as describedsequence of therapeutic progress as described
by Hokanson (1983).by Hokanson (1983).
 INITIAL CONTACT:-INITIAL CONTACT:-
 When clients first contact the clinic or enterWhen clients first contact the clinic or enter
the clinician's office, they often do not knowthe clinician's office, they often do not know
exactly what to expect.exactly what to expect.
 The first order of business, then, is forThe first order of business, then, is for
someone to explain generally what the clinic issomeone to explain generally what the clinic is
all about and the kind of help that can be given.all about and the kind of help that can be given.

3.  Whether this initial contact is made by aWhether this initial contact is made by a
therapist, a social worker, a psychologicaltherapist, a social worker, a psychological
technician, or someone else, it is important thattechnician, or someone else, it is important that
the contact be handled with skill and sensitivity.the contact be handled with skill and sensitivity.
 Once the client's reasons for coming have beenOnce the client's reasons for coming have been
discussed, the next step in the general se­discussed, the next step in the general se­
quence can be explained. It may be useful atquence can be explained. It may be useful at
this point to discuss several specific issues.this point to discuss several specific issues.

4. ASSESSMENT:-ASSESSMENT:-
 Once it has been mutually agreed that theOnce it has been mutually agreed that the
client can likely profit from continued contactclient can likely profit from continued contact
with the clinic, one or more appointmentswith the clinic, one or more appointments
can be ar­ranged for an assessment of thecan be ar­ranged for an assessment of the
client’s problems.client’s problems.
 As we know that variety of assessmentAs we know that variety of assessment
procedures may be followed, depending onprocedures may be followed, depending on
the exact nature of the client's problem, thethe exact nature of the client's problem, the
orientation of the professional staff, andorientation of the professional staff, and
other factors.other factors.
 Intake interview, psychological tests areIntake interview, psychological tests are
often involved in assessment process.often involved in assessment process.

5.  For some clients, consultations with otherFor some clients, consultations with other
professionals may be desirable. likeprofessionals may be desirable. like
Neurologists, medical physicians.Neurologists, medical physicians.
 For some clients whose problems are related toFor some clients whose problems are related to
economic problems or unemployment,economic problems or unemployment,
additional consultation with social workers oradditional consultation with social workers or
job counselors may be appropriate.job counselors may be appropriate.
 After all the information has been compiled andAfter all the information has been compiled and
analyzed, a preliminary integration is attemptedanalyzed, a preliminary integration is attempted
 What is desirable here is not a simpleWhat is desirable here is not a simple
diagnostic label but a comprehensivediagnostic label but a comprehensive
construction of the client's problems in light ofconstruction of the client's problems in light of
all the psychological, environmental, andall the psychological, environmental, and
medical data available.medical data available.

6. THE GOALS OF TREATMENT:-THE GOALS OF TREATMENT:-
 As soon as the assessment data are integratedAs soon as the assessment data are integrated
(the therapist and client can begin to discuss(the therapist and client can begin to discuss
more systematically the nature of the problemmore systematically the nature of the problem
and what can be done about them.and what can be done about them.
 Some therapists describe this phase as aSome therapists describe this phase as a
period of negotiation over the goals ofperiod of negotiation over the goals of
treatment. Others suggests that client andtreatment. Others suggests that client and
therapist enter into a ‘contract’therapist enter into a ‘contract’
 No one can absolutely promise a perfect cureNo one can absolutely promise a perfect cure
or resolution ofor resolution of allall problems.problems.
 It is important to understand that variousIt is important to understand that various
features of the contract may be modified asfeatures of the contract may be modified as
time goes on.time goes on.

7.  As therapy proceeds, that client may becomeAs therapy proceeds, that client may become
more open and comfortable and thus bettermore open and comfortable and thus better
able to accept an expanded set of goals.able to accept an expanded set of goals.
 Some clients will want to expand their goals forSome clients will want to expand their goals for
treatment as they gain more confidence andtreatment as they gain more confidence and
trust in the therapist.trust in the therapist.
 Therapists must try to take clients only whereTherapists must try to take clients only where
they are psychologically prepared to go.they are psychologically prepared to go.
Moving too fast or setting up grandioseMoving too fast or setting up grandiose
treatment objectives can frighten or alienatetreatment objectives can frighten or alienate
certain clients.certain clients.
 Hokanson (1983) uses a classification ofHokanson (1983) uses a classification of
therapy goalstherapy goals

8.  Therapeutic Goal is Crisis managementTherapeutic Goal is Crisis management
 Therapeutic goal is Behavior changeTherapeutic goal is Behavior change..
 Therapeutic goal is CorrectiveTherapeutic goal is Corrective
emotional experienceemotional experience..
 Therapeutic goal is Insight and change.Therapeutic goal is Insight and change.
The goal of psychotherapy is to improveThe goal of psychotherapy is to improve
the patient's level of psychosocialthe patient's level of psychosocial
adjustment and to increase the patient'sadjustment and to increase the patient's
capacity for achieving satisfactions fromcapacity for achieving satisfactions from
life.life.

9. IMPLEMENTING TREATMENTIMPLEMENTING TREATMENT
 After the initial goals are established, theAfter the initial goals are established, the
therapist decides on the specific form oftherapist decides on the specific form of
treatment.treatment.
 It may be client-centered, cognitive, behavioral,It may be client-centered, cognitive, behavioral,
or psychoanalytic.or psychoanalytic.
 Exactly what is expected of the client will beExactly what is expected of the client will be
detailed as well -free association, "homework"detailed as well -free association, "homework"
assignments, self monitoring, or whatever.assignments, self monitoring, or whatever.
 Inherent in all of this is the issue of informedInherent in all of this is the issue of informed
consent.consent.

10. TERMINATION, EVALUATION ANDTERMINATION, EVALUATION AND
FOLLOWUPFOLLOWUP
 As the therapist begins to believe the client isAs the therapist begins to believe the client is
able to handle his or her problemsable to handle his or her problems
independently, dis-cussions of termination areindependently, dis-cussions of termination are
initiated.initiated.
 Sometimes termination is a gradual process inSometimes termination is a gradual process in
which meet-ings are reduced,which meet-ings are reduced,
 Clients do sometimes terminate suddenly, inClients do sometimes terminate suddenly, in
some cases before the therapist feels it issome cases before the therapist feels it is
appropriateappropriate

11.  Many therapists find that "booster sessions"Many therapists find that "booster sessions"
scheduled months after termination-perhaps 6scheduled months after termination-perhaps 6
months and then one year later can be quitemonths and then one year later can be quite
helpful.helpful.
 It is important to evaluate with clients theIt is important to evaluate with clients the
progress they have made.progress they have made.
 Therapists should also compile data and makeTherapists should also compile data and make
notes on progress.notes on progress.
 The most reliable data, of course, will comeThe most reliable data, of course, will come
from formally designed re-search projectsfrom formally designed re-search projects

12. Common Elements ofCommon Elements of
PsychotherapyPsychotherapy
1. Realistic relationship between patient and1. Realistic relationship between patient and
therapisttherapist
2. Restoration of morale2. Restoration of morale
3. Release of emotion3. Release of emotion
4. Rationale4. Rationale
5. A combination of active listening and5. A combination of active listening and
talkingtalking
6. Suggestion6. Suggestion

13. Types of PsychotherapyTypes of Psychotherapy
 Psychotherapy encompasses a large numberPsychotherapy encompasses a large number
of treatment methods, each developed fromof treatment methods, each developed from
different theories about the causes ofdifferent theories about the causes of
psychological problems and mental illnesses.psychological problems and mental illnesses.
 There are more thanThere are more than 250250 kinds ofkinds of
psychotherapy, but only a fraction of thesepsychotherapy, but only a fraction of these
have found mainstream acceptance.have found mainstream acceptance.

14.  The methods of therapists vary depending onThe methods of therapists vary depending on
their theory of personality, or way oftheir theory of personality, or way of
understanding another individual.understanding another individual.
 Most therapies can be classified asMost therapies can be classified as
(1) Psychodynamic,(1) Psychodynamic,
(2) Humanistic,(2) Humanistic,
(3) Behavioral,(3) Behavioral,
(4) Cognitive,(4) Cognitive,
Or (5) Eclectic.Or (5) Eclectic.
 In the United States, about 40 percent ofIn the United States, about 40 percent of
therapists consider their approach eclectic.therapists consider their approach eclectic.
Popular Therapies Include :Popular Therapies Include :

15.  Forms of therapy that treat more than oneForms of therapy that treat more than one
person at a time includeperson at a time include
 Group therapy,Group therapy,
 Family therapy,Family therapy,
 and Couples therapy.and Couples therapy.
 These therapies may use techniques fromThese therapies may use techniques from
any theoretical approach. Other forms ofany theoretical approach. Other forms of
therapy specialize in treating children ortherapy specialize in treating children or
adolescents with psychological problems.adolescents with psychological problems.
Another Class of TherapiesAnother Class of Therapies

16. Psychotherapeutic ResearchPsychotherapeutic Research
Now we will briefly review the methods ofNow we will briefly review the methods of
psychotherapy research, the results of severalpsychotherapy research, the results of several
major outcome studies, and the recent trends inmajor outcome studies, and the recent trends in
psychotherapy research.psychotherapy research.
 Cartwright (1956), Bergin (1971), and HadleyCartwright (1956), Bergin (1971), and Hadley
and Strupp (1977) called attention to theand Strupp (1977) called attention to the
likelihood of deterioration effects in somelikelihood of deterioration effects in some
psychotherapy patients and the need,psychotherapy patients and the need,
therefore, to study out­comes in therapy.therefore, to study out­comes in therapy.

17.  The work that really stood the psychotherapyThe work that really stood the psychotherapy
establishment on its ear was Eysenck's (1952)establishment on its ear was Eysenck's (1952)
report.report.
 The significance of Eysenck's work lies less inThe significance of Eysenck's work lies less in
the validity of his conclusions (which manythe validity of his conclusions (which many
deemed flawed) than in the attack he made ondeemed flawed) than in the attack he made on
the field's complacency.the field's complacency.
 To better understand the nature of therapeuticTo better understand the nature of therapeutic
change, we will consider issues of researchchange, we will consider issues of research
design and method, the results of out­comedesign and method, the results of out­come
studies, and the process of change itself.studies, and the process of change itself.

18. SOME GENERAL CONCLUSIONSSOME GENERAL CONCLUSIONS
 J. D. Frank's (1979) conclusions about psychotherapy:J. D. Frank's (1979) conclusions about psychotherapy:
 Nearly all forms of psychotherapy are some whatNearly all forms of psychotherapy are some what
more effective than unplanned or in formal help.more effective than unplanned or in formal help.
 One form of therapy has typically not been shown toOne form of therapy has typically not been shown to
be more effective than another for all conditions.be more effective than another for all conditions.
 Clients who show initial improvement tend to maintainClients who show initial improvement tend to maintain
it.it.
 Characteristics of the client, the therapist, and theirCharacteristics of the client, the therapist, and their
interaction may be more important than therapeuticinteraction may be more important than therapeutic
technique.technique.

19.  Telch (1981), for one, argues that the more potentTelch (1981), for one, argues that the more potent
the therapeutic technique being used, the lessthe therapeutic technique being used, the less
important are therapist or client characteristics.important are therapist or client characteristics.
 Lazarus (1980) also argues that specific therapiesLazarus (1980) also argues that specific therapies
are indicated for specific problems.are indicated for specific problems.
 At the same time, however, he seems to suggestAt the same time, however, he seems to suggest
that various nonspecific factors play an importantthat various nonspecific factors play an important
role in improvement.role in improvement.
 Careful research should be designed to help usCareful research should be designed to help us
predict which therapy will best work for a givenpredict which therapy will best work for a given
problem.problem.

20.  Therapy is an intermittent process that occurs, forTherapy is an intermittent process that occurs, for
example, once a week. Thus, it is only a small part of aexample, once a week. Thus, it is only a small part of a
client's ongoing life.client's ongoing life.
 What happens in therapy may interact with otherWhat happens in therapy may interact with other
experiences in complex ways.experiences in complex ways.
 Changes in the client may threaten family members,Changes in the client may threaten family members,
who then quietly conspire to sabotage treatment.who then quietly conspire to sabotage treatment.
 Example of a client who had done Masters and wantedExample of a client who had done Masters and wanted
to be married, became numb and paralyzed.to be married, became numb and paralyzed.
 The whole process is so complex and interactive thatThe whole process is so complex and interactive that
it is difficult for research to show what factors init is difficult for research to show what factors in
therapy are related to client change or lack of it.therapy are related to client change or lack of it.

21.  Perhaps the greatest reality limitation of all isPerhaps the greatest reality limitation of all is
suggested by Barlow's (1981) charge that manysuggested by Barlow's (1981) charge that many
clinical psychologists simply do not payclinical psychologists simply do not pay
attention to outcome research.attention to outcome research.
 Persons (1995) discuss how deficits in trainingPersons (1995) discuss how deficits in training
and the perceived inaccessibility of resourcesand the perceived inaccessibility of resources
have caused clinicians to delay adoptinghave caused clinicians to delay adopting
empirically supported treatment techniques.empirically supported treatment techniques.

22.  However, Chambless et al. (1996) has said it best:However, Chambless et al. (1996) has said it best:
 Psychology is a science. Seeking to help those inPsychology is a science. Seeking to help those in
need, clinical psychology draws its strength andneed, clinical psychology draws its strength and
uniqueness from the ethic of scientific validation.uniqueness from the ethic of scientific validation.
 Whatever interventions that mysticism, authority,Whatever interventions that mysticism, authority,
commercialism, politics, custom, convenience, orcommercialism, politics, custom, convenience, or
carelessness might dictate, clinical psychologistscarelessness might dictate, clinical psychologists
focus on what works.focus on what works.
 They bear a fundamental ethical responsibility toThey bear a fundamental ethical responsibility to
use where possible interventions that work and touse where possible interventions that work and to
subject any intervention they use to scientificsubject any intervention they use to scientific
scrutiny.scrutiny.