clinical psychology

1. PSYCHOLOGICALPSYCHOLOGICAL
INTERVENTIONS ANDINTERVENTIONS AND
THEIR GOALSTHEIR GOALS
Lecture 25Lecture 25

2. INTRODUCTIONINTRODUCTION
INTERVENTION DEFINED:INTERVENTION DEFINED:
In a most general way, psychologicalIn a most general way, psychological
intervention is a method of inducingintervention is a method of inducing
changes in a person's behavior, thoughts,changes in a person's behavior, thoughts,
or feelings.or feelings.
Psychotherapy involves intervention in thePsychotherapy involves intervention in the
context of a professional relationship – acontext of a professional relationship – a
relationship sought by the client or the client'srelationship sought by the client or the client's
guardians.guardians.

3.  Psychologists are involved inPsychologists are involved in interventionintervention
whenever they purposefully try to producewhenever they purposefully try to produce
change in the lives of others in three ways.change in the lives of others in three ways.
 First, there has been a recent emphasis inFirst, there has been a recent emphasis in
clinical psychology (and, indeed, in psychologyclinical psychology (and, indeed, in psychology
in general) on "positive psychology," includingin general) on "positive psychology," including
thethe promotionpromotion of health and positive behaviors.of health and positive behaviors.
 This approach typically targets broadThis approach typically targets broad
populations and is exemplified by programspopulations and is exemplified by programs
that teach. For example, stress management,that teach. For example, stress management,
exercise and healthy eating, and socialexercise and healthy eating, and social
competence skills.competence skills.

4.  Second, programs designed toSecond, programs designed to preventprevent
psypsychopathology and diseases have a longerchopathology and diseases have a longer
history.history.
 These programs typically target groups who are atThese programs typically target groups who are at
elevated risk for developing disorder (e.g., low ­elevated risk for developing disorder (e.g., low ­
weight infants, children of depressed mothers,weight infants, children of depressed mothers,
victims of assault) and are designed to reduce thevictims of assault) and are designed to reduce the
probability of adverse outcomes in these samples.probability of adverse outcomes in these samples.
 Third, the most common form of intervention inThird, the most common form of intervention in
clinical psychology is psychotherapy: the processclinical psychology is psychotherapy: the process
used toused to treattreat various types of disorders once theyvarious types of disorders once they
have occurred.have occurred.

5. GOALS OF PSYCHOLOGICAL INTERVENTIONGOALS OF PSYCHOLOGICAL INTERVENTION
Psychological interventions have been developedPsychological interventions have been developed
to change behaviors.to change behaviors.
 Reduce risk for AIDS.Reduce risk for AIDS.
 Prevent violent behavior.Prevent violent behavior.
 Healthy patterns of diet and exercise.Healthy patterns of diet and exercise.
 Helps children in school.Helps children in school.
 Aggression in children and major depressionAggression in children and major depression

6. WHAT ARE WE TRYING TO CHANGE?WHAT ARE WE TRYING TO CHANGE?
 Psychologists help people change various levels ofPsychologists help people change various levels of
functioning.functioning.
 Some interventions are intended to change whatSome interventions are intended to change what
people do, to change particular problempeople do, to change particular problem behaviors.behaviors.
 For example, an intervention may be designed toFor example, an intervention may be designed to
reduce the amount and frequency of the consumptionreduce the amount and frequency of the consumption
of alcohol or cigarette smoking.of alcohol or cigarette smoking.
 Other interventions are designed to changeOther interventions are designed to change emotionsemotions
byby decreasing emotional dis­tress and increasingdecreasing emotional dis­tress and increasing
emotional comfort.emotional comfort.

7.  Other interventions are intended to change the waysOther interventions are intended to change the ways
that peoplethat people think.think.
 For example, to stop persistent thoughts about aFor example, to stop persistent thoughts about a
traumatic experience or to help individuals developtraumatic experience or to help individuals develop
more positive and optimistic beliefs about the future.more positive and optimistic beliefs about the future.
 Psychological interventions also may be designed toPsychological interventions also may be designed to
change underlyingchange underlying biological processesbiological processes
 Examples include the use of psychological techniquesExamples include the use of psychological techniques
to reduce blood pressure, lower resting heart rate, orto reduce blood pressure, lower resting heart rate, or
decrease headache pain.decrease headache pain.

8.  Finally, interventions can be designed toFinally, interventions can be designed to
change thechange the environmentenvironment rather than the person,rather than the person,
 E.g., changing the structure and resources of aE.g., changing the structure and resources of a
junior high or middle schooljunior high or middle school
 Most interventions are, in fact, designed toMost interventions are, in fact, designed to
produce change in more than one of theseproduce change in more than one of these
levels of functioning.levels of functioning.

9.  Much of the work carried out by clinicalMuch of the work carried out by clinical
psychologists is concerned with the preventionpsychologists is concerned with the prevention
or treatment of specific forms ofor treatment of specific forms of
psychopathology as defined in thepsychopathology as defined in the DSM-IVDSM-IV..
 But clinical psychological interventions are alsoBut clinical psychological interventions are also
concerned with broader social problems thatconcerned with broader social problems that
are not included as specific diagnosticare not included as specific diagnostic
categories in the DSM-IV.categories in the DSM-IV.
 These include problems in learning andThese include problems in learning and
development, difficulties in daily living, anddevelopment, difficulties in daily living, and
problems in interpersonal relationships.problems in interpersonal relationships.

10.  Advances in clinical health psychology andAdvances in clinical health psychology and
behavioral medicine have expanded the focusbehavioral medicine have expanded the focus
of interventions in clinical psychology to includeof interventions in clinical psychology to include
a number of physical disorders and diseases.a number of physical disorders and diseases.
 Psychologists contribute directly to thePsychologists contribute directly to the
prevention and treatment of, among otherprevention and treatment of, among other
diseases, cancer, diabetes, hypertension, anddiseases, cancer, diabetes, hypertension, and
AIDS.AIDS.

11. DEFININGDEFINING
PSYCHOTHERAPYPSYCHOTHERAPY

12. According to Wolberg, psychotherapy is theAccording to Wolberg, psychotherapy is the
treatment by psychological means, oftreatment by psychological means, of
problems of an emotional nature, in which aproblems of an emotional nature, in which a
trained person (therapist) deliberatelytrained person (therapist) deliberately
establishes a professional relationship withestablishes a professional relationship with
the patient tothe patient to
(i) remove, modify or retard existing(i) remove, modify or retard existing
symptoms,symptoms,
(ii) mediate disturbed patterns of behavior(ii) mediate disturbed patterns of behavior
andand
(iii) promote positive personality growth and(iii) promote positive personality growth and

13. J. D. Frank (1982) elaborates this general theme asJ. D. Frank (1982) elaborates this general theme as
followsfollows
 ‘’‘‘’‘Psychotherapy is a planned, emotionallyPsychotherapy is a planned, emotionally
charged, confiding interaction between a trained,charged, confiding interaction between a trained,
socially sanctioned healer and a sufferer. Duringsocially sanctioned healer and a sufferer. During
this interaction the healer seeks to relieve thethis interaction the healer seeks to relieve the
sufferer's distress and disability through symbolicsufferer's distress and disability through symbolic
communications, primarily words but alsocommunications, primarily words but also
sometimes bodily activities. The healer may orsometimes bodily activities. The healer may or
may not involve the patient's relatives and othersmay not involve the patient's relatives and others
in the healing rituals. Psychotherapy also oftenin the healing rituals. Psychotherapy also often
includes helping the patient to accept and endureincludes helping the patient to accept and endure
suffering as an inevitable aspect of life that can besuffering as an inevitable aspect of life that can be
used as an opportunity for personal growth.’’used as an opportunity for personal growth.’’

14.  By the above definitions we can understandBy the above definitions we can understand
that psychotherapy is a guide to:that psychotherapy is a guide to:
 Finding help for emotional distress (oftenFinding help for emotional distress (often
without the need for medications).without the need for medications).
 Personal freedom, growth, and self-Personal freedom, growth, and self-
actualization.actualization.
 Space and safety to explore and understandSpace and safety to explore and understand
yourself.yourself.
 Resolve inner conflicts and help to create newResolve inner conflicts and help to create new
potential.potential.

15. GENERAL GOALS OFGENERAL GOALS OF
PSYCHOTHERAPYPSYCHOTHERAPY

16.  Strengthening motivation for making efforts atStrengthening motivation for making efforts at
adaptation.adaptation.
 Reducing emotional pressure by facilitatingReducing emotional pressure by facilitating
emotional expression in therapeutic setting.emotional expression in therapeutic setting.
 Providing opportunities for unlearning or re-Providing opportunities for unlearning or re-
learning of behaviors.learning of behaviors.
 Attempting changes in perceptions of the self,Attempting changes in perceptions of the self,
others and the world in general.others and the world in general.

17.  Enhancing insight.Enhancing insight.
 Enhancing the capacity for effective decision-Enhancing the capacity for effective decision-
making or problem solving.making or problem solving.
 Facilitating interpersonal relationship.Facilitating interpersonal relationship.
 Bringing about changes in the immediate socialBringing about changes in the immediate social
environment.environment.
 Releasing potential for personal growth.Releasing potential for personal growth.
 Helping clients change unproductive ways ofHelping clients change unproductive ways of
thinking and behavingthinking and behaving

18. FEATURES COMMON TO MANY THERAPIESFEATURES COMMON TO MANY THERAPIES
 The apparent diversity amongThe apparent diversity among
psychotherapies can sometimes lead us topsychotherapies can sometimes lead us to
overlook the marked similarities among them.overlook the marked similarities among them.
 Yet most psychotherapy has a great deal inYet most psychotherapy has a great deal in
common - a commonality that in manycommon - a commonality that in many
respects outweighs the diversity.respects outweighs the diversity.
 Hundreds of "brands" of psychotherapy haveHundreds of "brands" of psychotherapy have
been identified.been identified.
 Some are effective, whereas others probablySome are effective, whereas others probably
are not.are not.

19.  Lambert and Bergin (1994) provide a list ofLambert and Bergin (1994) provide a list of
common factors categorized according to acommon factors categorized according to a
sequential process that they believe issequential process that they believe is
associated with positive outcome.associated with positive outcome.
 Briefly, they propose thatBriefly, they propose that supportive factorssupportive factors
lay the groundwork for changes in clients'lay the groundwork for changes in clients'
beliefs and attitudesbeliefs and attitudes ((learning factorslearning factors – for– for
example, cognitive learning, insight), whichexample, cognitive learning, insight), which
then lead to behavioral changethen lead to behavioral change ((action factorsaction factors
– for– for example, mastery, taking risks).example, mastery, taking risks).
 Some of the factors are discussed below.Some of the factors are discussed below.

20. THE EXPERT ROLETHE EXPERT ROLE
 It is assumed that the therapist brings to theIt is assumed that the therapist brings to the
therapy situation something more thantherapy situation something more than
acceptance, warmth, respect, and interest.acceptance, warmth, respect, and interest.
 In all forms of psychotherapy, patients have aIn all forms of psychotherapy, patients have a
right to expect that they are seeing not only aright to expect that they are seeing not only a
warm human being but a competent one aswarm human being but a competent one as
well.well.
 Mutual understanding and mutual acceptanceMutual understanding and mutual acceptance
of the different roles to be played would seemof the different roles to be played would seem
sufficient to guarantee the maintenance ofsufficient to guarantee the maintenance of
mutual re-spect.mutual re-spect.

21. THE RELEASE OF EMOTIONS / CATHARSISTHE RELEASE OF EMOTIONS / CATHARSIS
 Psychotherapy is an emotional experience.Psychotherapy is an emotional experience.
 whether a patient who, session after session,whether a patient who, session after session,
maintains a calm, cool, detached or intellectualmaintains a calm, cool, detached or intellectual
demeanor is really benefiting.demeanor is really benefiting.
 The problems that bring a person toThe problems that bring a person to
psychotherapy are typically important ones.psychotherapy are typically important ones.
 The release of emotions, orThe release of emotions, or catharsiscatharsis as it isas it is
sometimes termed, is a vital part of mostsometimes termed, is a vital part of most
psychotherapies.psychotherapies.
 In some brands of psychotherapy, the goal mayIn some brands of psychotherapy, the goal may
be to gain better control over the expression ofbe to gain better control over the expression of
one's emotions.one's emotions.

22. RELATIONSHIP/THERAPUTIC ALLIANCERELATIONSHIP/THERAPUTIC ALLIANCE
 For some the nature of the relationshipFor some the nature of the relationship or,or,
therapeutic alliancetherapeutic alliance between patient andbetween patient and
therapist is the single element most responsibletherapist is the single element most responsible
for the success of psy-chotherapy.for the success of psy-chotherapy.
 Where else can patients find an accepting, non-Where else can patients find an accepting, non-
judgmental atmosphere in which to discussjudgmental atmosphere in which to discuss
their innermost urges, secrets, andtheir innermost urges, secrets, and
disappointments?disappointments?
 The effective therapist is someone who can beThe effective therapist is someone who can be
accepting, nonjudgmental, objective, insightful,accepting, nonjudgmental, objective, insightful,
and professional all at the same time.and professional all at the same time.

23. ANXIETY REDUCTION/RELAESE OFANXIETY REDUCTION/RELAESE OF
TENSIONTENSION
 Initially, it is important that the anxietyInitially, it is important that the anxiety
accompanying the patient's problems in livingaccompanying the patient's problems in living
be reduced enough to permit examination ofbe reduced enough to permit examination of
the factors responsible for the problems.the factors responsible for the problems.
 The essential conditions are required to reduceThe essential conditions are required to reduce
the anxiety of clients.the anxiety of clients.

24.  In instances in which the anxiety level isIn instances in which the anxiety level is
extremely high, some patients may require, onextremely high, some patients may require, on
medical advice.medical advice.
 Some clients may experience side effects toSome clients may experience side effects to
medications, and medications may actuallymedications, and medications may actually
interfere with some forms of psychologicalinterfere with some forms of psychological
treatmenttreatment

25. INTERPRETATION / INSIGHTINTERPRETATION / INSIGHT
 Many nonprofessionals erroneously viewMany nonprofessionals erroneously view
psychotherapy as a rather straightforwardpsychotherapy as a rather straightforward
process in which in the end the personprocess in which in the end the person
achieves the insight.achieves the insight.
 With the sudden, explosive force of revelation,With the sudden, explosive force of revelation,
this insight strikes home. A brief period ofthis insight strikes home. A brief period of
wonderment follows, as the problem falls awaywonderment follows, as the problem falls away
like melting snow.like melting snow.
 This, of course, is a scenario from a bad movieThis, of course, is a scenario from a bad movie
or from the fantasies of a beginning therapistor from the fantasies of a beginning therapist
 There is, however, an element of reality in theThere is, however, an element of reality in the
foregoing scenario.foregoing scenario.

26.  A broad band of psychotherapies does attachA broad band of psychotherapies does attach
importance to patients' childhood experiences,importance to patients' childhood experiences,
 InterpreInterpretation is a very common component oftation is a very common component of
psychotherapy.psychotherapy.
 An important element in many forms ofAn important element in many forms of
psychotherapy is the attempt to get the patientpsychotherapy is the attempt to get the patient
to view past experience in a different light.to view past experience in a different light.

27.  The importance attached to insight has erodedThe importance attached to insight has eroded
over the years.over the years.
 Insight may be seen as a facilitator ofInsight may be seen as a facilitator of
psychological growth and improvement, but notpsychological growth and improvement, but not
as something that by it will inevitably bringas something that by it will inevitably bring
about such changes.about such changes.
 Indeed, waiting for insight to free one fromIndeed, waiting for insight to free one from
problems can be a delaying tac­tic used byproblems can be a delaying tac­tic used by
some patients to avoid taking the responsibilitysome patients to avoid taking the responsibility
for initiating changes in their livesfor initiating changes in their lives..

28. BUILDING COMPETENCE / MASTERYBUILDING COMPETENCE / MASTERY
 In one sense, a goal of most therapies is to make theIn one sense, a goal of most therapies is to make the
client a more competent and effective human being.client a more competent and effective human being.
 Therapy can be a setting in which the client learnsTherapy can be a setting in which the client learns
new things and corrects faulty ways of thinking.new things and corrects faulty ways of thinking.
 The client may be "tutored" on more effective ways toThe client may be "tutored" on more effective ways to
find a job, or sexual information may be provided tofind a job, or sexual information may be provided to
help alleviate past sexual difficulties and promote ahelp alleviate past sexual difficulties and promote a
better sexual adjustment in the future.better sexual adjustment in the future.
 Bandura (1989) has emphasized the importance ofBandura (1989) has emphasized the importance of
feelings of self­efficacy in promoting a higherfeelings of self­efficacy in promoting a higher
performance level in the individualperformance level in the individual

29. NONSPECIFIC FACTORSNONSPECIFIC FACTORS
 Call it faith, hope, or expectations for increasedCall it faith, hope, or expectations for increased
competence, successful therapy tends to becompetence, successful therapy tends to be
associated with suchassociated with such nonspecific factors.nonspecific factors.
 Numerous factors can conspire to promote suchNumerous factors can conspire to promote such
expectancies.expectancies.
 Successful therapy can almost always beSuccessful therapy can almost always be
characterized as having rekindled the patient's hope,characterized as having rekindled the patient's hope,
faith, and morale.faith, and morale.
 It seems unlikely that therapy can be reduced toIt seems unlikely that therapy can be reduced to
nothing more than what some have disparaginglynothing more than what some have disparagingly
referred to as a placebo effectreferred to as a placebo effect

30.  In U. D. Frank's (1982) description ofIn U. D. Frank's (1982) description of
psychotherapy, he notes that therapy involvespsychotherapy, he notes that therapy involves
a rationale, conceptual scheme, or myth thata rationale, conceptual scheme, or myth that
provides a plausible explanation for theprovides a plausible explanation for the
patient's difficulties and also prescribes a ritualpatient's difficulties and also prescribes a ritual
for restoring equilibrium.for restoring equilibrium.
 So, whatever we call it nonspecific factor,So, whatever we call it nonspecific factor,
placebo effect, or faith – It becomes anplacebo effect, or faith – It becomes an
important element in the therapy processimportant element in the therapy process