Interventions Exam I

Informed and intentional application of clinical methods and interpersonal stances that are derived from established psychological principles to assist people in modifying behaviors, cognitions, affect, and other characteristics in the direction that the participants define as desirable.

• 1. Guides Therapy
• 2. Describes presenting symptoms, problems, behaviors
• 3. "delimits" relevant information
• 4. Serves to organize info
• 5. Helps in conceptualization
• 6. Guides treatment, interventions

• 1. Cognitive
• 2. Behavioral
• 3. Affective
• 4. Development
• 5. Systemic
• 6. Contextual
• 7. Spiritual

• 1. provides understanding of case (conceptualization)
• 2. provides guidance on how to proceed (interventions)
• 3. provides way to evaluate its effectiveness (evaluation)

• 1. Assess client's needs
• 2. Developing conceptualization and treatment plan
• 3. Selecting Interventions
• 4. Implementing and evaluating interventions

• 1. engaging the client
• 2. assessing problems and strengths
• 3. establishing a working contract
• Tasks are repeated through therapy process

• 1. monitoring relationship
• 2. direct work, implementing techniques
• 3. monitor progress, modifying treatment

• 1. modifying relationship
• 2. evaluating progress and accomplishments
• 3. referrals, transferring learned skills
• 4. addressing termination and loss
• 5. tapering sessions

• 1. Interpretation
• 2. Insight
• 3. Good therapeutic relationship
• 4. Therapist characteristics
• 5. Behavioral change
• 6. Support

• 1. Client's positive expectations of therapy
• 2. Therapeutic Relationship

Client's faith and confidence in therapy, the therapist, and the process of treatment

• 1. Congruent
• 2. Genuineness
• 3. Unconditional Positive Regard
• 4. Empathy

covert and overt activities people engage in therapy to make changes to behavior, affect, cognitions, and realtionships related to problem of development

• Raising client's level of awareness leads to change
• Therapies emphasize conscious awareness-increase info available so clients can make best response
• Feedback and Education

Release of emotions in therapy leading to change

• Modifying stimuli that control how we respond
• Can change how we respond to specific stimuli or change the environment so the stimulus doesn't occur often

Changing our responses to stimuli

changing environment to minimize stimulus occurence

• Contingency Control: Behavior occurence based on the consequences following behavior. If contingencies are changed, likely to change behavior
• Contingency Management: modifying contingincies in environment
• Re-evaluation: modifying responses to consequences without changing contingencies

• 1. client factors
• 2. therapeutic relationship
• 3. hope and expectancy for change
• 4. theoretical model/intervention

• 1. Precontemplation
• 2. Contemplation
• 3. Preparation
• 4. Action
• 5. Maintenance
• 6. Relapse
• 7. Treatment

• Uninformed about the consequences of their behavior, demoralized
• Denial of any problem
• Resistant, not ready for treatment

• 1. Validate lack of readiness
• 2. Clarify: decision is theirs
• 3. Encourage re-evaluation of current behavior
• 4. Encourage self-exploration, not action
• 5. Explain ad personalize the risk

• See that there is a problem but not ready to act.
• Procrastination and ambivalence.
• Waiting for the magic moment.

• 1. Validate lack of readiness
• 2. Clarify: decision is theirs
• 3. Encourage evaluation of pros and cons of problem and behavior change
• 4. Identify and promote new, positive outcome expectations

• Plan of action.
• Has typically taken some action in the past

• 1. Identify and assist in problem solving re: obstacles
• 2. Help patient identify social support
• 3. Verify that patient has underlying skills for behavior change
• 4. Encourage small initial steps

Specific, overt modification in lifestyle; sustained effort at making changes

• 1. Focus on restructuring cues and social support
• 2. Bolster self-efficacy for dealing with obstacles
• 3. Combat feelings of loss and reiterate long-term benefits

• 6-12 months of no symptoms
• maybe up to 5 years of effort
• not a static change

• 1. Plan for follow-up support
• 2. Reinforce internal rewards
• 3. Discuss coping with relapse

• 1. Establishing the relationship and defining the problem
• 2. Assessment and establishing counseling goals
• 3. Designing and implementing interventions
• 4. Termination, follow-up, and evaluation

• 1. Therapist factors (empathy, congruence, interpersonal/communication skills)
• 2. Working alliance between client and therapist

Therapeutic Relationship

• 1. Collaborative
• 2. Understanding
• 3. Consistency

• 1. Client sense of safety
• 2. perception of being understood
• 3. satisfaction with therapy
• 4. decreases premature termination
• 5. allows client exploration

• 1. Feel with the client without taking on the client's feeling
• 2. Take on client's feelings and obsess about client after session

• 1. Communicating understanding
• 2. Feeling sorry/sad for the client

considering the context and society of both the therapist and client

• Valuing the client
• Appreciating the client as a unique and worthwhile person
• Noncritical attitude and speech
• Expressing positive regard: affirming client's sense of worth

• Core trait in the helping relationship
• Behaving in a moral and ethical manner
• Being reliable and consistent
• Respond in a caring and respectful manner
• Interactional and reciprocal

• Genuineness in therapeutic relationship
• Honesty
• Open expressions of feelings and attitudes

• Attention communicated: Facial expressions, eye contact, body positions and movement, verbal responses
• Barriers: being judgmental, biased or piegeonholing; attending to facts, interrupting, personal and cultural preferences

• Therapist and client agreement on
• therapy goals
• actions steps for attaining goals
• emotional bond in therapeutic realtionship

• when client and therapist succumb to hostile expressions during the therapy session
• 1. Confrontation
• 2. Withdrawal

• 1. Discuss the relationship and what is occurring
• 2. Take responsibility for your role in the rupture
• 3. Allow yourself to apologize for misunderstandings
• 4. Give client space to express fears about negative feelings and about the relationship
• 5. Be aware of your countertransference

• 1. Focusing on the first issue in a session
• 2. Overlooking physical or medical issues
• 3. Desire to rescue clients from their unhappiness
• 4. Perfectionistic tendencies
• 5. Unrealistic expectations
• 6. Getting carried away with the latest techniques
• 7. Geting lost in the counseling process
• 8. Using inappropriate phrases
• 9. An excessive desire to help
• 10. An excessive desire to be liked
• 11. Getting too emotionally involved
• 12. Taking things too personally
• 13. Difficulty differentiating normal from abnormal
• 14. Being uncertain about self-disclosure
• 15. Being uncertain about confidentiality

• -Natural interest in people
• -Ability to listen
• -Comfortable with verbal communication
• -Empathetic and understanding
• -Ability to introspect

• 1. Consent of client/guardian to release info
• 2. Court order
• 3. Continued treatment requiring communication with healthcare agencies (insurance)
• 4. Comply with the law- mandatory reporting
• 5. Communicate a threat, or warn individuals of clear and imminent danger (alternative = Crisis)

• 1. Failure to Protect
• 2. Failure to Warn
• 3. Failure to Prevent

whether counselor has caused harm to client

professional negligence, not following accepted standards

• -Follow ethical standards
• -Follow accepted practices
• -Carry liability insurance
• -Consult
• -Liability can be civil or criminal

• Pros:
• -can help strengthen relationship
• -can normalize experiences for the client

• Cons
• -can put therapist in danger
• -could be bad for the client if it removes safety of the therapy relationship

• -Will it benefit the patient?
• -How much discomfort will it cause the therapist?
• -Is it about therapist's outside life or within the session?
• -What purpose does answering the question serve?

clients react to therapist based on elements from their past

1. Focus on the immediate relationship: "you seem angry at me and I wonder what that's about"

2. Interpret the meaning of the transference: "perhaps your anger towards me is related to the frustration of having you dad be so unavailable to you"

3. Use questions to promote insights: "can you recall an earlier time in your life when you felt angry like this"

4. Teach, advise, and educate about the transference: "we all have times where we transfer emotional reactions from prior relationships onto other people who are significant to us. When it happens here, it is usually useful for us to process in the session. As I'm saying this, are  you aware of any particular reactions that you are having about me?"

5. Self-disclosure: "there are also times in my life where I react to someone in my current life with unresolved issues from my past"

the therapist's feelings and attitudes about the client

• 1. Gain Awareness: become aware of strong emotional reactions to client; practice self-insight
• 2. Develop conceptual understanding: awareness of hunches about what is happening at the moment relating to the client
• 3. Examine and take responsibility for contributions to relational issues with clients
• 4. Empathetic attunement: manage own anxiety to manage defensiveness, be aware of self and client
• 5. Boundaraies or self-integration: be able to separate self from other
• 6. Seek group and individual consultation and supervision

Affiliative: client desires to bring therapist close

Distancing: behaviors intended to disrupt relationship

• -lack of social skills or knowledge
• -may not understand boundaries
• -uncomfortable discussing intimate aspects of his life

• -may be attempt to express authority or power
• -implicit authority and power the therapist may trigger in the client (especially when therapist is younger)
• -May respond by attempting to make the therapist feel uncomfortable as well

commenting on the therapist's attractiveness or politely asking clinician on a date

a long-standing client who knows the limits who asks the clinician out

a client who is anxious and makes an off-color joke

a client who leers at the clinician and tells her if she wants more info she will have to accompany him to his house