Therapeutic Process

1
Therapeutic Process

• Clinical Assessment
• Therapy

2
Clinical Assessment

• At the initial clinical assessment
• Identify the main dimensions of a clients
  problem.
• Predict the future under many potential
  conditions.
• Understand their range of behavior so that the
  effects of treatment can be measured.
• The goals of assessments include
• Identifying and describing symptoms.
• Determining how often and severe the issue is.
• Determining the potential causal factors.
• Exploring the individuals personal resources
  that might be assets in treatment.

3
Clinical Assessment

• An assessment should include a social history
  including
• Personality factors
• Social context
• For psychological assessment to proceed
  effectively, the
• client must feel comfortable with the clinician.
• Assessment
• Physical
• Psychological

4
Clinical Assessment

• Physical Assessment
• Can be manifested physically as
• Causal factors
• Symptom Patterns
• Medial examination is necessary in the initial
  assessment.
• Neurological non-invasive examinations are
  necessary for brain damage cases
• EEG, CAT, PET, fMRI
• Halstead-Reitan battery
• (Popular neuropsychological examination)
• Halstead Category Test
• Tactual Performance Test
• Rhythm Test
• Speech Sounds Perception Test
• Finger Oscillation Test

5
Clinical Assessment

• Psychological Assessment
• Provides a realistic picture of an individual in
  interaction with his or her social environment.
• Procedures commonly used in psychosocial
  assessments
• Assessment interviews
• Structured
• Unstructured
• Clinical observation of behavior
• General categories of psychological tests
• Intelligence tests such as the WISC-III and
  WAIS-III
• Personality tests

6
Clinical Assessment

• Psychological Tests
• Projective Tests
• Process
• Unstructured stimuli presented to subject.
• Subject projects meaning or structure onto the
  stimuli.
• Projections reveal hidden motives.
• Examples
• Rorschach
• Thematic Apperception Test
• Sentence Completion Test
• Draw-A-Person Test
• Objective Tests
• Process
• Subject is required to read and respond to
  itemized statements or questions.
• Cost effective and fast.
• Examples
• MMPI-2

7
Clinical Assessment

• Projective Tests
• Rorschach
• Hermann Rorschach
• 10 official inkblots
• It is not based on what you see in the inkblot.
• Thematic Apperception Test
• Henry Murray and Christiana Morgan
• Picture interpretation test
• Uses 30 provocative and ambiguous pictures.
• The client must tell the story
• What has led up to the event shown
• What is happening at the moment
• What the characters are feeling and thinking, and
  
• What the outcome of the story was.
• DMM (Defense Mechanisms Manual) and SCOR (Social
  Cognition and Relations)

8
Clinical Assessment

• Projective Tests
• Sentence Completion Test
• Logical extension of word association methods.
• Present the client with a series of partial
  sentences that they must complete.
• Draw-A-Person Test
• Florence Goodenough
• DAP or Goodenough-Harris Draw-A-Person Test
• Children are asked to draw
• Man
• Woman
• Themselves
• Infers a childs level of cognitive development.

9
Clinical Assessment

• Integration of assessment data issues
• Potential cultural bias.
• Theoretical orientation of the clinician.
• Underemphasis on the external situation.
• Insufficient validation.
• Inaccurate data or premature evaluation.

10
Clinical Assessment

• Benefit of classifying abnormal behavior
• The introduction of order
• The enabling of communication
• The enabling of statistical research
• Insurance issues
• Remember A classification systems usefulness
  depends largely on its
• Reliability
• Validity

11
Clinical Assessment

• Three main approaches to classifying behavior
• Categorical Approach
• Patient is healthy or disordered.
• No overlap.
• Dimensional Approach
• Patient falls along a range from superior
  functioning to completely impaired functioning.
• Prototypal Approach
• Conceptual entity depicts an idealized
  combination of characteristics.
• Some of which the patient may not have.
• DSM-IV-TR States that it is categorical but it
  is actually prototypal.

12
Clinical Assessment

• Multiaxial System (Five Axis System)
• Axis I (Reports all disorders except Axis II)
• Clinical Disorders.
• Other Conditions that may be a focus of clinical
  attention.
• Axis II (First diagnosed in infancy/childhood)
• Personality Disorders.
• Mental Retardation.
• Axis III (Diabetes, heart problems, acid
  refluxetc.)
• General Medical Conditions.
• Axis IV (Social Env., lottery, job, divorce,
  schooletc.)
• Psychosocial and Environmental Problems.
• Axis V (GAF Scale, Rank 1-10 on 10 items, 100
  Good, 1 Bad)
• Global Assessment of Functioning.

13
Therapy

• Psychotherapy follows the belief that people with
  disorders can change.
• ______________________________________________
• Why people seek therapy
• They feel overwhelmed by a highly stressful
  situation.
• They were referred by their physician.
• They have experienced long-term distress.
• They feel they have not lived up to their own
  potential.

14
Therapy

• Basic therapeutic relationship includes
• Sense of working collaboratively on the problem.
• Agreement between patient and therapist about the
  goals and tasks of therapy.
• Affective (emotional) bond between patient and
  therapist.
• Qualities that can enhance the process
• Clients motivation.
• Clients expectation.
• Protected setting.
• Good match between client and therapist.

15
Therapy

• Estimated gains depend on many factors
• Therapists impression of changes that have
  occurred.
• Clients reports of change.
• Reports from the clients family or friends.
• Comparison of pretreatment and post-treatment
  scores on tests.
• Measures of change in selected behaviors.

16
Therapy

• Dont forget
• Therapy is not always good.
• Some patients are harmed by therapy.
• Modern treatment choices
• Psychotherapy
• Psychopharmacology
• ECT
• Neurosurgery

17
Therapy

• Pharmacology
• Antipsychotics
• Tardive Dyskinesia
• Atypical Antipsychotics
• Lower risk of side effects
• Antidepressants
• SSRIs (Lexapro, Prozac)
• SSNRIs (Effexor, Cymbalta)
• Monoamine Oxidase Inhibitors
• Tricyclic Antidepressants
• Reuptake blockers
• Trazodone
• Benzodiazepines
• Lithium

18
Therapy

• Electroconvulsive Therapy (ECT)
• Treats severe mood disorders.
• Anesthetics allow patients to sleep through the
  procedure.
• Bilateral ECT appears to be more effective than
  unilateral ECT.
• ECT produces some short-term side effects
  including amnesia.

19
Therapy

• Neurosurgery
• Severe forms of OCD.
• Seizures.
• Avoided at all cost.

20
Therapy

• Psychotherapy
• Behavioral Approaches
• Exposure therapy, Aversion therapy, Modeling,
  Reinforcement, Token Economies
• Cognitive/Cognitive-Behavioral Therapy
• Modifying thought process
• Rational Emotive Therapy, Stress-Inoculation
  Therapy
• Becks Cognitive Therapy states that depression
  results from
• Clients illogical thinking about themselves.
• Clients illogical thinking about the world
  around them.
• Humanistic Therapy
• Client-centered therapy
• Existential therapy
• Gestalt therapy
• Psychodynamic Therapy
• Free association
• Analysis of dreams
• Analysis of resistance
• Analysis of transference