Abnormal behavior therapy

2021-07-15 04:52 PM

No evaluation interview is the same 

The primary focus of the following chapters is on the effectiveness of various therapeutic techniques. Such a focus ignores the fact that relationships in therapy are intrinsically person-to-person, including the relationship between the client and the therapist. Therapy is not simply the systematic application of a set of techniques without regard to the therapeutic formula, to the client's needs and responses to therapy. Therefore, this chapter focuses on the treatment process and how the therapist and client influence its effectiveness. By the end of this chapter, you will understand:

Process of assessment and intervention in clinical work sessions.

Client factors influence treatment outcomes.

Therapist characteristics.

Their work in therapy sessions.

Therapy is often described as a 'one hour only 50 minutes' undertaking. During these 50 minutes, the therapist will record points to note, review symptoms during treatment, and may plan therapy for the next working session, or right in the treatment session. will come. Usually, the therapist spends the first one or two sessions understanding the problems the client is having; see why they choose to come to you at this time and not any other time; what problems they want to share and how they want to make changes. The therapist will guide his or her work after conducting these introductory sessions. The final sessions will be devoted to seeing how the individual will cope in the future and the gradual release of dependence on the therapist.

Evaluation problems

Although much progress has been made thanks to the rich and varied development of different methods, the clinical interview remains the primary tool for understanding client problems. Shea (1998) sets out six goals of this initial assessment:

Establish a therapeutic relationship between the client and the therapist.

Learn basic information about the client.

Must understand the client's problem.

Try to explain these problems: what it is, what causes the problems, and so on.

Planned intervention plan: relax, identify and change cognitive errors, increase activity etc.

Create a feeling of peace of mind about the treatment for the client.

No evaluation interview is the same as another. However, there are basic pieces of information that every therapist wants to have after the interview. That is:

Manifestations of the problem: including the nature of the problem that prompted the client to seek help; emotions and other problems they are experiencing; about when these things appear and take place; have these problems happened before; the impact of these problems on the client's daily life; and how is the client coping with his or her problems?

Circumstances where the problem occurs: include the family and social circumstances in which the client lives; whether the client has support from those two environments; work and other related social issues such as legal issues.

Client characteristics: including the client's strengths and weaknesses; their expectations of the therapist.

It is very important that the therapist not only listens to the client but also observes them. The therapist can check to see if their appearance speaks to the client's problem - whether they are indifferent to themselves; Does the client's appearance indicate that the client is depressed, or manic...? The therapist can look for evidence of the client's abnormal thinking. Oddly enough, it is often the evidence itself (self-evidence). However, that is usually not the case. It is easy to understand when a client tells his or her story from their own perspective and perception. And through the distortion of current perception, they have absolute confidence that it is true. Therefore, the issue must be examined so closely that the therapist can determine whether it is true that the client has a distorted perception, and if so, where it is. In addition, it is also very important to pay attention to the mood of the client. Do they suffer from major depression? Do their feelings match what they say? Each emotion can reveal the nature of the problem and the client's response to it.

This step is an important step in the treatment process, because it gives us an initial picture of the problem (see chapter 1) and how the treatment will be carried out in the future. early period. Surprisingly, few studies have evaluated the reliability and validity of this procedure (Powel and Lindsay, 1994). It is certain that this step will produce as many biases as those present in the diagnostic process. The therapist factor can lead to failure if there is bias in questioning the client; do not understand the information given; and failed to identify matches for the client's well-informed utterances. The client also has a role to play in this process. Many people find it difficult to tell a stranger their personal, secret stories. They withhold important information and wait until the therapist has built their trust in them before they can confide in them. To avoid these, it has been argued that the therapy process requires the therapist to have a better understanding of the client's problem and then to test and reassess that perception through the process. therapy. Therefore, while the initial assessment of the client's problem may be less accurate, the therapist's examination and review will further deepen the client's perception of the problem in the treatment process. Whether. It has been argued that the therapeutic process requires the therapist to have a better understanding of the client's problem and then to examine and reassess that perception through the course of therapy. Therefore, while the initial assessment of the client's problem may be less accurate, the therapist's examination and review will further deepen the client's perception of the problem during treatment. Whether. It has been argued that the therapeutic process requires the therapist to have a better understanding of the client's problem and then to examine and reassess that perception through the course of therapy. Therefore, while the initial assessment of the client's problem may be less accurate, the therapist's examination and review will further deepen the client's perception of the problem during treatment. Whether.

Standard interview process

The initial evaluation interviews of many therapists are unstructured interviews. However, there are also many standardized interview procedures. In such interviews, the therapist asks prepared questions and is often directed at determining whether the subject has diagnostic criteria for a particular disorder. Often used more in clinical research than in clinical practice, because in research it is very important to identify the study object and ensure that it can be compared with other groups of subjects with the same diagnose.

Perhaps the most widely used is the structured clinical interview (APA 2000) designed to elicit sufficient information to make a diagnosis according to the DSM. However, there are other types of interviews such as: Diagnostic Interview Schedule (Diagnostic Interview Schedule - Robins et al. 1981) and Diagnostic Interview Schedule for Children (Diagnostic Interview Schedule for Children - Costello et al. 1985) ). Although such standardized tools have been used, the consensus among observers in making a diagnosis is far from perfect.

Other assessment approaches involve the use of self-scoring questionnaires. These methods can measure both general problems and specific problems. Some are simply measuring the severity of a problem. Others such as the Beck Depression Inventory (Beck Depression Inventory - Beck et al. 1961) provide cut-off points. If the score is above the cutoff point, the likelihood of a diagnosis status after the formal diagnostic interview is high.

These types of assessments provide simple, relatively effective screening tools for investigating the presence of mental health problems, but do not provide a detailed, complete clinical picture. These measures are widely used in clinical practice and have a high degree of reliability that is repeated, resulting in a relatively consistent classification of the client. Examples of these types of measures are briefly summarized below:

Specific symptom measurements

There are many other assessment tools that are also used. What all these tools have in common is observing key behaviors. For example, a therapist might visit a patient with a phobia at home, observing how they cope with a fear-related problem. Observation can be done through role-playing. For example, a cognitive assessment may involve talking out loud while imagining yourself in a situation or role-playing. A more well-founded approach might include a process known as thought sampling. In these models, at predetermined times, which can be identified by clock beeps, an individual can speak loudly and what they are thinking at the time will be recorded. An alternative approach also helps assessment based on the client's diary. This diary was used to measure key factors in therapy including frequency of panic attacks or anger, the nature of cognitive responses to events, and the effectiveness of the practice. new adaptive behaviors such as relaxation or cognitive restructuring.

Work through the problem

Before making a final assessment, the therapist understands and provides a preliminary explanation of the issues facing the client. This will determine the focus and content of the various interventions during therapy. For example, in cognitive-behavioral therapy, issues covered in therapy would include uncovering inappropriate perceptions or behaviors through Socratic dialogue, learning to relax, etc. Typical therapy sessions are divided into 3 steps:

Review the homework assigned from the previous session.

Identify and work on new problems according to a predefined plan or problems that arise from a previous session.

The therapist and client jointly consider how new skills or insights can be applied to the 'real world' as homework for clients. This type of exercise requires the client to practice new skills in a planned manner.

Some interventions, such as teaching anxiety management skills (relaxation, self-training), may follow a pattern of designed intervention. With these interventions, there is even a manual detailing the content of each week's therapy session. Other interventions, such as for anorexia nervosa or depression, maybe less structured or more dependent on the needs of the client. The duration of therapy also varies depending on the method. Clients in cognitive therapy may attend only 8-12 weeks of therapy. On the other hand, psychoanalytic therapy usually lasts much longer.

Some of the specific interventions performed in the second step of therapy were reviewed in previous chapters and described with specific disorders. Instead of repeating them here, we will look at a few more general elements that benefit clients in therapy. Powell and Lindsay (1994) identify many important and common components to many cognitive-behavioral interventions, including:

Establish achievable expectations: whether manifest or not, it is important to convince the client that progress will be made. However, they are also forewarned that there is no such thing as an overnight miracle, that everything takes time and change must be gradual, step by step.

Reinforcement of progress: the client is reassured about achievable success, or about mastery and motivation to continue solving his or her problems.

Feedback on progress: the client's belief in change is highlighted by feedback on progress. When clients face problems or failures positively, it also means that they have made progress. Instead of seeing failure as evidence of incompetence or incompetence, they can reframe the experience to promote positive change later.

Ensure a step-by-step approach to change: progress is gradual so that the client can adapt. Cognitive-behavioral therapy programs see those that provide skills: skills to identify and change cognitive maladaptive, relaxation skills, social skills, and adjustment skills before the interference of others in his life etc. For all skills, progress is made through practicing simple skills in relatively simple situations before they are complicated and used in more difficult situations. It is important that the steps in progress are large enough for the client to feel progress, but not so difficult for them to feel discouraged or give up. The cooperation of the client to achieve the goal is essential.

Modeling: The therapist may ask the client to practice model learning skills. Some interventions aimed at teaching specific skills, such as social skills, may include quantitative identification of existing patterns of new behavior. Modeling can also be explicit or implicit. Through silent interaction or asking about opinions and preferences, the therapist can provide appropriate behavioral patterns. Through Socratic dialogue, a therapist can identify and analyze maladaptive perceptions and provide a model that clients can follow outside of the therapeutic situation.

Practice: The more you practice each new skill, the easier it is to use, especially in emotionally stressful situations. Thus, in cognitive-behavioral therapy, clients need to practice new skills, first in therapy sessions and then at home. Combined with a step-by-step approach, skills are built and gradually maximized the effectiveness of behavior change learning.

When it comes to more general principles, Frank (1961) argues, in his draft of Persuasion and Reconciliation, that the reason clients seek therapy is that they are so demoralized that they need to be treated. seek help. He argues that therapy, as we define it, creates four factors that benefit the client:

The relationship between the client and the therapist.

The therapeutic setting is socially acceptable as a place for reconciliation.

The theory explains the development of the problem.

The intervention is based on that theory.

Therapy sessions provide opportunities for learning; strengthen the client's confidence and hope in remission; helping them see successful experiences that increase their ability to master, overcome others' feelings of hate, and stimulate them emotionally. Frank (1961) asserts that such results can be obtained from therapy sessions as well as in informal sessions of wizards or healers.

End of treatment

The end of therapy must be carefully planned, especially when the client has been in therapy for a long time. Prepare for the end of therapy with treatments that have been going on for a long time and the therapist has helped the client to deal with acute and personal issues that are often more elaborate than those of time short and not with emotional problems, like stress management group. Such preparation typically includes three elements:

A summary of progress made during therapy: including a review of the client's initial dysfunctions, early treatment outcomes, and how far they have progressed.

Therapeutic Progress Analysis: analysis and feedback on the progress clients have made, what can confirm and reinforce action and the potential to solve similar problems in the future.

Looking into the future: includes looking at what problem’s individuals may face in the future and what they can do to prevent and deal with them?

With different therapeutic approaches, the specific content of these problems is also different. Working time is also different depending on the length of treatment, with preparation, the time will not last more than a few sessions. The number of sessions may gradually decrease towards the end of the therapy period as the client gradually becomes independent and copes well on his own without the therapist's intervention as support. Finally, it is important to see if the client will find the therapist again when he or she is unable to cope with future situations. And it is not superfluous if the therapist considers the client's return to therapy when the need arises. Another approach that is becoming more and more applicable is to plan a future session when the client has a dilemma, then the therapist and client can discuss and think together even if the client has coped relatively well. Support sessions like these have been shown to be effective in preventing relapse.