Psychotherapy Essentials to Go Achieving Psychotherapy Effectiveness

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Transcript of Psychotherapy Essentials to Go Achieving Psychotherapy Effectiveness

  • PSYCHOTHERAPYESSENTIALSTOGO

    AchievingPsychotherapyEffectivenessMolynLeszcz

    ClarePain

    JonHunter

    RobertMaunder

    PaulaRavitz

    SERIESEDITORS:PaulaRavitzandRobertMaunder

    W.W.NORTON&COMPANYNewYork|London

    ANORTONPROFESSIONALBOOK

  • Contents

    Acknowledgments

    SeriesIntroduction

    1IntroductiontoAchievingPsychotherapyEffectiveness2LearningObjectives3CommonFactorsandtheImportanceofRelationships4DevelopingaSharedUnderstandingofaClientsRelationalWorld5EngagingintheProcessofTherapy6AccountingforTrauma7FinalThoughtsGlossary

    LessonPlans

    Quiz

    AppendixA:Role-PlayTranscripts

    AppendixB:PracticeReminderSummary

    AppendixC:AnswerKey

    AppendixD:TherapistWorksheet:AssessingandReflectingonCommunication

    AppendixE:RecommendedReadings

    References

    PracticeReminderCard

  • OTHERTITLESINTHESERIESINCLUDE:

    CognitiveBehavioralTherapyforDepressionMarkFefergrad&AriZaretsky

    CognitiveBehavioralTherapyforAnxietyMarkFefergrad&PeggyRichter

    InterpersonalPsychotherapyforDepressionPaulaRavitz,PriyaWatson,&SophieGrigoriadis

    MotivationalInterviewingforConcurrentDisordersWayneSkinner&CarolynneCooper

    DialecticalBehaviorTherapyforEmotionDysregulationShelleyMcMainandCarmenWiebe

  • MolynLeszcz

    Forallwhohavetaughtme.

    ClarePain

    Dedicatedtoallthosewhoworktohealfromtraumaticexperiences.

    JonHunter

    Formykids,whohavetaughtmesomuch.

    RobertMaunder

    ForMomandDad.

    PaulaRavitz

    Formyfamily.

  • SeriesIntroduction

    Psychotherapyworks.Meta-analysesdemonstratethatpsychotherapyreducesthesymptomsandimpactofthementaldisordersthatmostcommonlyinterferewithpeopleslives,includingdepression,anxiety,andtheextraordinarychallengesthatemergefromconcurrentaddictions,mentalillnesses,andpersonalitydisorders.Theconsensustreatmentguidelinesthatprovideclinicianswithevidence-baseddirectionfortreatingdepression,anxiety,andothermentaldisordersrecommendpsychotherapy,sometimesasafirstlineoftreatment.

    Atthesametime,practicingeffectivepsychotherapyisverychallenging.Foronething,treatmentguidelinesrecommendspecificmodalitiesofpsychotherapyforspecificdisorders,suchasInterpersonalPsychotherapy(IPT)fordepression,CognitiveBehavioralTherapy(CBT)fordepressionoranxiety,MotivationalInterviewing(MI)formentalhealthissuesandsubstanceabusedisorders,andDialecticalBehaviorTherapy(DBT)forborderlinepersonalitydisorder.Therapistsworkingatthefrontlinesofmentalhealthcareseealloftheseproblems,butacquiringextensivesupervision,training,andcertificationinanyoneofthesemodalitiesiscostlyandchallenging,andbeinganexpertinalltypesofpsychotherapyisvirtuallyimpossible.Howcanafront-linetherapistusethecoreskillsofdifferentmodalitiesofpsychotherapyeffectivelytohelphisorherclientsovercomethedebilitatingeffectsofmentalillness?

    PsychotherapyEssentialstoGorespondstothechallengethattherapistswhoarenot(yet)expertsfaceinacquiringthecoreskillsofpsychotherapy.Itisdesignedtobeusefulforbothnewtherapistsandthosewhoaremoreexperiencedbutwanttolearnthecoretechniquesofdifferenttypesofpsychotherapy.Italsoisarefreshercourseonthetechniquesthatexperiencedtherapistsarealreadyfamiliarwithandcanbeusedforteachingcounselingtechniquestohealthworkers.

    Thisprojectemergedinresponsetotheneedsofmentalhealthcareworkerswhowerefacingextraordinarychallenges.Workingincommunityclinicsinremote,underservicedareas,theseclinicianswereunabletoprovidepsychotherapytotheirclientsbecausetheyhadminimalpsychotherapytrainingandlimitedmeansofacquiringit.Caseloadswereoftenheavyandresourcesforreferringclientstopsychotherapistswereextremelylimited.Theseclinicianswantedtobutwereunabletousepsychotherapeutictechniquestohelptheirclientswhoweresufferingfromdepression,anxiety,andconcurrentdisorders.Needlesstosay,itwasnotfeasibleforthesehealthworkerstoobtainthetraining,observation,andone-to-onesupervisionthatarerequiredtobecomeexpertsinspecificmodalitiesofpsychotherapy.Surely,therewasabetteralternativethanprovidingnopsychotherapyatall!

    Drawingonthewealthofexpertiseofthecontributingauthorsinthisseries,whoareallfacultyorstaffathospitalsaffiliatedwiththeUniversityofToronto,wecreatedthemanualsandvideosthatareatthecoreofthePsychotherapyEssentialstoGomaterialsaswellasalloftheaccompanyinglessonplansinordertomeettheneedsofcliniciansand

  • theirclients.Themanuals,videosandlessonplansworked.Wetestedthematerialsthatwedevelopedwithhealthcareworkersofseveraldisciplinesandlevelsofexperiencefromthecaseworkersincommunitymentalhealthcareclinicswhoseneedsinitiatedtheprojectandtomedicalstudents,nurses,familymedicineandpsychiatryresidents,andsocialworkers.Theirknowledgeincreased,theyusedthetechniquesthattheyhadlearned,andtheyreportedthattheyhadbecomemoreconfidentandeffectiveclinicians,evenwithdifficultclients.Evenseasonedtherapistsbenefitedfrombrushinguponthespecifictherapyprotocols.

    ThefirstfivebooksandDVDsofthePsychotherapyEssentialstoGoseriesteachtheskillsofMotivationalInterviewing,CognitiveBehavioralTherapy(foranxietyandfordepression),DialecticalBehaviorTherapy,andInterpersonalPsychotherapy.Thesematerialsarenotintendedtoreplacefulltrainingintheseevidence-supportedpsychotherapeuticmodels;rather,theyintroduceanddemonstratetechniquesthatcliniciansandstudentscanintegrateintotheircareofpeoplewithcommonmentalhealthproblems.

    ThissixthbookanditsaccompanyingDVDaddresspsychotherapyeffectivenessacrosseverymodalityoftherapy.Regardlessofwhichtypeofpsychotherapyatherapistprovides,doingpsychotherapyrequirestherapiststobeflexibleandresponsivetotheirclients.Alsotherapistsandclientsmustformandsustainastrongworkingrelationship:thetherapeuticalliance.Ineverymodalityofpsychotherapy,agoodtherapeuticallianceleadstogoodclinicaloutcomes.Withsomeclientsthechallengesencounteredinformingandmaintaininganallianceprovideawindowontheinterpersonaldifficultiesthatruninterferenceinsomeoftheirotherimportantrelationships.Thisbookonpsychotherapyeffectivenesssynthesizesthemostimportantcommonfactorsofpsychotherapiesandprovidesatherapistwithanapproachtounderstandingandmanagingchallengestoestablishingandmaintainingatherapeuticalliance.

    Learningpsychotherapymeanschanginghowyoubehaveasaclinicianandchanginghabitualbehaviorisnotoriouslydifficult.Learningnewprofessionalbehaviortakestimeandpracticeyouneedtoexperienceanewwayofbehaving;itisntenoughtoreadaboutitorhearaboutit.Experientiallearningismosteffectivewhenitincludesdemonstration,modeling,andpractice.Foreachbookintheseries,wesuggestthatyoufirstwatchtheDVD,thenreadtheaccompanyingtext,andthenfollowtheinstructionsinthelessonplanstopracticeandconsolidateyourlearning.Takethequizbeforestartingthisprocessinordertoassessyourknowledgeandyourneeds,andthentakeitagainafterhavingcompletedallofthelessons,inordertoassessyourprogress.Afterward,usethesummarycardofpracticeremindersinyourdailyclinicalwork.

    Forthoseinterestedinmoretraining,furtherreadingandclinicalsupervisionarerecommended.WehopethatthetechniquespresentedintheseintroductoryPsychotherapyEssentialstoGomaterialswillexpandyourclinicalrepertoireandwillimproveyourcompetenceandconfidenceinworkingwithclientswithmentalhealthproblems.

    Notesaboutlanguage.First,thosewhoprovidecareandtreatmentforpeoplewithmentalhealthproblems,andindividualswhoreceivethatcare,preferawiderangeof

  • namesforthoseroles,andsomehavestrongfeelingsabouttheirpreferences.Forthesakeofconsistency,throughoutthisserieswerefertotheformerindividualsastherapists(occasionallyoptingforcliniciansforthesakeofsomevarietyofexpression)andthelatterasclients.Wedothisinspiteofthefactthatsomemodalitiesofpsychotherapyareexplicitaboutwhichtermsarepreferable.Wehopethesearereadtobetheinclusiveandnonprescriptivechoicesthatareintended.Second,thegenderofthetherapistsandclientswearediscussingisirrelevant.Wehaveadoptedtheconventionofreferringtothetherapistasfemaleandherclientasmale,forthesakeofeconomyoflanguage.Whendiscussingdevelopmentalprocesses,thechildwehaveinmindistheonewhowillgrowupintoaclient,sowehavegenerallymadehimmaleaswellforconsistency.Whendiscussingachildandhisorherprimarycare-provider,wecalltheadultinthatroleaparent,acknowledgingthatthereareotherswhoalsoservetheparentingrole.

    PaulaRavitzandBobMaunder

  • PSYCHOTHERAPYESSENTIALSTOGO

    AchievingPsychotherapyEffectiveness

  • 1::IntroductiontoAchievingPsychotherapyEffectiveness

    EachofthepreviousbooksinthePsychotherapyEssentialstoGoseriesisderivedfromaspecifictypeofpsychotherapythatisdescribedinamanualandsupportedbyevidence.Thisbookisalittledifferent.Justlikeitspredecessors,itisgroundedinevidence-supportedpsychotherapypractices;however,unliketheotherinstallmentsofthisseries,AchievingPsychotherapyEffectivenessdoesnotdescribeaparticularmodality.Instead,wefocusontheories,principles,andpracticesthatimprovetheeffectivenessofalmostanytypeofpsychotherapy.Weprovideananswertothisquestion:Whatcanimproveatherapistseffectiveness?

    Theauthorscometothisquestionfromdifferentdomainsofexpertise,fromInterpersonalPsychotherapy,grouppsychotherapy,andpsychotherapeuticapproachestotraumaandtoadaptingtoseriousillness.Differenttypesofpracticeledustofavordifferentmodelsofpsychotherapy,buteachofusturnstoevidencetodeterminetheelementsofourworkthataremostvaluableandmostimportanttoteachandreinforce.Theevidenceleadsustoagreeontheessentialingredientsthatarecommontoeffectivepsychotherapiesofeverytype,andthisbookprovidesaworkingsynthesisofthoseingredients.AchievingPsychotherapyEffectivenessendeavorstohelpyoutobecomethemosteffectivepsychotherapistthatyoucan,regardlessofthemodelofpsychotherapythatyoupractice.

  • 2::LearningObjectives

    Thefollowingobjectiveswillhelpyoutofocusyourlearningasyoureadthetext,viewtheDVD,andcompletethelessonplans.

    Attheendofthisbook,wehopethatyouwillbeabletoachievethesegoals:

    1.Listthetherapistsqualitiesthatcanpromoteatherapeuticalliance.

    2.Devel