PSYCHOLOGICAL PSYCHOLOGICAL INTERVENTIONS AND INTERVENTIONS AND

THEIR GOALSTHEIR GOALS

Lecture 25Lecture 25

INTRODUCTIONINTRODUCTION

INTERVENTION DEFINED:INTERVENTION DEFINED:

In a most general way, psychological In a most general way, psychological intervention is a method of inducing intervention 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 the Psychotherapy involves intervention in the context of a professional relationship – a context of a professional relationship – a relationship sought by the client or the client's relationship sought by the client or the client's guardians.guardians.

Psychologists are involved in Psychologists are involved in intervention intervention whenever they purposefully try to produce whenever 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 in First, there has been a recent emphasis in clinical psychology (and, indeed, in psychology clinical psychology (and, indeed, in psychology in general) on "positive psychology," including in general) on "positive psychology," including the the promotion promotion of health and positive behaviors.of health and positive behaviors.

This approach typically targets broad This approach typically targets broad populations and is exemplified by programs that populations and is exemplified by programs that teach. For example, stress management, teach. For example, stress management, exercise and healthy eating, and social exercise and healthy eating, and social competence skills.competence skills.

Second, programs designed to Second, programs designed to prevent prevent psypsychopathology and diseases have a longer chopathology and diseases have a longer history.history.

These programs typically target groups who are at These 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 the victims 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 in Third, the most common form of intervention in clinical psychology is psychotherapy: the process clinical psychology is psychotherapy: the process used to used to treat treat various types of disorders once they various types of disorders once they have occurred.have occurred.

GOALS OF PSYCHOLOGICAL INTERVENTIONGOALS OF PSYCHOLOGICAL INTERVENTION

Psychological interventions have been developed Psychological 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

WHAT ARE WE TRYING TO CHANGE?WHAT ARE WE TRYING TO CHANGE?

Psychologists help people change various levels of Psychologists help people change various levels of functioning.functioning.

Some interventions are intended to change what Some interventions are intended to change what people do, to change particular problem people do, to change particular problem behaviors.behaviors.

For example, an intervention may be designed to For example, an intervention may be designed to reduce the amount and frequency of the consumption reduce the amount and frequency of the consumption of alcohol or cigarette smoking. of alcohol or cigarette smoking.

Other interventions are designed to change Other interventions are designed to change emotions emotions by by decreasing emotional dis tress and increasing decreasing emotional dis tress and increasing emotional comfort.emotional comfort.

Other interventions are intended to change the ways Other interventions are intended to change the ways that people that people think.think.

For example, to stop persistent thoughts about a For example, to stop persistent thoughts about a traumatic experience or to help individuals develop traumatic 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 to Psychological interventions also may be designed to change underlying change underlying biological processesbiological processes

Examples include the use of psychological techniques Examples include the use of psychological techniques to reduce blood pressure, lower resting heart rate, or to reduce blood pressure, lower resting heart rate, or decrease headache pain.decrease headache pain.

Finally, interventions can be designed to Finally, interventions can be designed to change the change the environment environment rather than the person, rather than the person,

E.g., changing the structure and resources of a E.g., changing the structure and resources of a junior high or middle schooljunior high or middle school

Most interventions are, in fact, designed to Most interventions are, in fact, designed to produce change in more than one of these produce change in more than one of these levels of functioning.levels of functioning.

Much of the work carried out by clinical Much of the work carried out by clinical psychologists is concerned with the prevention psychologists is concerned with the prevention or treatment of specific forms of or treatment of specific forms of psychopathology as defined in the psychopathology as defined in the DSM-IVDSM-IV..

But clinical psychological interventions are also But clinical psychological interventions are also concerned with broader social problems that concerned with broader social problems that are not included as specific diagnostic are not included as specific diagnostic categories in the DSM-IV.categories in the DSM-IV.

These include problems in learning and These include problems in learning and development, difficulties in daily living, and development, difficulties in daily living, and problems in interpersonal relationships.problems in interpersonal relationships.

Advances in clinical health psychology and Advances in clinical health psychology and behavioral medicine have expanded the focus behavioral medicine have expanded the focus of interventions in clinical psychology to include of interventions in clinical psychology to include a number of physical disorders and diseases.a number of physical disorders and diseases.

Psychologists contribute directly to the Psychologists contribute directly to the prevention and treatment of, among other prevention and treatment of, among other diseases, cancer, diabetes, hypertension, and diseases, cancer, diabetes, hypertension, and AIDS.AIDS.

DEFINING DEFINING PSYCHOTHERAPYPSYCHOTHERAPY

According to Wolberg, psychotherapy is the According to Wolberg, psychotherapy is the treatment by psychological means, of treatment by psychological means, of problems of an emotional nature, in which a problems of an emotional nature, in which a trained person (therapist) deliberately trained person (therapist) deliberately establishes a professional relationship with establishes a professional relationship with the patient to the patient to

(i) remove, modify or retard existing (i) remove, modify or retard existing symptoms, symptoms,

(ii) mediate disturbed patterns of behavior and (ii) mediate disturbed patterns of behavior and

(iii) promote positive personality growth and (iii) promote positive personality growth and development.development.

J. D. Frank (1982) elaborates this general theme as J. D. Frank (1982) elaborates this general theme as followsfollows

‘’‘‘’‘Psychotherapy is a planned, emotionally Psychotherapy is a planned, emotionally charged, confiding interaction between a trained, charged, confiding interaction between a trained, socially sanctioned healer and a sufferer. During socially sanctioned healer and a sufferer. During this interaction the healer seeks to relieve the this interaction the healer seeks to relieve the sufferer's distress and disability through symbolic sufferer's distress and disability through symbolic communications, primarily words but also communications, primarily words but also sometimes bodily activities. The healer may or sometimes bodily activities. The healer may or may not involve the patient's relatives and others may not involve the patient's relatives and others in the healing rituals. Psychotherapy also often in the healing rituals. Psychotherapy also often includes helping the patient to accept and endure includes helping the patient to accept and endure suffering as an inevitable aspect of life that can be suffering as an inevitable aspect of life that can be used as an opportunity for personal growth.’’used as an opportunity for personal growth.’’

By the above definitions we can understand By the above definitions we can understand that psychotherapy is a guide to:that psychotherapy is a guide to:

Finding help for emotional distress (often Finding 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 understand Space and safety to explore and understand yourself.yourself.

Resolve inner conflicts and help to create new Resolve inner conflicts and help to create new potential. potential.

GENERAL GOALS OF GENERAL GOALS OF PSYCHOTHERAPYPSYCHOTHERAPY

Strengthening motivation for making efforts at Strengthening motivation for making efforts at adaptation.adaptation.

Reducing emotional pressure by facilitating Reducing 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.

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 social Bringing about changes in the immediate social environment.environment.

Releasing potential for personal growth.Releasing potential for personal growth.

Helping clients change unproductive ways of Helping clients change unproductive ways of thinking and behavingthinking and behaving

FEATURES COMMON TO MANY THERAPIESFEATURES COMMON TO MANY THERAPIES The apparent diversity among The apparent diversity among

psychotherapies can sometimes lead us to psychotherapies can sometimes lead us to overlook the marked similarities among them.overlook the marked similarities among them.

Yet most psychotherapy has a great deal in Yet most psychotherapy has a great deal in common - a commonality that in many common - a commonality that in many respects outweighs the diversity.respects outweighs the diversity.

Hundreds of "brands" of psychotherapy have Hundreds of "brands" of psychotherapy have been identified.been identified.

Some are effective, whereas others probably Some are effective, whereas others probably are not.are not.

Lambert and Bergin (1994) provide a list of Lambert and Bergin (1994) provide a list of common factors categorized according to a common factors categorized according to a sequential process that they believe is sequential process that they believe is associated with positive outcome.associated with positive outcome.

Briefly, they propose that Briefly, they propose that supportive factorssupportive factors lay the groundwork for changes in clients' lay the groundwork for changes in clients' beliefs and attitudes beliefs and attitudes ((learning factors learning factors – for – for example, cognitive learning, insight), which example, cognitive learning, insight), which then lead to behavioral change then 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.

THE EXPERT ROLETHE EXPERT ROLE It is assumed that the therapist brings to the It is assumed that the therapist brings to the

therapy situation something more than therapy situation something more than acceptance, warmth, respect, and interest.acceptance, warmth, respect, and interest.

In all forms of psychotherapy, patients have a In all forms of psychotherapy, patients have a right to expect that they are seeing not only a right to expect that they are seeing not only a warm human being but a competent one as warm human being but a competent one as well.well.

Mutual understanding and mutual acceptance Mutual understanding and mutual acceptance of the different roles to be played would seem of the different roles to be played would seem sufficient to guarantee the maintenance of sufficient to guarantee the maintenance of mutual re spect.mutual re spect.

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 intellectual maintains a calm, cool, detached or intellectual demeanor is really benefiting.demeanor is really benefiting.

The problems that bring a person to The problems that bring a person to psychotherapy are typically important ones.psychotherapy are typically important ones.

The release of emotions, or The release of emotions, or catharsis catharsis as it is as it is sometimes termed, is a vital part of most sometimes termed, is a vital part of most psychotherapies.psychotherapies.

In some brands of psychotherapy, the goal may In some brands of psychotherapy, the goal may be to gain better control over the expression of be to gain better control over the expression of one's emotions.one's emotions.

RELATIONSHIP/THERAPUTIC ALLIANCERELATIONSHIP/THERAPUTIC ALLIANCE For some the nature of the relationship For some the nature of the relationship or, or,

therapeutic alliance therapeutic alliance between patient and between patient and therapist is the single element most responsible therapist 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 discuss judgmental atmosphere in which to discuss their innermost urges, secrets, and their innermost urges, secrets, and disappointments?disappointments?

The effective therapist is someone who can be The 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.

ANXIETY REDUCTION/RELAESE OF ANXIETY REDUCTION/RELAESE OF TENSIONTENSION

Initially, it is important that the anxiety Initially, it is important that the anxiety accompanying the patient's problems in living accompanying the patient's problems in living be reduced enough to permit examination of the be reduced enough to permit examination of the factors responsible for the problems.factors responsible for the problems.

The essential conditions are required to reduce The essential conditions are required to reduce the anxiety of clients.the anxiety of clients.

In instances in which the anxiety level is In instances in which the anxiety level is extremely high, some patients may require, on extremely high, some patients may require, on medical advice.medical advice.

Some clients may experience side effects to Some clients may experience side effects to medications, and medications may actually medications, and medications may actually interfere with some forms of psychological interfere with some forms of psychological treatmenttreatment

INTERPRETATION / INSIGHTINTERPRETATION / INSIGHT Many nonprofessionals erroneously view Many nonprofessionals erroneously view

psychotherapy as a rather straightforward psychotherapy as a rather straightforward process in which in the end the person process 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 of this insight strikes home. A brief period of wonderment follows, as the problem falls away wonderment follows, as the problem falls away like melting snow.like melting snow.

This, of course, is a scenario from a bad movie This, 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 the There is, however, an element of reality in the foregoing scenario.foregoing scenario.

A broad band of psychotherapies does attach A broad band of psychotherapies does attach importance to patients' childhood experiences,importance to patients' childhood experiences,

InterpreInterpretation is a very common component of tation is a very common component of psychotherapy.psychotherapy.

An important element in many forms of An important element in many forms of psychotherapy is the attempt to get the patient psychotherapy is the attempt to get the patient to view past experience in a different light.to view past experience in a different light.

The importance attached to insight has eroded The importance attached to insight has eroded over the years.over the years.

Insight may be seen as a facilitator of Insight may be seen as a facilitator of psychological growth and improvement, but not psychological growth and improvement, but not as something that by it will inevitably bring as something that by it will inevitably bring about such changes. about such changes.

Indeed, waiting for insight to free one from Indeed, waiting for insight to free one from problems can be a delaying tac tic used by problems can be a delaying tac tic used by some patients to avoid taking the responsibility some patients to avoid taking the responsibility for initiating changes in their livesfor initiating changes in their lives..

BUILDING COMPETENCE / MASTERYBUILDING COMPETENCE / MASTERY

In one sense, a goal of most therapies is to make the In 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 learns Therapy 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 to The client may be "tutored" on more effective ways to find a job, or sexual information may be provided to find a job, or sexual information may be provided to help alleviate past sexual difficulties and promote a help 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 of Bandura (1989) has emphasized the importance of feelings of self-efficacy in promoting a higher feelings of self-efficacy in promoting a higher performance level in the individualperformance level in the individual

NONSPECIFIC FACTORSNONSPECIFIC FACTORS Call it faith, hope, or expectations for increased Call it faith, hope, or expectations for increased

competence, successful therapy tends to be competence, successful therapy tends to be associated with such associated with such nonspecific factors.nonspecific factors.

Numerous factors can conspire to promote such Numerous factors can conspire to promote such expectancies.expectancies.

Successful therapy can almost always be Successful 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 to It seems unlikely that therapy can be reduced to nothing more than what some have disparagingly nothing more than what some have disparagingly referred to as a placebo effectreferred to as a placebo effect

In U. D. Frank's (1982) description of In U. D. Frank's (1982) description of psychotherapy, he notes that therapy involves a psychotherapy, he notes that therapy involves a rationale, conceptual scheme, or myth that rationale, conceptual scheme, or myth that provides a plausible explanation for the provides a plausible explanation for the patient's difficulties and also prescribes a ritual patient'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 an placebo effect, or faith – It becomes an important element in the therapy processimportant element in the therapy process