Week 8 - Clinical Psychology 1

Question 1

Who can make assessment orders?

Answer 1

Only medical practitioners (others can apply to the practitioner to do the assessment)

Question 2

What is an assessment order?

Answer 2

Allows for capacity to be assessed without consent of the person, in order to confirm whether the person meets the assessment criteria, and to determine if the person meets the treatment criteria

Question 3

Who is a part of the tribunal that makes a treatment order?

Answer 3

A chair person (who is a lawyer)

A psychiatrist

A person with experience in mental health

Question 4

How can you prove that a therapy is effective, even if it is not?

Answer 4

Have a strong allegiance to the therapy

Increase patient’s expectations

Use weak spots of randomised trials

Design trial in the right way: small samples, waiting list control groups but no comparative trials

Use the right publication strategy

Question 5

How can randomised control trials be manipulated to produce better results?

Answer 5

“Weak spots” of randomised trials - risk of bias

Small samples

Waiting list control group

No comparative trials

Question 6

What are the “weak spots” of randomised trials?

Answer 6

aka “Risk of bias”

Can randomise participants by using date of admission, date of birth or clinic reord number instead of randomly generating them

Allocation concealment - Can assign participants you expect will respond well to the treatment

non-blinded raters of clinical assessments of outcome

ignoring drop outs

Question 7

How do small sample sizes increase the likelihood that a treatment will be proven effective?

Answer 7

Make it possible that there are systematic differences between groups as..

numbers are not large enough to be able to accurately reproduce a chance distribution of these differences

The influence of outliers is inflated

Question 8

How do waitlist control groups increase the likelihood that a treatment will be proven effective?

Answer 8

Waitlist control groups result in much larger effects for the therapy than other control groups

Question 9

How are treatment orders made?

Answer 9

By the Mental health tribunal (min 3 members to hear a request), following application from an approved medical practitioner. Another approved practitioner must also have assessed when there isn’t an existing assessment order.

Question 10

What might a treatment order require of someone?

Answer 10

Be given specified treatment

Treated at a particular place, such as a hospital or community mental health premises

Require a person who is being treated to be admitted to and detained in an approved facility so that the person can be treated

Provide for other incidental matters that the mental health tribunal thinks are necessary or desirable in the circumstances

Question 11

What are advanced care statements/directives?

Answer 11

Plan put in place in advance of incapacity

In Tas, people with decision-making capacity or a person legally appointed as the enduring guardian can complete an advance care directive.

it may contain instructional directives or values directive

Question 12

In Tasmania, a person who has decision-making capacity is able to do what?

Answer 12

Appoint an enduring guardian

Complete an instructional and/or values advance care directive

Question 13

What does an advance care directive come into effect?

Answer 13

When the person loses decision-making capacity

Question 14

What is an instructional directive?

Answer 14

a person can provide specific directions about treatment that they would consent to, refuse and/or withdraw

Question 15

What is a values directive?

Answer 15

A person can describe their more general views regarding their values and preferences for care

Question 16

What should we base therapeutic practices on?

Answer 16

The scientist-practitioner model

Question 17

What is the scientist-practitioner model?

Answer 17

Scientist-practitioner psychologists embody a research orientation in their practice and a practice relevance in their research

Question 18

What are the criticisms of the scientist-practitioner model?

Answer 18

The changing face of science - behaviourist and beyond

Clinicians can derive knowledge from practice

Science/evidence doesn’t always inform practice

How many practitioners conduct research?

Question 19

What are common therapy factors?

Answer 19

Attributes which are intrinsic to many (if not all) psychotherapeutic approaches

Therapeutic alliance
Expectancies (of client and clinician)
Instilling hope
Providing an explanation of behaviour and rationale for treatment

Question 20

What are specific factors of therapy?

Answer 20

The techniques associated with specific therapies (for example, exposure techniques in CBT). Specific factors must be ‘manualisable’- instructions for the activity must be able to be developed and clinicians must be able to be taught how to apply the factors

Question 21

What therapy factors can be tested for efficacy?

Answer 21

Specific factors

Question 22

How can you test the efficacy of specific factors?

Answer 22

Random control trials and then if sufficient evidence of efficacy, these therapies can be considered to be empirically supported therapies

Question 23

What did Ahn and Wampold (2001) find about the empirically supported therapies?

Answer 23

No difference between therapies which had the required specific factors, and those with no or few specific factors and suggested that it is common factors which are important for treatment to work

Question 24

What is the scientific-practitioner gap?

Answer 24

Some practitioners argue that we should be focused on the common factors - therapeutic alliance, increasing self-efficacy, enhancing expectancy

Others argue that as a scientific discipline we need to focus on measurable, manualisable specific factors

Others argue this is a false dichotomy - increasingly we are measuring common factors (especially therapeutic alliance) and integrating them into empirically supported therapies (EST) is generally recognised as being important

Question 25

What are some unwanted outcomes of clinical treatment?

Answer 25

Deterioration of existing symptoms

Emergence of new symptoms

Dependency on therapist

Non compliance of client

Negative wellbeing/distress

Stress/changes in family relations

Question 26

In Lilienfield, 2014 what are the four underlying cognitive impediments to accurately evaluating improvement in psychotherapy?

Answer 26

Naive realism

Confirmation bias

Illusory Causation

Illusion of control

Question 27

What are the 3 overarching categories that describe the 26 causes of spurious therapeutic effectiveness?

Answer 27

a) perception of client change in its actual absence
b) misinterpretations of actual client change stemming from extra therapeutic factors
c) misinterpretations of actual client change stemming from nonspecific treatment factors

Question 28

What is the threefold framework for evidence based practice?

Answer 28

a) research findings regarding the efficacy and effectiveness of psychotherapies
v) clinical expertise
c) client values and preferences

Question 29

How are empirically supported therapies (ESTs) different from evidence-based practice?

Answer 29

ESTs are interventions that have been demonstrated to work better than no treatment (or an alternative treatment) for specific disorders in independently replicated

a) controlled between-subject designs
b) single-subject designs, namely thought in which participants serve as their own controls

Question 30

Why is evidence-based practice more reliable than empirically supported therapies?

Answer 30

Incorporates control groups

within-subject designs

blinding

randomisation

other methodological bulwarks against inferential mistakes

Question 31

What are the implications of naive realism on the evaluation of a psychotherapy outcome?

Answer 31

Can lead clinicians, researchers and others to assume that they can rely on their intuitive judgements

As a consequence, these individuals may

a) misperceive change when it does not occur
b) misinterpret it when it does
c) or both