I found the article of Lilienfeld(2007) very much informative and provocative. The article is comprehensively informative by 1) critically evaluating and updating earlier conclusions regarding deterioration effects in psychotherapy, 2) outlining methodological obstacles standing in the way of identifying potentially harmful therapies(PHTs), 3) providing a provisional list of PHTs(p.53). What I mean by “provocative” is that his argument of listing “PHTs” and calling for mental health professionals’ being aggressive in confronting the hazard posed by PHTs is compelling and legitimate with a possibility of inviting confrontation and complaints from those who have been and is using the treatments(i.e CISD, DARE, Boot-camp intervention, and so on). Even Lilienfeld was cautious by stating that the list of PHTs was tentative, I had a feeling that he must’ve had guts to put it forward in a public arena. Lilienfeld has my support on this move of heightening awareness of PHTs as he is indeed right that “knowing possible harms of therapies” is an obligation to therapists. Prior to reading the article, my knowledge and awareness on PHTs was very limited. I was surprised to know that 5 to 10% of clients(at maximum, p.54) could experience deterioration effects and the prevalence of PHTs was quite high(for example, about 25% of psychotherapists in the mid 1990s use two or more recovered-memory techniques, such as hypnosis and guided imagery…). I’m glad to have an opportunity to think about PHTs and issues related to them.
In the section of future research directions, Lilienfeld mentioned therapist variables and client variables. Specifically, clients can be at risk for deterioration when working with charismatic yet highly confrontational and intrusive encounter-group leaders. And client individual differences, such as high levels of borderline personality disorder traits, sometimes contribute to deterioration(p.64). As it is valuable to search for therapist variables and client variables in a respective manner, exploring a good match between them(so to speak “a goodness of fit”) will be intriguing and beneficial to therapy outcomes. This is rather off the topic, but I’ve seen many couples and parent-child relationships in conflict or trouble just because of the goodness of fit. One of my close friends who were very sensitive and anxious had hard time brining up her difficult daughter. Distressed by stress from the rearing, she came near to depression, and her girl had to go through play and speech therapies. Had my friend, I think, been easy going with the daughter, or had the daughter’s temperament been easy, things would not been exacerbated to the extent. Also, in my anecdotal experiences with many married couples around me, a couple gets to fight just because they are so different in personality wise. A husband is very much plan-driven, organized, and anxious while his wife being rather impulsive and enjoying spontaneity. The difference first appears to be not so significant, but accumulations and repetitive exposure to the difference results in a great deal of emotional conflicts. For a long time, I’ve been thinking a lot about compatibility among certain characteristics or personalities or traits, when involving in a relationship whether parent-child or marital ones. I do believe that the compatible or synergetic effects do exist in a working relationship as a therapist and a client, although no data or evidence is provided, and thus it does not sound scientific. My goal as a therapist if I becomes one someday is to know myself, letting along knowing harm. And by 1)actively and consciously searching for client variables compatible with my therapist style, 2) keeping myself exposed to ESTs and PHTs outcome literatures, I want to avoid potential harms at my best strength.
2007년 11월 25일 일요일
2007년 11월 11일 일요일
DBT : acceptance and change.
Lienhan(1993) presents the concept of Borderline Personality Disorder(BPD) with four approaches; 1) the single continuum approach , 2) biologically oriented approach, 3) eclectic-descriptive approach, 4) biosocial approach. The biosocial approach-emphasizing an interaction between an individual’s constitutional predisposition toward dysreguating emotions and an environment that invalidates the individual’s private experience(Hayes et al, 2004)-, is the theoretical foundation from which the author designed Dialectical Behavior Therapy(DBT) to treat individuals with BPD. According to the author, DBT is distinctive in several ways from CBT approaches to BPD, although most of DBT is application of CBT. DBT’s emphasis is on “dialectics”, which means the reconciliation of opposites in a continual process of synthesis(p.19). The synthesis in treatment occurs between acceptance and change. The therapist needs to accept the patient with a notion of unconditional positive regard, while coaching the patient to change. The therapist actively teaches the patient to accept him(her)self and to change to better regulation emotion, cultivate interpersonal skills, increase tolerance levels and so on. Over therapy period, more emphasis is placed on the process not the structure, while the therapist functions as a consultant to the person, which is core characteristic of the therapeutic relationship in DBT model.
The author introduces two studies showing the effectiveness of DBT with population of BPD. The first RCT investigated the treatment outcomes of DBT against individual psychotherapies. DBT participants reported a significantly less frequency of parasucidal behaviors, the low rate of treatment dropout, fewer days of hospitalization compared to TAU group. They were also rated higher on global adjustment by interviewers. However, interestingly, the participants did not report a success in accepting and tolerating both themselves and reality. But not surprisingly, accepting and tolerating seemingly problematic oneself or world is very tough task, even to an average people. The second RCT investigated the effectiveness of addition of group skills training to DBT as individual therapy is the usual therapy. It is found that the DBT group skills training is not efficacious.
According to Hayes et al(2004), there are more body of empirical evidence showing that DBT is effective in treating substance use eat-disorders as well as BPD. And growing consensus is made that DBT is the only empirically supported treatment for BPD. This can be attributed to Lienhan’s design of DBT with a focus on BPD, following her expertise dealing with parasuicidal individuals with BPD. The processes of how DBT was first designed and supported is one of exemplary ways to expand the list of ESTs. 1) Extracting remarkable resemblance of seeming different psychological behaviors and disorders through research work(e.g parasuicidal vs. BPD), 2) Integrating existing treatment approaches to best serve a specific population(e.g adopting “acceptance” form “Zen” and “change” from CBT), 3) Gaining evidence of the effectiveness of the treatment through RCTs and clinical trials.
The author introduces two studies showing the effectiveness of DBT with population of BPD. The first RCT investigated the treatment outcomes of DBT against individual psychotherapies. DBT participants reported a significantly less frequency of parasucidal behaviors, the low rate of treatment dropout, fewer days of hospitalization compared to TAU group. They were also rated higher on global adjustment by interviewers. However, interestingly, the participants did not report a success in accepting and tolerating both themselves and reality. But not surprisingly, accepting and tolerating seemingly problematic oneself or world is very tough task, even to an average people. The second RCT investigated the effectiveness of addition of group skills training to DBT as individual therapy is the usual therapy. It is found that the DBT group skills training is not efficacious.
According to Hayes et al(2004), there are more body of empirical evidence showing that DBT is effective in treating substance use eat-disorders as well as BPD. And growing consensus is made that DBT is the only empirically supported treatment for BPD. This can be attributed to Lienhan’s design of DBT with a focus on BPD, following her expertise dealing with parasuicidal individuals with BPD. The processes of how DBT was first designed and supported is one of exemplary ways to expand the list of ESTs. 1) Extracting remarkable resemblance of seeming different psychological behaviors and disorders through research work(e.g parasuicidal vs. BPD), 2) Integrating existing treatment approaches to best serve a specific population(e.g adopting “acceptance” form “Zen” and “change” from CBT), 3) Gaining evidence of the effectiveness of the treatment through RCTs and clinical trials.
2007년 11월 4일 일요일
Emotion Theory & Contemporary Learning Theory
Barlow(2000) and Mineka & Zinbarg(2006) both explore the nature and development of anxiety disorders. The authors agree that psychological vulnerability based on early experience is very important in understanding the etiology and maintenance of anxiety disorders. In addition, they share a strong emphasis of the effect of uncontrollability and unpredictability in the process of the disorders. Based on the research in animal studies, the authors contemplate the consequence of early experience with uncontrollability and conclude that a sense of control during development seem to inhibit the development of different anxiety disorders. This result is linked to studies in human regarding the concept of locus control. Evidences point that parenting style of encouraging the healthy sense of control over environments and experiences appear to equip children immunize against emotionally stressful events. Those studies taken together, Barlow(2000) strongly asserts that uncontrollability works as mediator between negative life events and the emergence of anxiety early in development. More specifically, Mineka & Zinbarg(2006) show how perception of uncontrollability is possible source of individual differences in vulnerability to the effects of social phobia, posttraumatic stress disorder, generalized anxiety disorder.
Barlow(2000) takes integrative accounts of cognitive science and neuroscience and learning theory in order to explain emotion related disorders such as anxiety and depression. He points out that different types of emotions are similar or distinctive in terms of phenomenological, behavioral expressive, psychometric and neurobiological leve(p.1249). For example, while the emotions of fear and anxiety seem to be fundamentally different emotions, anxiety and depression seem to be share common traits. Unlike Barlow(2000), Mineka & Zinbarg(2006) focus on the effectiveness of contemporary learning theory with a focus on anxiety disorders. Mineka & Zinbarg(2006) show how a contemporary learning theory contributes to capture the richness and complexity associated with development and course of anxiety disorder. Moreover, their argument-learning approaches are better grounded in research findings, and thus they provide a more explicit factors promoting and inhibiting the development of different anxiety disoders- is compelling with a wide variety of evidences. In addition, the authors suggest contemporary learning models can provide a good way of identifying populations at higher risk for anxiety disorder and preventive measures to be taken in parenting style.
Both emotion theory and contemporary learning approaches add comprehensive and cogent explanations on the etiology and development of anxiety disorders. They incorporate the role of genetic and temperamental variables into their models based on empirically supported research findings. Not only do the research finings and models make us understand the nature and processes of anxiety disorders in depth, but they also provide important implications on the treatment or prevention approaches to the disorders.
Barlow(2000) takes integrative accounts of cognitive science and neuroscience and learning theory in order to explain emotion related disorders such as anxiety and depression. He points out that different types of emotions are similar or distinctive in terms of phenomenological, behavioral expressive, psychometric and neurobiological leve(p.1249). For example, while the emotions of fear and anxiety seem to be fundamentally different emotions, anxiety and depression seem to be share common traits. Unlike Barlow(2000), Mineka & Zinbarg(2006) focus on the effectiveness of contemporary learning theory with a focus on anxiety disorders. Mineka & Zinbarg(2006) show how a contemporary learning theory contributes to capture the richness and complexity associated with development and course of anxiety disorder. Moreover, their argument-learning approaches are better grounded in research findings, and thus they provide a more explicit factors promoting and inhibiting the development of different anxiety disoders- is compelling with a wide variety of evidences. In addition, the authors suggest contemporary learning models can provide a good way of identifying populations at higher risk for anxiety disorder and preventive measures to be taken in parenting style.
Both emotion theory and contemporary learning approaches add comprehensive and cogent explanations on the etiology and development of anxiety disorders. They incorporate the role of genetic and temperamental variables into their models based on empirically supported research findings. Not only do the research finings and models make us understand the nature and processes of anxiety disorders in depth, but they also provide important implications on the treatment or prevention approaches to the disorders.
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