HELPING PEOPLE CHANGE

A. The Natural History of Psychopathology
1. The acute-chronic distinction
   a. Time-limited disorders (e.g., adjustment disorders)
      (1) Situation specific
      (2) Maturing out
   b. Episodic disorders
   c. Long-term disorders
      (1) Stable
      (2) Progressive deterioration
   d. Partial and full remission
2. "Home" remedies
   a. Rest and relaxation
   b. Adaptive coping
      (1) Emotion-focused
      (2) Problem-focused
   c. Self-directed change
      (1) Recognizing the problem
      (2) Motivation to change
      (3) A plan of action
      (4) Costs and incentives
      (5) Obstacles and resources
3. Informal helping
   a. Social support
   b. Natural helpers
   c. The media and the Internet

B. Seeking Professional Help
1. What determines the choice?
   a. Personal distress and distress of others
   b. Helplessness
   c. Perecived value of seeking vs. non-seeking
   d. Availability (access, cost, etc.)
2. Who decides?
   a. Personal decision
   b. Professional referral
   c. Pressure from others
   d. Legal mandates
3. Who provides the help?
   a. Psychiatry
   b. Clinical psychology
   c. Psychiatric social work
   d. Psychiatric nursing
   e. Allied specialties
      (1) Art, music and occupational therapy
      (2) School psychologists and guidance and adjustment counselors
   f. Other
      (1) Psychoanalyst
      (2) Psychotherapist
      (3) Counselor
      (4) Hypnotherapist
   g. Is one profession better than another?
      (1) Training and experience
      (2) Theoretical orientation
      (3) The specialist-generalist issue
4. Statistics
   a. How many need help?
   b. How many get help?

C. Paradigms of Professional Helping
1. Linking paradigms of etiology to paradigms of treatment
2. Biomedical
   a. Basic goal: alter biology
      (1) The general paresis model
      (2) Treating symptoms versus treating the cause
   b. Methods
      (1) ECT
      (2) Psychosurgery
      (3) Psychopharmacology
      (4) Holistic health and alternative medicine
3. Intrapsychic
   a. The concept of "root cause"
   b. Psychodynamic approaches
      (1) The role of insight: making the unconscious conscious
      (2) Defenses and resistance
      (3) Free association, transference and interpretation
      (4) Freudian psychoanalysis and modern psychodynamic psychotherapy
   c. Humanistic approaches and the role of authenticity
      (1) Self-awareness and self-expression
      (2) Basic goodness and self-actualization
      (3) Client-centered therapy: empathy and unconditional positive regard
      (4) Existential therapy and the search for meaning
4. Cognitive-behavioral
   a. Overt behavior and relearning
      (1) Applying classical and operant conditioning
      (2) Skills training
      (3) Etiology as unimportant
   b. Covert behavior and cognitive restructuring
      (1) The role of cognition in psychopathology
      (2) Combining cognitive and behavioral approaches: CBT
5. Systems
   a. Changing social systems
   b. Couples and family therapies
   c. Group methods
   d. Community psychology
      (1) Outreach
      (2) Primary and secondary prevention

D. Assessing the Value of Treatment
1. Defining the goal
   a. What constitutes success?
   b. Who determines it and how?
   c. How much change, and for how long?
2. Empirical research
   a. Internal vs. external validity
      (1) Competing hyptotheses
         (a) Time
         (b) Changing circumstances
         (c) Placebo
         (d) Regression toward the mean
         (e) Non-specific effects (viz. Frank's theory of persuasion and healing)
      (2) To whom do the findings apply?
   b. Beware of case studies
   c. Surveys (e.g. the Consumer Reports study)
   d. Experiments
      (1) Group designs
         (a) Controlling bias: the double-blind design
         (b) Control and comparison groups
         (c) Placebo control designs
      (2) Single-subject designs
      (3) Efficacy vs. effectiveness
      (4) Statistical vs. clinical significance
   e. What influences outcome?
      (1) Treatment variables (e.g. length)
      (2) Treater variables (e.g. experience)
      (3) Client variables (e.g. YAVIS)
      (4) Client-treater interaction
      (5) Process variables
   f. Using meta-analysis
      (1) Eysenck's challenge
      (2) Recent meta-analyses (see Lilienfeld Chapter 12)

Copyright ©1998 Beverly J. Volicer and Steven F. Tello, UMass Lowell.  You may freely edit these pages for use in a non-profit, educational setting.  Please include this copyright notice on all pages.