discussion #6 disease

+

Treatment Strategies

+ Premises of Biopsychosocial Therapy n  The biopsychosocial therapy model presumes that:

n  1). Therapy is an articulation of the biopsychosocial model for the clinical practice of psychotherapy

n  2). The goal of therapy is to achieve the integration of the chronic condition as part of a patient’s healthy sense of self.

n  3). Therapy seeks to help the patient construct an illness representation that will promote treatment adherence. An important aspect of treatment involves the alignment of the therapist’s and patient’s explanatory models.

n  4). The therapeutic process is informed by a comprehensive biopsychosocial assessment

n  5). The establishment of therapeutic alliance is key

n  6). Treatment is tailored to fit patient’s unique needs including their cognitive, emotional, and personality styles, as well as their expectations

+ Phases in the Treatment Process n  PHASE 1- ENGAGEMENT:

n  The therapist seeks to establish a therapeutic relationship and to maximize a patient’s readiness and motivation to change to develop.

n  PHASE 2- ASSESSMENT/PATTERN ANALYSIS: n  The therapist assesses a patient’s level of distress and impairment in

addition to examining maladaptive patterns of affect, cognition, and behaviors.

n  PHASE 3- INTERVENTION: n  The focus is on the modification of maladaptive patterns with the goal

of achieving the integration of the chronic illness perspective into a patient’s sense of self

n  PHASE 4- MAINTENANCE OR TERMINATION: n  The focus is on maintaining the change or reducing a patient’s

reliance on the treatment relationship if termination is warranted. This phase includes relapse prevention

+ PROCESS & OUTCOME GOALS

DEFINED

n PROCESS GOALS: n Specific procedural objectives and

processes associated with each stage of the treatment process

n OUTCOME GOALS: n Treatment outcome targets for change

that are specified for each phase of chronic illness

+ PROCESS & OUTCOME GOALS

PHASE PROCESS GOALS OUTCOME GOALS

1. Engagement a)  Establish a therapeutic alliance b)  Maintain the therapeutic alliance c)  Recognize, use, and manage

clinician countertransferences

Manage crises related to the chronic illness diagnosis

2. Assessment Pattern Recognition/Analysis

a) Complete the BPS assessment b) Specify a diagnostic formulation c) Create a clinical formulation d) develop the treatment formulation

Assist with patient’s stabilization and restructuring of activities/ routines

3. Pattern Change a)  Implement the treatment formulation and intervention sequencing plan

b)  Monitor outcome goals and revise the treatment formulation

c)  Deal with countertransferences

Facilitate the grief process, assist patient in constructing a “new self”, and promote self-management

4. Maintenance/ Termination

a) Develop a relapse prevention plan b) Process replapses c) Monitor achieved changes d) Evaluate/Implement a termination plan

Integrate the illness into patient’s life; Seek life purpose and meaning

+ Assessment & Treatment Tools

There are multiple self-report questionnaires available for the assessment of psychological factors in chronic medical conditions. Some common, evidence-based tools include:

n  The Illness Perception Questionnaire (Weinman et al., 1996) is a self-report measure used to assess the cognitive representation of illness. n  http://www.uib.no/ipq/

n  The Multidimensional Health Locus of Control Scales (Wallston, Wallston, & De Vellis, 1978) measures a patient’s perceived control over health events n  http://www.vanderbilt.edu/nursing/kwallston/mhlcscales.htm