This is the Chapter 1 of the book The Individual (de Bruin, E., 1st Edition). Which is content for the exam of the Theory component of Module 4 (The Individual) of the University of Twente, in the Netherlands.

Chapter 1:

Making use if different delivery formats to enhance access and effectiveness

Time:

• Process/ outcome of therapy own pace
• Long-term therapy may contribute to dependency/ client being stuck
• Therapist-defined time boundaries: brings about strong therapeutic frame/ holding environment. Characteristic psychoanalytic/ psychodynamic approaches
• Frequency/ length sessions:

• Long sessions --> increase emotional intensity work
• Hight frequency sessions -->  therapist gets to know rhythms of client’s life

• Long term therapy:

• Anxious individuals in any social situation --> initially need long period of time to learn to trust therapist sufficiently --> then develop new/different ways to relate to others
• Co-morbidity: when client has multiple problems
• Long term health conditions: benefit from ongoing psychotherapeutic support
• Brief therapy: (less 20 min) pressures to reduce waiting times --> development effective models for time-limited work.

• Time limited therapy:

• Appropriate when clients present problems arising from life events
• 2 + 1 model: clients offered 2 sessions one week apart --> a follow-up meeting 3 months later --> 60% significant benefits
• Front-load sessions: 3 sessions 1^st week --> 1 session 2^nd week --> final session 1 month later
• Principles time-limited counselling:

• Initial assessment: assess readiness/ appropriateness of work
• Active involvement client: homework
• Specific focus: seek address underlying personality issues
• Active approach: provides client new perspectives/ experiences
• Stage structure: stages related to specific aim/ focus
• End therapy: consolidate gains/ explore possible implications for the loss of therapy

• Intermittent therapy:

• Interruption, not termination: therapy will pause when gained enough to proceed with life
• Intermittent therapy: active approach

• Advantages:

• Client positioned as empowered (ability to make important decisions about their treatment)
• Remember better learned material from sessions and use it day-to-day basis

• Single-session therapy (walk-in service): 90-120 minutes

• Preparing client: ensure client suitable high-intensity session/ identify focus session/ ensure safety wellbeing client

Place:

• Emotional geography: mental health/ well-being/ emotional healing shaped by locations which people live and where they receive help
• Organisational contexts:

• Large organisations --> bureaucratic procedures, good quality procedures/ training/ supervision
• Smaller organisations --> decision  making face-to-face meetings of those involved
• Management structures: offer voluntary/ confidential relationships

• Inter-professional work: specialist work alongside colleagues from other professional groups, with their own organisational “territories”
• Organisations as an open system: analysis organisational cultures/ values
• Employee assistance programmes:

• In-house: counsellors employed by organization
• Out-of-house: external counselling agency under contract to the organization
• Paid by employer --> suspicion over confidentiality/ pressure on the counsellor to produce results consistent need of the organization

Who can be a therapist?

• Therapist: represents caring face community as a whole
• Professional therapist: with differing degrees of professional involvement

• Private practice: develop own personal therapeutic style
• Healthcare  organisations: function within tightly defined protocols

• Non-professional counsellors: same work, without same training/ scale of payment --> experience determines quality results

• Disadvantages: burnout/ development professional distancing or detachment clients

• Low-intensity support workers: trained helping, male use evidence-based resources

• Stepped care models: offer the least intrusive form of intervention

• Embedded counselling: use counselling skills/ therapeutic principles, but professional role is not explicitly of a psychotherapeutic.
• Self-help groups: people similar problem, meet together without assistance professional leader à transcends budgetary limitations

• Professional assistance: help get started, proactive role, determine where to meet and how to proceed
• Ideology: explicit set of ground rules

• New self-narrative and sense of identity: previous identity destroyed

• Peers:

• Peer counselling model: expression here-and-now awareness of feelings/ bodily states. No “expert” interpretation/ guidance on person in listening/ helping role

• Advantages:

• Easy access
• Absence power imbalance
• Opportunity acquire helping skills/ experience

• Therapeutic communities: residential settings, individuals seeking psychotherapeutic help live together period time, receive intensive therapy à away from pressures/ threats everyday life, participants engage process of recovery/ renewal

• Therapist: is everyone, plus the shared culture created

Who is the client?

• Individuals:

• One-to-one therapy: reflects/ maintains individualist stance --> issue --> individualisation of what in reality are social problems

• Sometimes emotional/ behavioural problem does not exist “in” the individual, but arises pattern interaction between members family/ cultural group

• Autonomous motivation: extent client chooses to attend therapy themselves

• Couples:

• Couple therapy: recognise problems rooted in relationship rather than being attributable to individual issues --> aims achieve shared understanding what they want from each other, and how they want to be together.

• Families:

• Family therapy: set unique challenges/ opportunities

• Groups: exhibit broader range interpersonal behaviour --> aim to identify/ define curative or therapeutic factors in groups

• Curative factors: grounded perceptions of clients regarding helpful material, which provides valuable pointers to how the group might be run

• Communities:

• At community level: identify and make own capacity for support/ healing/ challenging both internal/ external sources of oppression
• Preventative interventions: strict regulations to prevent, in field mental health, 3 levels of prevention:

• Primary prevention: reduce future incidence of a problem
• Secondary prevention: targeting those at risk
• Tertiary prevention: minimise negative impact of existing disorder/ problem

Technologies:

Any form of practical application of scientific knowledge’

• Telephone:

• Telephone counselling: provide more counselling than any other type of counselling

• Faceless helper: perceived as ideal, imagined as whoever caller wants/ needs

• Client perception of its value:

• Control: participants can hang up
• Convenience: participants can call whenever they want
• Absence of inhibiting influences: free of cost

• Internet:

• Email counselling: asynchronous (time-delayed counselling)/ synchronous (contact in real time).

• Advantages:

• Permanent record therapy contact
• Typing effective means of externalising problem
• By writing, reflective process emerges
• Expression of feelings in the “now”

• Communication by video link: for clients find it hard to travel
• Computer-based/ online assessment: assessment purposes delivered on-screen
• Online therapy sites:

• Beating the Blues: intervention mild/ moderate levels of depression. Consists of characterisation (stories people have struggled overcome depression) + conversational self-help exercises
• FearFighter: package developed use in anxiety
• Moodgym site: self-help exercises promote psychological well-being

• Text messaging: used frequent basis, consisten with favoured mode of communication
• Apps:

• Mood 24/7: rate mood regular basis throughout the day

• Chat rooms: online sites where people communicate each other specific problem. Some include involvement counsellor, as a resource or monitor.
• Virtual reality: experience different levels of severity of their problem. Therapist directly coach them in use coping strategies
• Avatars: externalise/ express different aspect of self. Allows reflection/ insight

Self-help materials:

• Active client: client active by reflecting. Effectiveness relies on capacity for self-healing
• Categories bibliotherapy: explicit self-help manuals, understand resolve particular difficulty. Cognitive behavioural theoretical approach

• Autobiographical/ biographical works: support/ insight/ hope
• Fictional texts: life stories/ behavioural patterns/ relevant coping strategies

• Value self-help: depends on context in which it is used

Combining formats:

• Adding on (adjunctive interventions): assembling package

• Stepped care: begins least intrusive/ intensive format --> ratches up to more demanding formats

1. Access self-care materials
2. Time-limited psychotherapy of generic nature
3. Long-term, focused on specific disorder (empirically validated form of treatment)
4. Inpatient hospital treatment

• Adjunctive interventions: another form of help alongside therapy
• Programmes/ communities: planned packages incorporate different formats