Psychotherapy and Applied Psychology – Détails, épisodes et analyse

It's Part 2 of Dan's conversation with Dr. Robert Krueger as they continue to dive deep into the alternative model of personality disorders.

Dr. Krueger is a clinical psychologist and member of the DSM-5 Personality Disorders Workgroup. Dan and Dr. Krueger explore the concept of personality disorders and the alternative model of personality disorders (AMPD). Can personality disorders be seen as extreme versions of regular personality traits, and can these traits have both adaptive and maladaptive features depending on the context? Then, Dr. Krueger goes over the importance of understanding the individual and their goals when working with personality disorders, rather than viewing them as unremittingly pathological.

Special Guest:
Dr. Rober Krueger
HiTop Website
The Personality Inventory for DSM-5 (PID-5)
Practitioner's Guide to the Alternative Model of Personality Disorders

Keywords: personality disorders, DSM-5, clinical case conceptualization, alternative model, AMPD, diagnostic criteria, self-related dysfunction, personality traits, psychiatric classification

Takeaways

Understanding a person's personality is important in clinical case conceptualization.

The decision-making process behind the alternative model for personality disorders involved considering the scientific evidence and the impact on individuals who have already been diagnosed.

The Alternative Model for Personality Disorders (AMPD) includes criterion A (self-related dysfunction) and criterion B (personality traits).

There is a tension between making psychiatric classification more scientifically justifiable and clinically beneficial while considering the impact on individuals.

Self-report measures for criterion A may have limitations, and additional perspectives, such as expert judgments and collateral data, can provide a more comprehensive understanding of personality pathology.

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Join in on another brilliant episode of Psychotherapy & Applied Psychology. This week, Dan is joined by Dr. Robert Krueger and discuss the ongoing studies of personality disorders.

Dr. Krueger is a clinical psychologist and member of the DSM-5 Personality Disorders Workgroup. Dan and Dr. Krueger discuss the importance of understanding a person's personality in clinical case conceptualization as well as the tension between wanting to make psychiatric classification more scientifically justifiable and clinically beneficial. Dr. Krueger provides an overview of the Alternative Model for Personality Disorders (AMPD) and the criteria for diagnosis, as well as the distinction between criterion A (self-related dysfunction) and criterion B (personality traits).

Stay tuned for Part 2!

Special Guest:
Dr. Rober Krueger
HiTop Website
The Personality Inventory for DSM-5 (PID-5)
Practitioner's Guide to the Alternative Model of Personality Disorders

Keywords: personality disorders, DSM-5, clinical case conceptualization, alternative model, AMPD, diagnostic criteria, self-related dysfunction, personality traits, psychiatric classification

Takeaways

Understanding a person's personality is important in clinical case conceptualization.

The decision-making process behind the alternative model for personality disorders involved considering the scientific evidence and the impact on individuals who have already been diagnosed.

The Alternative Model for Personality Disorders (AMPD) includes criterion A (self-related dysfunction) and criterion B (personality traits).

There is a tension between making psychiatric classification more scientifically justifiable and clinically beneficial while considering the impact on individuals.

Self-report measures for criterion A may have limitations, and additional perspectives, such as expert judgments and collateral data, can provide a more comprehensive understanding of personality pathology.

Sound Bites

"I find it hard to do clinical case conceptualization without thinking about a person's personality."

"The DSM exerts a strong kind of way of influencing the way people think about cases and in our culture more broadly."

"The DSM-5 Personality Disorders Workgroup had a number of psychologists involved, which is somewhat unusual."

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In this conversation, Dan speaks with Dr. Scott Miller about improving psychotherapy using feedback and using feedback to facilitate deliberate practice.

The conversation covers Scott's journey in the field of therapy, his experiences in different settings, and the development of feedback-informed treatment (FIT). FIT involves soliciting formal feedback from clients about their progress and engagement in therapy. The therapist uses this feedback to tailor the treatment to better fit the client's needs. The conversation also touches on the importance of monitoring outcomes and the challenges of implementing feedback-informed care. In this part of the conversation, Scott and Dan discuss the importance of measuring progress and using feedback to inform treatment decisions. They emphasize the need to consider adding or removing elements from the treatment plan if there is no progress after a certain number of sessions. They also discuss the concept of outcome-focused treatment and the importance of involving the client in the decision-making process. Scott shares an analogy from medicine to illustrate the need for a collaborative approach to treatment. They also discuss the challenges and objections to implementing measurement-based care, including concerns about burdening clients and the need for training and support for clinicians. They highlight the benefits of using feedback measures to facilitate conversations about termination and the potential for improving outcomes through deliberate practice.

Special Guest:
Dr. Scott Miller: Make sure to check out Scott's website which is full of useful resources!

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In this conversation, Dr. David Klonsky dives deep into the Three-Step Theory of Suicide, explaining why some people consider suicide and some attempt suicide.

We begin the conversation with Dr. Klonsky talking about his side interest in combat sports and the psychology behind it. He shares his experience in martial arts and how it has influenced his understanding of the mental and emotional aspects of fighting. Dr. Klonsky also talks about his work as a consultant and analyst for combat sports, including his appearances on the Fight Network. He explains the importance of emotional readiness in combat sports and the role of approach-oriented emotions like excitement and anger. Dr. Klonsky emphasizes the need to overcome fear and interpret it as a natural response rather than a sign of unreadiness.

The main theme of the conversation is the study of suicide. The three-step theory is discussed, which includes the conditions under which people feel suicidal, the intensity of suicidal desire, and the capability to attempt suicide. Pain and hopelessness are identified as key factors in feeling suicidal, and the aversiveness of life is explored as a driving force behind suicidal ideation. The importance of understanding the distinction between suicidal ideation and suicide attempts is emphasized. The conversation explores the necessary conditions for suicidal desire, which include overwhelming pain, hopelessness, low connectedness, and capability. Pain and hopelessness are the primary motivators for suicidal desire, while connectedness acts as a pull towards life. Capability refers to the ability to overcome the barriers to suicide, which can be acquired through experience or dispositional factors. Mental illness, such as depression and post-traumatic stress disorder, can contribute to pain, hopelessness, and capability, increasing the risk of suicide. Understanding these factors can empower clinicians to intervene effectively and prevent suicide.

Special Guest:
E. David Klonsky

The following paper was referenced in the show:
The three-step theory of suicide: Description, evidence, and some useful points of clarification

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In this conversation, Dan welcomes Dr. Jon Elhai to discuss problematic smart phone and social media use.

This conversation explores the addictive aspects of social media and smart phones; however, they are not recognized as addictive disorders in the DSM or ICD. They also discuss the risk factors for excessive internet use, such as long-standing issues, coping styles, and internet-related cognitive biases like fear of missing out (FOMO). They discuss the importance of assessing the functional impairments caused by excessive use rather than just the duration of use. They explore the relationship between rumination, excessive reassurance seeking, and problematic use, and the potential negative mood effects of smartphone and social media use. In this conversation, Jon and Dan discuss the relationship between smartphone use and mental health, particularly depression. They highlight that excessive smartphone use is more likely to exacerbate existing mental health issues rather than cause them. They argue that social media and smartphones can have both positive and negative effects, depending on the individual and their circumstances. They also discuss the role of clinicians in assessing and treating problematic smartphone use, as well as the importance of parental guidance and government regulations to protect children from the potential harms of excessive digital media use.

Guest Starring:

Dr. Jon Elhai

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This week, Dan is joined by Dr. Jesse Owen,
Dan and Jesse peruse what multicultural psychotherapy really is and how to apply the multicultural orientation framework in psychotherapy and clinical training.

The conversation explores the concept of multicultural orientation (MCO) in psychotherapy/counseling. The MCO framework consists of three pillars: cultural humility, cultural opportunities, and cultural comfort. Cultural humility emphasizes the therapist's willingness to learn from the client's cultural experiences and not assume expertise. Cultural opportunities involve recognizing and exploring cultural aspects that arise in therapy sessions. Cultural comfort refers to the therapist's ability to navigate discomfort when discussing cultural topics. The conversation also touches on the importance of understanding clients' values and beliefs, even when they differ from the therapist's own. The MCO framework focuses on the salient identities, values, and beliefs of clients and how they influence the therapeutic process. It emphasizes the importance of understanding and acknowledging the cultural values and identities of both the therapist and the client. The framework is not intended to be a social justice framework, but rather a process-based model for psychotherapy. It aims to help therapists effectively connect with clients and address their individual needs, regardless of their cultural background. MCO training can also be applied to supervision, with a focus on understanding how the supervisor's and supervisee's identities influence the therapeutic process. Machine learning is being used to develop automated tools that provide real-time feedback and training on MCO skills.


Guest Starring:

Dr. Jesse Owen

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In this conversation, Dan talks with Dr. Katie Aafjes van Doorn about the effectiveness of teletherapy. 

Katie shares her perspective on teletherapy and its benefits, as well as the differences between phone and video therapy. They also explore the importance of the therapeutic presence in teletherapy and its potential impact on treatment outcomes. This conversation explores the challenges and benefits of teletherapy, focusing on the concepts of presence, therapeutic alliance, and the real relationship. Additionally, they cover topics such as the impact of teletherapy on therapeutic presence, the informal and conversational nature of teletherapy, the challenges of therapist disclosure, and the lack of boundaries in the therapeutic relationship. In the conversation they also discuss the potential benefits and drawbacks of teletherapy, the need for hybrid treatment approaches, and the impact of teletherapy on therapist fatigue. Additionally, the importance of training in teletherapy skills and the facilitation of interpersonal connection in teletherapy are explored. This conversation explores the challenges and opportunities of teletherapy, focusing on alliance ruptures, therapeutic skills, technical challenges, adapting approaches, training, client considerations, technical quality, pros and cons, effectiveness, attachment styles, and the importance of flexibility and individualized approaches.

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In this conversation, Dan and Dr. Terence Tracey talk about therapist expertise. 

Terry explains the importance of routine outcome monitoring (ROM) and the limitations of therapist expertise. They delve into the concept of hypothesis testing and the value of disconfirming hypotheses. Overall, the conversation explores the themes of therapy effectiveness, growth as a therapist, and the role of feedback in improving therapists' outcomes. The conversation explores the challenges of disconfirmation and the importance of routine outcome monitoring for therapist growth. It highlights the value of professional self-doubt and the willingness to ask questions and seek disconfirming evidence. The concept of confidence and the need to challenge and let go of ideas is discussed. The distinction between structured and unstructured professions is examined, with a focus on the ill-defined nature of psychotherapy. The role of deliberate practice in psychotherapy is explored, along with the need for supervision and ongoing feedback. The lack of improvement in therapists over time and the potential impact of training programs on therapist growth are also discussed. The conversation concludes with reflections on the reactions to the findings and the importance of minimizing confirmatory biases. The conversation explores the need for reflective practice in therapy and the barriers that prevent therapists from engaging in it. The idea of incentivizing reflective practice is discussed, along with the need for time to reflect and generate hypotheses. The conversation also touches on the challenges in integrating reflection into training and certification processes. The performative nature of expertise and the value of outcome data are explored. They cover topics such as building time for reflection, integrating reflection into practice, differentiating good and bad therapists, and the importance of outcome data.

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The Applied Psychology Podcast is hosted by Dan Cox and features conversations with the world's foremost applied psychology experts. We cover a variety of applied psychology topics such as psychotherapy, mental health, happiness, interpersonal relationships, and much more.

Listen to engaging and insightful episodes by subscribing to The Applied Psychology Podcast!

• music by audionautix.com

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Special Guest:
Dr. James Boswell

Society for Psychotherapy Research

Keywords

low motivation, readiness to change, diminished outcome expectations, non-directive approach, motivational interviewing, humanistic principles, ambivalence, transdiagnostic cognitive behavioral therapy, tailor therapy, therapeutic process, client-therapist relationship, matching, therapist selection, outcomes, preferences, routine outcome monitoring, therapist effectiveness, strengths and weaknesses

Takeaways

• Low motivation and readiness to change are related concepts in therapy.
• Therapists should have discussions with clients about their concerns and difficulties with change.
• Motivational interviewing principles and humanistic principles are important in working with clients who are low on motivation.
• Therapists should explore ambivalence about change and therapy, and work on building motivation and hope.
• Transdiagnostic cognitive behavioral therapy combines different disorder-specific treatments into one approach, providing a more efficient and evidence-based therapy.
• Therapists should tailor their approach based on the client's primary problem and explore their expectations and concerns.
• Bringing the therapeutic process into the room and using the client-therapist relationship can be effective in therapy, even when using a cognitive behavioral approach. 
• Matching clients with therapists based on characteristics like race or gender doesn't consistently lead to better outcomes.
• Matching black clients with a strong preference for black therapists can have a positive impact.
• Routine outcome monitoring feedback can be used to identify patterns of therapist effectiveness.
• Matching clients based on therapist outcomes can lead to more effective therapy.
• Therapists have concerns about how outcome data will be used and the potential consequences.
• There is a need for resources and training to help therapists improve in specific areas.
• The use of technology and AI could enhance process research and therapist training.
• The field needs to explore how to make use of session-level data to understand therapist effectiveness.
• Therapists and clients generally support the idea of using data to guide therapist selection.
• There is pushback from therapists who question the validity of outcome data and concerns about being pigeonholed.
• Resources for further exploration include articles by James Boswell and Michael Constantino on context responsive integration and the book 'Responsiveness in Psychotherapy' edited by Watson and Wiseman.

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