Clinical Interviewing and Diagnostic Skills
Summary - Final Exam
Articles from the past weeks:
A new therapy for each patient: Evidence‐based relationships and
responsiveness (material for exam 2)
The problem with randomized clinical trials is that they assume the patient sample to be
homogeneous, which is not the case. The goal is to enhance treatment effectiveness by tailoring
it to the unique individual and his/her particular situation. Attuning psychotherapy to the
particulars of the individual according to the generalities of the research findings is key. The dual
purposes of the third interdivisional APA Task Force on Evidence‐based Relationships and
Responsiveness were to identify effective elements of the therapy relationship and to determine
effective methods of adapting or tailoring therapy to the individual patient on the basis of his/her
transdiagnostic characteristics. the patient, the therapy relationship, and these transdiagnostic
adaptations exercise more influence on the outcome than the particular treatment method. The
clinical reality is that no single psychotherapy is effective for all patients and situations, no
matter how good it is for some. Clinical practise should be flexible. When it comes to
communication and relationships, the adaptation or responsiveness can be based on
patient-therapist similarity or complementarity. Conclusions of the task force are:
- The psychotherapy relationship makes substantial and consistent contributions to patient
outcome independent of the specific type of psychological treatment.
- The therapy relationship accounts for client improvement (or lack of improvement) as
much as, and probably more than, the particular treatment method.
- Practice and treatment guidelines should explicitly address therapist behaviours and
qualities that promote a facilitative therapy relationship.
,- Efforts to promulgate best practices and evidence‐based treatments without including the
relationship and responsiveness are seriously incomplete and potentially misleading.
- Adapting or tailoring the therapy relationship to specific patient characteristics (in
addition to diagnosis) enhances the effectiveness of psychological treatment.
- Adapting psychological treatment (or responsiveness) to transdiagnostic client
characteristics contributes to successful outcomes at least as much as, and probably more
than, adapting treatment to the client’s diagnosis.
- The therapy relationship acts in concert with treatment methods, patient characteristics,
and other practitioner qualities in determining effectiveness; a comprehensive
understanding of effective (and ineffective) psychotherapy will consider all of these
determinants and how they work together to produce a benefit.
- The following list summarizes the Task Force conclusions regarding the evidentiary
strength of (a) elements of the therapy relationship primarily provided by the
psychotherapist and (b) methods of adapting psychotherapy to patient transdiagnostic
characteristics.
, Practitioners will find that fitting the therapy to clients’ racial/ethnic culture, religious/
spiritual identity and treatment preferences will demonstrably improve treatment outcomes, and
doing so to clients’ coping style, reactance level, and stages of change will probably do so as
well. What doesn’t work?:
- Imposing a procrustean bed into the therapy is not suitable and appropriate
- Singularity regarding treatment protocols. One size does not fit all.
- Cultural arrogance. The clinician should refrain from imposing his/her cultural beliefs in
terms of gender, race/ethnicity, sexual orientation, and other intersecting dimensions of
identity that are culturally insensitive.
- Flexibility without fidelity. Therapist flexibility to the patient’s preferences, values, and
cultures promises that psychotherapy “fits” but not necessarily that it possesses research
support. Focusing solely on accommodating without addressing the client’s problems or
distress will not prove optimally effective.
Making Up People - Ian Hacking
“Sometimes, our sciences create kinds of people that in a certain sense did not exist before. I call
this ‘making up people’”. We constantly medicalise, biologise and geneticise the issues of people
(suicide and obesity). When the diagnosis of multiple personalities emerged, this started off as
2-3 personalities, soon increased up to 17. We have (a) a classification, multiple personalities,
associated with what at the time was called a ‘disorder’. We have (b) the people, those I call
‘unhappy’, ‘unable to cope’. There are (c) institutions, which include clinics. There is (d) the
knowledge: not justified true belief, once the mantra of analytic philosophers, but knowledge in
Popper’s sense of conjectural knowledge, and, more specifically, the presumptions that are
taught, disseminated and refined within the context of the institutions. Finally, there are (e) the
experts or professionals who generate (d) the knowledge, judge its validity, and use it in their
practice. They work within (c) institutions that guarantee their legitimacy, authenticity and status
as experts. They study, try to help, or advise on the control of (b) the people who are (a)
classified as of a given kind.
In 1955 this was not a way to be a person, people did not experience themselves in this way, but
in 1985 this was a way to be a person, to experience oneself, to live in society. We can say that
people with several ‘alter personalities’ undoubtedly existed in 1955, but were not diagnosed.
Summary - Final Exam
Articles from the past weeks:
A new therapy for each patient: Evidence‐based relationships and
responsiveness (material for exam 2)
The problem with randomized clinical trials is that they assume the patient sample to be
homogeneous, which is not the case. The goal is to enhance treatment effectiveness by tailoring
it to the unique individual and his/her particular situation. Attuning psychotherapy to the
particulars of the individual according to the generalities of the research findings is key. The dual
purposes of the third interdivisional APA Task Force on Evidence‐based Relationships and
Responsiveness were to identify effective elements of the therapy relationship and to determine
effective methods of adapting or tailoring therapy to the individual patient on the basis of his/her
transdiagnostic characteristics. the patient, the therapy relationship, and these transdiagnostic
adaptations exercise more influence on the outcome than the particular treatment method. The
clinical reality is that no single psychotherapy is effective for all patients and situations, no
matter how good it is for some. Clinical practise should be flexible. When it comes to
communication and relationships, the adaptation or responsiveness can be based on
patient-therapist similarity or complementarity. Conclusions of the task force are:
- The psychotherapy relationship makes substantial and consistent contributions to patient
outcome independent of the specific type of psychological treatment.
- The therapy relationship accounts for client improvement (or lack of improvement) as
much as, and probably more than, the particular treatment method.
- Practice and treatment guidelines should explicitly address therapist behaviours and
qualities that promote a facilitative therapy relationship.
,- Efforts to promulgate best practices and evidence‐based treatments without including the
relationship and responsiveness are seriously incomplete and potentially misleading.
- Adapting or tailoring the therapy relationship to specific patient characteristics (in
addition to diagnosis) enhances the effectiveness of psychological treatment.
- Adapting psychological treatment (or responsiveness) to transdiagnostic client
characteristics contributes to successful outcomes at least as much as, and probably more
than, adapting treatment to the client’s diagnosis.
- The therapy relationship acts in concert with treatment methods, patient characteristics,
and other practitioner qualities in determining effectiveness; a comprehensive
understanding of effective (and ineffective) psychotherapy will consider all of these
determinants and how they work together to produce a benefit.
- The following list summarizes the Task Force conclusions regarding the evidentiary
strength of (a) elements of the therapy relationship primarily provided by the
psychotherapist and (b) methods of adapting psychotherapy to patient transdiagnostic
characteristics.
, Practitioners will find that fitting the therapy to clients’ racial/ethnic culture, religious/
spiritual identity and treatment preferences will demonstrably improve treatment outcomes, and
doing so to clients’ coping style, reactance level, and stages of change will probably do so as
well. What doesn’t work?:
- Imposing a procrustean bed into the therapy is not suitable and appropriate
- Singularity regarding treatment protocols. One size does not fit all.
- Cultural arrogance. The clinician should refrain from imposing his/her cultural beliefs in
terms of gender, race/ethnicity, sexual orientation, and other intersecting dimensions of
identity that are culturally insensitive.
- Flexibility without fidelity. Therapist flexibility to the patient’s preferences, values, and
cultures promises that psychotherapy “fits” but not necessarily that it possesses research
support. Focusing solely on accommodating without addressing the client’s problems or
distress will not prove optimally effective.
Making Up People - Ian Hacking
“Sometimes, our sciences create kinds of people that in a certain sense did not exist before. I call
this ‘making up people’”. We constantly medicalise, biologise and geneticise the issues of people
(suicide and obesity). When the diagnosis of multiple personalities emerged, this started off as
2-3 personalities, soon increased up to 17. We have (a) a classification, multiple personalities,
associated with what at the time was called a ‘disorder’. We have (b) the people, those I call
‘unhappy’, ‘unable to cope’. There are (c) institutions, which include clinics. There is (d) the
knowledge: not justified true belief, once the mantra of analytic philosophers, but knowledge in
Popper’s sense of conjectural knowledge, and, more specifically, the presumptions that are
taught, disseminated and refined within the context of the institutions. Finally, there are (e) the
experts or professionals who generate (d) the knowledge, judge its validity, and use it in their
practice. They work within (c) institutions that guarantee their legitimacy, authenticity and status
as experts. They study, try to help, or advise on the control of (b) the people who are (a)
classified as of a given kind.
In 1955 this was not a way to be a person, people did not experience themselves in this way, but
in 1985 this was a way to be a person, to experience oneself, to live in society. We can say that
people with several ‘alter personalities’ undoubtedly existed in 1955, but were not diagnosed.
