Choosing an intervention

[ikibah]

I'm in my third semester in a clinical MSW program and I am currently in a number of different courses emphasizing the practice and analysis of different theories and types of interventions. My question is how did most of you decide on which kind of intervention you would use to be your "go to" or are any of you eclectic? To be honest when I'm at field now I find myself bouncing around different concepts that are seen in many of the different interventions.
To sum up my question:

Do you have an intervention to call your own or are you eclectic?
If so, how did you come to choose this intervention?
In session, do you ever find yourself straying from "your" intervention and start using others? i.e you primarily use solution-focused therapy, however the conversation with the client has found you wondering about the client's subconscious and how it may be playing a role; prompting you to start implementing a psychodynamic intervention.

Thanks for this...looking forward to hearing from you guys.

---

Members don't see this ad.

 

[WisNeuro]

I was trained broadly in CBT and psychodynamic modalities. I'm pretty empirically based, so I stick to the EST/EBT world pretty closely, so mostly CBT. Which aligns to my treatment population pretty well, CPT/PE for PTSD for the small amount of PTSD patients that I do see outside fo my primary neuropsych service duties.

 

[Therapist4Chnge]

While I don't conduct therapy, I do make a ton of referrals and try and match what I see to be the problem with the most supported intervention. For instance, I saw someone awhile back who had co-occurring PTSD (related to their brain injury), so when I made a referral for treatment I found a couple of clinicians who provide Prolonged Exposure Therapy. In contrast, there are some providers in the surrounding community who provider EMDR and related sham treatments that I refuse to send anyone.

One caution about "eclectic"….it is important to have a STRONG understanding in all of the models you utilize before you start mixing them. Conceptually there are some models that fit well together, while others are actually opposed…though people still use them. I personally like to conceptualize and formulate interventions from one perspective (CBT), though I'll consider other models to provide a different perspective. There are aspects of attachment that I think fit well, as do some of the pillars of different family-systems models.

Mixing and matching can often complicate treatment, so it is important to develop an approach that you feel comfortable with and realize the limitations (as every approach will have them).

 

[smalltownpsych]

When you use the term intervention, I tend to think of specific techniques or strategies to implement, bur it sounds like you are referring to what I have usually heard referred to as theoretical orientation. I think it is important to be clear on the distinction between the two. My primary theoretical orientation is Object Relations which is psychodynamic and that tends to be how I conceptualize and formulate treatment plans. That does not mean that I cannot use interventions from other theories especially when they are proven effective. For example, if a client has difficulty with specific phobia, my intervention would be to help them formulate a systematic desensitization strategy which is a straight up behavioral intervention. I will assess family dynamics and relationship issues and affect regulation, and if any of those areas are problematic, I will tend to use techniques to increase insight and affective expression/regulation and explore how those are connected to relating to others. It is usually not so clear-cut though which is why it is crucial to be grounded in one theory before integrating too much as T4C was saying.

 

[clip.clop]

I guess I don't think of it in such a dichotomous manner...everything seems to make more sense to me when I approach problems/case formulations and respective treatments with a more fluid/open mindset. Though, to be sure, I echo Therapist4Chnge--fluidity is only as good as one's comprehension of various txs.

Most of my training has been with CBT underpinnings, but I've found myself moving more toward third-wave treatments overall. Actually, I should say I just find myself moving more and more away from traditional CBT overall. I've found, so much, that it feels like a lot of tire-spinning more often than not. ACT makes much more sense to me than traditional CBT in terms of mechanisms of change, and while the data seem promising I also respect that there's still more research to be done to establish a comparable empirical basis for such treatments' efficacy and effectiveness.

I also REALLY love DBT for just about any problem that'll have it. DBT, ACT, and the like are just so fantastically modifiable, it seems, but again I suppose that's only with a certain degree of understanding. Although, I will say my love for mindfulness-based treatments is qualified by my active distaste for the more predictable/traditional/hippie-esque methods of mindfulness.

All this said, I can pretty easily see the merit in much of the trademark therapies/interventions of most major theoretical orientations, it just depends on the problem/context.

 

[Fan_of_Meehl]

I'm in my third semester in a clinical MSW program and I am currently in a number of different courses emphasizing the practice and analysis of different theories and types of interventions. My question is how did most of you decide on which kind of intervention you would use to be your "go to" or are any of you eclectic? To be honest when I'm at field now I find myself bouncing around different concepts that are seen in many of the different interventions.
To sum up my question:

Do you have an intervention to call your own or are you eclectic?
If so, how did you come to choose this intervention?
In session, do you ever find yourself straying from "your" intervention and start using others? i.e you primarily use solution-focused therapy, however the conversation with the client has found you wondering about the client's subconscious and how it may be playing a role; prompting you to start implementing a psychodynamic intervention.

Thanks for this...looking forward to hearing from you guys.

Primarily cognitive-behavioral theoretical orientation here; traditional CBT university-based program including standard manualized approaches with some in-depth training in 'Beckian' cognitive therapy.

I'd say that the most troublesome aspect of the psychotherapy practices that I see is a lack of ongoing case-formulation and hypothesis testing. Interventions, per se, are of course important to 'turn a bolt' or 'loosen a screw' but good case formulation (along with, of course, the therapeutic relationship) is where it's at.

 

[Goobernut]

I am in a similar position Ikibah. I decided to look at what areas I wanted to work in. Since my goal is be co-located in a health clinic, I looked for modalities that worked best for that setting. I chose CBT and solution focused to compliment it. And working on Motivational interviewing to add to my toolkit.

 

[Therapist4Chnge]

MI is a *great* option. Be warned though…there is legit MI and then what is taught in passing during a 20-30min presentation or CEU. That being said, I use MI quite frequently when I get consulted for in-pt work.

 

[Goobernut]

Yes, so far I've just had the minimal exposure as part of a class (scaling questions etc). Getting myself in an officially sanctioned training is next on the list. Ugh, it's buyer beware concerning any training.