Our Clinical Approach
At Sullivan + Associates, we have developed our own approach to psychotherapy/
Psychotherapy/
Step 1 – Establish a connection
It is critically important that our clients feel comfortable with their clinician. When there are comfort and rapport, clients are more likely to "open up" and answer questions as openly and honestly as possible. Clients are also more likely to have confidence that their clinician can help them to achieve their goals.
Step 2 – Ask a lot of questions... and then ask more questions!
During the first session, the clinician will likely ask many questions to develop a strong understanding of the client's thoughts, feelings, behaviours, family background, medical history, past psychological history, etc. Once there has been a thorough understanding of these areas, the clinician will be better equipped to correctly identify the issue(s) and establish an effective treatment plan.
Step 3 – Develop an understanding/
In some cases, this can be quite evident and straightforward, in other cases, there may be a combination of issues or contradicting thoughts and beliefs which can make this step a bit more challenging. Once the clinician has a good understanding of the issue(s), this information will be shared with the client to confirm that the working hypothesis accurately describes their experience.
Step 4 – Measure the issue
Whenever possible, we want to measure the severity of the issue (i.e., difficulties with anxiety, depression, etc.) so we can establish a baseline measure. This measure will allow the client and the clinician to track progress during the course of treatment and help to identify when mid-course corrections need to be made and ultimately when the client has achieved their goal!
Step 5 – Identify limiting patterns in thinking, behaving and beliefs that are contributing to the issue or are interfering with the solution
Depending on the situation, there are times when thoughts and behaviours can create problems in our daily lives; sometimes life happens, and everyday life can become challenging very quickly. In these situations, our response to the problem can result in patterns of thinking and behaving that do not help us achieve a solution.
Regardless of where problems originate, it is important to identify patterns of thinking and behaving that are ineffective and establish new, effective patterns that will not only allow us to think and behave more effectively but to feel better.
Step 6 – Identify the client's motivation for change
The single most significant factor that determines whether a client will make the change they desire is their level of motivation. According to the Transtheoretical Model of Change, individuals move through a series of 6 stages of change.
Below is a brief description of each stage.
Stage 1 – Pre-contemplation
The person has yet to acknowledge a problem.
Stage 2 – Contemplation
The individual acknowledges there is a problem but isn't ready to make a change.
Stage 3 – Preparation/
The person is getting ready to change and is almost ready to act.
Stage 4 – Action/
The individual is actively involved in changing their thinking and behaviour.
Stage 5 – Maintenance
The person continues to do the correct things to maintain their changes in thinking and behaviour.
Stage 6 – Relapse
The individual has returned to old behaviour and thought patterns and experiences a decline in functioning.
Our clients often enter psychotherapy/
When motivation to change is a challenge for the client, the clinician will focus on finding positive reasons for a change, as well as negative consequences that can be avoided by making a change.
Step 7 – Customize a treatment plan
With most treatment modalities (i.e., CBT, DBT, etc.), there is an established protocol, however, with psychotherapy/
Step 8 – Teach effective skills and strategies
It was mentioned earlier that ineffective patterns of thinking, behaving, and limiting beliefs often contribute to problems or interfere with our ability to find the solution. At this stage of our clinical approach, the clinician will teach the client new skills and propose strategies that will help create effective patterns of thinking and behaving and challenge limiting beliefs. Effective progress in these areas will lead to improved feelings such as improvements in mood, a decrease in anxiety, etc.
Step 9 – Create a sense of certainty that treatment will work
What would you do if you knew you couldn't fail? This question typically has a pretty simple answer - anything! Studies show that evidence-based psychotherapy is highly effective at treating psychological/
We believe an important factor is that people can lack a sense of certainty that treatment can work. When a client is highly motivated and feels confident that they will achieve the results they want, clients tend to engage in therapy fully, utilize the skills and strategies they have learned and completed the homework assigned by the clinician. When this level of action and commitment is demonstrated, clients tend to get better results, which reinforces their beliefs and feeling of certainty that treatment will work. This is an essential step in our clinical approach!
Step 10 – Work collaboratively to tackle the issue
The client's role in all aspects of psychotherapy/
Step 11 – Track progress
Whenever there is an issue that can be measured with a psychometric test, it is essential to administer the measures at different points throughout the treatment process. These results provide critical feedback, as it helps the client and clinician to determine if the result is being achieved and if it is occurring as quickly as anticipated. Based on these results, mid-course corrections might need to be made, or things might be going exactly as expected!
Taking measurements at different points also helps to reinforce the "path of progress" approach we like to employ. Clients can occasionally struggle with "all or nothing" thinking when it comes to achieving goals. With this type of thinking pattern, people can view goals as something they have achieved or haven't achieved, with no middle ground. However, achieving a goal by 50% or 75% is meaningful and will contribute to the client feeling better. Taking measurements at set times and seeing results will help the client and clinician feel confident that the treatment plan is working and that the ultimate goal can be achieved by continuing to follow the plan.
For some treatment issues, an effective psychometric measure has yet to be created. In these situations, progress is tracked based on the clients self-report as well as the clinician's observations (i.e., based on the client feedback and how the client presents at appointments).
Step 12 – Modify the treatment plan until the result is achieved
It has been said, "If at first, you don't succeed, try, try again." That's true, but commonly in life, obstacles show up, and plans need to be modified to achieve success. When something doesn't work well, we view that as valuable, useful feedback we can use to adjust our approach to another treatment method or strategy that will work.
Psychological Assessment Approach
Step 1 – Establish a connection
Although it may not seem particularly important for a Psychologist to establish a connection with a client to complete a clinical interview, it is! When a client feels comfortable and confident with the assessor, they are more likely to provide open, honest, detailed answers, which is critical for the Psychologist to answer the assessment question effectively.
Step 2 – Ask a lot of questions... and then ask more questions!
When completing a clinical interview, there are potentially a lot of avenues that the Psychologist can explore with the client. To determine an appropriate, well-defined assessment question, it is essential that the Psychologist ask many questions. These questions will help to provide the framework for the assessment, as well as determine what psychometric measures will be administered.
Step 3 – Understand the issue and develop a working hypothesis
Based on the results of the clinical interview and possibly a screening measure administered before the interview, the Psychologist will define the assessment question, establish a working hypothesis (i.e., query a learning disability, explore a particular psychological issue, etc.) and select the appropriate psychological measures. The results of these measures will help to determine if the hypothesis is correct.
Step 4 – Administer the psychometric measures and score immediately to ensure the results answer the assessment question
The Psychometrist administers the psychometric measures (i.e., self-report questionnaires, paper and pencil tests, measure of verbal and non-verbal abilities, memory, speed of processing, etc.) and scores the results immediately, the results of these tests will help to determine if the assessment question has been answered or if further measures need to be administered.
Step 5 – If the assessment question isn't answered completely, administer more measures
Once the original measures have been administered and scored, the assessment question may not be fully answered. For instance, when completing a Psychoeducational (learning) assessment, the original assessment measures may help to confirm the hypothesis that the client has a reading disability. However, in this case, an additional measure would need to be administered (the CTOPP) to determine where the processing deficit in reading ability exists. This is critical information for the Psychologist, as they can now pinpoint where the problem lies and make appropriate recommendations that will help to improve the client's reading ability.
Step 6 – Prepare a timely, understandable, useful psychological report
Psychological reports can be complicated, cumbersome and difficult to understand when laden with psychological jargon. Over the past 12 years, it has become increasingly evident that our reports needed to be simplified.
During the past 3 years, our reports have been streamlined and focus on answering a specific assessment question. The reports are not too lengthy or overly-detailed (to prevent overwhelming the reader) and average 6 - 8 pages in length. The writing style focuses on using plain language and avoiding psychological jargon so it can be easily understood by the reader. We also do our best to highlight the strengths of the client, as well as identify the areas of difficulty. Based on the results of the report, customized recommendations are made specifically for the client.
Step 7 – Provide feedback about the assessment
A feedback session with the client (or with the client's parents in the case of children and adolescent clients) is always scheduled following the assessment. The Psychologist will review the results of the psychometric measures by outlining what each specific test was designed to measure and how the client performed. The Psychologist will also explain how their observations from the clinical interview meshed with the scores on the psychometric measures to answer the assessment question, which could potentially lead to a diagnosis. During the final (and crucial!) step, the Psychologist will review their recommendations and discuss how these suggestions can be implemented efficiently and effectively.