Stepped Care 2.0: A Paradigm Shift in Mental Health by Peter Cornish

Author:Peter Cornish
Language: eng
Format: epub
ISBN: 9783030480554
Publisher: Springer International Publishing

4.9 Step 7: Flexible Intensive Individual Programming

Step 7 is undoubtedly where most work currently happens in mental healthcare. While the demand can be reduced with the implementation of SC2.0, social workers, psychologists, counsellors, physicians, nurses and psychiatrists will continue to deliver some form of talk therapy on a routine basis. Often the style, complexity, duration and interval of treatment are different depending on the provider or discipline. This is a good thing, as one size does not fit all. Client preference and choice are core principles of SC2.0. However, there is considerable debate among providers and uncertainty among help-seekers about what to expect from whom.

In SC2.0, informed consent is especially important. This is partly because the model and approaches are new. It is also because having clear expectations improves outcomes. Equally important to informed consent is role clarity. This includes the expectations and roles of both client and provider, but increasingly in our more collaborative care networks, we need to do more to develop interprofessional role clarity. What should a nurse do in the SC2.0 system? What about the family physician, a psychiatrist or a psychologist? While we have not yet worked this out, the model does provide a kind of scaffolding for exploring and testing out role differentiation. This is detailed more in Chap. 6.

Have you ever wondered why psychotherapists typically work in the context of the 50-min hour? This has been the case for more than a century. An hour is a useful period of time for costing. An hourly rate is easily understood and remains the most common unit for pricing all wages in our economy. The extra 10 min afforded by the 50-min hour, of course, ensures that time spent with record keeping and other administrative tasks are factored into the pricing. But what does science say about this? Is this unit of time any better than others for improving mental health? And then, what about weekly intervals, why do we practice psychotherapy at one-week intervals? Is there evidence to support this? Is the weekly 50-min session in the best interest of help-seekers or is it really for providers? Of course, we do need a system that is sustainable. The needs of providers are important, but they should not preclude innovation.

Very little research has addressed these questions. That in itself is interesting. Why hasn’t this been studied more? The research that has been conducted suggests that there is nothing particularly beneficial or important about intervals and session duration (Erickson, Lambert, & Eggett, 2015; Turner, Valtierra, Talken, Miller, & DeAnda, 1996). While it is true that much more study is warranted before drawing firm conclusions, proponents of SC2.0 encourage more experimentation in general and this also applies to the use of time. In the context of continuous therapeutic measurement, client preference and a trial and error philosophy, therapists operating at Step 7 can become much more creative with time. Sometimes we ask our clients at the beginning of Step-7 sessions, “What would you prefer today, a targeted

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