“Teaching Moments” in Psychotherapy: Addressing Emergent Life Events Using Strategies From a Modular Evidence-Based Treatment

Abstract

Emergent life events (ELEs) are unexpected, acute client stressors reported in psychotherapy sessions that are associated with reduced evidence-based treatment (EBT) integrity and client progress. As a potential solution, this study examined the extent to which ELEs could be appropriately addressed using existing EBT strategies. Participants were 34 low-income youth (ages 5–15, 50% male, 85% Latino) seen by 18 therapy providers in the modular EBT condition (MATCH) of a community effectiveness trial. MATCH experts rated descriptions of 75 ELEs from therapy sessions on how well they might be addressed clinically by any of MATCH’s 33 strategies for youth anxiety, depression, trauma, or conduct problems (i.e., “addressability”). MATCH-expert ratings were compared with observationally coded provider responses to ELEs. Results revealed that when assuming the presence of youth and caregiver in session, two-thirds of ELEs were identified as fully addressable and nearly all ELEs (96%) were partially addressable. ELEs related to family issues were most common but least likely to be addressable. Problem Solving and Relaxation skills could address the greatest percentage (87%) of ELEs. The most common supplemental content not explicitly prescribed in MATCH, but identified as necessary to fully address ELEs, was “assessing and empathic listening.” Provider responses often were incongruent with MATCH-expert raters regarding which strategies to use for which ELEs. In summary, most ELEs reported in a diverse community sample could be theoretically harnessed as “teaching moments” for skills within an existing, multi-problem EBT. However, providers may benefit from development of a structured resource to guide them in choosing the most effective response when these unexpected events arise.

Clinician Maladaptive Anxious Avoidance in the Context of Implementation of Evidence-Based Interventions: A Commentary

“…Within the implementation context, we can conceptualize maladaptive anxious avoidance as occurring when clinical decision making is primarily driven by a clinician's own affective reaction to a given EBI, rather than by the best interests of the patient, leading to avoidance of delivering some or all of that EBI. In contrast, adaptive anxious avoidance may arise when a clinician experiences discomfort at the thought of delivering a given EBI in a session where a patient has recently learned of the death of a close family member; this is likely an appropriate emotional reaction that should drive clinician decision-making to adjust the treatment plan (52).…”

Workforce Support for Urban After‐School Programs: Turning Obstacles into Opportunities

“…Indeed, frontline afterschool providers routinely report feeling unprepared for these inevitable conversations with youth and families and look to us for guidance. Borrowing from a growing literature on emergent life events in therapeutic interactions (Guan, Boustani, & Chorpita, 2018), we interpret acute stressors not as distractions that impede learning, but as opportunities for compassion and life skills practice-for staff and for youth-such as emotional awareness, mindfulness, and communication (e.g., journaling) within the very real context of grief and anger.…”

How community therapists describe adapting evidence‐based practices in sessions for youth: Augmenting to improve fit and reach

“…Emergent life events were cited as one context in which therapists would defer elements of EBP delivery to attend to the crises (Barnett et al, 2018; Guan, Park, & Chorpita, 2019). Emergent life events have been linked to reduced adherence to planned session activities, yet, are largely addressable using supplemental content (Guan et al, 2017; Guan, Boustani, & Chorpita, 2019). Thus, session engagement or lack of engagement may portend therapist decisions to augment treatment with supplemental content such as problem solving.…”