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Chapter 11: General Issues in Psychotherapy (Efficacy vs. Effectiveness of…
Chapter 11: General Issues in Psychotherapy
Does Psychotherapy Work?
Hans Eysenck: published a study claiming that most clients got better without therapy and psychotherapy was not beneficial; eventually disproven after inspiring many subsequent empirical outcomes
Meta-analysis: statistically combines the results of many separate studies to create numerical representations of the effects of therapy as tested across massive numbers of settings, therapists, and clients
Hans Strupp: pioneering psychotherapy researcher
Tripartite model: identification of three parties who have a stake in how well therapy works and who may have different opinions about what constitutes a successful therapy outcome
Parties include the client, therapist and society
Efficacy vs. Effectiveness of Psychotherapy
Efficacy: extent to which psychotherapy works in the lab
Effectiveness: the extent to which psychotherapy works in the real world
Psychotherapy works and the benefits endure over periods of time however some clients worsen, drop out or only have short-term benefits
There is a gap that exists between those who conduct efficacy research on psychotherapy and those who practice it
Dissemination of research is necessary to bridge gap
Collaboration between researchers and practitioners: practice-oriented research
Mental Health magazine found that psychotherapy had positive lasting effects
any effectiveness study raises methodological questions about bias
Alternate ways to measure outcome
neurobiological effects: using fMRI and PET shows that psychotherapy produces reliable changes the brain activity and structure
Medical cost offset: many people with mental or emotional problems will either seek medical assistance or put off treatment so long that the problem worsens- seeking psychotherapy reduces medical cost
Which Type of Psychotherapy is Best?
Dodo Bird Effect: each therapy seems to work about equally
explained by common factors across psychotherapy
Therapeutic Relationship/Alliance
quality of therapeutic relationship strongly contributes to psychotherapy outcome; may be the best predictor of therapy outcome
connection between a good therapeutic alliance and client improvement is not a one-way street; as clients improve, their relationship with their therapists improves
therapist's ability to provide empathy and acceptance to the client is important
Other Common Factors
Hope/positive expectations: therapists providing optimism which may exhibit effects before techniques are applied
Attention/Hawthorne Effect: attention of client and therapist can be directed toward the clients issues and may represent a novel approach to the problem; acknowledging the problem may promote improvement before the intervention begins
Therapeutic relationship
Desensitization to threatening stimuli
Confronting a problem
Skill training
Three-stage sequential model of common factors
Stage 1: Support factors stage- strong therapist-client relationship, therapist warmth and acceptance and trust
connecting with client and understanding their problems
Stage 2: Learning factors stage- changing expectations about oneself, changes in thought patterns, corrective emotional experiences and new insights
facilitating change in their beliefs and attitudes about their problems
Stage 3: Action factors- taking risks, facing fears, praticing and mastering new behaviors and working through problems
encouraging new and more productive behaviors
Specific Treatments for Specific Disorders (Discounting the Dodo Bird Effect?)
Diane Chambless: psychotherapy researcher who has argued strongly against the idea that all psychotherapy approaches are equally efficacious
champion of the movement toward manualized, evidence-based treatments and has led the task forces that established criteria for efficacious treatments for specific disorders and determined which therapies made that list
Stanley Messer & Bruce Wampold: preponderance of evidence points to the widespread operation of common factors in determining treatment outcome
Perspective approach: specific therapy techniques are viewed as the treatment of choice for specific disorders
Client preferences, enhancement of the therapy relationship and outcome affect retention
Arguments for both sides of the argument
for target outcomes, the particular techniques of cognitive-behavior therapy were better predictors
For general quality of life, common factors were better predictors
client characteristics, therapist characteristics, problem characteristics and extra therapeutic factors can have a powerful impact on the client's well-being at the end of therapy
What Types of Psychotherapy do Clinical Psychologists Practice?
The Past and the Present
Eclectic/integrative therapy was the most commonly endorsed orientation in every survey- therapists rarely use solely one technique
Combined orientations are extremely common, but surveys suggest that the combination of cognitive and behavioral approaches is the most common
Cognitive therapy has become more popular- it is the most commonly endorsed single-school approach
Stages of Change Model
Precontemplation stage: no intention to change at all- clients are unaware of their problems
Contemplation stage: aware that a problem exists, considering doing something to address it, but not ready to commit to any real effort in that direction
Preparation stage: intending to take action within a short time
Action stage: actively changing behavior and making notable efforts to overcome their problems
Maintenance stage: preventing relapse and retaining the gains made during the action stage
The Future: approaches to therapy
mindfulness-based approaches to therapy
cognitive and behavioral approaches to therapy
multicultural approaches to therapy
eclectic/integrative approaches to therapy
therapies involving the internet and other forms of technology evidence-based practice
Eclectic and Integrative Approaches
Eclectic therapy: selecting the best treatment for a given client based on empirical data from studies of the treatment of similar clients
Integrative approach to therapy: blending techniques in order to create an entirely new, hybrid form of therapy
John Norcross: explained that the psychotherapy integration movement grew out of a dissatisfaction with single-school approaches and a concomitant desire to look across and beyond school boundaries to see what can be learned from other ways of thinking about psychotherapy and behavior change