PSYCHOTHERAPY

LECTURE OUTLINE

• The context of psychotherapy

• Evaluating the effects of psychotherapy

• Evidence-based practice

• Marital, family, and group therapy

• Self-help and mutual aid strategies

PSYCHOTHERAPY

The Context of Psychotherapy

• Who provides psychotherapy – Clinical and counseling psychologists, social workers, psychiatrists, marital and family counselors

• Who seeks psychotherapy? YAVIS clients (Schofield, 1964)

• Duration of psychotherapy – Consumer Reports (1995) study – 2900 readers of CR

PSYCHOTHERAPY

The Context of Psychotherapy

• Common elements of psychotherapy across different theoretical perspectives (Frank, 1961) – client hopes, expectations, and help-seeking of own free will; client should also like, respect, and trust therapist; therapist care and concern for client; therapeutic alliance

PSYCHOTHERAPY

The Context of Psychotherapy

• Unique elements of psychotherapy that vary according to different theoretical perspectives – insight vs. action orientation; directive vs. non-directive; focus on emotion, cognition, behaviour; techniques used; homework

• Need for therapies that are culturally-sensitive – not “one size fits all,” cultural competency of therapists

PSYCHOTHERAPY

The Context of Psychotherapy

• How does therapy differ from a conversation between 2 friends in which one friend is sharing a problem with her or his friend?

PSYCHOTHERAPY

The Context of Psychotherapy – Questions to ask a potential therapist

• What are your professional qualifications?

• Have you ever worked with this type of problem before?

• How would you describe the way you work?

• How many times do you think it will be necessary to see me?

PSYCHOTHERAPY

The Context of Psychotherapy – Questions to ask a potential therapist

• What are the treatment options for me? Are their clinics or other practitioners who work with this type of problem?

• What is the research evidence on the best type of treatment for my problem?

• What can I expect from treatment? How will I be different at the end of treatment?

• How much do you charge? Do you have a sliding fee scale?

PSYCHOTHERAPY

Evaluating the Effects of Psychotherapy

• Historical context – Eysenck’s (1952) review

• Deterioration effects (Bergin & Lambert, 1978) – the “psychonoxious therapist” – distasteful personality, unusually high fees, sexual exploitation, subtle manipulation or abuse

• Potential for recovery and problem of relapse – need for long-term perspective and understanding that therapy is one part of an individual’s journey of healing

PSYCHOTHERAPY

Evaluating the Effects of Psychotherapy – Meta-analysis

• a technique for evaluating effectiveness across studies

• To examine outcomes of interventions, the mean of control or comparison group is subtracted from the mean of the intervention group and divided by the pooled standard deviation (SD)

PSYCHOTHERAPY

Evaluating the Effects of Psychotherapy – Meta-analysis

• An effect size (ES) of 1 means that those in the intervention group score 1 SD higher than those in the control group

• .2 = small effect, .5 = medium effect, .8 = large effect

PSYCHOTHERAPY

Evaluating the Effects of Psychotherapy – Meta-analysis

• In their review of 475 studies, Glass et al. (1980) found an average ES of .8 (a large ES)

• Behavioural and cognitive-behavioural therapies had higher ESs than psychodynamic, Gestalt, and “verbal,” insight-oriented therapies

• Similar findings reported of meta-analyses of psychotherapy for children (Weiss & Weisz, 1995)

PSYCHOTHERAPY

Evaluating the Effects of Psychotherapy

• Therapist factors - empathy, warmth, genuineness, confidence in ability to help, experience, absence of emotional problems, preparation of clients for therapy

PSYCHOTHERAPY

Evaluating the Effects of Psychotherapy

• Client factors – motivation/readiness for change, anxiety, depression, subjective discomfort

• Aptitude by treatment interactions (ATI) – Question of “Is therapy effective?” is not the best questions; better to ask “What works best for whom under what conditions?”

PSYCHOTHERAPY

Evidence-based Practice or Empirically-supported Therapy

• At least 2 randomized controlled trials (RCTs) demonstrating superiority to an established treatment or placebo controls

• At least 10 single-case design studies

• And use of treatment manuals, clear specification of client characteristics, and findings reported by 2 different research teams

PSYCHOTHERAPY

Marital, Family, and Group Therapy

• Marital and family therapy – Systems framework

• Theoretical approaches to marital and family therapy

• Evaluation of marital and family therapy

PSYCHOTHERAPY

Marital, Family, and Group Therapy

• Insight-oriented group therapies – Psychodrama (Moreno), sensitivity, and encounter groups

• Action-oriented group therapies – Social skills and assertiveness training

• Components of group therapy process – goals, therapeutic factors, group cohesion, role of therapist, client selection

• Evaluation of group therapy

PSYCHOTHERAPY

Self-help and mutual aid strategies

• Self-help strategies – books, audiotapes, videotapes, computer programs, Dr. Phil type programs

• Mutual aid groups and organizations – wide range of support groups run by and for people with mental health challenges, such as AA, Narcotics Anonymous, etc.

PSYCHOTHERAPY

SUMMARY

• Those who seek help are often not those who need help the most

• Wide range of therapeutic strategies available

• But there are common factors in therapy

• Needs to be research support for therapeutic approaches

PSYCHOTHERAPY

SUMMARY

• Evidence that many different types of therapy can be effective

• Behavioural and cognitive-behavioural approaches have the most empirical support, but these approaches have generated the most research

• There is also evidence that some therapists are harmful, “psychonoxious therapist”

PSYCHOTHERAPY

SUMMARY

• Research needs to find out which approaches work best for whom and under what conditions

• There are also a variety of self-help and mutual aid strategies that can reach a large number of people at relatively low cost that may be quite helpful