CHAPTER 11

• During the early period of psychotherapy, Hans Eysenck concluded that most clients got better without therapy and that, in general, psychotherapy was of little benefit.
• Hans Strupp, a legendary and pioneering psychotherapy researcher, identified three parties who have a stake in how well therapy works and who may have different opinions about what constitutes a successful therapy outcome.
• Strupp, Hadley, and Gomez-Schwartz labeled their theory the tripartite model (with tripartite literally meaning “three parties”.
• Efficacy is the success of a particular therapy in a controlled study conducted with clients who were chosen according to particular study criteria.
• Effectiveness is the success of a therapy in actual clinical settings in which client problems span a wider range and are not chosen as a result of meeting certain diagnostic criteria.
• According to the transdiagnostic approach, what needs treatment are not the superficial symptoms of a particular disorder, but the underlying pathology that causes those symptoms and the symptoms of related disorders.
• The main target of the transdiagnostic approach is the emotional disorders, a loose term intended to cover the disorders characterized by sadness (e.g., major depression) and anxiety (e.g., generalized anxiety disorder).
• The reluctance of practitioners to adopt treatments supported by efficacy studies has created a significant challenge in terms of dissemination of these treatments.
• One dissemination strategy that has received a lot of attention and increasing collaboration between researchers and practitioners is a strategy often called practice-oriented research.
• Practice-research networks are one manifestation of this strategy, in which groups of therapists and researchers work as teammates in all phases of a research study (Castonguay & Muran, 2015; Youn, McAleavey, & Castonguay, 2015).
• As an example of an effectiveness study, Consumer Reports magazine in 1995 surveyed its many subscribers about their experiences with psychotherapy. The primary finding was that for the vast majority of respondents, psychotherapy had very positive, lasting effects.
• Precontemplation stage — no intention to change at all. These clients are largely unaware of their problems, and they may have been pressured to enter therapy by family or friends who are more aware than they are themselves.
• 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. These clients are often ambivalent and are not yet willing to give up the benefits of the behavior they recognize as somewhat problematic.
• Preparation stage — intending to take action within a short time (e.g., weeks, a month). These clients may be taking small steps but have not made significant or drastic change.
• Maintenance stage — preventing relapse and retaining the gains made during the action stage. This stage lasts indefinitely.
• Action stage — actively changing behavior and making notable efforts to overcome their problems. More than any other stage, this stage requires sustained effort and commitment to the therapeutic goals.
• Stages of change is a series of stages that represent a given client's readiness for change in psychotherapy. These include: precontemplation, Contemplation, Preparation, Action, and Maintenance.