Topic 10-11 (General Issues in Psychotherapy)

• Psychotherapy


  The professional activity of clinical psychologists
• Hans Eysenck (1952) published a historic study and concluded that most clients got better without therapy and that, in general, psychotherapy was of little benefit
• Many of those empirical studies on therapy outcome were conducted in the 1960s and 1970s. By the late 1970s and 1980s, meta-analyses began to appear
• Who researchers should ask about psychotherapy outcome

  • Clients
  • Therapists
  • Society
• Clients' opinions about therapy outcome

  Extremely valuable but can also be extremely biased
• Therapists


  Have more experience in mental health issues, may have more reasonable expectations, but could still be biased
• Society


  Tend to bring a perspective that emphasizes the client's ability to perform expected duties in a stable, predictable, unproblematic way
• Efficacy


  Extent to which psychotherapy works "in the lab"
• Effectiveness


  Extent to which psychotherapy works "in the real world"
• Psychotherapy WORKS! Its benefits appear to endure over long periods of time, exceed placebo effects, and represent clinically (not just statistically) significant change in clients' well-being
• 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
• 3 Basic Elements of the Unified Protocol


  • Reducing the amount of negative thought in which clients engage
  • Preventing unhealthy ways of avoiding unpleasant feelings
  • Encouraging behaviors that facilitate positive rather than negative feelings
• Effectiveness studies indicate that psychotherapy works as it is commonly applied in realistic settings
• In the hundreds of empirical studies designed to compare the efficacy of one form of therapy with the efficacy of another, the typical result is that the competing therapies are found to work about equally well
• The "Dodo Bird Verdict"

  The finding that different forms of psychotherapy are about equally effective
• Common Factors in Psychotherapy


  • Therapeutic Relationship/Alliance
  • Hope (Positive Expectations)
  • Attention
• Three-stage Sequential Model of Common Factors

  1. Support Factors

  2. Learning Factors

  3. Action Factors
• It would be premature to conclude that all therapies are equal for the treatment of all disorders
• Client preferences are important to consider for retention (keeping the client from dropping out of therapy), enhancement of the therapy relationship, and, ultimately, outcome
• Change in therapy can be attributable to many factors: client characteristics, therapist characteristics, problem characteristics, and extratherapeutic forces
• Types of Psychotherapy Practiced by Clinical Psychologists

  • Eclectic/Integrative therapy
  • Combination of cognitive and behavioral approaches
  • Psychodynamic/psychoanalytic therapy (declining)
• Psychotherapy with individual clients dominates the professional activities of contemporary clinical psychologists
• Stages of Change Model


  • Precontemplation Stage
  • Contemplation Stage
  • Preparation Stage
  • Action stage
  • Maintenance Stage
• Future Psychotherapy Trends


  • Mindfulness-based approaches
  • Cognitive and behavioral approaches
  • Multicultural approaches
  • Eclectic/integrative approaches
  • Therapies involving the use of the Internet and other forms of technology
• Eclectic Approach


  Involves blending techniques in order to create an entirely new, hybrid form of therapy
• Integrative Approach


  Involves selecting the best treatment for a given client based on empirical data from studies of the treatment of similar clients