Overview/General Issues in Psychotherapy

• Psychotherapy is a developmental process that will assist the client in gaining a logical and clear understanding of their core attitudes, beliefs and recurrent emotions, patterns of thinking, behavior, and personality, which may have resulted in specific challenges, poor quality of life, and interpersonal relationships.
• Counselling is a type of therapeutic method that aids a person in overcoming unwanted emotions and behavioural habits.
• The fundamental goal of counselling is to enable the client reveal his concerns to a professional with extensive knowledge of the human mind, so that the client can receive help in adapting to normal and efficient everyday routines.
• Counselling is a short-term treatment that places emphasis on a specific symptom or situation, whereas psychotherapy is an approach that provides long-term relief and aims to gain a deeper cognizance of a person’s problems.
• Some people make a small distinction between the two terms. “Counseling” is a brief treatment that targets a specific symptom or situation, while “psychotherapy” is a longer-term treatment that attempts to gain more insight into someone’s problems. However, many people use the terms interchangeably.
• Questions about the outcome of psychotherapy have been prominent throughout the history of clinical psychology, and studies investigating these questions have taken many forms.
• Through the mid-1900s, most of the evidence offered in support of psychotherapy came in the form of anecdotes, testimonials, and case studies—essentially, subjective descriptions of individual clients’ progress, usually written by the therapists themselves.
• Controlled, empirical studies of therapy outcome didn’t appear regularly until the 1950s (Weissmark & Giacomo, 1998).
• Hans Eysenck (1952) published a historic study during this early period. Its claims were noteworthy and controversial.
• After reviewing some of the early empirical studies on psychotherapy outcome, Eysenck concluded that most clients got better without therapy and that in general, psychotherapy was of little benefit.
• A meta-analysis statistically combines the results of many separate studies—in some cases, hundreds—to create numerical representations of the effects of psychotherapy as tested across massive numbers of settings, therapists, and clients.
• Tripartite model (Hans Strupp) - with “tripartite” literally meaning “three parties"
• Clients are the ones whose lives are affected by therapy, and improving their lives in some meaningful way is presumably the focus of the therapy.
• Clients’ opinions about therapy outcome are extremely valuable, but they can also be extremely biased.
• Some clients may be overly eager to see positive results, especially after investing significant time and money, and therefore overestimate therapy’s benefits.
• Therapist—the second party—as another source of feedback. The therapist typically has more experience in mental health issues than the client and may therefore have more reasonable expectations.
• Therapists witness only a fraction of clients’ lives, and they may feel that negative evaluations reflect poorly on their own therapeutic skills.
• Society, can take the form of any outsider to the therapy process who has an interest in how therapy progresses. This can include the general public, the legal system, clients’ family and friends, clients’ employers, and especially today, managed care companies who pay the psychotherapy bill.
• Society

  • These third parties tend to bring a perspective that emphasizes the client’s ability to perform expected duties in a stable, predictable, unproblematic way.
• Certainly, the question of who to ask is crucial to the process of measuring therapy outcome. Thankfully, researchers need not choose a single perspective exclusively; they can and often do solicit multiple opinion
• Psychotherapy outcome, especially from the client’s perspective, must take into consideration the fact that clients from diverse cultures often hold widely varying expectations about the psychotherapy process.
• A culturally competent therapist will be able to attain more successful psychotherapy outcome by appreciating the presumptions related to each client’s cultural background.
• Training psychotherapists to be culturally competent is the foundation on which they can build an appreciation of client’s expectations about psychotherapy.
• This training should encompass four levels:

  • self-understanding (of one’s own cultural values)
  • listening to clients’ cultural values
  • accepting clients’ cultural values
  • understanding clients’ cultural values
• Efficacy studies typically feature well-defined groups of patients, usually meeting diagnostic criteria for a chosen disorder but no others; manualized treatment guidelines to minimize variability between therapists; and random assignment to control and treatment groups.
• Effectiveness studies tend to include a wider range of clients, including those with complex diagnostic profiles; allow for greater variability between therapists’ methods; and may or may not include a control group for comparison to a treatment group.
• Effectiveness studies lack the internal validity of efficacy studies because the researchers control and manipulate fewer variables.
• Perspective of the Therapies

  • Psychodynamic Psychotherapy
  • Humanistic Psychotherapy
  • Behavioral Psychotherapy
  • Cognitive Psychotherapy
  • Group and Family Therapy