Issues in Psychotherapy, Psychodynamic, Humanistic

• Chapters


  • Chapter 11 - General Issues in Psychotherapy
  • Chapter 12 - Psychodynamic Psychotherapy
  • Chapter 13 - Humanistic Psychotherapy
  • Chapter 14 - Behavior Therapy
  • Chapter 15 - Cognitive Psychotherapy and Mindfulness-Based Therapies
  • Chapter 16 - Group and Family Therapy
• Efficacy


  The extent to which psychotherapy works in a controlled research study
• Effectiveness


  The extent to which psychotherapy works with actual clients treated by therapists in real-world settings
• Efficacy studies maximize internal validity by controlling as many aspects of therapy as possible
• Effectiveness studies have greater external validity as their methods better match therapy in real clinical settings
• Thousands of efficacy studies have consistently shown that psychotherapy is beneficial
• The average effect size for psychotherapy in efficacy studies is 0.85, indicating the average person receiving therapy is better off than 80% of those not receiving therapy
• The benefits of psychotherapy appear to endure over long periods of time, exceed placebo effects, and represent clinically significant change
• A small minority of therapy clients do appear to worsen during the therapy process or experience only short-lived benefits
• The overarching theme of this large body of psychotherapy research must remain the same—psychotherapy is beneficial. This consistent finding across thousands of studies and hundreds of meta-analyses is seemingly undebatable
• Not only does psychotherapy work, 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
• Psychotherapy is not a panacea—a small minority of therapy clients do appear to worsen during the therapy process
• Some clients drop out of therapy prematurely, and others experience only short-lived benefits
• These negative effects clearly appear to be the exception rather than the rule
• 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
• Transdiagnostic approach


  • Focuses on reducing the amount of negative thought in which clients engage, especially when they anticipate upcoming events, preventing unhealthy ways of avoiding unpleasant feelings, and encouraging behaviors that facilitate positive rather than negative feelings
• Data for the efficacy of the unified protocol for the emotional disorders is strong and growing
• There is an undeniable and unfortunate gap between those who conduct efficacy research on psychotherapy and those who practice it
• Reluctance of practitioners to adopt treatments supported by efficacy studies

  Has created a significant challenge in terms of dissemination of these treatments
• Dissemination of evidence-based treatments has become a major focus of researchers of psychotherapy outcome
• Numerous strategies have been employed to increase dissemination, with varying results
• Practice-oriented research, where researchers and therapists collaborate as partners throughout the process, can help bridge the gap between research and practice
• Effectiveness studies indicate that psychotherapy works as it is commonly applied in realistic settings
• Effectiveness studies complement efficacy studies, and together they strongly support the benefits of psychotherapy
• Psychotherapy changes the brain, as shown by neuroimaging studies
• Psychotherapy reduces medical costs, as clients receiving therapy spend fewer days in the hospital and see their medical costs reduced
• Dodo Bird Verdict


  The typical result in hundreds of empirical studies designed to compare the efficacy of one form of therapy with the efficacy of another is that the competing therapies are found to work about equally well
• The various forms of psychotherapy—psychoanalysis, humanism, cognitive, behavioral, and others—are quite discrepant from one another, so how could they consistently produce such similar results?
• Common factors


  Fundamental components shared by all forms of psychotherapy that contribute to their similar results
• The notion that different therapies benefit from the same underlying mechanisms was suggested as early as the 1930s and has been reiterated numerous times since then
• Common factors


  • They are therapeutic and function as "active ingredients" in all forms of psychotherapy, which helps explain the comparable results of the various approaches
• Common factors for psychotherapy outcome

  • Therapeutic relationship/alliance
  • Hope (or positive expectations)
  • Attention
• Therapeutic relationship/alliance


  A strong relationship between therapist and client
• Research unequivocally indicates that the quality of the therapeutic relationship strongly contributes to psychotherapy outcome
• The therapeutic relationship is perhaps the most crucial single aspect of therapy and the best predictor of therapy outcome
• The quality of the therapeutic relationship is vital to therapy regardless of how much emphasis the therapist places on it
• Therapeutic relationship components


  • Alliance between therapist and client
  • Sense of collaboration
  • Goal consensus
  • Cohesion (for group therapy)
  • Empathy
  • Positive regard and affirmation
  • Providing feedback to clients
• Researchers have also begun to examine the extent to which graduate programs teach their students about the therapeutic relationship/alliance
• Hope (or positive expectations)


  Therapists of all kinds provide hope or an optimism that things will begin to improve
• Attention


  Also known as the Hawthorne effect, the attention the therapist and client direct toward the client's issues may represent a novel approach to the problem