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• Intervention


  Inducing change via professional relationship, Solve or prevent problems, Achieve latent potential
• Psychotherapy


  Treatment for emotional problems, Affect changes in the individual (e.g., reduce symptoms), Professionally established relationship
• Efficacy


  • Person receiving treatment must show significant reduction in the levels of dysfunction, Focus on internal validity
• Effectiveness


  • Treatment option must be representative, Emphasize external validity
• Effect size


  Change relative to a comparison group that does not receive the treatment
• Types of studies


  • Efficacy studies
  • Effectiveness studies
• 1995 study done by Consumer Reports magazine summarized the survey responses of 4,000 readers who had sought treatment for a psychological problem
• Most respondents well educated, median age = 46, half women
• Majority reported some improvement, Those who felt the worst before treatment reported the most improvement, All types of mental health professionals appeared to be equally effective, Respondents who received psychotherapy alone improved as much as those who received psychotherapy plus medication, Longer treatment (more sessions) was related to more improvement
• Evidence Based Treatments (EBTs)


  Question of efficacy vs. other treatments, EBTs have produced significant change in trials, APA established criteria for EBTs in 1995, Combine trials of EBTs through use of meta-analysis
• Evidence Based Practice (EBP)


  Broader, contains non controlled trials (i.e., no control or comparison group), Question of whether one can scientifically measure effect without a comparison group, Rise in use with healthcare reforms
• Common factors


  • 3 Types: supportive, learning, action, Involved in all effective psychotherapies
• Therapeutic alliance


  Relation between client/ therapist, Unique in importance, Not necessarily curative, Must be non-judgmental, objective, insightful, professional
• Expert role


  Expert knowledge about psychological problems, Competency/ training, Maintaining equal respect
• Building competency


  Therapist as educator, Promote self-efficacy, Facilitate mastery experiences, Influence of immeasurables: hope, belief, "Placebo effect" of therapist
• Patient/ client variables


  • Degree of distress
  • Intelligence
  • Age
  • Motivation (voluntary)
  • Openness
  • Gender
  • Race, ethnicity, social class
  • Reactions to patient
• Therapist variables


  • Age, sex, ethnicity
  • Personality
  • Empathy, warmness, genuineness
  • Emotional well-being
  • Experience
  • Professionals vs. Paraprofessionals
• Course of clinical intervention

  1. Initial contact

  2. Assessment

  3. Goals of treatment established

  4. Implementing treatment

  5. Termination, evaluation, follow up
• Stages of change


  • Pre-contemplation
  • Contemplation
  • Preparation
  • Action
  • Maintenance
  • Termination
• Groups in psychotherapy research

  • Experimental: receive treatment
  • Control: do not receive treatment
  • Waiting list control: treatment delayed until after study
  • Attention only control: meet with clinician, but no "active" treatment given
• Assessment of patient functioning conducted in parallel fashion for experimental and control groups, Before and after study
• Sample: Is it representative?, Patient variables that may influence outcome, Outcome measures: Identical for every patient?, Nature of the study
• Behavior therapy (BT) and psychodynamic therapy (PT) better at termination and follow-up compared to waiting list control
• Meta-analysis by Smith, Glass, & Miller (1977) of 475 studies, 25,000 patients, 78 therapies, average of 16 sessions
• Competence & adherence tied to positive outcome, Client emotionally processing session material tied to outcome, Degree of cooperation and positive affect in session positively tied to outcome
• Recent trends: Focus of psychotherapy research on efficacy & effectiveness, Factors related to higher efficacy and effectiveness, Practice guidelines recommend specific form of treatment for specific problems, Common goal to achieve effective treatment
• Manualized Treatment


  Prescribed treatment method, Encourage innovation, Therapeutic alliance, Managed care