Psychotherapy treatment including removing or modifying symptoms mediating disturbed patterns of behavior and promoting positive personality growth o Meta analysis procedure to statistically combine results of existing studies calculates effect size for each study and PSYCHOTHERAPY combines them Tripartite model of assessing efficacy effectiveness o Who o When o How Client biased both positively and negatively Therapist biased due to time spent Society anyone who is affected by therapy progression Multiple time points right after 1 month 6 months etc Observation interview questionnaires Efficacy vs Effectiveness o Efficacy whether the average person receiving treatment is less dysfunctional than average person not receiving treatment Evidence supports the efficacy of psychotherapy Results of Efficacy studies Hans Eysenck 1952 7000 patients treated with psychoanalysis or eclectic therapy o o Compared with data from untreated neurotic patients o No difference in recovery rate Smith Glass and Miller 1980 475 studies meta analysis with 25 000 patients o o Average effect size for psychotherapy is 0 85 o Recent meta analyses support this o Effectiveness clients report clinically significant benefit from the intervention Not everyone benefits Results of Effectiveness studies Consumer Reports 1995 Survey of 4000 readers treated some improvement for majority Found psychiatrists psychologists and social workers to be equally effective and helpful Psychotherapy alone is as effective as psychotherapy and medication o o o o Longer treatment more improvement o BUT sampling bias and no control o More recent approaches Employ neuroimaging to assess brain changes that accompany treatment successful therapy produces reliable changes in brain activity and structure Examines cost saving associated with treatment few days in hospital and ER Comparison of Effectiveness of Different Psychotherapies o The Dodo Bird Verdict Early studies suggested all treatments were equally effective o Common factors to all forms of psychotherapy Therapeutic Alliance accepting nonjudgmental Warmth positive regard acceptance The Expert Role Catharsis release of emotions Anxiety reduction tension release Attention hope Nonspecific factors Interpretation insight Building competence mastery Which kind of clients benefit from which treatment o Specific Therapeutic Variables that Influence Therapy Outcome The Client Intelligence Distress severe and comorbid personality disorders worse outcomes Age beliefs that individuals 40 years do better but little evidence Motivation believed to be important mixed support Openness to therapy very important Gender no evidence Race ethnicity SES little evidence Does the Therapist matter Age sex ethnicity no evidence Personality little evidence Empathy warmth genuineness some support Emotional well being self awareness is important Experience and professional identification mixed evidence that experience discipline matters o Therapeutic Alliance Nature and strength of the working relationship between therapist and client contribute to positive outcome Therapeutic bond one of best predictors of therapy outcome Eclectic vs Integrative 1 3 of all therapists describe themselves as eclectic Select best treatment for a given client based on empirical data from treatment studies Integrative blending components of different therapies to create a new form of therapy growing in popularity o o Efficacy of Different Approaches for Depression o NIMH Collaborative depression research project Elkin et al 1989 250 patients in 3 sites Pittsburgh Washington Oklahoma City Randomized controlled trial 4 groups CBT IPT Imipramine and drug placebo Intervention 16 sessions RESULTS All 4 groups showed improvement in depression after treatment Little difference between the 3 active treatment groups Findings maintained at 18 month follow up Current belief CBP and ITP effective for depression at least as effective as antidepressant therapy o Anxiety Gould et al 1995 Meta analysis comparing effectiveness of psychological and pharmacological treatments for panic disorder Treatment more effective than no treatment or placebo CBT with an exposure component were more effective than medication and associated with best maintenance over time Similar results for social phobia OCD Studies find that if therapy is going to be effective at all it will usually be effective relatively quickly Dose Response Question o o Howard et al 1986 40 of patients improve by 8th session 75 in 6 months of weekly treatment The Chambless Criteria o Diane Chambless 1995 used to develop practice guidelines o APA Division 12 list of studies that are empirically supported Empirically Supported Treatments o Anxiety stress CBT GAD and panic disorder Exposure treatment agoraphobia Treatment Well Established Criteria 1 At least 2 good between group design studies demonstrating efficacy superior to pill placebo or alternative treatment or equivalent to an established treatment 2 Large series of single case design experimental 9 demonstrating efficacy 3 Standardized treatment protocol 4 Participants clearly specified 5 Shown by 2 different investigators 1 2 2 studies showing that treatment is more effective than a wait list control group 1 study meeting most of the well established criteria Probably efficacious Promising At least one well controlled group design intervention and another less rigorous study with positive findings o Depression Exposure and response prevention OCD Exposure and guided mastery phobias Behavior therapy cognitive therapy IPT PSYCHOANALYTIC AND PSYCHODYNAMIC APPROACHES Sigmund Freud o Most current psychotherapy influenced by Freud still used today orthodox psychoanalysis o Freudian Theory Personality Components Id concerned with drive satisfaction provides the motive power follows the pleasure principle the horse Ego rational thought controls and channels id follows the reality principle the rider Superego Oversees balance between ego and id internalized parental control much like a conscience Libido the sexual life energy that drives the id other researchers dispute Freud s sexual emphasis Conscious Consists of mental contents of which you are currently aware ever changing Preconscious consists of things in long term memory that influence behavior memories and thoughts that aren t presently on your mind but easily could be Subconscious consists of things you re unaware of but that influence you the primary personality component