Clinical Counseling Psych Notes Test 3 10 22 2012 10 16 2012 Psychological Interventions Learning Objectives What is psychotherapy What are the common features of most psychotherapies What steps are involved in the typical course of psychotherapy What does efficacy research entail What does effectiveness research entail What are the differences between them Is psychotherapy efficacious Effective What is the supporting research Learning Objectives What is the Dodo bird hypothesis Why did it begin LECTURE ONLY What evidence is there against the Dodo bird hypothesis Is all psychotherapy the same What is the supporting research What are Evidence Based Treatments What is manualized treatment What are the arguments for and against manualized treatments TEXT ONLY Psychological Intervention P sychological Intervention Intervention P sychotherapy T herapy Who Why What Psychotherapy is a form of treatment for problems of an emotional nature In which a trained person deliberately establishes a professional relationship with a patient With the object of removing modifying or retarding existing symptoms of mediating disturbed patterns of behavior and of promoting positive personality growth and development Common Features Relationship Therapeutic Alliance o Nature of the relationship between therapist and client Building Competence Mastery o Self confidence in ability to accomplish goals The Expert Role o Training knowledge experience Nonspecific Factors o Faith Hope Expectations Placebo Effect Typical Course Initial Contact Assessment Goals of Treatment Implementing Treatment Termination Evaluation Follow Up INITIAL CONTACT Services offered Credentials of therapists Fees Confidentiality Initial ContactAssessmentGoals of TreatmentImplementing TreatmentTermination Evaluation Follow Up Process Refer ASSESMENT Intake Interview Initial Testing Conceptualization of Problem GOALS OF TREATMENT Discuss prioritize problems Agree on goals Length frequency Responsibilities IMPLEMENTING TREATMENT Proceed with treatment Assess throughout Modify goals if necessary TERMINATE WHEN Goals reached Client is independent Plan ahead Provide data Elicit Feedback Follow up or booster session Psychotherapy Research Pre t Treatmen Measures Treatmen t Post t Treatmen Measures Psychotherapy Research ON SLIDES Two types of research studies Efficacy Studies Effectiveness Studies Pre Treatment MeasuresTreatmentPost Treatment Measures Psychotherapy Research Two types of research studies o Efficacy Studies Is the therapy efficacious Is the average person receiving the treatment significantly less dysfunctional than the average person not receiving the treatment Psychotherapy Research Two types of research studies o Efficacy Studies Psychotherapy Research Two types of research studies o Effectiveness Studies Very controlled Often take place in research labs Patients are pre screened and paid to participate Therapists are closely supervised Is the therapy effective Do clients report clinically significant benefit from therapy Psychotherapy Research Two types of research studies o Effectiveness Studies real world not research lab Range of clients Range of therapists Psychotherapy Research So what s the answer Does therapy work o Efficacy Research Eysenck 1952 Examined outcomes across 24 treatment studies Concluded that psychotherapy did not work 72 of patients improved with no treatment Only 44 of patients in treatment improved Eysenck s work was controversial and has been criticized However it inspired future research Psychotherapy Research So what s the answer Does therapy work o Efficacy Research Smith Glass Miller 1980 Examined 475 psychotherapy outcome studies Concluded that the average person receiving psychological treatment is functioning better than 80 of those not receiving treatment Psychotherapy Research So what s the answer Does therapy work o Effectiveness Research Consumer Reports 1995 Survey of 4 000 readers who had sought treatment for a psychological problem Most people reported improvement Psychotherapy Research So what s the answer Does therapy work o Effectiveness Research Consumer Reports 1995 Those who felt worse Mental health prof vs family physicians Psychotherapy alone psychotherapy meds In therapy longer Psychotherapy Research So what s the answer Does therapy work o Effectiveness Research Consumer Reports 1995 Limitations Psychotherapy Research So what s the answer Does therapy work o Overall research supports the conclusion that therapy generally helps Psychotherapy Research Is all psychotherapy the same o Luborsky Singer Luborsky 1975 o All therapies were generally the same in terms of outcomes o Fueled the Dodo bird hypothesis Psychotherapy Research Dodo bird hypothesis o All therapies are winners all produce equivalent outcomes o Common factors produce outcomes not specific features of different therapies Psychotherapy Research Opposition to the Dodo bird hypothesis Smith Glass Miller 1980 Recent Trends Focus of Psychotherapy Research o Does psychotherapy work o Which type of psychotherapy works for which diagnosis Chorpita et al 2011 Documented evidence base for several different approaches to therapy For example Anxiety Lots of evidence for CBT Exposure Minimal support for hypnosis psychodynamic play therapy Recent Trends Evidence Based Treatment EBT EST EVT o Those interventions or techniques that have produced significant change in clients in controlled clinical trials o Criteria disseminated by American Psychological Association Recent Trends Evidence Based Treatment EBT EST EVT Well established treatments MUST At least 2 good group designs by different investigators why o Be able to show results are conclusive and generalized not just one person getting same results Show that it is superior to a pill or another treatment Or equivalent to an already established treatment If you meet some of the criteria but not all you will fall in the PROBABLY EFFICACIOUS TREATMENT group If treatment is not tested it falls in the EXPERIMENTAL TREATMENT group Psychology is a science Seeking to help those in need clinical psychology draws its strength and uniqueness from the ethic of scientific validation Whatever interventions that mysticism authority commercialism politics custom convenience or carelessness might dictate clinical psychologists focus on what works They bear a fundamental ethical responsibility to use where possible interventions that work and to subject any intervention they use to
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