Learning Objectives Test 3 Chapter 11 1 What is psychotherapy Psychotherapy is a form of treatment for problems of an emotional nature with the object of removing modifying or retarding existing symptoms of mediating disturbed patterns of behavior and of promoting positive personality growth and development 2 What are the common features of most psychotherapies Four common features and client 1 Relationship therapeutic alliances nature of the relationship between therapist 2 Building competence mastery self confidence in ability to accomplish goals 3 The expert role training knowledge experience 4 Nonspecific factors faith hope expectations Placebo Effect 3 What steps are involved in the typical course of psychotherapy 5 steps 1 Initial Contact services offered credentials of therapists fees confidentiality process refer 2 Assessment intake interview initial testing conceptualization of problem 3 Goals of treatment discuss prioritize problem agree on goals length frequency responsibilities 4 Implementing treatment 5 Termination Evaluation Follow Up Terminate when goals reached proceed with treatment assess throughout modify goals if necessary client is independent plan ahead provide data Elicit feedback follow up or booster session different types of control refer to slides 13 18 waitlist only control the individuals are not getting treatment it s not due to any other kind of treatment the only thing that has happened to them is the passage of time if you compare to waitlist only you are comparing to see if time effected it 4 What does efficacy research entail What does effectiveness research entail What 1 Is the therapy efficacious so does the treatment work Is the average person 2 Is the average person receiving the treatment significantly less dysfunctional are the differences between them the two types of psychotherapy research are efficacy studies and effectiveness studies Efficacy getting treatment better off than an average person not getting treatment than the average person not receiving the treatment very controlled often take place in research labs patients are pre screened and paid to participate therapists are well trained and closely supervised patients randomly assigned the therapists all have the same training and are closely monitored to make sure they are maintaining the treatment Effectiveness clients actually get better real world not a research lab range of clients range of therapies the main goal is to see if these therapies actually work in the real world but not easy to do these types of studies because you need a lot of resources 1 Is the therapy effective 2 Do clients report clinically significant benefit from therapy do real world 5 Is psychotherapy efficacious Effective What is the supporting research Efficacy Research 1 Eysenck 1952 examined outcomes across 24 treatment studies 2 Smith Glass and Miller 1980 this work was controversial and has been criticized no control no concluded that psychotherapy did not work 72 of patients improved with no treatment only 44 of patients in treatment improved standard of improvement question as to how he actually interpreted his data functioning better than 80 of those not receiving treatment legitimate study examined 475 psychotherapy outcome studies concluded that the average person receiving psychological treatment is this sounds better and is much less criticized because it was a much more overall it says therapy works 1 Consumer Reports 1995 survey of 4 000 readers who had sought treatment for a psychological most people report some improvement those who felt worse had most improvement in therapy longer reported more improvement mental health professional vs family physicians reported greater Effectiveness Research problem progress and better satisfaction psychotherapy alone is equal to treatments that had psychotherapy and medications back so maybe skewed or inaccurate limited sample of who we re asking in the consumer report retrospective people got it at a specific time and had to think psychotherapy alone psychotherapy meds meaning that lots of limitations but in the real world that s what happens limitations Yes psychotherapy is effective this is one of the biggest studies there is of effectiveness overall research supports the conclusion that therapy generally helps 6 What is the Dodo bird hypothesis Why did it begin LECTURE ONLY all therapies were generally the same in terms of outcomes regardless of the Luborsky Singer Luborsky 1975 therapy there was the same outcome what fueled the Dodo bird hypothesis hypothesis from Alice in Wonderland book the characters all get wet so the Dodo bird tells them to run around the lake until they dry when they asked the bird who won he said everybody has won and all must have prizes this hypothesis says that all therapies are winners all produce equivalent outcomes common factors produce outcomes not specific features of different therapies 7 What evidence is there against the Dodo bird hypothesis opposition to the hypothesis can be found in Smith Glass Miller 1980 the results showed that generally 80 of people in therapy had success but that some therapies work better than others ex 99 for non RET cognitive therapies but only 61 for undifferentiated counseling 8 Is all psychotherapy the same What is the supporting research no it is not all the same we know that psychotherapy works so now research is going towards which type of psychotherapy works for which diagnosis Chorpita et al 2011 documented evidence base for several different approaches to therapy For example one thing they looked at was anxiety lots of evidence for CBT and Exposure minimal support for hypnosis psychodynamic and play therapy 9 What are Evidence Based Treatments EBT EST EVT are all the same things EBT are those interventions or techniques that have produced significant change in clients in controlled clinical trials criteria disseminated by American Psychological Association some evidence that the results have produced change in clients 1 Well established Treatments you have to meet these criteria or have several different studies showing the same thing these are the best according to the APA treatment has been proven to be better than placebo or other established treatments 2 Probably Efficacious Treatments this is okay meet some of the criteria but not all 3 Experimental Treatments not quite there yet 10 What is manualized treatment What are the arguments for and against undermining the
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