Chapter 11 1 What is psychotherapy Clinical Psych Exam 3 SG What Psychotherapy is a form of treatment for problems of an emotional Who In which a trained person deliberately establishes a professional nature relationship with a patient Why With the object of removing modifying or retarding existing symptoms of mediating disturbed patterns of behavior and or promoting positive personality growth and development 2 What are the common features of most psychotherapies Relationship Therapeutic Alliance nature of the relationship between Building Competence Mastery Self confidence in ability to accomplish therapist and client goals The Expert Role Training knowledge experience Nonspecific factors faith hope expectations placebo effect 3 What steps are involved in the typical course of psychotherapy o Services offered credentials of therapists fees confidentiality Initial Contact process refer Assessment Goals of Treatment responsibilities Implementing Treatment o Intake Interview Initial Testing Conceptualization of Problem o Discuss prioritize problems agree on goals length frequency o Proceed with treatment assess throughout modify goals if necessary Termination Evaluation Follow up o Terminate when goals reached client is independent o Plan ahead provide date elicit feedback follow up or booster session 4 What does efficacy research entail What does effectiveness research entail What are the differences between them Efficacy Studies Is the therapy efficacious Is the average person receiving the treatment significantly less dysfunctional than the average person not receiving the treatment o Very controlled o Often take place in research labs o Patients are pre screened and paid to participate o Therapists are closely supervised Effectiveness Studies Is the therapy effective Do clients report clinically significant benefit from therapy o Real world not research lab o Range of clients o Range of therapists 5 Is psychotherapy efficacious Effective What is the supporting research Efficacy Research Eysenck 1952 examined outcomes across 24 treatment studies Concluded that psychotherapy did not work 72 of patients improved with no treatment and only 44 of patients in treatment improved Eysenck s work was controversial and has been criticized however it inspired future research 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 Effectiveness Research 1995 Consumer Reports Survey of 4 000 readers who had sought treatment for a psychological problem most people reported improvement Those who felt worse in therapy longer mental health professionals versus family physicians psychotherapy alone psychotherapy meds Limitations Overall research support the conclusion that therapy generally helps 6 What is the Dodo bird hypothesis Why did it begin LECTURE ONLY The question is all psychotherapy the same which led to a study that all therapies were generally the same in terms of outcomes fueled the Dodo bird hypothesis Luborsky Singer and Luborsky 1975 Dodo bird hypothesis 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 8 Opposition to the dodo birth hypothesis Smith Glass Miller 1980 Is all psychotherapy the same What is the supporting research What type of psychotherapy works for which diagnosis o Chorpita 2011 Documented evidence base for several different approaches to therapy For example anxiety lots of evidence for CBT Exposure minimal support for hypnosis psychodynamic and play therapy 9 What are Evidence Based Treatments Those interventions or techniques that have produced significant change in clients in controlled clinical trials criteria disseminated by American Psychological Association EBT EST EVT 10 What is manualized treatment What are the arguments for and against manualized treatments Manualized treatment psychotherapeutic treatment that is presented and described in a standardized manual format Some have criticized manual based treatment for undermining the clinical judgment of clinicians for not being tailored to patients with multiple problems and for ignoring therapist effects on outcome Psychological testing and clinical judgment literature suggests that clinical judgment and clinical prediction are limited and are likely to be outperformed by an empirically supported manualized treatment that prescribes for the therapist the methods of intervention for a given problem There is no data to support the position that manual based treatments are inferior to treatment as usual with regard to comorbid psychological patients Wilson also argues that manual based treatments actually encourage clinical innovation because they help identify patients who do not seem to respond to first choice treatments Finally he points out that manual based treatments require clinical skill and a positive therapeutic alliance o He does acknowledge that treatment manuals need to become more therapist friendly and suggests providing more practical guidelines as well as more discussions of commonly encountered problems in implementing the treatment o Other advantages are this form of treatment is more focuses more engaging from the patients perspective and easier to teach supervise and monitor o The clinicians who master it will be much more attractive to managed care companies because these treatments are recognized as effacious and efficient Chapter 12 1 Who was Sigmund Freud What did he contribute to the field of psychology The psychodynamic Perspective was rooted in psychoanalytic theory Sigmund Freud was the most influential contributor to the field of personality and therapy 2 How did the study of hysteria influence Freud Anna O Josef Breuer hysteria Jean Charcot used hypnosis to treat hysteria 3 What are the assumptions of the Freudian view Psychic determinism everything has meaning purpose significance Unconscious motivation the cause of disturbed behavior The instincts Eros the life instincts sec hunger thirst art music literature Thantos the death instincts dark side of human behavior self destructive behavior 4 What are the three basic structures of personality according to the Freudian view Id deep inaccessible portion of the personality instincts urges desire for immediate gratification
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