Evaluating Psychotherapy’s Effectiveness

Module 5.5c

LEARNING TARGETS:

• Describe the effectiveness of psychotherapy & explain how we can make this judgment.
• Describe which psychotherapies are more effective for specific disorders.
• Describe three elements that are shared by all forms of psychotherapy.
• Describe the personal factors that influence the therapist-client relationship.
• Explain when a person should seek therapy and what they should look for in a therapist.
• Describe the ethical principles that guide psychotherapy.

Are Psychotherapies Effective?�Client Perceptions

• 89% say they were “fairly well satisfied”
• Why the high number?
• People enter therapy in crisis – many would have gotten better over time
• Spontaneous Remission - Some people improve with nothing more than the passage of time
• Generally, clients speak well of their therapists
• Clients tend to believe the therapy will work – placebo effect
• Want to believe therapy is worth the effort (effort justification) – don’t want to admit it may not have been helpful

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Are Psychotherapies Effective?�Clinicians’ Perceptions

• Many case studies show clients improve through therapy.
• Skeptics point out:
• People enter therapy in a severely distressed state so the likelihood they would get better even without therapy is high.
• Therapists may focus on evidence that just confirms what they want to believe - Confirmation Bias
• Regression Toward the Mean – Tendency for unusual events or emotions to eventually regress/return to normal
• People often mistake the natural return to normal as due to treatment.

Are Psychotherapies Effective?�Outcome Research

• Most people do not seek help with problems and still get better
• Randomized Clinical Trials – double blind studies with placebo groups to compare the effectiveness of treatment
• Meta-analysis used to combine and interpret/summarize the results of large numbers of studies has found:

• On average, the person who completes treatment is better off than about 80 percent of those in the untreated control group.
• Benefits are usually apparent in a relatively short period of time
• Gains that people make tend to endure – less risk of relapse
• Brain-imaging technologies show that psychotherapy alone produces distinct physiological changes in the brain that are associated with a reduction in symptoms

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Which Psychotherapies Work Best?

• Different treatments work better for different disorders
• Behavioral – bed wetting, phobias, compulsions, marital difficulties, sexual dysfunction
• Psychodynamic – depression, anxiety
• Cognitive & Cognitive Behavioral – anxiety, PTSD, depression, OCD
• Nondirective (Person-centered) counseling – mild to moderate depression
• The more specific the problem, the greater the hope

• Due to a comorbidity (overlapping) of disorders in many people, multiple therapies may be used.
• Evidence Based Practice – using the treatment that research shows works best for a particular disorder and your patient’s preferences & characteristics.

How to Psychotherapies Help People?

• All psychotherapies offer three basic benefits…
1. Hope for discouraged people – improves morale & creates self-efficacy
2. A new perspective – new approach = new attitude towards making changes
3. An empathetic, trusting, caring relationship – Therapeutic Alliance – a bond of trust & understanding between therapist and client as they work together to overcome the client’s problem.

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• In General, those who receive psychotherapy tend to improve more than those who don’t.
• People with clear-cut, specific problems improve the most.

Factors in Successful Therapy

• Therapeutic relationship—caring and mutually respectful
• Therapist characteristics—caring attitude, ability to listen, sensitive
• Client characteristics—motivated, actively involved, emotionally and socially mature
• External circumstances—a stable living situation and supportive family members
• Culture match – therapist should reflect the culture/beliefs of the client

When should we seek therapy?

• APA Common Trouble signals:
• Feelings of Hopelessness
• Deep & lasting depression
• Self-destructive behavior (substance abuse, self-harm)
• Disruptive fears
• Sudden mood shifts
• Thoughts of suicide
• Compulsive rituals (hand washing)
• Hearing voices or seeing things others don’t see
• Emotional bond between therapist & client is the most important factor effective therapy

Therapists & their Training

Ethical Principles in Psychotherapy

• APA Ethical Guidelines:
• Beneficence & Nonmaleficence – Seek to benefit the client and do no harm
• Fidelity & Responsibility – Establish trust and define your role as therapist, uphold a professional standard of conduct.
• Integrity – Be honest, truthful, accurate – don’t make promises you can’t keep.
• Justice – Be fair and try to help everyone have access and the benefits of therapy.
• Respect for People’s Rights & Dignity – Respect the dignity & worth of clients and protect their right to privacy, confidentiality, & self-determination.