PSYCHOTHERAPY

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• PSYCHOTHERAPY
• LECTURE OUTLINE
• The context of psychotherapy
• Evaluating the effects of psychotherapy
• Evidence-based practice
• Marital, family, and group therapy
• Self-help and mutual aid strategies

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• PSYCHOTHERAPY
• The Context of Psychotherapy
• Who provides psychotherapy Clinical and
  counseling psychologists, social workers,
  psychiatrists, marital and family counselors
• Who seeks psychotherapy? YAVIS clients
  (Schofield, 1964)
• Duration of psychotherapy Consumer Reports
  (1995) study 2900 readers of CR

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• PSYCHOTHERAPY
• The Context of Psychotherapy
• Common elements of psychotherapy across
  different theoretical perspectives (Frank, 1961)
  client hopes, expectations, and help-seeking of
  own free will client should also like, respect,
  and trust therapist therapist care and concern
  for client therapeutic alliance

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• PSYCHOTHERAPY
• The Context of Psychotherapy
• Unique elements of psychotherapy that vary
  according to different theoretical perspectives
  insight vs. action orientation directive vs.
  non-directive focus on emotion, cognition,
  behaviour techniques used homework
• Need for therapies that are culturally-sensitive
  not one size fits all, cultural competency of
  therapists

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• PSYCHOTHERAPY
• The Context of Psychotherapy
• How does therapy differ from a conversation
  between 2 friends in which one friend is sharing
  a problem with her or his friend?

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• PSYCHOTHERAPY
• The Context of Psychotherapy Questions to ask a
  potential therapist
• What are your professional qualifications?
• Have you ever worked with this type of problem
  before?
• How would you describe the way you work?
• How many times do you think it will be necessary
  to see me?

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• PSYCHOTHERAPY
• The Context of Psychotherapy Questions to ask a
  potential therapist
• What are the treatment options for me? Are their
  clinics or other practitioners who work with this
  type of problem?
• What is the research evidence on the best type
  of treatment for my problem?
• What can I expect from treatment? How will I be
  different at the end of treatment?
• How much do you charge? Do you have a sliding
  fee scale?

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• PSYCHOTHERAPY
• Evaluating the Effects of Psychotherapy
• Historical context Eysencks (1952) review
• Deterioration effects (Bergin Lambert, 1978)
  the psychonoxious therapist distasteful
  personality, unusually high fees, sexual
  exploitation, subtle manipulation or abuse
• Potential for recovery and problem of relapse
  need for long-term perspective and understanding
  that therapy is one part of an individuals
  journey of healing

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• PSYCHOTHERAPY
• Evaluating the Effects of Psychotherapy
  Meta-analysis
• a technique for evaluating effectiveness across
  studies
• To examine outcomes of interventions, the mean
  of control or comparison group is subtracted from
  the mean of the intervention group and divided by
  the pooled standard deviation (SD)

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• PSYCHOTHERAPY
• Evaluating the Effects of Psychotherapy
  Meta-analysis
• An effect size (ES) of 1 means that those in the
  intervention group score 1 SD higher than those
  in the control group
• .2 small effect, .5 medium effect, .8
  large effect

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• PSYCHOTHERAPY
• Evaluating the Effects of Psychotherapy
  Meta-analysis
• In their review of 475 studies, Glass et al.
  (1980) found an average ES of .8 (a large ES)
• Behavioural and cognitive-behavioural therapies
  had higher ESs than psychodynamic, Gestalt, and
  verbal, insight-oriented therapies
• Similar findings reported of meta-analyses of
  psychotherapy for children (Weiss Weisz, 1995)

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• PSYCHOTHERAPY
• Evaluating the Effects of Psychotherapy
• Therapist factors - empathy, warmth,
  genuineness, confidence in ability to help,
  experience, absence of emotional problems,
  preparation of clients for therapy

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• PSYCHOTHERAPY
• Evaluating the Effects of Psychotherapy
• Client factors motivation/readiness for
  change, anxiety, depression, subjective
  discomfort
• Aptitude by treatment interactions (ATI)
  Question of Is therapy effective? is not the
  best questions better to ask What works best
  for whom under what conditions?

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• PSYCHOTHERAPY
• Evidence-based Practice or Empirically-supported
  Therapy
• At least 2 randomized controlled trials (RCTs)
  demonstrating superiority to an established
  treatment or placebo controls
• At least 10 single-case design studies
• And use of treatment manuals, clear
  specification of client characteristics, and
  findings reported by 2 different research teams

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• PSYCHOTHERAPY
• Marital, Family, and Group Therapy
• Marital and family therapy Systems framework
• Theoretical approaches to marital and family
  therapy
• Evaluation of marital and family therapy

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• PSYCHOTHERAPY
• Marital, Family, and Group Therapy
• Insight-oriented group therapies Psychodrama
  (Moreno), sensitivity, and encounter groups
• Action-oriented group therapies Social skills
  and assertiveness training
• Components of group therapy process goals,
  therapeutic factors, group cohesion, role of
  therapist, client selection
• Evaluation of group therapy

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• PSYCHOTHERAPY
• Self-help and mutual aid strategies
• Self-help strategies books, audiotapes,
  videotapes, computer programs, Dr. Phil type
  programs
• Mutual aid groups and organizations wide range
  of support groups run by and for people with
  mental health challenges, such as AA, Narcotics
  Anonymous, etc.

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• PSYCHOTHERAPY
• SUMMARY
• Those who seek help are often not those who need
  help the most
• Wide range of therapeutic strategies available
• But there are common factors in therapy
• Needs to be research support for therapeutic
  approaches

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• PSYCHOTHERAPY
• SUMMARY
• Evidence that many different types of therapy
  can be effective
• Behavioural and cognitive-behavioural approaches
  have the most empirical support, but these
  approaches have generated the most research
• There is also evidence that some therapists are
  harmful, psychonoxious therapist

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• PSYCHOTHERAPY
• SUMMARY
• Research needs to find out which approaches work
  best for whom and under what conditions
• There are also a variety of self-help and mutual
  aid strategies that can reach a large number of
  people at relatively low cost that may be quite
  helpful