Evaluating psychotherapy

Sec 4 Evaluation is level 6

objectives

• Summarize the Therapeutic alliance• Evaluate the problems with therapy (-)• Analyze what therapies work with what

disorders (+)• List the ways therapy harms patients (4)

Common ingredients in successful therapy

Therapeutic alliance: bond between therapist and client

When clients want to be helped

When therapists distinguish normal cultural patterns from individual psychological problems

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Therapeutic alliance

• Psychotherapy is relationship• Success depends on what both parties bring to

table• Therapeutic alliance- the bond of confidence

and mutual understanding established between therapist and client, which allows them to work together to solve problems

• Goals same

Qualities of the participants

• Most likely to do well in therapy=motivated to improve

• Support from family • Develop personal style to deal with problem• Personality traits hostile and negative more

resistance to therapy • Carl Rodgers (ch 2)- empathy, warmth, being

genuine= best traits for therapist

Culture and therapeutic connection

• Different backgrounds= may be successful • But cultural differences may cause

misunderstanding• Lifetime of racism and cultural distrust African

American’s may distrust White therapist• Asian-Americans, Latinos, African Americans

more likely to stay with ethnic matched therapist

Successful therapy

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Science-Practitioner Gap

• Breach between scientist and therapists• One reason: professional schools not

connected to academic psychology departments- train solely for therapy

• New therapies trying to gain foothold with no scientific support at all

• Neurolinguistic programming (NLP)- match learning styles with brain type- BOGUS

The scientist-practitioner gap

Some psychotherapists believe that evaluating therapy using research methods is futile.

Scientists find that therapists who do not keep up with empirical findings are less effective and can even harm clients.

Economic pressures require empirical assessment of therapies.

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Problems in assessing Therapy

• Proliferation of therapies + economic pressures from drug companies= need scientific evidence

• Can’t just ask someone did therapy help?

Problem with therapy• Testimonials “ I would have never found love, taken that job,

moved to Escalon without Dr. Blitznik • Can’t be own control group: how do you know would not

have found love without Dr. Blitznik• Placebo effect: anticipation of success, buzz. About Dr.

Blitznik• Never here about people who drop out or get worse• Thanks to justification of effort, people put time, money

effort in tell you its worth it• Don’t want to say “ saw Dr. B. for 5 years and boy was it a

waste of time!”

What works? Objective #3

• Here comes the evidence showing the benefits of psychotherapy

• Emotional disorders; cognitive and behavior therapies

Which therapy?DepressionCognitive therapy

Anxiety disordersExposure techniques

Anger and impulsive violenceCognitive therapy

Health problemsCognitive and behavior therapies

Childhood and adolescent behavior problemsBehavior therapy

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Depression

• Cognitive therapy best success Mood disorders (especially depression)

• Often as effective as antidepressant drugs, and less likely to relapse when treatment over

• LEARN LESSONS in therapy last long after therapy• Evidence: randomized, controlled study 120

adults that had attempted suicide: given 1 of 2 conditions cog. Therapy or referral and call back

• Cog. Study group ½ as likely to attempt suicide

Anxiety disorders

• Exposure techniques most effective for P.T.S.D., agoraphobia, specific phobias like public speaking

• Cog. Behavior therapy for generalized anxiety, O.C.D. and panic disorder

Anger and impulsive violence

• Cognitive therapy• Reducing chronic anger, abusiveness, hostility• Teaches people how to express anger more

calmly and constructively

Health problems

• Cog. Behavior therapy cope with pain, chronic fatigue syndrome, headaches and irritable bowel syndrome

Childhood and adolescent behavior problems

• Behavior therapy is the most effective• For bed wetting

Your turnYou have arachnophobia, an intense fear of spiders. What kind of therapy should you seek out for the best chance of resolving your problem?1. Direct brain intervention2. Cognitive therapy3. Psychodynamic therapy4. Behavioral therapy

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Your turnYou have arachnophobia, an intense fear of spiders. What kind of therapy should you seek out for the best chance of resolving your problem?1. Direct brain intervention2. Cognitive therapy3. Psychodynamic therapy4. Behavioral therapy

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Relapse prevention

• Cognitive behavior approaches highly effective• Substance abuse, depression, sexual offenses

When Therapy Harms

• Every treatment carries risks• Even aspirin• So does psychotherapy• Risks increase with following factors

When therapy harmsUse of empirically unsupported, potentially dangerous therapeutic techniques

Inappropriate or coercive influence, which can create new problems for the client

Prejudice or cultural ignorance on the part of the therapist

Unethical behavior, especially sexual intimacy, on the part of the therapist

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Harms #1

• The use of empirically unsupported, potentially dangerous techniques

• Memory does not work like movie camera so can misremember

• Hypnosis, sodium amytal (barbiturate called truth serum)

• Can enhance suggestibility

Harms #2

• Inappropriate or coercive influence, which can create new problems for the client

• Inadvertently creates disorders through suggestion

• 1980’s 90’s = multiple personality disorder

Harms #3

• Prejudice or cultural ignorance on the part of the therapist

• Prejudiced against gender, culture sex

Harms #4

• Sexual intimacies or other unethical behavior on the part of the therapist

• Unethical

Summary

• Types of disorders with treatment= psychoanalyst