Evaluating Psychotherapies Is Psychotherapy Effective? The Relative Effectiveness of Different Therapies Evaluating Alternative Therapies Commonalities Among Psychotherapies Culture and Values in Psychotherapy

Who do people turn to for help with psychological difficulties? Evaluating Therapies

Is Psychotherapy Effective? It is difficult to gauge the effectiveness of psychotherapy because there are different levels upon which its effectiveness can be measured. 1.Does the patient sense improvement? 2.Does the therapist feel the patient has improved? 3.How do friends and family feel about the patient’s improvement?

Client’s Perceptions If you ask clients about their experiences of getting into therapy, they often overestimate its effectiveness. Critics, however, remain skeptical. 1.Clients enter therapy in crisis, but crisis may subside over the natural course of time (regression to normalcy). 2.Clients may need to believe the therapy was worth the effort. 3.Clients generally speak kindly of their therapists.

“Regression Toward the Mean” Definition: The tendency for extremes of unusual scores to fall back (regress) toward their average. Basically, if we are going through extreme happenings (feeling low when we don’t ordinarily feel that way), we will most likely “regress” (return) to our average state eventually, even without doing anything. We have a way of balancing out, basically. This relates to the evaluation of therapeutic methods because we may feel as though seeking treatment is what helped us, when maybe we were really just regressing towards the mean – or naturally returning to our normal state of mind, with or without help. The phenomenon of regression toward the mean was first noted by Sir Francis Galton in the nineteenth century. He observed that in any series of random events clustering around an average, an extraordinary event is, by mere chance, most likely to be followed by an ordinary event. For example: Very tall fathers are likely to have slightly shorter sons and very short fathers, somewhat taller sons. Regression toward the mean helps explain why great movies are often followed by poor sequels, why poor presidents often have better successors, and why extremely intelligent women tend to have slightly duller husbands.

Examples of Regression Towards the Mean in Sports Regression toward the mean operates with regularity in sports, particularly when luck is mixed with skill. While sports commentators recognize its effect, they often offer different explanations. Amos Tversky notes, “Listen to the commentators at the Winter Olympics. If a ski jumper has done well on his last jump, they say, ‘He’s under immense pressure, so he’s unlikely to do as well this time.’ If he did poorly, they say, ‘He’s very loose and can only improve.’” Perhaps the so-called “Sports Illustrated Jinx” can also be understood in terms of regression toward the mean. According to sports folklore, the “Sports Illustrated Jinx” dooms teams or athletes appearing on the cover to lose after they are featured. For example: Earvin “Magic” Johnson of the Los Angeles Lakers graced the cover when his team was leading the NBA championship series. The Lakers then lost the title to the Boston Celtics in seven games. Similarly, the New York Islanders were on the cover going for their fifth straight Stanley Cup. They lost four straight to Edmonton. Tennis players and golfers seem to suffer the most after appearing on the cover. Researchers Tim Leone and Robbie Gluckson found that the performance of these athletes fell off more than 83 percent of the time. The performance of swimmers, skiers, football rushers, and crew members also dropped off significantly after cover appearances. At the same time, the researchers found that baseball pitchers and teams, as well as basketball players and teams (“Magic” Johnson being one exception), did well more than 70 percent of the time after they were on the cover. Several observers have noted that athletes appear on the cover only after performing unusually well. Regression toward the mean would explain their poorer subsequent performance.

Clinician’s Perceptions Like clients, clinicians believe in therapy’s success. They believe the client is better off after therapy than if the client had not taken part in therapy. 1.Clinicians are aware of failures, but they believe failures are the problem of other therapists. 2.If a client seeks another clinician, the former therapist is more likely to argue that the client has developed another psychological problem. 3.Clinicians are likely to testify to the efficacy of their therapy regardless of the outcome of treatment.

Outcome Research How can we objectively measure the effectiveness of psychotherapy? Meta-analysis of a number of studies suggests that thousands of patients benefit more from therapy than those who did not go to therapy.

Outcome Research Research shows that treated patients were 80% better than untreated ones.

Fig. 15-6, p. 605 Figure 15.6: Recovery as a function of number of therapy sessions. Based on a national sample of over 6000 patients, Lambert, Hansen, and Finch (2001) mapped out the relationship between recovery and the duration of treatment. These data show that about half of the patients had experienced a clinically significant recovery after 20 weekly sessions of therapy. After 45 sessions of therapy, about 70% had recovered. Source: Adapted from Lambert, M. J., Hansen, N. B., & Finch, A. E. (2001). Patient- focused research: Using patient outcome data to enhance treatment effects. Journal of Consulting and Clinical Psychology, 69, Copyright © 2001 by the American Psychological Association. Used by permission of the publisher and authors.

The Relative Effectiveness of Different Therapies Which psychotherapy would be most effective for treating a particular problem? DisorderTherapy DepressionBehavior, Cognition, Interpersonal AnxietyCognition, Exposure, Stress Inoculation BulimiaCognitive-behavior PhobiaBehavior Bed WettingBehavior Modification

Evaluating Alternative Therapies 57% of those who have had anxiety attacks and 54% who have had depression have used alternative treatments such as herbal medicines, massage, and spiritual healing (Kessler & others, 2001). Do alternative therapies hold up under scientific scrutiny?

Eye Movement Desensitization and Reprocessing (EMDR) In EMDR therapy, the therapist attempts to unlock and reprocess previous frozen traumatic memories by waving a finger in front of the eyes of the client. EMDR has not held up under scientific testing.

Light Exposure Therapy Seasonal Affective Disorder (SAD), a form of depression, has been effectively treated by light exposure therapy. This form of therapy has been scientifically validated. Courtesy of Christine Brune

Commonalities Among Psychotherapies Three commonalities shared by all forms of psychotherapies are the following: 1.A hope for demoralized people. 2.A new perspective. 3.An empathic, trusting and caring relationship. © Mary Kate Denny/ PhotoEdit, Inc.

Culture and Values in Psychotherapy Psychotherapists may differ from each other and from clients in their personal beliefs, values, and cultural backgrounds. A therapist search should include visiting two or more therapists to judge which one makes the client feel more comfortable.

Therapists & Their Training Clinical psychologists: They have PhDs mostly. They are experts in research, assessment, and therapy, all of which is verified through a supervised internship. Clinical or Psychiatric Social Worker: They have a Masters of Social Work. Postgraduate supervision prepares some social workers to offer psychotherapy, mostly to people with everyday personal and family problems.

Therapists & Their Training Counselors: Pastoral counselors or abuse counselors work with problems arising from family relations, spouse and child abusers and their victims, and substance abusers. Psychiatrists: They are physicians who specialize in the treatment of psychological disorders. Not all psychiatrists have extensive training in psychotherapy, but as MDs they can prescribe medications.

Table 15.2 Myers: Psychology, Ninth Edition Copyright © 2010 by Worth Publishers