Module 72

Is Psychotherapy Effective? What Causes Improvement? Even if clients do improve, is the improvement really caused by therapy? It could be: regression to the mean, drifting from initial crisis back to an average state. the client’s motivation to appear better in order to please the therapist or to justify the cost of therapy. There are different measures of the value and effectiveness of psychotherapy: whether the client is satisfied whether the client senses improvement whether the therapist sees improvement whether there has been an observable, measured change in initial symptoms Click to reveal bullets on left. Click to reveal sidebar. The crucial question related to the first bullet point is, “would the client have improved even without therapy?” Click to reveal bottom bar. The placebo group might receive a bogus intervention. See if students can guess the value of a control group: to control for maturation/regression to the mean, getting better with time. See if students can guess the value of a placebo: to control for client expectations of improvement with intervention. In this case, “control for” means “make sure improvement is not caused by.” To track the effectiveness of an intervention, use a control group not receiving the intervention, or even a placebo group. To measure effectiveness, use objective, observable measures of symptoms rather than relying on client or therapist perceptions. Studying Treatment Outcomes

Understanding Outcome Data If we find that even people in a control group (e.g. on a waiting list) showed improvement, is therapy a waste of time? About 80 percent of untreated people have poorer outcomes than the average treated person. Number of persons People are more likely to improve with treatment. No animation. Instructor: to see if students understand this information, ask the following question and wait for laughter as well as a response: “What percentage of TREATED people had poorer outcomes than the average treated person? [The answer is just under 50 percent, by definition]? Do you find this surprising? Would you find it surprising if almost 50 percent of your test scores were lower than your average score? A statistics-savvy student might speaks up here, using information from the intelligence chapter to ask, “don’t you mean “median” score?” Or s/he might challenge whether it’s really 50 percent depending on skewing of the data. The student is technically correct, but ask her/him to keep focus on the main point. Meta-analysis: A procedure for statistically combining the results of many different research study

Results of Outcome Research Some forms of psychotherapy have been found to be effective for certain problems: Depression Anxiety Phobias Bedwetting Cognitive-behavioral Psychodynamic therapy Exposure therapy Behavior conditioning Click to show the most effective therapy for each problem.

Using Outcome Research in Therapy Evidence-based practice refers to the use of outcome research about the effectiveness of different techniques to select therapeutic interventions. Clinical decisions are made based on more than just outcome research. No animation. Instructor: knowledge about the brain, mind, and body is not indicated in the diagram but is possibly included in all three pillars, or even in a hidden fourth leg of this table. For example, knowing how memory reconsolidation works can make the difference in whether victims of trauma are helped or harmed by talking about their experiences. Students might ask, “is this part of clinical expertise? Part of client characteristics? Part of knowing the research evidence BESIDES outcome research?” There is no single correct answer to these questions.

Evaluating “Alternative” Therapies When new cures emerge, they are often promoted with testimonials. Problem: we don’t know if those “cures” were really caused by the intervention. In addition, we don’t know how many people received no benefit from the intervention. Solution: controlled studies with random assignment to non- intervention conditions. Challenge: making sure the interventions are performed by people trained in that area. No animation.

Eye Movement Desensitization and Reprocessing (EMDR) In EMDR therapy, the therapist attempts to unlock and reprocess previous frozen traumatic memories. The therapist waves a finger or light in front of the eyes of the client, in order to integrate past and present, and left and right hemispheres. Click to show bottom bar. Some studies show EMDR is effective and some do not. Studies which did not show effectiveness were critiqued by the founder as being done without adequate training in EMDR. Is this a valid critique of the research? Research suggests that the effectiveness of EMDR, even when it does work, may not depend on the eye movement technique.

Light Exposure Therapy Research supports the idea that daily exposure to bright light, especially with a blue tint, is effective in treating the depressive symptoms of seasonal affective disorder [SAD]. No animation.

What do effective psychotherapy styles seem to have in common? Hope: therapists assume the client has resources that can be used for recovery, and that improvement is possible A new perspective: new interpretations and narratives (from “victim” to “survivor”) can improve mood and motivate change The relationship: empathy, trust, and caring provide an environment for healthy growth Click to reveal bullets. The successful working relationship between therapist and client has been called the therapeutic alliance. Psychotherapy also may offer: 1. a safe place to explore feelings, ideas, self. 2. a source of ideas (not “advice”) and options for behaving and seeing things differently. 3. exercises in behavioral, cognitive, and emotional change. 4. affirmation for who you are, along with support for change. 5. a source of challenge and enrichment to support neural growth and integration. Therapeutic alliance: bond of trust and mutual understanding between therapist and client, who work together to overcome client’s problem

Client-Therapist Differences Therapists differ from clients (and from each other) in beliefs, values, cultural background, conversational style, and personality. Ways to serve diverse clients Therapists should be receptive, respectful, curious, and seek understanding rather than assuming it. The therapist and client do NOT have to have similar backgrounds for effective therapy and a good therapeutic relationship. It is more important to have similar ideas about the function and style of therapy. Click to reveal bullets. Instructor: you might begin introduce this slide by saying, “therapists do not say ‘I understand’ or ‘I know what you mean.’ Everyone’s has different experiences, backgrounds, meanings, and even if you’ve been through a similar event, the client may have experienced it differently.” Even if you go to the same denomination of church, your beliefs may serve a different function in your life. Research shows that therapists who are curious and open are more effective at working with clients from different backgrounds than therapists who study a great deal of diversity material.

Selecting a Psychotherapist Therapists and their Training Psychotherapists ≠ psychologists Psychologists (PhD, PsyD) do therapy plus intelligence and personality testing. Psychiatrists (MD, DO) prescribe medicine and sometimes do psychotherapy. Social workers (MSW) as well as counselors, nurses, and other professionals may be trained and licensed to diagnose and treat mental health disorders. People with a variety of different graduate degrees are able to provide psychotherapy. Specific training and experience in the area of your difficulty is worth asking about. What is most important is whether you and the therapist are able to establish an alliance.  Some of this is trial and error. If problems arise, you can try working it out, but switching therapists is okay. Click to reveal bullets.

What is the rationale for preventive mental health programs? Preventative mental health programs are based on the idea that many psychological disorders could be prevented by changing oppressive, esteem- destroying environments into more benevolent, nurturing environments that foster growth, self- confidence, and resilience Resilience: personal strength that helps most people cope with stress and recover from adversity and even trauma