Psychological Interventions Focusing on a broad overview of clinical interventions

Intervention Defined Psychological Intervention is a method of inducing changes in a person’s behavior, thoughts, or feelings. The terms intervention and psychotherapy have been used interchangeably. “Psychotherapy …is a planned activity of the psychologist, the purpose of which is to accomplish changes in the individual that make his life adjustment potentially happier, more constructive, or both.” Frank, 1982.

Does Psychotherapy help? Two issues to address when answering this question, the efficacy of a treatment and the effectiveness of a treatment. Efficacy studies place a premium on internal validity by controlling the types of clients in the study, by standardizing the treatments, and randomly assigning patients to treatment of no treatment groups. Effectiveness studies emphasize external validity and the representativeness of the treatment that is administered. A treatment is considered effective if the client reports significant relief or benefit.

Consumer Reports Study, 1995 Psychotherapy resulted in some improvement for the majority of respondents. Psychiatrists, psychologists, and social workers all received high marks as mental health professionals. Respondents who received psychotherapy alone improved as much as those who received psychotherapy plus medication. Longer treatment (more sessions) was related to more improvement.

Martin Seligman’s Amenability to Change Seligman invoked the concept of depth of a problem to explain the “changeability” of a variety of conditions or behaviors. Seligman’s review, analysis, and theory indicates why certain psychological problems seem relatively intractable whereas others can be alleviated with appropriate treatment. See Table 11-1 on page 294

Common Factors of Psychotherapy Associated with Positive Outcomes Support Factors Learning Factors Action Factors CatharsisAdviceBehavioral Regulation Identification with Therapist Affective ExperiencingCognitive Mastery Mitigation of IsolationAssimilation of Problematic Experiences Encouragement of Facing Fears Positive RelationshipsChanging Expectation for Personal Effectiveness Taking Risks ReassuranceCognitive LearningMastery Efforts Release of TensionCorrective Emotional Experience Modeling StructureExploration of Internal Frame of Reference Practice Therapeutic AllianceFeedbackReality Testing Therapist/Client Active Participation InsightSuccess Experience

Features Common to Many Therapies The Expert Role The Release of Emotions/Catharsis Relationship/Therapeutic Alliance Anxiety Reduction/Release of Tension Interpretation/Insight Building Competence/Mastery Nonspecific Factors

Nature of Specific Therapeutic Variables The Patient or Client The Degree of the Patient’s Distress Intelligence Age Motivation Openness Gender Race, Ethnicity, and Social Class Therapists’ Reactions to Patients

The Therapist Age, Sex, and Ethnicity Personality Empathy, Warmth, and Genuineness Emotional Well-Being Experience and Professional Identification

Course of Clinical Intervention Initial Contact Assessment The Goals of Treatment Implementing Treatment Termination, Evaluation, and Follow-up

Common, but Unfounded Assumptions Regarding Client/Therapist and Psychological Outcome REFER TO ACTUAL TABLE IN TEXT FOR ACCURATE DATE –THIS ISN’T ACCURATE Older Patients have worse outcomes. Only highly motivated patients achieve good outcomes. Women patients achieve better outcomes. Ethnic minority patients consistently achieve worse outcomes. Patients of high socioeconomic status achieve better outcomes. Older therapist produce better outcomes. Women therapists produce better outcomes. No strong support for this assumption Mixed support In general, biological sex appears unrelated to outcome No support for this assumption No relationship between social class and outcome. Mixed support Effect is equivocal SEE TABLE 11-3 (p. 307)

Stages of Change (Prochaska & Norcross, 2002) Precontemplation: the client has no intention of changing his/her behavior in the near future % of clients are in this stage. Contemplation: a client is aware that a problem exists but has not yet committed him/herself to trying to make changes % of clients are in this stage. Preparation: a client intends to make a change in the near future. Action: clients are changing their maladaptive behaviors, emotions, and/or their environment % of clients are in this stage. Maintenance: the client works on preventing relapses and on furthering the gains that have been made during the action stage. Termination: the client has made the necessary changes, and relapse is no longer a threat.

Issues in Psychotherapy Research What is the sample? What relevant patient variables were controlled? What were the outcome measures? What was the general nature of the study?

Types of Experimental Groups Treatment Group: receives the treatment being investigated Control Group: does not receive the treatment being investigated Waiting List Control Group: patient’s treatment is delayed until after the study is completed Attention Only Control Group: patients meet regularly wit a clinician, but no “active” treatment is administered Assessment of Patient Functioning: are conducted in parallel fashion for both treatment and control participants.

Comparative Studies A study that compares two or more techniques of psychotherapy in terms of efficacy. Temple University Study (1975) indicated that therapy accelerates change, rather than producing more change, as compared to no treatment. Psychoanalysts produced better outcomes with less disturbed patients, whereas the level of patient disturbance made no difference for behavior therapists. Suggested that behavior therapy may have greater versatility.

Meta-analyses A method of research in which one compiles all studies relevant to a topic or question and combines the results statistically. Smith and Glass Study 1977 Effect Size: the mean difference between treated and control participants’ scores on relevant outcome measures divided by the standard deviation of the control group. The average person who receives therapy is better off then the person who did not receive therapy. Table 11-4 (p. 315) Effect Size for Psychological Intervention A number of investigators have supported the general utility of meta- analysis

Recent Trends Focus of Psychotherapy Research Specific therapies applied to specific patients in specific ways Effectiveness of treatment with specific psychological problems The effects of psychotherapy versus medication

Recent Trends (Practice Guidelines) Recommend specific forms of intervention for specific psychological problems or disorders, and they have a common goal of “detailed specification of methods and procedures to ensure effective treatment for each disorder. APA published a list of empirically validated treatments in Empirically supported treatments: treatments for various psychological conditions that have been shown through careful empirical study to be either “well established” or “probably efficacious.”

Recent Trends Manualized Treatment Psychotherapeutic treatment that is presented and described in a standardized, manual format(I.e., outlining the rationales, goals, and techniques that correspond to each phase of the treatment). Wilson (1998) points out that manual-based treatment has greater clinical utility than it is given credit for. There is no data to support the position that manual-based treatments are inferior to treatment-as-usual with regard to comorbid psychological problems. Manual-based treatments require clinical skill and a positive therapeutic alliance. Wilson states that this form of treatment is more focused, often more engaging from the patient’s perspective, and easier to teach, supervise, and monitor.

General Conclusions Nearly all forms of psychotherapy are somewhat more efficacious than unplanned or informal help One form of therapy has typically not been shown to be more efficacious than another for all conditions Clients who show initial improvement tend to maintain it Characteristics of the client, the therapist, and their interaction may be as, if not more, important than therapeutic technique (Frank, 1979) Telch (1981) argues that the more potent the therapeutic technique being used, the less important are therapist and client characteristics. Lazarus (1980) argues that specific therapies are indicated for specific problems. Barlow (1981) charges that many clinical psychologists do not pay attention to outcome research.

General Conclusions (continued) Persons (1995) discusses how deficits in training and the perceived inaccessibility of resources have caused clinicians to delay adopting empirically supported treatment techniques. Chambless (1996) stated that psychology is a science. Seeking to help those in need, clinical psychology draws its strength and uniqueness from the ethic of scientific validation. Psychologists bear a fundamental ethical responsibility to use where possible interventions that work and to subject any intervention they use to scientific scrutiny. Clinical psychologists must learn more about the specifics of the efficacy and effectiveness of various forms of therapy and routinely implement this knowledge.