abnormal PSYCHOLOGY Fourth Canadian Edition Chapter 17 Outcomes and Issues in Psychological Intervention Prepared by: Tracy Vaillancourt, Ph.D. Modified by: Réjeanne Dupuis, M.A.

Chapter Outline Client Factors Influencing Psychotherapy Outcomes General Issues in Evaluating Psychotherapy Review of Behavioural and Cognitive Therapies Review of Couples and Family Therapies Review of Client-Centered Therapy Review of Psychoanalytic Therapy Psychotherapy Integration Review of Community Psychology

Client Factors Influencing Psychotherapy Outcomes Expectations about the outcome of therapy –Demoralization hypothesis Goals and motivation to change –Motivation Interviewing The impact of personality on therapy outcomes Therapist factors and working alliance –Therapeutic or working alliance

General Issues in Evaluating Psychotherapy Research Therapy as Researched vs. Therapy as Practised –Treatment manuals –Controlled studies Exclusion of people on various grounds Use of DSM diagnosis and thereby definition of patients as homogeneous –Efficacy and effectiveness

Evidence-Based Treatment Evidence-based treatment or empirically supported therapies –Needs to be: Multisite Longitudinal –Process of change, client factors, chronic mental illness, and the study of nondominant clinical paradigms need to be explored

Stepped Care Models

Review of Behavioural and Cognitive Therapies Core assumption is that way people construe their world is a major determinant of their feelings and behaviour –Evaluation of Counter-conditioning and Exposure Methods Some empirical support –Evaluation of Operant Methods Proved successful with a wide range of behavioural problems –Generalization and Maintenance of Treatment Effects

Evaluation REBT Ellis’s rational-emotive behaviour therapy (REBT) –Emotional suffering is due primarily to unverbalized assumptions and demands people carry around with them as they negotiate their way in life Evidence –  self-reports of general anxiety, speech anxiety, and test anxiety. –Improves self-reports and behaviour for social anxiety –Inferior to exposure-based treatments for agoraphobia. –May be useful in treating excessive anger, depression, and anti- social behaviour. –Useful only as part of more comprehensive behavioural programs for sexual dysfunction. –  Type A behaviour pattern –Useful as a preventive measure for untroubled people –Appears to achieve effects through  in irrationality of thought

Evaluation CT Beck’s Cognitive Therapy (CT) –That people in emotional distress operate with schemas that are impossible to live with –In contrast to Ellis, focuses on the lack of objective evidence that depressed and anxious people have for maintaining their maladaptive schemas Evidence –Effectiveness of CT under intensive study for > 25 years –Works for depression Treatment response associated with modulated functioning in limbic and cortical regions –Helps clients change their cognitions

Reflections on CBT A return to cognitions Restructuring vs. reframing Importance of behaviour change in CBT Importance of emotions in CBT Phenomenological essence of CBT Relapse prevention in CBT Unconscious factors Relationship factors

Review of Couples and Family Therapy Basic Concepts and Techniques –Normality of Conflict –From Individual to Conjoint Therapy Approaches –Mental Research Institute Tradition –Cognitive-Behavioural Approaches –Integrative Behavioural Couples Therapy –Emotion-Focused Therapy Evaluation –Has beneficial effects for many relationship problems

Review of Client-Centred Therapy Basic Concepts and Techniques –Basic premise—people can be understood only in terms of their own phenomenology They become disordered when they fail to attend to own inner nature and instead guide behaviour according to others Places great emphasis on people’s freedom to choose Evaluation –Most research focused on relating outcome to personal qualities of therapists –Results have been inconsistent –Meta-analysis of studies (1978 to 1992) found that clients were better off after e intervention than about 80% of non- treated people

Review of Psychoanalytic Therapy General Issues with Classical Psychoanalysis –Difficult to assess effectiveness –Difficult to distinguish between classical psychoanalysis and psychodynamic psychotherapy in practice Outcomes of Research –Few outcome studies of long-term psychoanalytic treatment –Studies tend to lack no-treatment control group Evaluation of Brief Psychodynamic and Interpersonal Therapies –Outcome Research –Process Research

Psychotherapy Integration Eclecticism and theoretical integration in psychotherapy Three types of psychotherapy integration –Technical eclecticism –Common factorism –Theoretical integration Arguments against premature integration Meichenbaum’s constructivist CBT model

Community Psychology Community Psychology — Reaching out to large populations in an attempt to prevent the onset or spread of a physical illness or a mental disorder Mental Health Promotion – Techniques –Mass-media campaigns –Instructional programs in schools Universal preventive interventions –Targeted to general public that has not been identified on basis of individual risk Examples of community psychology programs: –Canadian eating-disorder prevention programs –Canadian programs for the early detection and prevention of schizophrenia –School-based programs for the prevention of cigarette smoking

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