2. PSYCHOTHERAPY
LECTURE OUTLINE
The context of psychotherapy
Evaluating the effects of psychotherapy
Evidence-based practice
Marital, family, and group therapy
Self-help and mutual aid strategies

3. The Context of Psychotherapy
Who provides psychotherapy – Clinical and counseling psychologists, social workers, psychiatrists, marital and family counselors
Who seeks psychotherapy? YAVIS clients (Schofield, 1964)
Duration of psychotherapy – Consumer Reports (1995) study – 2900 readers of CR

4. The Context of Psychotherapy
Common elements of psychotherapy across different theoretical perspectives (Frank, 1961) – client hopes, expectations, and help-seeking of own free will; client should also like, respect, and trust therapist; therapist care and concern for client; therapeutic alliance

5. The Context of Psychotherapy
Unique elements of psychotherapy that vary according to different theoretical perspectives – insight vs. action orientation; directive vs. non-directive; focus on emotion, cognition, behaviour; techniques used; homework
Need for therapies that are culturally-sensitive – not “one size fits all,” cultural competency of therapists

6. The Context of Psychotherapy
How does therapy differ from a conversation between 2 friends in which one friend is sharing a problem with her or his friend?

7. The Context of Psychotherapy – Questions to ask a potential therapist
What are your professional qualifications?
Have you ever worked with this type of problem before?
How would you describe the way you work?
How many times do you think it will be necessary to see me?

8. The Context of Psychotherapy – Questions to ask a potential therapist
What are the treatment options for me? Are their clinics or other practitioners who work with this type of problem?
What is the research evidence on the best type of treatment for my problem?
What can I expect from treatment? How will I be different at the end of treatment?
How much do you charge? Do you have a sliding fee scale?

9. Evaluating the Effects of Psychotherapy
Historical context – Eysenck’s (1952) review
Deterioration effects (Bergin & Lambert, 1978) – the “psychonoxious therapist” – distasteful personality, unusually high fees, sexual exploitation, subtle manipulation or abuse
Potential for recovery and problem of relapse – need for long-term perspective and understanding that therapy is one part of an individual’s journey of healing

10. Evaluating the Effects of Psychotherapy – Meta-analysis
a technique for evaluating effectiveness across studies
To examine outcomes of interventions, the mean of control or comparison group is subtracted from the mean of the intervention group and divided by the pooled standard deviation (SD)

11. Evaluating the Effects of Psychotherapy – Meta-analysis
An effect size (ES) of 1 means that those in the intervention group score 1 SD higher than those in the control group
.2 = small effect, .5 = medium effect, .8 = large effect

12. Evaluating the Effects of Psychotherapy – Meta-analysis
In their review of 475 studies, Glass et al. (1980) found an average ES of .8 (a large ES)
Behavioural and cognitive-behavioural therapies had higher ESs than psychodynamic, Gestalt, and “verbal,” insight-oriented therapies
Similar findings reported of meta-analyses of psychotherapy for children (Weiss & Weisz, 1995)

13. Evaluating the Effects of Psychotherapy
Therapist factors - empathy, warmth, genuineness, confidence in ability to help, experience, absence of emotional problems, preparation of clients for therapy

14. Evaluating the Effects of Psychotherapy
Client factors – motivation/readiness for change, anxiety, depression, subjective discomfort
Aptitude by treatment interactions (ATI) – Question of “Is therapy effective?” is not the best questions; better to ask “What works best for whom under what conditions?”

15. Evidence-based Practice or Empirically-supported Therapy
PSYCHOTHERAPY
Evidence-based Practice or Empirically-supported Therapy
At least 2 randomized controlled trials (RCTs) demonstrating superiority to an established treatment or placebo controls
At least 10 single-case design studies
And use of treatment manuals, clear specification of client characteristics, and findings reported by 2 different research teams

16. Marital, Family, and Group Therapy
PSYCHOTHERAPY
Marital, Family, and Group Therapy
Marital and family therapy – Systems framework
Theoretical approaches to marital and family therapy
Evaluation of marital and family therapy

17. Marital, Family, and Group Therapy
PSYCHOTHERAPY
Marital, Family, and Group Therapy
Insight-oriented group therapies – Psychodrama (Moreno), sensitivity, and encounter groups
Action-oriented group therapies – Social skills and assertiveness training
Components of group therapy process – goals, therapeutic factors, group cohesion, role of therapist, client selection
Evaluation of group therapy

18. Self-help and mutual aid strategies
PSYCHOTHERAPY
Self-help and mutual aid strategies
Self-help strategies – books, audiotapes, videotapes, computer programs, Dr. Phil type programs
Mutual aid groups and organizations – wide range of support groups run by and for people with mental health challenges, such as AA, Narcotics Anonymous, etc.

19. PSYCHOTHERAPY
SUMMARY
Those who seek help are often not those who need help the most
Wide range of therapeutic strategies available
But there are common factors in therapy
Needs to be research support for therapeutic approaches

20. PSYCHOTHERAPY SUMMARY
Evidence that many different types of therapy can be effective
Behavioural and cognitive-behavioural approaches have the most empirical support, but these approaches have generated the most research
There is also evidence that some therapists are harmful, “psychonoxious therapist”

21. PSYCHOTHERAPY SUMMARY
Research needs to find out which approaches work best for whom and under what conditions
There are also a variety of self-help and mutual aid strategies that can reach a large number of people at relatively low cost that may be quite helpful