6. Periodically, someone contends that psychotherapy is no more effective than no
treatment at all. Discuss the conclusion (i.e., discuss the evidence) that the
techniques of psychotherapy are ineffective as it applies to: a) Rogerian therapy, b)
Gestalt therapy, c) behavior therapy, d) family therapy, e) eclectic therapies, and f)
cognitive therapy. What ethical problems does this conclusion raise (if it’s correct)?
What evidence is there to refute this conclusion (from the literature)? What
criticism of this drastic conclusion might a transtheoretical theorist use to refute the
- Reviews have concluded that a patient’s positive perception of a therapist’s
facilitative attitude has only a modest effect on treatment gains.
- When applied to a group of schizophrenics, Rogerian psychotherapy showed
no effect – certain disorders (notably brain diseases) are not effected by
- Studies have consistently shown that Gestalt therapy is superior to no
treatment, but have also shown that it is barely higher in success to placebo
treatment. It has also been shown that it is no more successful than other
methods of therapy.
- Effectiveness has been shown to vary significantly between therapies
depending on the characteristics of the patient, however. For example, Gestalt
therapy was shown to be most effective for patients who are internalizing,
have low-resistance, and are overly socialized. Patients who cope by acting
out and projecting, however, fared significantly better with cognitive therapy.
- A huge amount of studies have been performed to show the consistent positive
effect that behavior psychotherapy has over no treatment and placebo effects
on multiple different problems
- However, a primary criticism of behavior therapy is that it is too focused on
short term recovery and removal of symptoms without addressing the
underlying roots of the pathology. Similar to no treatment, there is a
significant risk for relapse when neglecting to address underlying issues to
psychopathology that other approaches might address
- Despite being successful in 66% of cases, some specific disorders (such as
alcohol dependence) have been found to be equally effective in treatment with
individual therapy than with family therapy.
- Also, no research has been performed proving the assumption that the
symptoms of the identified patient are really a reflection of problematic family
Eclectic: - The principle concern with eclectic theory is the constant need of the therapist
to continually keep up to date on the most effective methods of treatment.
While many studies have shown eclectic therapy to be superior to no
treatment, there have been problems in contrasting these results to other
single-theory methods because of researchers mistakenly identifying eclectic
therapies as a result of lacking information.
- Another potential criticism to eclectic therapy is the significance of matching
patient and therapist. This criticism is a kind of double-edged blade –
correctly matching therapist approach and patient characteristics can have a
significant effect on the patient’s performance, but incorrectly approaching the
patient can result in an opposite effect.
- Despite being found to be effective in many diverse aspects of problems,
cognitive therapy was found to be ineffective in one specific category, namely
in treating domestic violence. Cognitive therapy was found to have no effect
on batterers that was not already established by the action of being arrested.
- However, this result was also found when this category of patients was treated
using different psychotherapy approaches. All types of psychotherapy
currently produce little to no effect in these patients
- A 1952 study by Eysenck reported that 66% of patients will recover without
the need of psychotherapy treatment. The paper claimed that this percentage
of patients will experience spontaneous recovery as a possible result of mood
fluctuations or normal situation changes.
- This finding was later refuted by research such as the Smith, Glass and Miller
(1980) meta-analysis that found psychotherapy to be more effective than no
treatment in 500 cases.
7. A patient comes to a clinic complaining of intense anxiety attacks that are
interfering with his ability to go out of his home. What would a RET, a Gestalt, a
Freudian, a Rogerian, a behavior therapist, a cognitive therapist, and a family
therapist do if each one were confronted with such a patient? How would therapy
begin in each case and where would it go? How would a transtheoretical therapist
deal with this and what information would such a therapist need in order to decide
how to begin?
- A rational emotion therapist would attempts to establish a connection between
the anxiety attacks the patient is experiencing and the beliefs the patient holds
about being outside. For example, the patient may have the belief that “If I go
outside the sun will set me on fire”, resulting in the consequence of the patient
not going outside of his home and suffering extreme anxiety if he does - In this case, therapy would begin with the therapist attempting to discover the
A of the ABC model – the therapist would first have to identify the event that
lead to the faulty cognition causing the behavioural consequence. Once the
problematic cognition is identified, therapy would focus on disputing the
beliefs about the event from A in an attempt to change the patient’s belief.
- In gestalt therapy, the notion that taking responsibility for our own existence
is of primary importance. The therapist would attempt to raise the awareness
of the patient by making them aware of everything within their perceptual
field – ranging from their thoughts to their physical actions.
- This notion of making the patient aware of their perceptual field and therefore
responsible for their actions would be utilized to show the patient that they are
the one responsible for their anxiety and are therefore able to control it.
- Because Freudian therapy recognizes the root of anxiety as a result of
unconscious problems that developed during childhood, this therapy would
likely begin with the therapist attempting to discover the root of this anxiety.
Psychopathologies in Freudian therapy are the result of conflicts between the
id and the ego, and the therapist would likely attempt to establish a connection
between the anxiety that arises when the patient goes outside and the
unconscious desires of the id that are in conflict. The therapist would attempt
to raise the consciousness of the patient to make them aware of these desires.
- Rogerian therapy places positive regard and a warm therapeutic relationship
above all else, and that would be no exception in this case. The therapist
would likely begin by establishing a strong empathetic and genuine
relationship with the patient. The therapist would allow the patient to fully
explore their feelings and thoughts in an attempt to establish congruence
between their self-perception and their experiences, hopefully relieving this
- Because behavioural therapists view the source of psychopathology as
problems in learning, a behavioural therapist would likely begin by re-
conditioning the event of going outside with a more positive response, such as
muscle relaxation. This problem would likely be resolved through the use of
in vivo desensitization, in which the patient is exposed to stimuli that illicit
their abnormal response in increasing severity so it can be re-conditioned. For
example, the patient may begin by looking out a window, then proceed to
stand in front of a glass door, then finally take more and more steps outside
until the event no longer elicits their anxiety response. Cognitive:
- Rather than dispute the patient’s cognitive beliefs (like RET therapy), Beck’s
method of cognitive therapy questions the patient’s maladaptive cognitions in
an attempt to have the patient change them. The therapy would likely begin
with the patient explaining their problem to the therapist, and then would be
given “homework” to complete whenever they experience this problematic
situation. By keeping a daily record of automatic thoughts and writing out
alternative ways to perceive the situation of being outside, the patient
questions their cognitions and changes them.
- A family therapist would begin by determining the dynamic and
communication between members of the identified patient’s family. Because
family therapists believe that psychopathology is the result of unresolved
conflict within the family, the therapist would use the determined
relationships between family members to root out any unresolved issues that
may be resulting in the identified patient’s anxiety. These issues could be
resolved within the therapy setting.
- The first thing that a transtheoretical therapist should attempt to do with a new
patient is determine which stage of change the patient is in. The stage of
change the patient is in will be reflected by the patient’s attitudes, intentions
and behaviors related to the readiness to change the patient expresses. The
stages of change are: Precontemplation, in which the patient has no intention
to change the behavior in the foreseeable future; Contemplation, in which the
patient is aware of the problem and is considering overcoming it, but has not
yet taken action; Preparation, in which the patient is intending to take action
and may report small behavioral changes; Action, in which the patient is
actively modifying their behavior or experiences in order to overcome the
problem through the use of much time and energy; Maintenance, in which the
patient is working to prevent relapse and consolidate the gains made during
the action stage, and finally; Termination, in which the patient no longer
experiences any temptation to return to the problem behavior and does not
have to work to prevent relapsing. Recycling is a stage that can occur in any
of the previously discussed stages of change, and is the relapse of the patient
that occurs subsequent to unsuccessful attempts to change.
- From the information provided regarding the current patient, it would seem
that this patient is in the Preparation stage. The individual has made the action
of seeking professional help and has accepted that anxiety experienced upon
leaving the house is a problematic behavior. For this psychopathology and in
regards to the stage of change the patient is in, a transtheoretical therapist
would likely work with the patient to develop an action plan for how they will work to change this behavior. Small steps would be taken towards change
through methods of counterconditioning and stimulus control in order to
substitute healthier behaviors in response to the stimulus of going outside.
Emphasis would also have to be placed on the patient’s feeling of self-
liberation so that the patient believes they have the autonomy to make the
8. If psychotherapy is only marginally more effective than a control group (i.e., no
therapy), why might it still be worth doing? What ethical and practical
considerations would suggest that one should/should not do therapy rather than let
spontaneous remission effect the cure?
Even if psychotherapy is only marginally more effective than a control, it might still be
worth doing for multiple reasons:
- Prevention of remission: in the case of behaviors and attitudes that would be
addressed by behavioral and cognitive therapies, allowing for spontaneous