1: Definitions of Psychotherapy
“hysteria” – concept of transference – by Freud & Breuer
Freud mostly cares for neurotic women.
1895: Abandons hypnosis for free association: noticed that patients would sometimes hesitate
(assumed it was cuz blocks were showing up for painful memories or taboo subjects.)
childhood memories & sexual themes would allways come up. (mebs cause yr a lady lying
near a man)
5 yrs later: publishes Interpretation of Dreams – concept of unconsc, theories of neuroses
1909: G. Stanley Something brings Freud to Clark Univ –talks published in 1910 in
American Journal of Psychology.
o ACADEMIA not interested (slowly warms,) PUBLIC likes it
Psychoanalysis is about abnormality & case studies – others do EXPERIMENTS on psychoanalytical
>20 clinics already existed, in universities. Most dealt w/ KIDS
WW1 NEED 1919 CLINICAL section of APA appears
WW11 MORE NEED, PTSD GOV’T funds university programs for clinical psychology
1949: APA says to be clinical, gotta be TRAINED as scientist & practitioner
Now: more & more clinical psychologies more & more varied theories about the subject
1950s & 60s 1959 1976 1979 Today
humanistic, more 36 distinct, 100 >200 400-500
DIFFERENT DEFINITIONS OF PSYCHOTHERAPY:
Norcross, 1990: informed & intentional application of clinical methods & interpersonal stances
derived from ESTABLISHED psychologies. GOAL assist people to MODIFY their behaviours,
cognitions, emotions, and/or other personal characteristics in directions that the participants deem
Desirability? Corsini, 2007: Formal process of interaction between two parties, each usually consisting of one
person but can be 2/+ in each. GOAL amelioration of distress in 1 of the parties relative to
any/ all of the following areas of disability or malfunction: cognitive functions (disorders of
thinking), affective functions (suffering or emotional discomforts), or behavioural functions
(inadequacy of behaviour).
THERAPIST: has some theory of personality’s origins, development, maintenance, and
change, applies some method of treatment logically related to the theory, and has
professional and legal approval to act as a therapist.
Theory, logic, legal approval, distress
** Anyone in Canada can theoretically call themselves a PSYCHOTHERAPIST. Vs. Clinical
THE ROLE OF THEORIES
All psychotherapies are METHODS OF LEARNING– they intended to change people – make
them think or feel differently & to make them act differently(cog, affective, behavioral)
help the person learn something new
relearning something they have forgotten
learning what one already knows. …???
All psychotherapies are pathways to:
a new way of seeing life - a re-evaluation of self and others.
- The psychotherapist is a persuader or FACILITATOR attempting to CHANGE OPINIONS.
CORE ASPECTS OF PSYCHOTHERAPY: relationship + target of intervention
WORKING ALLIANCE INVENTORY MEASURES THINGS THAT MAKE THERAPY GOOD:
(necessary, o Caring/Acceptance
but not o Confidentiality
sufficient) GOALS o Understanding & agreement on GOALS of treament
TASKS o Agreeing upon TASKS & methods
BUT HOW IS THIS DIFFERENT FROM PLAIN OL’ FRIENDSHIP?
distilled ROLES of each member in the therapeutic relationship
specific TECHNIQUE TECHNIQUES / METHODS
ANXIETY SENSITIVITY INDEX: question checklist – fear of bodily sensations
CBT is v. good for PANIC DISORDER – treats fear of bodily sxs REDUCES panic attacks
For OCD - supportive therapy (where relationship is most important) is almost USELESS. Behav
& Cog are best. Ex: ERP – Exposure & Response-Prevention
BECK’S MODEL OF DEPRESSION
Psychonalysts said people with depression really had REPRESSED ANGER. Beck found out this
Negative events Cognitive appraisal Depressed emotion behaviors… Neg events
SPECIFIC TECHNIQUES & RELATIONSHIP FACTORS INTERACT THERAPEUTIC RESPONSES
2: Aspects of Clinical Research
HYPOTHESES: Clearer hypotheses better-constructed study
RELIABILITY OF FINDINGS: replicability & robustness (sample size etc.)
INDEPENDENT & DEPENDENT VARIABLES: have to be operationalized. What’s the diff
INTERNAL VALIDITY: how well a measure measures what it’s supposed to measure.
Potential Problems: confound.
Establish good Inclusion Criteria
Make Control Groups
EXTERNAL VALIDITY: how well findings represent general population
Effectiveness within tightly controlled populations? STUDY – Meta-Analysis of Efficacy of Psychotherapy – 1977, SMITH & GLASS
Any therapy seems better n none (.68 effect size) but none better than others. Amt of training,
type of therapy did not correlate w/ outcomes. RELATIONSHIP seemed important
STUDY – WESTEN & MORRISON META-ANALYSIS OF depression, panic, GAD studies
Multiple Meanings of Efficacy
> Effect Size Estimates vs. Clinically Significant Improvement
Effect Sizes: quantitative not qualitative
small - 0.3
medium - 0.5
large – 0.8 (means that ~83% of those treated got better)
… this doesn’t tell us how MUCH people have actually improved. Just how MANY.
> Improvement vs. Complete Recovery
Maybe interview to check if patients still have sxs that qualify for a DSM diagnosis
> Intent to Treat sample vs. Completers Sample
The final sample doesn’t necessarily take attrition into account.
Modal # of sessions of therapy per person in therapy= 1
> Effective Efficacy
> The number of patients that seek additional treatment
Often not taken into account, but might be a sign of remission, having contracted a NEW problem
(perhaps even CAUSED by the study!)
relapse plan: patients taught to notice early warning signs & get treatment before they get bad.
> The absolute magnitude of mean # of symptoms after treatment
Initial Response vs. Sustained Efficacy
*Treatment effects at post-treatment vs. effects at longer follow-up intervals
*Efficacy versus Effectiveness Research Treatment States Vs. Treatment of Disorders
*Reducing an episode of depression versus preventing its recurrence by targeting underlying
*Risk of repeated episodes = 85% over 10-15yrs
*Treating symptoms versus characterological disorders
*Short vs. Long-term Focus of change
Empirically Unsupported vs. Empirically Untested
Criteria for inclusion:
published between 1990-1998