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PSYC1000 - Module 53

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University of Guelph
PSYC 1000
Harvey Marmurek

Course: PSYC*1000 (DE) Professor: Harvey Marmurek Schedule: Summer, 2012 Textbook: Psychology – Tenth Edition in Modules authored by David G. Myers Textbook ISBN: 9781464102615 Module 53: Evaluating Psychotherapies Today’s providers of psychotherapy include clinical and counselling psychologists clinical social workers clergy, marital and school counsellors and psychiatric nurses. Is Psychotherapy Effective? Does psychotherapy work? Who decides? Clients’ Perceptions: 89% said they were at least fairly well satisfied. People often enter therapy in crisis. Clients may need to believe the therapy was worth the effort. Clients generally speak kindly of their therapists. Clinician’s Perceptions: Therapists appreciate thanks at ends of sessions but hear little from clients who experience only temporary relief and seek out new therapists for recurring problems. Regressing from Unusual to Usual: Clients’ and therapists’ perception of therapy’s effectiveness are vulnerable to inflation from two phenomena. Placebo effect (power of belief in treatment) and regression toward the mean (tendency for unusual events/emotions to regress/return to their average state. Outcome Research: Hans Eysenck launched a spirited debate, summarizing studies showing that two- thirds of those receiving psychotherapy for non-psychotic disorders improved markedly. He also reported similar improvement among untreated persons – time is a great healer. Randomized clinical trials randomly assign people on a waiting list to therapy or no therapy. Results studied by meta-analysis (statistical procedure that better off than 80% of the untreated individuals on waiting lists… by definition 50% of untreated people are also better off than the average untreated person. Those not undergoing therapy often improve, but those undergoing therapy are more likely to improve more quickly, and with less relapse. How do (a) the placebo effect and (b) regression toward the mean bias clients’ and clinicians’ appraisals of the effectiveness of psychotherapies? (a) the placebo effect is the healing power of belief in a treatment. Patients and therapists who expect a treatment to be effective may believe it was. (b) given the natural tendency of extraordinary happenings to regress back to ordinary ones, patients and clinicians may attribute a normal regression to successful treatment. The Relative Effectiveness of Different Psychotherapies Are some psychotherapies more effective than others for specific disorders? Clients seem equally satisfied whether treated by a psychiatrist, psychologist or social worker; whether seen in a group or individual context; whether the therapist had extensive or relatively limited training and experience. There is often an overlapping – or comorbidity – of disorders. Behavioural conditioning has achieved favourable results with specific behavioural problems. Psychodynamic therapy has success with depression and anxiety. Cognitive and cognitive-behavioural therapy has helped with anxiety, PTSD, depression. Therapy is most effective when the problem is clear-cut. To encourage evidence-based practice APA have followed the Institute of Medicine’s lead, advocating that clinicians integrate the best available research with clinical expertise and with patient preferences and characteristics. Therapy is more likely to be helpful for those with the most defined problems. Evaluating Alternative Therapies How do alternative therapies fare under scientific scrutiny? Eve Movement Desensitization and Reprocessing (EMDR): Shapiro developed EMDR while walking in a park and observing that anxious thoughts vanished as her eyes spontaneously darted about. Tens of thousands have taken the training. No since Mesmer introduced animal magnetism (hypnosis) more than two centuries ago has a new therapy attracted so many devotees so quickly. 84-100% of single-trauma victims report that yes it works. The treatment need take no more than three 90-minute sessions. Some argue that eye movements serve to relax or distract patients, thus allowing the memory-associated emotions to extinguish. EMDR does work better than doing nothing – but argue same results if they focused on tapping a finger or watched a finger wag. Light Exposure Therapy: Seasonal affective disorder (SAD) – give people a daily dose of intense light. After four weeks, 61% of those exposed to the morning light greatly improved, as had 50% exposed to evening light and 32% exposed to placebo. Morning bright light does indeed dim SAD symptoms for many people. Moreover, it does so as effectively as taking antidepressant drugs or undergoing cognitive-behavioural therapy. Which of the following alternative therapies has shown promise as an effective treatment? Light therapy What is evidence-based clinical decision making? Using this approach, therapists make decisions about treatment based on research evidence, clinical expertise, and knowledge of the client. Commonalities Among Psychotherapies What three elements are shared by all forms of psychotherapy? • Hope for demoralized people • A new perspective • An empathic, trusting, caring relationship The emotional bond between therapist and client – the therapeutic alliance – is a key aspect of effective therapy. Those who undergo psychotherapy are more likely to show improvement than those who do not undergo psychotherapy. Culture, Gender, and Values in Psychotherapy How do culture, gender, and values influence the therapist-client relationship? All therapies offer hope, and nearly all therapists attempt to enhance their cl
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