PowerPoint  Lecture Notes Presentation
Chapter 16
Psychological Treatment
Abnormal Psychology, Eleventh Edition
by
Ann M. Kring, Gerald C. Davison, John M. Neale,
& Sheri L. Johnson
Psychodynamic Treatment


Briefer and more active than traditional
psychoanalysis
Both emphasize:
» Importance of early parental relations
» Unconscious symptoms

Therapist listens for core emotional and relationship
themes
» Looks to patient’s reaction to therapist for clues

Use of interpretation to facilitate insight
» Understanding facilitates cathartic release of emotion
» Symptom reduction assumed to follow from increased
insight and understanding of patterns
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Experiential Therapies

Basic assumption that humans are innately good
» Emphasize our creative and expressive aspects


Aims to promote growth by helping client
understand and value internal emotions and needs
Therapist provides safe environment for this
exploration
» Use of empathy

People’s innate goodness and effectiveness is
thwarted by too many internalized demands and
preferences from others and from society
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Experiential Therapies

Roger’s Client-Centered Therapy
» People can be understood only from the vantage
point of their own perceptions and feelings
» Humans are innately good, effective, and selfdirected
– Self-actualization
» People’s innate goodness and effectiveness is
thwarted by internalized demands and preferences
from others
» Conditions of worth vs unconditional positive
regard
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Experiential Therapies

Gestalt therapy (Fritz Perls)
» Help clients realize how they block themselves from
experiencing and expressing their emotions and needs
» Focus on the here-and-now, rather than past
» Emphasis on techniques
– “I” language
– Empty chair
– Attention to nonverbal and paralinguistic cues

Emotion-Focused therapy (Greenburg)
» Combines elements of client-centered and gestalt
therapies
» Adaptive and maladaptive emotions
– Foster awareness of maladaptive emotions and learn to
regulate them
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Behavioral Therapies

Exposure
» Effective for several anxiety disorders

Operant techniques
» Useful for behavioral problems and substance
abuse
» Behavioral activation therapy for depression
(Jacobson et al., 2001)

Especially effective for childhood problems
» Bed-wetting, thumb-sucking, nail-biting,
aggression, tantrums
» Parent training often integral to treatment success
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Cognitive Behavioral Therapy

All based on awareness of maladaptive thoughts
» Modifying cognitions alters feelings, behavior, &
symptoms



Beck’s Cognitive Therapy
Ellis Rational Emotive Behavior Therapy
Recent innovations:
» Linehan’s Dialetical Behavior therapy
» Mindfulness based cognitive therapy
» Acceptance and Commitment therapy

All emphasize awareness of emotions without impulsive
reacting
» Acceptance
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Cognitive Behavioral Therapy

Beck’s CBT

» Several studies have
demonstrated its
effectiveness for
depression
» CBT as effective as
medication for severe
depression (Hollon et
al., 2002)
– Effects maintained
over 1 year follow up
CBT effective for:
»
»
»
»
»
»
Depression
Panic disorder
GAD
Social phobia
Chronic pain
Irritable bowel
syndrome
» Bulimia nervosa
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Couples Therapy

About 50% of marriages end in divorce within first 7 years.
» Those in distressed marriages, 2 – 3 x more likely to
experience a psychological disorders
– Marital distress may be either a trigger for or a consequence of a
disorder

Predictors of relationship distress
» Signs of conflict and differences are ignored
– Demand-withdraw cycle
» Stone-walling
» Defensiveness
» Expressions of contempt for partner

Treatment focus:
» Improving communication, problem-solving, satisfaction,
trust, and positive feelings
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Table 16.1 Goals in Different Forms
of Couples Therapy
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Family Therapy

Based on assumptions
» Problems of the family influence each member
» Problems of each member influence the family

May include:
» Focus on roles within family, e.g., parental
responsibilities
» Identification of family “scapegoat”
» Teaching communication and problem-solving
» Psychoeducation
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Treatment Outcome Research


Therapy is effective
Analysis of over 300
studies showed
most people (75%)
improved after
therapy (Lambert &
Ogles, 2004)
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Table 16.2 Examples of Empirically
Supported Treatments for Adult Disorders
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Figure 16.2 Stepped Care
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Standards for Treatment Outcome
Research


Clear definition of sample and diagnoses
Clear description of treatment
» Driven by treatment manual


Reliable and valid outcome criteria
Control or comparison treatment conditions
» Randomized controlled trials (RCTs)
– No treatment, placebo, other treatment


Random assignment
Sample of sufficient size for statistical tests
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Challenges to Evaluating Treatment Outcomes:
Table 16.3 Treatments that May be Harmful
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Challenges to Evaluating Treatment
Outcomes

Use of treatment manuals
» Detailed set of instructions for implementing treatment
at each stage of therapy
» Minimize therapist differences
» Increase internal validity but may reduce external
validity
– Alternative: manuals that offer freedom to therapists

Defining the sample
» Based on DSM diagnosis
» Samples should be selected by psychological profiles
instead
– Match clients to treatment
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Challenges to Evaluating Treatment
Outcomes

Concerns about those who are excluded
from treatment studies, including
» Individuals with more than one disorder
» Participants who refuse participation
because they may receive control condition
or placebo

Makes generalization difficult
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Treating Disorders in the Real World

Efficacy
» Determination of whether a treatment works under
ideal conditions

Effectiveness
» How well a treatment works in the real world

Standards for real world outcome research
»
»
»
»

Broad range of problems in sample
Allow therapists more flexibility
Examine broad range of outcomes
Briefer assessments
Effectiveness research can focus on how to
foster better treatment in the community
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Evidence of Treatment
Effectiveness

Traditional psychoanalytic therapy
» Clients with severe psychopathology (e.g.,
schizophrenia) do not do as well as those
with anxiety disorders
» People with more education tend to do
better than those with less education
» Poor outcomes are more likely when a
therapist makes frequent interpretations of
transference reactions
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Evidence from Randomized
Control Trials (RCT)


Psychodynamic therapy
Although psychodynamic treatment has received
support, there are three important caveats:
» Psychodynamic treatment offers advantage compared
to control only when treatment lasts more than 20
sessions
» Psychodynamic treatments have not been found to be
more helpful than general treatment as offered in the
community
» Brief psychodynamic therapies fare best when
therapists use a manual and receive specific training
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Evidence from Randomized
Control Trials (RCT)

Experiential therapies
» Demonstrated positive effect, mostly for
less severe problems
» Emotion-focused therapy has the strongest
results
» Two studies suggest that Gestalt therapy,
with unrestrained emotional expression, led
to deterioration in some participants
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Evidence from Randomized
Control Trials (RCT)

Cognitive therapy
» Beck’s therapy achieves greater short-term
improvement than wait-list controls, noncognitive behavioral treatments, and a
heterogeneous group of other psychotherapies
– Also appears to prevent future depressive episodes
» REBT also has demonstrated effectiveness as
does Marlatt’s Relapse Prevention Therapy
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Evidence from Randomized
Control Trials (RCT)

Couples Therapy
» About 80% of couples report improvement
compared to those who receive no treatment
» More successful than individual therapy in
reducing relationship distress

Family therapy
» Efficacy in reducing symptoms of broad range
of disorders
– Schizophrenia, agoraphobia, substance abuse,
bipolar disorder
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Choosing Among Therapies



Much debate and controversy about
comparisons among therapies
For depression, CBT may have small
advantage over other therapies
CBT seems to have a distinct advantage over
other therapies in treatment of anxiety disorders
» Except for exposure therapy

Couples vs. individual treatment
» Both relieve depression
» Couples therapy also leads to greater relationship
improvements
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Importance of Culture and Ethnicity in
Psychological Treatment
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Importance of Culture and Ethnicity in
Psychological Treatment

Most RCT samples have been white, non-Hispanic
people
» Results may not apply to other groups

Ethnic matching
» Preference for therapist from similar background
– Outcomes are not better with therapist-client match
» Cultural competence may matter more than ethnic
matching

All ethnic groups are highly heterogeneous
» Avoid stereotyping
» Consider the degree to which the person is assimilated
into, and holds the same values, as the majority culture
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Importance of Culture and Ethnicity in
Psychological Treatment

Several studies have tested whether standard empirically
validated treatments work with culturally diverse
populations
» Group IPT efficacious for people living in Ugandan villages
» Efficacy of CBT for African Americans with anxiety disorders
» Treatments for childhood anxiety and disruptive disorders do
not vary by ethnicity

Standard treatments can be enhanced by adding
culturally sensitive components
» Family values and spirituality in Latino cultures
» Sensitivity to higher rates of trauma experienced by African
American women
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Therapy Process Research


Draw the best ideas from different
treatments
Two types of process research
» Common factors approach
– Therapeutic alliance that includes empathy, positive
regard, engagement, goal setting with flexibility
» Mechanisms of change
– Changes in cognitions as a result of CBT

Both behavioral activation and medication alone result in
cognitive change
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COPYRIGHT
Copyright 2009 by John Wiley & Sons, New
York, NY. All rights reserved. No part of the
material protected by this copyright may be
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