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
PSYCHOTHERAPY
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
PSYCHOTHERAPY
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
PSYCHOTHERAPY
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 culturallysensitive – not “one size fits all,” cultural
competency of therapists
PSYCHOTHERAPY
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?
PSYCHOTHERAPY
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?
PSYCHOTHERAPY
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?
PSYCHOTHERAPY
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
PSYCHOTHERAPY
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)
PSYCHOTHERAPY
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
PSYCHOTHERAPY
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)
PSYCHOTHERAPY
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
PSYCHOTHERAPY
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?”
PSYCHOTHERAPY
Evidence-based Practice or Empiricallysupported 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
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
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
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.
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
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”
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