Evaluating Psychotherapy’s Effectiveness

1. Evaluating Psychotherapy’s Effectiveness Module 72

2. Are Psychotherapies Effective?Client Perceptions • 89% say they were “fairly well satisfied” • Why the high number? • People enter therapy in crisis – many would have gotten better over time anyways • Spontaneous Remission- Some people improve with nothing more than the passage of time • Belief the therapy is worth the effort – don’t want to admit it may not have been helpful • Generally, clients speak well of their therapists • Placebo Effect – Belief in therapy = success • Confirmation Bias causes us to select info that confirms our beliefs

3. Are Psychotherapies Effective?Clinicians’ Perceptions • Many case studies show clients improve through therapy. • Skeptics point out: • People enter therapy in a severely distressed state so the likelihood they would get better even without therapy is high. • Regression Toward the Mean – Tendency for unusual events or emotions to eventually regress/return to normal • People often mistake the natural return to normal as due to treatment.

4. Are Psychotherapies Effective?Outcome Research • Most people do not seek help with problems and still get better • Randomized Clinical Trials – double blind studies with placebo groups to compare the effectiveness of treatment • Meta-analysis used to combine and interpret the results of large numbers of studies has found: • On average, the person who completes treatment is better off than about 80 percent of those in the untreated control group. • Benefits are usually apparent in a relatively short period of time • Gains that people make tend to endure – less risk of relapse • Brain-imaging technologies show that psychotherapy alone produces distinct physiological changes in the brain that are associated with a reduction in symptoms

5. Studies on Psychotherapy

6. Factors in Successful Therapy • Therapeutic relationship—caring and mutually respectful • Therapist characteristics—caring attitude, ability to listen, sensitive • Client characteristics—motivated, actively involved, emotionally and socially mature • External circumstances—a stable living situation and supportive family members

7. Which Psychotherapies Work Best? • Different treatments work better for different disorders • The more specific the problem, the greater the hope • Behavioral – bed wetting, compulsions • Psychodynamic – depression, anxiety • Cognitive-Behavioral – anxiety, PTSD, depression, OCD • Due to a comorbidity (overlapping) of disorders in many people, multiple therapies may be used. • Evidence Based Practice – using the treatment that research shows works best for a particular disorder and your patient’s preferences & characteristics.

8. The rates of improvement for more than 2,000 people in weekly psychotherapy and for 500 people who did not receive psychotherapy. Clearly, psychotherapy accelerates both the rate and the degree of improvement for those experiencing psychological problems. SOURCE: McNeilly & Howard, 1991.

9. Are Alternative Therapies Effective?

10. Eye movement desensitization reprocessing (EMDR) • Treatment technique in which patients suffering from traumatic memories visually follow her waving finger while simultaneously holding a mental image of disturbing memories, events, or situations • EMDR is more effective than no treatment at all (Placebo Effect) • EMDR is no more effective than exposure therapy and other standard treatments for anxiety disorders • Several research studies have found no difference in outcome between treatments that incorporated eye movements and “sham” EMDR

11. Therapeutic Touch Therapy • Therapists move their hands above the person’s body to “push energy fields into balance.” • No evidence has been found to support the effectiveness of this therapy

12. Light Exposure Therapy • Therapy for Seasonal Affective Disorder by exposing the patient to artificial light mimicking that of the sun • Can be as effective as taking antidepressant or doing cognitive-behavior therapy • Research supports a connection between exposure to light and melatonin levels in the blood, which affects levels of alertness

13. Elements Shared by All Psychotherapies • All Therapies offer at least 3 benefits: • Hope for demoralized people • May function as a placebo, improving morale • A new perspective – provides an alternative way of viewing self and responding to one’s world • An empathetic, trusting, caring relationship • Therapeutic Alliance - Therapist who is empathetic, seeks to understand client’ s experience & communicates care and concern to the client. Earns the client’s trust and respect. • People who feel supported by close relationships are less likely to seek therapy

14. Culture, Gender & Values • Therapy training programs provide training in cultural sensitivity & recruit underrepresented minorities • A Therapist’s personal beliefs often become the beliefs of a client. • Therapist should be up front with their values

15. Prevention • Lifestyle Change – this could prevent a disorder by increasing resilience – ability to cope with stress & recover from adversity • Reform society/environment – It’s not the people who are sick, it’s the environment making them sick • Poverty, meaningless work, constant criticism, unemployment, racism, sexism, heterosexism • All of these increase stress, undermine people’s competence and personal control