Mod 72: Evaluating Psychotherapies & Prevention Strategies

Evaluating Psychotherapies

Therapy sessions can be conducted by clinical/counseling psychologists; clinical social workers, clergy; marital & school counselors & psychiatric nurses

72.1 Is Psychotherapy Effective?

Clients’ Perceptions: a very strong YES!!

Most are fairly well satisfied with their therapy [Why else would they stay in it?]

Not the “whole story”

  • Most people enter therapy during a crisis
  • Put in the time & $$ so like to believe it was worthwhile
  • View their therapist in a positive light

Clinicians’ Perspective

Again, YES!

See growth during sessions, but problem lies with what happens after sessions are over?

Could be seeing other therapists!

Thinking Critically About: Regressing from Unusual to Usual

Placebo effect: believe that the treatment must be effective so it is!

Regression towards the mean: generally, most people return to normal or average functioning

Exception would be personality & schizophrenic type disorders

Usually see extremes return towards average

Research

Question is how to measure different types of therapies effectively

Best way is to use randomized clinical trials

Using meta-analysis: combining many studies on therapy & gain statistical data

Results indicate that 50% of the control group will improve on their own

BUT more improve that were enrolled in therapy

Improved faster & had less of a chance of relapsing

Therapy is cost effective—lose less time to absences/work loss

72.2 The Relative Effectiveness of Different Psychotherapies

Behavioral therapies: specific behavior problems

phobias, compulsions, marital issues & sexual dysfunctions

Psychodynamic: depression & anxiety

Cognitive & cognitive behavioral: anxiety, PTSD & depression

Any type of therapy works best when there is a specific, definable problem like phobias or panic issues

Depression & anxiety are not as well defined [most likely due to comorbidity]

See more issues with relapsing

Very difficult to treat personality disorders & schizophrenia (specifically negative symptoms & chronic types)

Some of the “alternative therapies” can actually be harmful like Scared Straight

Basically, seek a type of evidenced based therapy (behavioral, cognitive, psychodynamic)

More likely to be covered by insurance

72.3 Evaluating Alternative Therapies

Eye Movement Desensitization & Reprocessing (EMDR): concept that having eyes move while processing PTSD experience, helps to break the anxiety/panic

Jury is out on this therapy

Light Exposure

SADs treatment—morning light has been found effective

72.4 Commonalities Among Psychotherapies

Three Benefits

  • Hope—life can be better; create self-efficacy
  • Give person a new perspective (especially in cognitive therapy)
  • Build trusting & empathetic relationship with the therapist

Therapeutic alliance

72.5 Culture, Gender & Values in Psychotherapy

Therapist & treatment needs to reflect person’s culture

The individualistic attitudes of the West may make someone raised in Eastern collectivism uncomfortable

Includes religious differences

You are responsible for Close-Up72.6

72.7 Preventing Psychological Disorders

Therapies can build resilience –learn how to cope with stress & how to recover

Most of the building in NYC returned to normal by the January after 9/11

Attempt to treat disorders by preventing them

Poverty, meaningless work, constant criticism, unemployment, racism & sexism can all lead to an attack on a person’s competence, control & self-esteem

Increases depression, substance abuse & suicide rates

Try to prevent by training counselors, parents & teachers

Especially good communication skills