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