Chapter 11: General Issues in Psychotherapy Clinical Psychology by Andrew M. Pomerantz

1. GENERAL ISSUES
IN
PSYCHOTHERAPY

2. PSYCHOTHERAPY
sometimes called a "talking treatment“.
 last only a few sessions, while others are long-term,
lasting for months or years.
A psychotherapist may be a psychologist,s, a licensed
clinical social worker or mental health counselor, a
psychiatric nurse practitioner, psychoanalyst, or
psychiatrist.
WHAT DOES IT LOOK LIKE?

3. PSYCHOTHERAPY
• Trusting Relationship between the client
and the therapist.
WHAT MAKES PSYCHOTHERAPY
WORK?

4. DOES PSYCHOTHERAPY WORK?
• Mid-1900s, most of the evidence offered in support of
psychotherapy came in the form of anecdotes, testimonials
and case studies,
• Hans Eysenck Study. (1952) He concluded that most clients
got better without therapy and that in general, psychotherapy
was of little benefit.
• Meta-Analysis. Statistically combines the results of many
separate studies to create numerical representations of the
effects of psychotherapy as tested across numbers of
settings, therapists, and clients.

5. WHOM, WHEN, and HOW SHOULD
RESEARCHERS ASK?
• Hans Strupp a legendary and pioneering
psychotherapy researcher, identified three parties
who have a stake in how well therapy works and who
may have different opinions about what constitutes a
successful therapy outcome.
• Tripartite model
CLIENT
THERAPIST
SOCIETY

6. WHOM, WHEN, and HOW SHOULD
RESEARCHERS ASK?
• Immediately after therapy
• Follow-up
• Before therapy Ends
WHEN?
WHO?
•Researcher

7. WHOM, WHEN, and HOW SHOULD
RESEARCHERS ASK?
•Questioners
•Interviews
HOW?

8. EFFICACY VS. EFFECTIVENESS of
Psychotherapy
• EFFICACY refers to 'in the lab.' Most recent
psychotherapy studies are efficacy studies. They
maximize internal validity- the ability to draw
conclusions about the cause-effect relationship
between therapy and outcome- by controlling as
many aspects of therapy as possible. Feature well-
defined groups of patients, usually meeting diagnostic
criteria

9. EFFICACY VS. EFFECTIVENESS of
Psychotherapy
• EFFECTIVENESS include wider range of
clients, including those with complex
diagnostic profiles; allow for greater variability
between therapist methods. May include
control and treatment group. Lack the internal
validity. Have greater external validity takes
place in real settings.

10. RESULTS IN EFFICACY STUDIES
A primary finding of a landmark meta-
analysis of 475 psychotherapy efficacy
studies was that the average effect size
for psychotherapy was 85 indicating that
“ the average person who receives
therapy is better off at the end of it that
80% of the person who do not”

11. RESULTS IN EFFECTIVENESS
Stated by Seligma (1995)
There were a number of clear-cut results, among them:
1. Treatment by a mental health professional usually
worked. Most respondents got a lot better.
Average over all mental health professionals of the 426
people who were feeling very poor when they began
therapy, 87% were feeling very good, good, or at least
so-so by the time of the survey.
Of the 786 people who were feeling fairly poor at the
outset, 92% were were feeling very good, good, or at
least so-so by the time of the survey.

12. • indicate that psychotherapy works
when tested in controlled setting
(Efficacy)
• indicate that psychotherapy works as
it is commonly applied in realistic
settings. (Effectiveness)

13. ALTERNATE WAYS TO MEASURE
PSYCHOTHERAPY OUTCOME
(DIRECT and INDIRECT)
DIRECT
• FUNCTIONAL MAGNETIC RESONANCE
IMAGING (FMRI)
• POSITRON EMISSION TOMOGRAPHY (PET)
neuroimaging technologies have found that successful
therapy for particular disorders produces reliable changes
in brain activity and structure.

14. Behavioral Therapy – Obsessive- Compulsive Disorder
 Has been found to decrease metabolism in the caudate
necleus,
 behavior activation affects the dorsal striatum of
depressed clients, and
 both cognitive behavioral therapy and interpersonal
psychotherapy have been found to decrease activity in
dorsal frontal regions and increase activity in ventral
frontal and subcortical regions

15. ALTERNATE WAYS TO MEASURE
PSYCHOTHERAPY OUTCOME
(DIRECT and INDIRECT)
INDIRECT
 Medical cosy offset is another intriguing way to assess
the outcome of psychotherapy.
“Many people with mental or emotional problems will
either seek medical (rather than psychological) assistance
or will put off treatment for so long that the problem
worsens the individual’s psychical state, necessitating
medical treatment”

16. • More than 90 studies on this issue found that, on
average, clients receiving therapy spent fewer
days in the hospital and saw their medical cost
reduced by 15.7%, while comparable clients in
control groups spent more days in the hospital
and saw their medical costs reduced by 12.3%.
• Additionally, psychotherapy has been found to
reduce the need for emergency room visits

17. WHICH TYPE OF PSYCHOTHERAPY
IS BEST?
• “DODO BIRD VERDICT”
• Saul Rosenzweig, basically
states that more than 500
different kinds of
psychotherapies are equally
effective.

18. Common Core Features why
they’re essentially equally
effective.
• A therapist with skill
• A sympathetic (or empathetic) therapist
• A close rapport between the therapist and patient
• Common therapeutic goals

19. THERAPEUTIC RELATIONSHIP
• Alliance a partnership between two allies
working in a trusting relationship toward a
mutual goal.
WORKING ALLIANCE
THERAPEUTIC ALLIANCE
the most crucial single aspect of therapy

20. Other Common Factors
• Hope (positive expectations) Therapists of all kinds provide hope or an
optimism that things will begin to improve.
• Attention (Hawthorne effect) the therapist and client direct toward the
clients issues may represent a novel approach to the problem.
• Three-stage sequential model of common factors beginning with
the 'support factors' stage -strong therapist-client relationship, Second
stage 'learning factors' including such aspects as changing expectations
of self, changes in thought process, corrective emotional experiences.
Third stage ' action factors' taking risks, facing fears, practicing and
mastering new behaviors.

21. Three-stage sequential model of
common factors
1. Connecting with them and
understanding their problems.
2. Facilitating change in their beliefs and
attitudes about their problems.
3. Encouraging new and more productive
behaviors.

22. • Dianne Chambless prolific and highly respected
psychotherapy researcher. Argued against the idea that all
psychotherapy approaches are equally efficacious
• (“Beware the Dodo Bird: Dangers of Overgeneralization”)
• Stanley Messer and Bruce Wampold review the literature on
the therapy efficacy and conclude that “ the preponderance of
evidence points to the widespread operation of common factors
such as therapist-client alliance in determining treatment
outcome.
• Perspective Approach specific therapy techniques are viewed
as the treatment of choice for specific disorders. should be
replaced by an approach that more broadly emphasizes
common factors, especially the therapeutic relationship.

23. What types of psychotherapy
clinical psychologist practice?

25. STAGES OF CHANGE MODEL
Precontemplation stage no intention to change at all.
These clients are largely unaware of their problems, and
they may have been pressured to enter therapy by family
or friends
Contemplation stage aware that a problem exists,
considering doing something to address it, but not ready
to commit to any real effort
Preparation stage intending to take action within a
short time. These clients may be taking small steps but
have not made significant or drastic change

26. STAGES OF CHANGE MODEL
• Action stage Actively changing behavior and
making notable efforts to overcome their problems.
More than any other stage requires sustainable
effort and commitment to the therapeutic goal
• Maintenance stage preventing relapse and
retaining the gains made during the action stage.
This stage lasts indefinitely.

27. THE FUTURE
The trends they foresee for the near
future;
Cognitive and Behavioral approaches to therapy
Culturally sensitive therapy
Eclectic/Integrative approaches to therapy
Empirically supported or evidence-based forms
of therapy

28. ECLECTIC and INTEGRATIVE
Approaches
• Eclectic Therapy (Technical Eclecticism) involves
selecting the best treatment of similar clients. turns to
the empirical literature as soon as the diagnosis is made
and practices whatever technique the literature
describes for the diagnosis.
• Integrative Approach involves blending techniques
in order to create an entirely new, hybrid form of
therapy. May combine elements of psychoanalytic,
cognitive, behavioral, humanistic, or other therapist
into a personal therapy style

29. • JOHN NORCROSS
explained that the psychotherapy
integration movement grew out of 'a
dissatisfaction with single-school approaches
and a concomitant desire to look across and
beyond school boundaries to see what can be
learned from other ways of thinking about
psychotherapy and behavior change'

30. MARAMING
SALAMAT!


31. QUIZ 2017