Psyc 401 Readings - Final Exam

____________ psychotherapy is a verbal interaction in which qualified professionals use psychological pro- cedures to alleviate distress and promote adaptive living in people who would like their help

individual

although psychotherapy can be defined in other ways that are equally as appropriate to the previous one, this definition is advanta- geous in waht two respects

• it encompasses the nature and goals of psychotherapy ie who does what to whom and for what purpose

• differentiates psychotherapy from actions and events that, although psychotherapeutic, are not integral components of psychotherapy

in a survey of members and fellows in the Society for Clinical Psychology, 76% of the respondents reported conducting psychotherapy and doing so far more frequently in _________ sessions than in _______, _______ , or ________ formats

individual , group, family, couple

As a ____________ interaction, psychotherapy consists of ______ and not ________. Psychotherapy may include treatment procedures that are mediated by ________ exchanges but are not themselves entirely ______, such assigning homework, recommend-ing meditation exercises, or advising engagementin or abstinence from certain activities - such procedures may play an important role in psychotherapy but psychotherapy has traditionally been labeled the _______ _______ and its key components are what patients and therapists ______ to each other and the relationship that forms between them

verbal, words, actions, verbal, verbal , talking cure, say

the requisite of a qualified professional for psychotherapy to occur does not refer to any particular degree, license, or certification but to therapists having.....

sufficient education, training, experience, and commitment to conduct psychotherapy com- petently

(Friends and qualified professionals can listen to what a person has to say and respond in helpful ways. butthe likelihood of psycho- therapeutic verbal interactions occurring between two people is considerably enhanced if one of them possesses the knowledge and skills of a qualified therapist)

psychotherepatuic relationships differ from friendships in 2 important respects - what are they

• psychotherapy is a non mutual relationships in that it concerns the well being of just one of the parties to it

• psychotherapy involves formal arrangements that rarely characterize friendships (tend to include a treatment contract that prescribes specific roles for the participants both of whom are elected to meet certain treatment responsibilities (ie both parties to the treatment contract have agreed to meet for sessions of a specified length and to continue meeting for a certain period of time or number of sessions or for as long as seems helpful

describe how psychotherepatuc relationships are not mutual like firendhisp

• friends ordinarily alternate in discussing each other's interests and problems but psychotherapy tends only to the needs and of the person being treated

• friendships they deepen and dissolve as enjoyment in them waxes and wanes, but therapists do not ordinarily continue or end a treatment relationship on the basis of the pleasure it gives them.

• -Unlike friends, therapists do not bring their personal needs directly into the treatment relationship, unless they have good clinical reason for doing so, nor do they respond to anger and criticism by reciprocating in kind

what are some features of the formal arrangements in the therapeutic relationship that’s not common to friendships

therapists ordinarily see their patients only during scheduled sessions, keep these sessions free from interruption, and seldom discuss matters unrelated to the purpose of the treatment.

With respect to restricting the definition of psychotherapy to psychological procedures, psychotropic medication and hospitalization are examples of treatments that often prove _____________ but are not _________

psychotherapeutic, psychtohterapy
(Likewise, taking a warm bath or getting a massage may improve a person's frame of mind, and thus be therapeutic, but physical pleasures and the laying on of hands are not an inte- gral part of psychotherapy)

As for using psychological procedures to alleviate distress and promote adaptive living, people come to psychotherapy principally for three reasons - what are they

• for relief from distressing symptoms of psychological disorder

• for help in dealing w problematic circumstances in their lives

• for personal enrichment through enhanced capacities to work productively and relate comfortably with others

depending on why the person has sought psychotherapy , the primary goals of the treatment will be some combination of what

• symptom relief

• - problem resoltuion
  - increased sense of self satisfaction and wellbeing

Greenberg, McWilliams, and Wenzel defined psychotherapy as "any psychological service provided by a trained professional that primarily uses forms of ____________ and interaction to assess, diagnose, and treat dysfunctional emotional reactions, ways of _________, and behavior patterns"

communication, thinking

in addition to overall common goals, therapy should also serve________ purposes

preventative -

People who have been helped to resolve problems in their lives should leave treatment better equipped to ______ with these and similar life problems in the future. Personal __________ and enhanced self-satisfaction gained through psychotherapy should be sustained in the years following termination of the treatment. In each of these respects, then, psychotherapy should always have ________as well as ________ goals

cope, equipped, preventative,e curative

what group does the last element in the definition of psychotherapy (refers to people who would like help) seem to exclude

this defining characteristic Amy appear to exclude from receiving psychotherapy, people who have not sought help voluntarily but for whom treatment has been compelled ie court order or bc of spouse

why is conducting psychotherapy w ppl who have not sought help challenging

bc psychotherapy is not a magical or medical procedure, it cant be imposed or have much effect on ppl who are not willing aprticiaptns in the process, and active participation in the treatment may be elusive when a person is being seen by comulsion

does the difficulties associated with treatment for people compelled prevent beneficial psychotherapy

no - Instead, it means that therapists working with people who are being seen involuntarily must kindle some receptivity to the treatment process, perhaps by demonstrating that they can suggest solutions to problemtns the person has been having - the demonstration of the benefit of talking boat problems can interest involuntary ppl in getting further help and lead to prdocutuve engagement in therapy

Psychotherapy is a powerful psychological intervention that can help people with many types of psychological concerns and disorders feel better and function more effectively. it is indicated and can benefit people who are troubled by symptoms of psychological and some health disorders, difficulties in coping with circumstances in their lives, dissatisfaction with the kind of person they are, or dysfunctional or distressing relationships.Yet psychotherapy is not indicated for everyone, nor is it certain to alleviate every kind of psycho logical difficulty - what are characteristics that are likely to enhance or limit what psychotherapy can accomplish ; what are characersitcs that can foster or hinder progress in psyhtoerhtapy

• characteristics of people and their mental state that are likely to enhance or limit what psychotherapy

• characteristics of therapists and the treatment relationship that can foster or hinder progress in psychotherapy

there are at least 3 characteristics of ppl entering psychotherapy that are known to influence the benefits or limitations of their treatment - what are they

• psychological good health predicts positive outcome in therapy, whereas severe disturbance limits what psychotherapy can accomplish

• - a moderate level of emotional distress fosters progress in psychotherapy whereas minimal distress limits a persons involvement in the treatment process and excessive distress impairs the persons ability to concentrate on the content of therapy

how does psychological good health predicts postive outcome in therapy, whereas severe disturbance limits what psychotherapy can accomplish

-just as good physical health promotes rapid recovery in ppl who need surgery, ppl who have been functioning reasonably well despite issues and concdnies that bring them for psychical help have better prospects for benefiting than people who have history of adaptive shortcoming and recurring issues

- the relationship of good psyc health and progress in therapy doesn’t mean seriously disturbed ppl cant profit - therapy is designed address their condition an has proved at least somewhat beneficial even in severe disorders
- eagerness to enter psychotherapy, hope of being able to make changes in themselves or lives and anticipation the therapy will facilitate these changes increasing the prospects of benefits- meaning that reluctance to be engaged in therapy, pessimism about possibility of change na doubt about therapy can make a difference are likely to limit participation in it and get gains from it - impact of expectations

how does moderate level of emotional distress foster progress in therapy

• within moderate limits, the more anxious and upset a person the more likely they will be to remain active in therapy

• - moderate distress motivate ppl to persevere in the demanding task of participating in therapy which predicts improvement
  - the more self satisfied, complacent and unperturbed a person he less likely they think therapy is worth their effort and time so less likely to be profitably engaged
  - a disorganizing level of anxiety or preoccupying extent of depression an prevent ppl form engaging in calm consideration of their problems - when deeply overwhelmed therapy may have to follow or be paired w meds or other interventions to alleviate distress enough for them to participate productively in therapy

What is the characteristic difference btw symptomatic and personality disorders

• ppl w symptomatic disorders are usually eager to to rid themselves of unwelcome thoughts and unpleasant feelings, which are often of recent origin and have had an acute onset

• - ppl w personality disorder usually involve inflexible and well entrehcend behvaiour patterns of longstanding, they also atrubte respoinsibitly for problems they have to the actions or attuned sof others or circumstances out of their control ( so to them resolution of issues rests w changes to otehrs but not in themselves)
  - symptomatic disorders are consequently more amenable to psychotherapy than people with a personality disorder, whose comfort with themselves and their disinterest in change tend to limit their participation and progress in treatment.

As in the case of people who have not come for treatment voluntarily, effective psychotherapy with individuals with _________ disorders is nevertheless possible if the therapist can get them involved in the treatment process

personality

higher initial _________ reduce premature _________ and improve overall treatment outcome

expectations, termination

why is it that athough initially strong motivation, high hopes, and positive expectations enhance the likelihood of a person's benefiting from psychotherapy, their absence does not preclude the possibility of a positive outcome

like ppl who come in to therapy involuntarily or have features of personltiy disorder, those who are initially pessimitic and skeptical about being helped can nevertheless still make progress if the therapistt can stir in them some interest in the treatment process and some enthusiasm fir it

t or f - Unlike attitudes and expectations, demographic characteristics such as age, socioeconomic status, and cultural background are largely unrelated to outcome in psychotherapy

t - Psychotherapy has proved helpful to people from early childhood into the later years, and neither youth nor old age contraindicates psychotherapy as a potential treatment value

economically disadvan- taged and cultural minority individuals who become engaged in psychotherapy have been found to profit from it as _______ and as much as advantaged majority group members

frequently

even though economic and cultural disadvantage do not con- traindicate psychotherapy or necessarily limit its benefits, therapists must be sufficiently ________ to the cultural and socioeconomic context in which their patients live to respond to them effectively and engage them __________ in their treatment

sensitive, productively

Attention to therapist characteristics that are likely to promote or limit progress in psychotherapy derived from the seminal contributions of what therpasityl who was among the first to emphasize how therapists should be

carl rogers - .he stressed in particular that progress in psychotherapy depends on therapists' ability to relate to their patients with empathy, warmth, and genuineness.

________ is the ability to assume the perspective of other people and understand their needs, feelings, and frame of reference.

Empathy

what do empathic therapists do

listen carefully to their patients and respond in verbal and nonverbal ways that demonstrate an accurate grasp of their attitudes and concerns

__________ consists of showing positive regard for patients in ways that help them feel safe, secure, and appreciated for who they are

warmth

what do warm therapists do

the convey that they value their patients as people despite any objectionable features of their personality, lifestyle or behavioural history - they evaluate and change their patients' statements and actions when they consider it useful to do so but dont denigrate them as a person

___________involves relating to patients in an open, truthful, and authentic fashion

genuineness

what do genuine therapist do

• they say only what they mean and act only in ways that are comfortable and natural for them

• the avoid the artificiality of being definitive when they lack conviction or expressing uncertainty when they have a definite opinion

there is a a significant relation ship between therapist expressions of empathy, warmth, and genuineness and ________ outcomes in psychotherapy. This holds true in many different kinds of psychotherapy and for many different kinds of patients, meaning that therapist manifesta- tions of ________ , _________, ________, and _________ can be expected to limit progress in psychotherapy.

positiv, aloofness, detachement, artificiality, insensitivity

Treatment relationship characteristics that fosteror limit progress in psychotherapy are subsumed within the concept of the ________ _______

working alliance

The working alliance in psychotherapy is an interactive process with what three defining characteristics

• an explicit agreement btw patient and therapist concurring the goals of treatment adn the methods to be used in pursuit of these goals

• consensus on the respective tasks to be used in pursuit of these goals

• a sufficiently strong patient therapist bond to sustain their collaboration during episodes of strain that commonly arose during therapy.

the _________ this working alliance is, and the more ________ therapists can repair ruptures that occur in it, the more likely people are to remain in psychotherapy, participate ______ in it, and derive ________fromit

strong, effectively , actively, benefit

better treatment outcomes have been found to be associated with patient-therapist_________ on the therapeutic goals and the procedures for achieving these goals and with therapist ability to restore a ___________ relationship when unavoidable events cause a patient to resist or withdraw from participation

agreement , collaborative

therapists' respectful _________ of patients' experiences of their treatment and their satisfaction with the treatment relationship, together with _______ monitoring of their clinical progress, improves treatment outcomes and reduces premature terminations

solicitation, joint

therapist inability to establish and maintain working alliance bonds with a person in psychotherapy limits the prospects for a positive treatment outcome - how have research fidngins confirmed this

therapists differ in there effectiveness and that progress int ehrapy is less likely when the therapists are not adept in developing and sustaining a good working alliances, suggesting that feeling rejected by the therapist whether warranted for not can be a root cause of negative outcomes in pscyhtoehrapy

many forms of psychotherapy align with four major perspectives on the nature of ________, the _____ of their problems, and the ________ approaches likely to help them improve their lives - what are they

people, origins , treatment
psychodynamic, Cogntive behavioural, humanistic-experiinetal and integrative

Psychodynamic perspectives in psychotherapy derived from the psychoanalytic formulations of Sigmund Freud , which comprise of what three core elements

• psychic determinism: views every psychological event as having a reason or cause that can be understood

• - a dynamic unconscious which posits that how ppl behave is influenced in part by thoughts and feelings which they are not fully aware
  - substantial influence of early life experience on subsequent personality development 0

Freud translated his formulations into a psychological treatment method based on ____ __________,, interpretation, and ______ analysis

free association, dream

waht does freud treatment method look like

• ppl talk as freely as they can about themselves and whats on their mind while the therapist listens, clarifies and explore the origins of the persons anxiety provoking thoughts and feelings

The ________process in psychoanalysis is intended to promote improved functioning through increased self-understanding, commonly referred to as _______

interpretive, insight

traditional psychoanalysis is an intensive treat- ment consisting of what ? what has it given rise to ?

• multiple weekly sessions extend- ing over an extended period of time

• given rise to many less intensive versions of psychoanalytic psychotherapy that subscribe to similar procedures but involve less frequent ses- sions than Freudian psychoanalysis, a briefer duration, and a narrower focus

Prominent among these subsequently developed psychodynamic psy- chotherapies are brief dynamic therapy and short-term dynamic psychotherapy- what are the intended for

• intended for working w mildly rather than Beverly disturbed ppl and are time limited by a specified number of sessions or by achievement of specific treatment goals related to reduced symptoms of emotional distress and improve interpersonal functioning

what is supportive expressive therapy

a manualsized form of dynamic psychotherapy that is applicable to a wide range of patients and problems nad can be either time limited or open ended and combeisn expressive interventions to promote change w supportive intervention to help ppl maintain their current level of functioning or return to some previously higher level

what is the central element of supportive expressive therapy

a carefully constructed case conceptualsiaiton - the core conflictual relationship theme- that desicibres a person relational patterns nad interpersonal and psychic conflicts and helps direct the persons treatment

what is interpersonal therapy

• a manuslzied time limited therapy that was derived from interpersonal theory and focus on a person current social relationships

• - originally devleepd for depression by exploring the interpersonal context int hich the depressive symptoms arose, this therapy has been adopted for other disorders
  - it is conducted int eh expectations hat episodes of psycholglcial disorders can be successfully treated by helping ppl identify adn understand interpersonal events in their lives that have triggered the onset of their symptoms

behavioral perspectives in psychotherapy emerged from B. F. Skinner's view that human behavior can be understood as learned connections between stimuli and responses and can be shaped by _________ some of these connections and _________others

reinforcing , extinguishing

An early application of Skinner's stimulus-response behaviorism was theformulation of __________ ________, a treatment for fears and anxiety in which the core elements are relaxation and reciprocal inhibition.

systematic desensitization

what happens in systematic desensitization

People receiving this treatment are trained in achiev- ing a state of relaxation, following which the state of being relaxed is repetitively paired with a real or fan- tasized version of stimuli that have been a source of their distress until their relaxation inhibits their pre- viously anxious or fearful reaction to these stimuli

in later developments, many behavior-ally oriented clinicians concluded that the nature of people and the psychological problems for which they seek help involve principles of ________ as well as ________, that is, not only stimulus-response connections but also thoughts and feelings thatlink experience and behavior

cognition, learning

what are the three widely know cognitive behavioural treatment approaches that flowed from the ecxpansion of behavioural therapy

• rational emotive behaviour therapy

• - dialectical behaviour therapy
  - cognitive therapy

what is rational emotive behaviour therapy ? whats the central technique?

• attributes psyc distress to unrealistic expectations, irrational beliefs and unwarranted feelings and the treatment focuses not on troubling events but on what people say to themselves about these events

• -central technique is disputation (consist of logicaly challenging a persons flawed convictions, the therapist becomes actively invovled in providing direction, education, homework, role playing nad other behavioural strategies for change

What is dialectical Behavioural therapy?

a multimodal CB treatment that was developed initially for working w chronically sucidal patients but hs proved useful in treating substance use, ED, BPD ADN antisocial PD

• the dialectical aspect of the therapy is a synthesozed emphasis on warm acceptance of patients and their problems on one hadn't and a variety of change oriented adn problem oriented strategies on the other including social skills rtraingina nd poorblme solving exercises

what is cognitive therapy

• , in common with rational emotive behavior therapy and dialectical behavior therapy, conceptualizes mental disorders as result- ing from maladaptive or faulty ways of thinking and distorted attitudes toward oneself and others

• As a divergence from these other two treatments, how- ever, cognitive therapy does not ordinarily involve behavioral strategies

• it concentrates efforts on cognitive restructuring which consist of helping ppl recognize and revise mistake, unwarranted adn ill advised perceptions and attidues that are causign their problems

A further treatment that combines elements of relaxation and cognitive restructuring is ________,, in which therapists make suggestions to patients concerning ways of reducing their anxiety and gain- ing better control of their behavior

hypnosis

Numerous techniques are used to induce a state of relaxation that promotes _________. These induction procedures sometimes produce an altered state of consciousness, traditionally known as a ________, but a this state is not necessary for hypno-sis to be effective. Even when fully awake, patients who are sufficiently relaxed and able to focus their attention on the therapist's suggestions can show behavioral and subjective responses associated with hypnosis. Effective hypnosis does require a degree of _________, however, which is fostered by positive attitudes and beliefs about hypnosis, __________ of being helped by it, and an ability to imagine suggested events

receptivity, trance,suggestibility, expectations

Humanistic-experiential perspectives in psycho- therapy derived from the parallel influence of Maslow's theoretical framework and Carl Rogers. Both of these major figures emphasized the ___________ of individuals, with each person being different from every other person and a product of his or her distinctive __________, temperament, and capacities. Maslow and Rogers emphasized people's psychological _______ rather than their ______, and they shared the optimistic belief that people are capable of making constructive changes in their lives and are inherently inclined to develop their human potential and thereby become -

uniqueness, experiences, strengths, limitations, self actualization

carl rogers formulated -_ therapy, a humanistic- experiential treatment that focuses on the person, not the person's problems, and aims at facilitating personal growth through expanded self-awareness

client-centered

. Instead of addressing psychological difficulties, client-centered therapy is oriented toward what

• helping people tap their psychological resources, achieve a sense of well-being, and move toward fulfillment of their human potential

• Promoting openness to their experience and fuller awareness of themselves are considered the main ways of helping people realize their potential, and Rogers considered this approach more beneficial than direct efforts to free people of troubling symptoms or solve their life problems

Client-centered therapists attempt to foster expanded self-awareness by ________ the thoughts and feelings a person appears to be experiencing at the moment

reflecting

Along with reflection, a second key element of Rogerian treatment is an encouraging, ________, and _________ engaged treatment atmosphere in which the relationship with the therapist contributes to personal growth

supportive, mutually

t or f - In traditional client-centered therapy, the climate of the therapeutic relationship is believed by itself to account for whatever gains are made in the treatment

t

Clinicians following in the humanistic- experiential footsteps of Maslow and Rogers have developed a variety of specific treatment approaches such as....

existential psyhtotehrapy, gestalt therapy, emotion focused therapy

waht is existential psychotherapy

• emphasizes the anxiety that often attends existence in a confusing and seemingly meaningless world

• Treatment accordingly seeks to help people find meaning in their lives,take responsibility for making decisions about them- selves, and feel free to endorse choices congruent with their own desires

what is gestalt psychotherapy

• attributes psychological dif- ficulties largely to insufficient contact with oneself and one's environment

• Individuals in this treat- ment are encouraged to become fully aware of their immediate thoughts, feelings, body sensations,and surroundings, and therapists use a variety of techniques designed to promote personal growth by sharpening how people experience themselves and enlarging their capacity for free expression

what is emotion focused therapy

• person-centered treatment in which emo- tional change is regarded as the essential ingredient of improving one's life and achieving a greater sense of well-being

• therapists attempt to foster personal growth by combining empathic entrance into an individual's internal frame of refer- ence with directive efforts to deepen the person's emotional experience

• promotes emotional processing by encourag- ing people to explore and learn from their feelings rather than avoiding or trying to suppress them - in a dditon to following and guying their person's experiences

____________perspectives in psychotherapy developed from an eclectic preference for drawing on psychodynamic, cognitive-behavioral, humanistic- experiential, and other conceptualizations in ways that would provide a desirable alternative to sole commitment to any one of these three traditional perspectives

integrative

The resulting integrative efforts have taken four forms, commonly referred to as what

technical, theoretical, common factors, and assimialtive

what is technical eclecticism

pragmatic treatment that applies whatever intervention appear likely to be helpful, without regard fro their theoretical origin

This pragmatic approach was first formulated within the context of behavior therapy as multimodal therapy, andit has more recently been refined) in the form of ________treatment selection. Concerned that theoretical orientations can often lead to ineffective treatment, recommended instead a ___________ therapy based on empirically supported principles for producing therapeutic change and taiored to each person's ________level, _________ style, and severity of functional impairment.

systemic, prescriptive , reactance, coping

what is theoretical integration

• seeks to blend traditional treatment approaches into an overarching theoreti- cal framework that, unlike technical eclecticism, enhances conceptual understanding of psychother- apy

• Also of note is a transtheoretical integration in which dif- ferent types of psychotherapy are used at different stages of treatment in the expectation that sound stage-treatment matching will prove more effec- tive than relying on any one type of psychotherapy

what are common factors concerned with

• neither w specific techniques nor w the theories that underlie them

• - emphasis are core ingredients of the therapy process that characterize all therpeias and have proven effective in promoting symptom relief adn behaviour change
  - "Corrective experiences" that challenge a per- son's fears or expectations characterize successful cognitive-behavioral, humanistic, and psychody- namic psychotherapies alike ( ie working alliance, expectiaotn of change, therapist communcaiotn of warmth genuineness empathy, and exposure to feared internal stem nad situations etc all proven effective)

what is assimilative integration

• a combinative approach int which therapists favour a particular theoretical orientation but draw as well on the perspectives and prescribed methods of other ireintatiosn when they consider it helpful to do so

• - combination of a preferred perspective with openness to auxiliary use of practices associated with other perspectives could be considered an integration of integrationist views.
  - By embracing both a preferred conceptualization and methods that are likely to work, assimilative eclecticism bridges technical and theoretical eclecticism and implicitly relies on common principles of effectiveness in selecting intervention strategies

Psychotherapy research has principally encom- passed two types of studies: _________ studies of the benefits and effects of treatment and _______stud- ies of the impact of therapist-patient interactions within treatment sessions

outcomes, process

what do outcome studies seek to determine ? process studies?

Outcome studies seek to determine whether psychotherapy works and whether some treatment methods work better than others, whereas process studies explore how psy- chotherapy works, with particular attention to the ingredients of the treatment and interactions that promote positive behavior change.

Outcome research in psychotherapy has evolved through increasingly refined attention to the criteria that should be used to evaluate treatment benefit, the _________group against which people receiving treatment should be measured, and the _________ controls that should govern the design of data collection.

comparison, epxeirmetnal

With respect to criteria for evaluating benefit, early outcome researchers merely asked patients and therapists whether they considered a course of treat- ment to have been helpful - whats good about this? whats bad?

Although direct inquiry is often a good route to discovery, patient and therapist opinion in this instance can be subject to numerous sources of bias or misperception

Over time, a consensus emerged that treatment outcome should be measured by waht

objec- tive indications of the extent to which the goalsof the therapy—whether symptom relief, problem resolution, or life enrichment and a sense of well- being—are achieved and sustained over time - lots fo proceeders have been developing for these assmesnts including many standard psyc tests

regarding the comparison group against whom people in treatment should be measured,the seemingly most logical way to evaluate whether psychotherapy is beneficial would be to compare treatment groups with no-treatment groups of people equally in need of treatment - what the issue with this and how is it resolved

• denying treatment to people who need it so that they can serve as comparison group for research purposes is questionable.

• - as alternative psychotherapy for no-treatment comparison groups has been delayed, rather than denied, by placing them on a waiting list
  - The results obtained with this research method can be misleading, however, because the wait-listing of the no-treatment groups has usually followed an intake evaluation process
  - Being evaluated and placed on a waiting list can itself prove psychotherapeutic, not only because people have had an opportunity to present their problems to an interested and attentive mental health professional but also because being on the psychotherapy waiting list can nour- ish reassuring expectations that help is on the way

Wait-listed people may consequently feel better and show improvement, which could be interpreted as __________ _______ and as evidence challenging the utility of psychotherapy, when strictly speaking they do not constitute a no-treatment compari- son group.

spontaneous remission

how can misleading in studies involving wait- listed comparison groups can be avoided

• by having psychotherapy patients serve as their own controls

• -n a pre-post, own-control research design, prog-ress and outcome in psychotherapy are measured by comparing patients' psychological functioning during or at the conclusion of treatment with their psychological status at the beginning of it
  - the information value of such progress and outcome comparisons is enhanced if the same or similar assessment procedures are used at each point in time

Outcome research has also examined the rela- tionship between the amount of psychotherapy people receive and the likelihood of their benefiting from treatment, which is known as the -_ ______

dsoe-effect ratio

what has data from a dose effect ration found

identified a positive but nonlinear relationship with a negatively accelerating curve

- so the more sessions patients have, the more likely they are to show improvement, but the size of this effect diminishes at the higher doses
- Generally speaking, then, more therapy has a greater probability of producing beneficial effects than does less therapy, but this dif- ference becomes smaller as the length of therapy increases

Concerning the experimental controls that should govern collection of psychotherapy out- come data, research has proceeded along two lines, __________ studies and _________ studies

efficacy, and effectiveness

what do efficacy studies aim to do

• aim to minimize the extent to which obtained data are confounded by variation in ppl receiving treatment, the treating therapists and the Manne din which the treatment is delivered

• - so these researchers conducted tare-fully controlled studies in which participants with just one and the same psychological disorder are assigned randomly to treatment and comparison groups; participants in treatment groups receive identical therapy, typically for a predetermined num- ber of sessions; and therapists administer the treat- ment precisely as specified by a treatment manual

the controlled format for conducting psychotherapy outcome research has become widely known as the _________ _________ _______(RCT) method and has served as the basis for identifying empirically sup- ported treatments for a broad range of psychological disorders

randomized control trial

The careful controls that characterize efficacy studies ensure highly dependable results with sub- stantial ________ _____, which gives good reason to believe that a beneficial outcome can be attributed to the treatment being delivered

internal validity - so RCT evaluation has sometimes been labeled the gold standard for determining the value of a treatment method

what is the issue with RCTs

the artificial conditions rarely represent real world psychotherapy, so lab findings may not generalize to real world circumstances and the strict controls are likely to boost internal validity as the expense of external or ecological validity

what to effectiveness studies provide

• provide a naturalistic alternative to lab research by studying the out- come of psychotherapy as it is delivered in the field to heterogeneous groups of people, including many with multiple disorders, and in a variety of clinic, hospital, and private office settings. - in the field, moreover, therapy typically proceeds flexibly, rather than as prescribed by a manual; people participate in deciding by whom and in what way they willbe treated, rather than by random assignment to a therapist and a treatment method; and the duration of the treatment is commonly variable rather than predetermined

Although consequently less internally rigorous than ________ research, _________ research is more attuned to psychotherapy outcomes in actual clinical practice

efficacy , effectiveness

Efficacy research has been limited in scope not only by a restricted selection of research participants that does not capture the _________ and complexity of people seen in actual psychotherapy practice, but also by a predominant focus on treatment _______. Research findings have indicated that positive progress in psychotherapy is far more attributable to _______ ________ (motivation and expectations) and features of the treatment __________ (such as the previously mentioned alliance and collaboration)

diversity, methods, patient characteristics, relationship

(psychotherapy researchers gen- erally concur that patient and relationship factors account for much more of the variance in treatment outcome than the particular treatment techniques, to which as little as 12% of improvement appears attributable)

a narrow emphasis on empirically supported treatments has gradually given way to the broader concept of - prac-ice, an official policy of the APA - defined as clinical practices based on "the__ of best available research with clinical experience in the context of patient characteristics, culture, and preferences"

evidence-based, integration

psychotherapy outcome research, whether designed to assess the efficacy or the effectiveness of a treatment, should be governed by attention to what?

the integrity of the therapy being delivered

what is treatment integrity

• refers to how well a course of psychotherapy adheres to the established guidelines for providing it

• - requires therapists to be competent in providing the technical aspects of a treatmentmethod in its intended manner and skillful in establishing a positive relationship with the person being treated
  - Without fidelity to the treatment methods being studied and therapists capable of implementing them, psychotherapy outcome studies are unlikely to provide dependable information about the benefit of these methods.