Psychotherapy Effectiveness

Dropout

a client ends therapy without mutual agreement - e.g. no-show and doesn’t return

What can we do about dropout?

overcome practical issues (scheduling, accessibility)
managing expectations (set & manage realistic expectations early on)
orienting to own approach - provide a clear orientation to the therapist’s approach and therapy process

Therapeutic Alliance

biggest determinant of outcomes, does not advocate for changing personality to fit each client, must be collaborative, have an affective bond, and agree on goals/tasks

General Psychotherapy Skills

boundaries, therapeutic alliance, listening, emotions, understanding, resistance/defense, techniques of intervention

Specific Psychotherapy Skills (e.g. CBT)

State cognitive model, Socialize patient into the cognitive model, Use structured cognitive model activities (mood check, bridging or prior session, agenda setting, homework review, capsule summaries, and patient feedback), Identify & elicit automatic thoughts, State & employ knowledge of the cognitive triad of depression, Use dysfunctional thought records as a tool in therapy, Identify common cognitive errors in thinking, Use activity scheduling as a tool in therapy, Use behavioral techniques as a tool in therapy, Plan booster sessions, follow-up, and self-help sessions appropriately with patients when terminating active therapy

The Dodo Bird Verdict

all forms of psychotherapy, regardless of specific techniques, are equally effective

Evidence-Based Treatments

difficulty to be truly objective because of human error and the subjectivity of psychology

Randomized Controlled Trials (RCTs)

the gold standard for efficacy research; used to determine treatment effectiveness by randomly assigning participants to different treatment groups

Outcome monitoring (why?)

not responding in treatment, determine effectiveness, adjust if need
may increase client buy-in
eliminate assumptions about progress
may identify new treatment targets and improve overall treatment outcomes.

Outcome monitoring (how?)

empirically tested measures, SUDS ratings, progress on client-specific goals, behavioral change