PSYC 365: Chapter 10

Psychotherapy:

methods of inducing changes in behavior, thought, and feelings to improve mental health and functioning 

Intervention: therapeutic // behavior improvement

Jerome Frank (1982) → Psychotherapy:

a planned, emotionally charged, confiding interaction between a trained, socially sanctioned healer and a sufferer… healer seeks to relieve sufferer’s distress and disability 

Barlow (2004) proposes the term “Psychological Treatment” for interventions that are…

• Derived from psychological science 

• Tailored to the psychological processes that cause and maintain particular problems and disorders, and

• Shown to work in controlled treatment outcome studies 

Major Approaches to Psychological Treatment: 

1. BEHAVIORAL: uses techniques derived from learning theory to modify behaviors associated with target problems 

2. COGNITIVE-BEHAVIORAL: focuses on identifying and modifying maladaptive thinking and behavior patterns that maintain target problems 

3. DIALECTICAL: focuses on developing skills for coping with stress, regulating strong emotions, and improving relationships with others 

4. MINDFULNESS/ACCEPTANCE: uses metaphors and experiential exercises based on relational frame theory to promote a healthier relationship with unwanted thoughts and feelings 

5. PSYCHODYNAMIC: Focuses on gaining insight into unconscious psychological forces thought to underlie target problems 

6. CLIENT-CENTERED (Humanistic): uses the client-therapist relationship and unconditional positive regard to promote full growth potential

Common Factor: in psychological treatment: 

• Empathy, supportive client-clinician relationship, and clients expectation of improvement 

• Different treatment strategies target different mechanisms lead to similar outcomes 

Pathways by which treatments work (Wampold, 2015): 

• Genuine client-practitioner alliance 

• Client’s optimistic expectations of improvement 

• Intervention techniques stimulating good health

Specific Factors: clinician prompts client to act resulting in…

• Changes to the psychological processes that cause, maintain target problem, and 

• Reductions in psychological distress, dysfunction 

Some methods used: 

• behavioral interventions

• Dynamic therapies 

• Cognitive-behavioral treatments 

• Acceptance and commitment therapy

Efficacy

how well treatment(s) perform in research studies 

• Case studies: repeated measurements of single client cannot be generalized to others similar cases 

• Single group pre-post studies address it; lack control group 

Randomized Control Trials (RCTs) determine efficacy of a treatment; gold standard 

• Have internal validity // used in meta-analysis

Treatment Effectiveness:

how well interventions performs outside of research settings 

• External Validity: generalizes study findings to situations outside of study 

• Meta-analysis shows routine psychological treatment administered in counseling centers is effective (could be improved more, especially for highly distressed clients) 

• Overall effectiveness and efficacy studies support benefits of psychological treatments

Multicultural Considerations:

 research on treatment effectiveness lacks diversity in participant samples despite same rates as white populations 

• RCTs now include underrepresented, low-income participants, though linguistic minorities still excluded 

• Treatments typically developed by white psychologists and tested on mainly white clients 

• Difficult to conclude which treatments benefit particular cultural groups 

• Available data suggest effectiveness across groups

WHOM Should We Ask? 

1. The Clients Opinions of own progress: 

• May be biased; may underestimate treatment benefits 

• May overestimate gains as money, time, and effort invested in treatment process 

2. Practitioners perspective may be misleading 

• Unable to report client behavior outside of clinical setting 

• Self-serving bias by under/overestimating own skills 

3. “Third” parties (parent, partner, teacher, employer, insurance provider etc.) 

• Mixed responses: family may underestimate treatment benefits, insurance providers may overestimate (to minimize own costs)

HOW Should We Ask? 

• Use standardized, reliable, and valid methods (dependent variables in treatment outcome studies) 

• Interview or self-report questionnaire for client

• Useful to gauge behavior progress 

• Direct observations of behavior, especially in settings where problem behavior occurs

WHEN Should We Ask? 

• When depends on aims of study, and clinician 

• Pretreatment assessment serves a baseline for post-treatment comparison 

• Follow-up assessments weeks, months, or even years after treatment ends 

• During treatment: some assess progress at each session to assess clients progress

Dismantling Studies: 

treatments with multiple components; identifying most beneficial ones 

• Some interventions are harmful 

• When clinicians deviate from, or misapply helpful interventions 

• Client functioning deteriorates, new problems appear, depends on clinician, and drops from treatment

Interactional Perspective: 

• Common and specific factors work together 

• Client-clinician relationship way more in specific theory-based techniques 

• Techniques work best when client trusts therapist and suggests treatments 

• Perception of strong client-therapist alliance leads to smooth treatment

(1) Initial Contact:

with clinical psychologist is a mix of anxiety, embarrassment, inadequacy, and suspicion 

• Psychologists begin by establishing rapport, explaining treatment process to gain trust 

• Allow clients to share multicultural experiences 

Clinicians trained in multicultural humility: not being aware of knowledge, skills of clients ( They adopt an empathetic, inquisitive, curious, and open-minded approach to understand clients )

Informed Consent:

information clients should know before starting treatment: INCLUDING 

• Professional qualifications 

• Fees

• Confidentiality and its limits 

• Other pertinent details 

• The process of treatment

Assessment Methods:

depending on the client's problem, the clinician uses several methods… 

• Consultants with other professionals 

• Neurological workup 

• Medical examination 

• Consultation with social workers, job counselors 

• Translators, in case of language barriers 

• Set clear goals, determine course of treatment

Providing Psychoeducation:

educational component of psychological treatment 

• Clients understand themselves, problems, and treatment 

• Misinformation corrected 

• Bibliotherapy: client reads material on own 

• Effective in reducing some psychological problems

(2) Implementing Treatment:

Managing emotional distress 

• Early client-practitioner relationship promotes supportive atmosphere 

• Clients gain emotional footing and confidence 

• Therapist uses direct reassurance or specific techniques 

( cognitive restructuring, acceptance and commitment therapy (ACT) metaphors, or progressive muscle relaxation)

Practice: assigning work/practice between sessions 

• Clients review progress between sessions with clinical psychologist 

• Clients practice skills taught in therapy sessions (self-monitor behaviors/cognitions) 

• Noncompliance may be due to a lack of follow-up, or unclear explanation of assignments 

Optimism and Self-Efficacy: clinical psychologist should aim optimism regarding positive chan

• provide reassurance to client and family / empower client / enhances self-efficacy

(3) Later Stage:

if client terminates therapy midway, clinician must find out reasons for it 

Termination, Evaluation, and Follow-up: 

• Encourages client to return for later sessions 

• “Booster sessions” scheduled months after termination (Found to be helpful) 

• Progress evaluation with client is important 

• Clinicians to compile such (progress) data

Evidence-Based Treatment (EBT):

 interventions or techniques that demonstrate beneficial effects in RCTs (randomized controlled trials)

Evidence-based Practice (EBP):

treatments informed by many sources, including scientific evidence about the intervention (i.e.EBT), clinical expertise, and client needs and preferences

Overcoming Complications with Dissemination 

Factors might complicate implementation of EBTs: 

• Intensive training for clinicians 

• Training workshops might be expensive 

• Therapists disinterested in changing treatments 

For successful dissemination of EBTs: 

• Educate on benefits of new approaches 

• Quality assurance systems at centers 

• Consider clients of different cultural backgrounds